‘I went to work with two legs and left with one’ – Gaza’s forgotten amputees

Photojournalist Paddy Dowling reports from Gaza on how the science of prosthetics is helping to rebuild lives for amputees

Mohammed Zidane, 40, sitting in his carpentry and upholstery workshop in Jebaliya Camp, Gaza, lost his leg during the fierce fighting of Gaza’s first war, which started in 2008 (Paddy Dowling)

The four wars in the besieged Gaza Strip between 2008 and 2021 have claimed the lives of 4,179 civilians and injured a further 19,425. The total number of patients who have required amputations as a direct result of the conflict with Israel currently stands at 536.

Dr Nabeel Al Shawa, a consultant orthopaedic surgeon, who has worked in Gaza since 1978, recalls his experience during the 2008 conflict, Gaza’s first war, working as a frontline doctor. “I remember the relentless thunder of the first air strikes,” he tells me. “By the time I arrived on shift at Gaza City’s Shifa Hospital, there were already 400 casualties in the accident and emergency wing; many were already lying in the corridors, dead.”

Gaza’s first war of 2008 killed 1,436 people, 225 on the first day. A further 5,400 were also injured. “I consider myself a religious man, with great faith in God,” Dr Al Shawa continues. “However, I found myself in the unimaginable position of having to play God. Triaging patients, the agony of deciding who lived and who died.” During the first 24 hours, Dr Al Shawa supervised 19 amputations.

Mohammed, who lives in the Bedouin area of Mousadar in Gaza, was watching television on 12 November 2019 when a tank shell was fired directly at his home. He lost his left leg in the blast (Paddy Dowling)

In the same war, Mohammed Zidane, 41, a paramedic seconded to Gaza fire department, also became familiar with making split second, life-changing decisions. He entered the towering inferno of a shelled 12-storey residential building located in the Maquousi area, north west Gaza, to evacuate the trapped and injured.

“We reached the ninth floor and were moving an injured elderly couple when another shell punched through the building,” he explains. “All I can say is, I went to work with two legs and left with one. I never ever imagined I would become an amputee; it has been life-changing.”

Human fascination with war, death and intense negative information is commonplace. But what attention is given to those severely injured in conflict, and what support is provided to help them rebuild their lives?

Abdel Rahim, 62, was also at work when he became an amputee. He was delivering bottled gas to the neighbourhood in 2012, the year of Gaza’s second war, when a tank shell struck a house he was passing. He explains: “Gaza’s insecurity in conflict has created acute instability. With unemployment running at nearly 70 per cent, opportunities for someone with a severe disability are limited to non-existent.”

The brutal reality remains: many Gazans injured in conflict have struggled to improve their lives. Instead, they are cast into the shadows and corners of society, deeply traumatised, destitute and forgotten.

Abdel Rahim was starting his day like any other in 2012, the year of Gaza’s second war, delivering bottled gas to the neighbourhood approximately 1.5km from the Israeli border, when a tank shell struck a house as he passed. The blast damaged the wall and injured his leg. He was alone with no bystanders or onlookers to assist him (Paddy Dowling)

Hamad Bin Khalifa Hospital, completed in 2019, funded by Qatar Fund For Development (QFFD) and erected by the Gaza Reconstruction Committee, designs, manufactures and maintains the most advanced prostheses in Gaza for those injured by conflict and accident, or born with congenital defects.

QFFD director general Khalifa bin Jassem Al-Kuwari explains: “Our commitment to assist the people of Gaza, a majority of whom live day-to-day by the finest of margins, remains unwavering. Patient-care is part of our broader commitment to assist people in Gaza, including those injured through conflict, by building resilience and providing them with the most basic human rights, commonly afforded to so many.”

The $16m (£12m) state of the art facility, complete with rehabilitation, physiotherapy, neurology and audiology wards, has crafted more than 200 prosthetic limbs, funded by the hospital. In addition, psychosocial support teams are on hand to work with each beneficiary to improve emotional wellbeing.

