Severe amputation injuries after Israeli military operations in Gaza: a retrospective, clinical follow-up study

Abstract

BackgroundFour major attacks on Gaza since 2006 have killed around 4000 and injured more than 17 000 Palestinians. An unknown number of the wounded suffered extremity injuries with amputations. The long-term functional, somatic, and psychosocial consequences of traumatic amputations in Gaza have not been reported. We describe the demography, anatomical distribution, and causative factors of a sample of traumatic amputations in Gaza in this ongoing study. MethodsWe studied 147 randomly selected Palestinian surviving casualties in Gaza who had suffered traumatic amputations following Israeli military operations during the period 2006–2014. All participants were aged over of 16 years when included. One additional patient was invited to participate but declined. We organised the study at a key rehabilitation centre, the Artificial Limb and Polio Centre (ALPC) in Gaza City. Data were collected from June to October, 2014. We recorded date and mechanism of injury as well as results of in-depth clinical examinations in each survivor. Records and self-administrated questionnaires in Arabic were translated into English and data analysed with SPSS common version 21·0. The Palestinian Ministry of Health, the board and directors at Al-Shifa Hospital, and ALPC approved the protocol. We obtained written informed consent from each patient. Findings11 women (7·5 %) and 136 men (92·5 %) with traumatic amputations participated. The mean age was 30·6 years (range 16–64). 85 patients (57·8 %) had unilateral lower extremity amputations, 31 (21·1%) bilateral lower extremity amputations, and 31 (21·1%) other amputations. Attacks from drones were reported by the survivors as the reason for explosions that caused amputation injury in 85 of the cases (57·8%). 52 (61.2 %) of such drone attacks had occured during declared military operations. 24 (31·6 %) had occurred during periods of ceasefire. Nine (11·8%) participants reported only the month and year of attack, not the exact day. InterpretationMilitary operations in Gaza have caused a large, unknown number of traumatic amputations. In our study, most participants had unilateral or bilateral lower limb amputations and the majority of injuries followed attacks with drone-carried weapons. Several participants were wounded during ceasefire periods. The need for rehabilitation is difficult to meet because of limited local resources. FundingNone.