GAZA CITY, Gaza Strip — Outside the Doctors Without Borders clinic in Gaza City, a dozen men hobble on crutches as orderlies wheel a stretcher carrying another young man out of an ambulance and into the clinic.
Almost all of the men have been injured in what Palestinians in this densely populated, desperately poor enclave call the “Great March of Return,” the 7-month-old series of weekly — and sometimes daily — demonstrations staged at the border fence with Israel.
The grass-roots, civil society movement was established to draw international attention to the Palestinian refugee issue and the 12-year-old Israeli and Egyptian blockade of the Gaza Strip. But the 40-mile-long border fence has quickly turned into a war zone as Islamic Front and Hamas Palestinian militants clash with Israeli forces.
The deadliest clash was in May, on the day Israel and the U.S. were marking the transfer of the U.S. Embassy from Tel Aviv to Jerusalem and the day Palestinians annually mourn the creation of the state of Israel in 1948. Infuriated Gaza residents staged a mass protest that ended with an estimated 53 people killed and 2,771 wounded — over 1,300 from gunshot wounds.
Since the beginning of the protests, the Israelis have defended their use of live-fire weapons as a last-resort means of self-defense against repeated efforts to breach the security fence. They blame Hamas for inciting violence.
Palestinians have thrown grenades, firebombs, explosives and rocks at Israel Defense Forces near the fence. At least one IDF soldier has been killed and one injured.
The protesters also burn tires and launch incendiary kites and balloons over the border, scorching nearly 9,000 acres of land, forests and farm fields so far.
On the Gaza side, at least 200 Palestinians have been killed and over 20,000 wounded. More than 5,400 have sustained severe gunshot wounds, particularly to their legs.
Gaza residents insist they will not relent in the face of superior Israeli force. Each week, men run to the fence fully aware of the high potential of getting shot.
“I talked with the people — they are feeling determination,” Ahmed Abu Retaima, a Gazan poet who helped start the civil march, said in an interview with The Washington Times.
Many of the wounded men he has visited have returned to the marches, even on their crutches, and sustained further injuries, he said.
“I ask more than one of them, ‘[Do] you regret to go to the fence and the protests?’ They say, ‘No, we [don’t] regret.’
“I see a lot of injured, after they leave the hospital, [they] go again to the fence and they were shot again,” he said.
It has become something of a practiced drill: When Palestinians are injured during the demonstrations, they are quickly ferried away by waiting ambulances to one of the few hospitals in the Gaza Strip under the auspices of the Palestinian Ministry of Health. There they are stabilized, treated and discharged. About 40 percent are referred to more specialized care with international nongovernmental organizations.
In September, the U.N. Office for the Coordination of Humanitarian Affairs appealed for $43.8 million for medical and psychosocial interventions for those wounded in the protests.
One of the international groups shouldering the burden is Doctors Without Borders, known by its French acronym MSF, which offers humanitarian surgical and medical assistance in conflict zones around the world. The Geneva-based MSF has had a permanent presence in the Gaza Strip since 2000, working through three wars between Israel and Hamas, the Palestinian faction that controls Gaza.
The U.S. and Israel consider Hamas to be a terrorist organization that refuses to recognize Israel’s right to exist.
Since the start of the protests on March 30, the group has had to exponentially increase its operations to deal with the steady stream of wounded men and sometimes women and children.
“At the beginning, we were working only in two or three clinics, and we had a temporary surgical team,” said Sasha Petiot, coordinator for MSF activities in Gaza. “From now on, we have four permanent surgical teams, which are both [orthopedic] and plastic [reconstructive], and we’re working in five clinics.”
The bulk of MSF’s funding comes from individual donors, private companies and foundations. Last year, its expenditures for the Palestinian territories in the West Bank and Gaza amounted to $6.7 million, with 18 international staff and 129 local employees.
Since the start of the protests, the doctors group has increased its staff in Gaza from 88 to over 247. Last year, they had 350 trauma patients and 14 surgical cases. This year, as of the third week in October, they have admitted 2,885 trauma patients and had 741 surgeries.
Each week, the clinic braces for a new influx of patients.
“We’ve never seen this amount of people injured at exactly the same place — it’s like automatic, almost — they have exactly the same injury, more or less the same profiles. In the world, we’ve never witnessed such a phenomenon,” said Mr. Petiot, who served in Congo before arriving in Gaza in July.
