Just off the acacia-lined highway to the Qatari capital of Doha is a three-story, whitewashed apartment complex built to host visitors at the 2022 FIFA World Cup. Until recently, the gated compound was unoccupied. Yet in the past several months, as part of a deal Qatar struck with Israel, Hamas, and Egypt to evacuate as many as fifteen hundred wounded Gazans in urgent need of medical care, it has begun to fill. The new residents are eight hundred and fifteen medical evacuees from the ongoing war, along with five hundred and forty-two of their relatives. Most are women and children.
Among the children was Gazal Bakr, a four-year-old wearing a miniature maroon Adidas tracksuit, its left pant leg tucked up into the elastic waistband. She hopped along furiously on her right leg. Although Gazal's name means "sweet talk" or "flirt" in Arabic, she was unflinchingly direct. "I don't like you!" she shouted as she passed the wheelchair belonging to her eighteen-year-old neighbor, Dina Shahaiber, who'd lost her left leg below the knee. Gazal, who'd just awoken from a nap, had little interest in ice cream. Instead, she wanted to do what she did most afternoons: play soccer by kicking the ball with her right foot and hopping after it. "Stop talking!" she declared to the well-meaning volunteers clucking around her. "You're making my head hurt!"
Gazal was wounded on November 10th, when, as her family fled Gaza City's Al-Shifa hospital, shrapnel pierced her left calf. To stop the bleeding, a doctor, who had no access to antiseptic or anesthesia, heated the blade of a kitchen knife and cauterized the wound. Within days, the gash ran with pus and began to smell. By mid-December, when Gazal's family arrived at
Nasser Medical Center—then Gaza's largest functioning health-care facility—gangrene had set in, necessitating amputation at the hip. On December 17th, a projectile hit the children's ward of Nasser. Gazal and her mother watched it enter their room, decapitating Gazal's twelve-year-old roommate and causing the ceiling to collapse. (Multiple news reports have described the event as an Israeli attack. The I.D.F. claimed the incident could have been caused by a Hamas mortar or the remnant of an Israeli flare.) Gazal and her mother managed to crawl out of the rubble. The next day, their names were added to the list of evacuees who could cross the border into Egypt and then fly to Qatar for medical treatment. Gazal's mother was nine months pregnant; she gave birth to a baby girl while awaiting the airlift to Doha.
UNICEF estimates that a thousand children in Gaza have become amputees since the conflict began in October. "This is the biggest cohort of pediatric amputees in history," Ghassan Abu-Sittah, a London-based plastic-and-reconstructive surgeon who specializes in pediatric trauma, told me recently. I met him in the waiting room of his plastic-surgery clinic on London's Harley Street, and we walked to a nearby pub for a glass of water. Abu-Sittah, a fifty-four-year-old British Palestinian with an angular face and tender, deep-set eyes, has treated child survivors of war for the past thirty years in Iraq, Yemen, Syria, and elsewhere.
Abu-Sittah is the author of "
The War Injured Child," the first medical textbook on the subject, which was published last May. In October and November, he spent forty-three days in Gaza, conducting emergency surgeries with Doctors Without Borders. He shuttled between two hospitals: Al-Shifa and Al-Ahli, which is also known as the Baptist hospital. The casualty rate was so high that, during some intense periods, he didn't leave the operating room for three days. "It felt like a scene from an American Civil War movie," he said.
In Gaza, Abu-Sittah was performing as many as six amputations a day. "Sometimes you have no other medical option," he explained. "The Israelis had surrounded the blood bank, so we couldn't do transfusions. If a limb was bleeding profusely, we had to amputate." The dearth of basic medical supplies, owing to blockades, also contributed to the number of amputations. Without the ability to irrigate a wound immediately in an operating room, infection and gangrene often set in. "Every war wound is considered dirty," Karin Huster, a nurse who leads medical teams in Gaza for Doctors Without Borders, told me. "It means that many get a ticket to the operating room."
To mark the gravity of these procedures, and to mourn, Abu-Sittah and other medical staff placed the severed limbs of children in small cardboard boxes. They labelled the boxes with masking tape, on which they wrote a name and body part, and buried them. At the pub, he showed me a photograph he'd taken of one such box, which read, "Salahadin, Foot." Some wounded children were too young to know their own names, he added, telling the story of an amputee who'd been pulled from rubble as the sole survivor of an attack.
attack.
The number of child amputees carries long-term implications, Abu-Sittah told me, listing his concerns. Israeli forces destroyed Gaza's only facility for manufacturing prosthetics and rehabilitation, the Hamad hospital, which was inaugurated in 2019 and funded by Qatar. The leading manufacturer of child prosthetics, the German company Ottobock, is working to supply the necessary components to children up to the age of sixteen, with donors in place to fund the project through its foundation. Procuring prosthetics, however, is only the first step. "Child amputees need medical care every six months as they grow," Abu-Sittah said. Because bone grows faster than soft tissue and severed nerves often reattach painfully to skin, child amputees require ongoing surgical interventions. In his experience, each limb requires eight to twelve more surgeries. To track this cohort, Abu-Sittah is consulting with the Centre for Blast Injury Studies at Imperial College London and the Global Health Institute at the American University of Beirut; their goal is to create a cloud-based database of medical records that can follow these kids wherever they go. For the rest of their lives, these amputees will need answers regarding their medical history. Abu-Sittah knows how this works: for years, as a pediatric trauma surgeon, he's fielded calls from his former patients.
Abu-Sittah, who'd recently travelled to Qatar to consult, recalled meeting a fourteen-year-old boy who'd lost his leg after being trapped under rubble. He'd spent a day beneath the debris holding the hand of his dead mother. "These are vulnerable people in the midst of the storm," he said.
On a sunny afternoon, I reclined on the beanbags with Iman Soufan, a thirty-three-year-old Palestinian volunteer who was leading art therapy. To encourage the kids to connect to something positive, Soufan told me, she had asked them to draw their favorite place in Gaza. One eight-year-old girl drew her large, happy house, then, next to it, added a puddle of blood. Soufan showed me a photograph of the picture and the caption, which read, "The war is destroying Gaza. My father is martyred. My grandfather is martyred. My grandmother is martyred. My uncle is martyred. My cousin is martyred."
As we spoke, curious children gathered around us. When a plane passed overhead, they held still, watching as it traced an arc across the sky. The response was common among children who'd experienced air strikes, a psychologist at the compound told me later. A pack of tween boys, who knew little English, poked into the conversation to pose political questions. They listed the names of world leaders and raised their eyebrows, asking me to offer a thumbs-up or thumbs-down. "Biden?" they asked. "Blinken?" I thought how unlikely it was that American boys their age would know the name of the U.S. Secretary of State, but, for these kids, such figures seemed all-powerful. Some didn't feel like talking to an American reporter. "
Masalama!" a boy named Ahmed, his face covered in shrapnel scars, yelled at me as he whizzed past on a scooter. "Goodbye!"