Patient flow and medical consequences of the Israeli operation Pillar of Defence: a retrospective study

Abstract

Background The Israeli military attack Pillar of Defence on the Gaza Strip, occupied Palestinian territory (also referred to as State of Palestine), from Nov 14–21, 2012, killed more than 190 and injured more than 1490 Palestinians. 48 of the people killed were aged 18 years or younger, and 16 were 5 years or younger. 504 of the people injured were aged 18 years or younger, and 195 were 5 years or younger. The rest of the individuals injured or killed were older than 18 years. Six Israelis were killed and 224 were injured. We were working in Al-Shifa Hospital, Gaza City, during the attacks and assessed the flow of patients through the emergency department during 8 days of bombing by the Israeli military. Methods Data for all patients brought to Al-Shifa Hospital's emergency department were obtained retrospectively from handwritten emergency department protocols, and intensive care unit (ICU) and operating room records. We recorded the total number of hospital admissions, deaths, admissions to the ICU, patients operated on, and patients transferred to Egypt. Data were gathered for admissions, demographics, cause of injury, surgery, ICU admissions, and deaths. Microsoft Excel 2010 was used to analyse the data. The study was approved by the hospital's director and board. Findings 680 of the injured or killed Palestinians were brought to the hospital's emergency department with injuries from bombing by drones, F-16 fighter planes, helicopters, or naval artillery: 501 (74%) male and 179 (26%) female individuals, including 74 (11%) children aged 18 years or younger. 145 (21%) Palestinians were admitted: 44 (30%) during the first 4 days and 101 (70%) during the last 4 days of bombing. 43 (30%) of 145 individuals needed intensive care (32 [74%] adults and 11 [26%] aged ≤5 years). Of the patients admitted to the ICU, 29 (67%) were discharged, 11 (26%) transferred to Egypt, and three (7%) died in the ICU. 62 (9%) of 680 people who were injured died: 50 (81%) were dead on arrival, seven (11%) died in the operating room, three (5%) died in the ICU, and two (3%) after transfer to Egypt. 110 (76%) of 145 patients admitted to Al-Shifa Hospital were operated on, most were taken directly to the operating room after rapid triage and critical stabilisation in the emergency department. 39 (35%) patients had laparotomies, and 42 (38%) orthopaedic, 22 (20%) neurosurgical, eight (7%) vascular, and four (4%) plastic surgical operations; total number of operations was greater than 110 because most patients had more than one trauma. 39 patients were transferred to Egypt. Most of the people with injuries were civilians. Interpretation A large influx of patients who had war trauma was managed in Al-Shifa Hospital despite the erosion of infrastructure, supplies, and general population health from the previous 5-year Israeli siege. Improved, stricter triage reduced patient admission during the 2012 Israeli military attack versus the Israeli military attacks in 2008–09. Additionally, hospital staff were better prepared and trained for the casualties of the 2012 military attack and few deaths occurred in the ICU. A high number of individuals with fatal injuries were dead on arrival, indicating the need for better prehospital triage to safeguard hospital capacity. Funding None.