In Gaza City, bandaged young men on crutches have external fixators on their legs. Fixators are large metal rods secured outside their legs with screws in the bone above and below fractures caused by the military-grade bullets.
“Basically, any country of the world, any health system, would have been overwhelmed,” Mr. Petiot said.
Gaza, he added, is further challenged by a deteriorating capacity because of the 12-year-old Israeli economic blockade and feuding between Hamas and the Palestinian Authority, which controls the West Bank.
“The Ministry of Health faces a lot of issues regarding a shortage of drugs, regarding fuel for the power. Also, the salaries have been cut because of a lack of understanding between [the Palestinian Authority] and the ruling [Hamas] government here,” he said. “So there’s many aspects that have been overwhelmed.”
Some 90 percent of the wounded have injuries to their lower limbs, Mr. Petiot said. Of those, half have open fractures. The bullets ripping through the limb also damage soft tissue, muscles and nerves, typically requiring multiple specialized surgeries and months of follow-up and physical therapy.
MSF staff are also concerned about the potential for an outbreak of osteomyelitis, a bone infection that can occur with such complicated injuries. Getting the necessary antibiotics for patients is challenging because of the siege, as well as keeping track of patients who may not continue with their follow-up appointments.
“This is something we’re seeing,” he said. “It’s very hard for the moment to assess the cohort, but based on some literature, we can have some average estimation that this might be a big outbreak.”
Mr. Petiot is also worried about the psychological impact on society at large.
“Now when you go into the Gaza streets and you see this cohort, or these people with the crutches, [it] is … having an impact on people regarding the future — because this is going to be a long-term impact.”
Also shouldering some of the burden is the International Committee of the Red Cross. Last year, the ICRC budget for the Palestinian territories was a little less than $50 million, its 11th-largest operation out of 15.
Since May 31, the group has added approximately $5.3 million in operation assistance to treat Palestinians shot at the border — this included opening a 50-bed surgical unit in Gaza’s largest hospital, Al-Shifa.
Red Cross doctors have provided 600 surgical consultations and performed 260 surgeries. The ICRC also supports an artificial limb center, which currently is treating 56 amputees and 109 patients in need of braces for limb stabilization.
In addition to the health crisis, Palestinians suffer from soaring unemployment rates. About 44 percent of people in the strip are unemployed, according to the World Bank, and the rate is 59 percent among those ages 15 to 29.
“For next year, [we will] help these people find new economic opportunities, to find a new source of income. Many of these people work as construction workers,” said Alyona Synenko, a spokeswoman for the ICRC mission working with Palestinians.
Although the organization is apolitical, Red Cross officials say they regularly press Hamas, Israeli and Palestinian Authority authorities on the need to negotiate a long-term political solution to end the carnage along the border.
“We are trying to respond to the immediate aftermath, but this is not something that’s going to bring the long-term solution to the problem — and to prevent these young people from going to the border area and putting themselves there in the first place,” she said. “To address this situation and provide responses need a long-term political solution, and this is not for humanitarians to provide.”
There is little sign that the situation will improve.
Over the weekend, an estimated 10,000 Palestinians in Gaza rioted at the border. Four were killed by Israeli fire and 85 were wounded, according to the Hamas-run Palestinian Ministry of Health. On Sunday, a fifth man died of injuries sustained while participating in the protests, according to the Health Ministry.
The protests were originally meant to end on May 14, marking the Palestinian commemoration of Nakba (catastrophe), marking the creation of the state of Israel in 1948. But last week — the 31st week of the demonstrations — Hamas praised the protests and vowed to continue until the siege is lifted and Palestinian demands are met.
On Friday, the military faction Islamic Jihad in the Gaza Strip, which often works under Hamas but at times breaks away, fired over 30 rockets toward communities in southern Israel, activating the Iron Dome missile defense system and triggering sirens in dozens of Israeli villages and cities. Israel retaliated by striking nearly 80 sites in the Gaza Strip, including Hamas military headquarters and Islamic Jihad munitions manufacturing and rocket launching sites, the IDF spokesman’s office said.
Mr. Abu Retaima praises the international NGOs for increasing their aid but said the political and military stalemate with Israel shows no signs of resolving in the near future.
“We need more of these efforts,” he said, adding that it is unlikely Palestinians will stop going to the border fence.
“I think the Palestinian people will continue this way because they feel that they haven’t lived a normal life because of the Israeli occupation,” he said. “What can we do? We cannot stay in silence because before the return march [started], we were [slowly] dying inside.”
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