Weam, 16, born and raised in Khan Younis, was injured during the war of 2014, Gaza’s third war. ‘I just couldn’t accept the fact that I had lost my limb, it was very difficult for me,’ she says. She received her new prosthetic limb from HBK Hospital in November 2020 (Paddy Dowling)

Historically, Gaza’s amputees have either been serviced by the Gaza Artificial Limbs and Polio Center (ALPC) or have received treatment for more advanced prostheses, outside the enclave, across centres in Europe, Canada and the US at a cost of up to $120,000 per patient.

Overseas travel created challenges for patients seeking permission to leave the strip, however, as did the maintenance of prostheses engineered abroad, which are brought back to the territory with tight controls over a comprehensive list of restricted “dual use” materials and components.

The corridors of Hamad Bin Khlifa Hospital where an assortment of trial and final-fit limbs await collection. A total of 679 Gazans have required amputation across the four wars and the Great March of Return (Paddy Dowling)

“Our prostheses are constructed from the strongest lightweight materials possible – titanium, carbon fibre – and they use the most sophisticated joints available,” says Ahmed Al Absi, head of prosthetics at Hamad Hospital. “The key is designing each prosthesis to suit the patient’s lifestyle or profession, here in Gaza, and without the need for travel.”

Ahmed Saeed Al Najar, 28, an amputee from Gaza’s third war in 2014, was helping families reach safer areas of Rafah, southern Gaza, when a drone rocket pierced the sunroof of his taxi and exploded. Six passengers were with him. Three were dismembered, including his closest friend, Saher.

Al Najar, rescued from the wreckage of his car, suffered extensive burns, the loss of his right eye, multiple shrapnel wounds and the loss of his right leg from the mid-thigh point, amputated by the blast. “The new limb from Hamad Hospital has been life changing,” he tells me. “It has enabled me to ride a motorbike and earn a living as a delivery driver to support my family.”

A drone strike came in through the sunroof of Ahmed Saeed Al Najar’s taxi and exploded in the car, instantly killing and dismembering three passengers, including his best friend (Paddy Dowling)

In addition to the casualties of Gaza’s four wars, the Great March of Return demonstrations between between March 2018 and November 2019 resulted in 316 deaths, 19,464 injured and 143 amputations.

In May this year, 67 children were among those killed in Gaza’s fourth war, with 685 injured. Saleh Hmid, 6, held his father’s hand as they walked to the shop to buy bread when the blast from an anti-personnel drone rocket – designed to maim or kill, often by decapitation – amputated his leg. Saleh will be fitted for the first of a lifetime of prostheses. These are his aspirations: “I hope that one day I will be able to do the things I used to enjoy like playing football with my brothers and friends, swimming and running on the beach.”

Many amputees fortunate enough to be gifted with such advanced prostheses have been able to rebuild their lives and return to a sense of normality, but the scars of war remain for many.

Ahmed Saleh Hmid, 39, an accountant, was on the way to the shops with his three sons (including Saleh, 6) in May 2021 when a shell struck Baghdad Street near their home. Saleh suffered severe trauma to his right leg below the knee and a shattered right arm. He is undergoing intense physiotherapy at Hamed Bin Khalifa hospital physio department. Saleh needs his upper arm strength to be able to use crutches. Hopefully by September 2021 the consultation process can begin and Saleh can receive his new limb (Paddy Dowling)

“Many of us who have been injured in war are trapped between life and death, suffering more than those who have been killed,” Abdel Rahim said. “For Gazans, only in death can you experience peace.”

Despite the indignation of being trapped in a thin ribbon of land that runs along the coast of the Mediterranean Sea, with such dismal prospects, Gazans, including those injured in conflict, are down but not out. Notwithstanding the years of loss, struggle and sacrifice, they do not expect the world’s pity, but they ask to be heard and, as Mohamed Eliwa, aged 19 and an amputee as a result of the Great March of Return, explained, “We just want the world to see us.”

Amputees are evidence of man’s inhumanity to man. Prosthetics are evidence of man’s concern for others, but they do not justify the greater evil, even if they give hope.