As death continues to take many forms and steal an ever-increasing number of lives in Gaza, escaping it merely marks the continuation of a protracted agony. Every act of violence committed by Israeli forces causes irreversible loss, whether financial, social, emotional, or physical. By rendering healthy life unattainable for the large majority of the population, Israel’s military actions do not just debilitate a Palestinian present, but also cripple any chances of a Palestinian future. As such, a generation of Palestinian children has been physically and psychologically scarred by Israel’s war on Gaza, their futures irrevocably altered, as newly acquired disabilities limit their mobility and independence in a home ravaged by destruction.
Politics of life and death
According to a recent study published in the Lancet, the accumulative effects of the violence unleashed by Israel on Gaza could lead to the death of over 186,000 people. This estimate accounts for both direct and indirect deaths, taking into consideration the impact of large-scale forced starvation, lack of access to healthcare, and rapid spread of diseases amidst crumbling public infrastructure and sanitation systems. This would mean that at least 8 percent of Gaza’s population have lost their lives since October 7.
The remaining 92 percent did not emerge unscathed, neither psychologically nor physically. This article focuses particularly on the physical toll of Israel’s war on Gaza, all while acknowledging the weight of the psychological toll incurred by Palestinians within and outside Gaza. Prior to Israel’s latest war on Gaza, statistics showed that at least 21 percent of households within the strip had at least one member suffering from physical or mental disability. While limited data exists to confirm the trend reported by health personnel on the ground, UNICEF estimates that there has been a significant increase in disabilities, resulting directly from the violence inflicted by Israeli forces. The physical trauma caused by violence often leads to significant and lasting impairment, termed “acquired disability,” that dramatically alter individual life trajectories.
Israel has effectively ensured that all remaining life in Gaza is irreversibly damaged for generations to come
Israel has engaged in genocidal, urbicidal, and ecocidal actions that have not only produced mass death, but also mass disability. While genocide refers to the destruction of life, urbicide and ecocide respectively refer to the destruction of cities and urban areas, and to the destruction of the environment and ecosystems of a given territory. By demolishing vital civilian infrastructure, deliberately targeting hospitals, persecuting health personnel, restricting access to basic necessities including food and water, and causing extensive long-term damage to the natural environment, Israel has effectively ensured that all remaining life in Gaza is irreversibly damaged for generations to come.
The main injuries resulting from the extensive use of explosive weapons in a densely populated area are fractures, damage to peripheral nerves, amputations, spinal cord trauma and paralysis, traumatic brain injuries, and burns. As a matter of fact, the weapons employed by Israeli forces are designed to maximize casualty, by including additional metal that fragments into smaller pieces of shrapnel and lacerates blood vessels.
Children are particularly vulnerable to losing their limbs from missiles and shells, because the fragility and smaller size of their bodies mean their blood vessels are more difficult to repair. Constant exposure to bombings and military actions also puts them at risk of suffering severe sensory impairments, such as hearing loss. They are additionally threatened by the presence of poliovirus, a highly infectious disease causing permanent deformities and paralysis. Only vaccination and high hygiene standards can help contain the outbreak of polio, which rapidly spreads through contact with contaminated food, water, or patients. Yet, the Israeli government is only taking measures to prevent the disease from spreading amongst its military personnel, deliberately neglecting Gaza’s population.
If not through targeted destruction and medical neglect, Israeli forces instrumentalize medical knowledge to disable. Testimonies from recently released Palestinian detainees report repeated physical and psychological torture, including from Israeli health personnel, causing permanent damages to Palestinian bodies and psyches.
Disabling Gaza’s youth
These interlinked acts of violence are exercised against a particularly unique demographic structure. Prior to October 7, 47 percent of Gaza’s population were children under 18, most of whom have lived their entire lives under Israel’s blockade, frequent incursions, and multifaceted violence. As of 2018, 80 percent of Gaza’s children were reporting high levels of emotional distress and over 50 percent were contemplating suicide.
Israeli forces’ unbridled violence has killed, orphaned, displaced, and maimed at unprecedented rates. As a result, Gaza concentrates the largest pediatric amputee population, with over 1,000 children losing at least a leg during the first 10 weeks of the war. Experts estimate that over 10 children lose one or both of their legs every day, which includes babies born after October. In many cases, the loss of limbs or senses could have been avoided, had patients been able to receive emergency care or the adequate medications. Yet, the shortage of medical supplies amidst unsanitary conditions facilitates the rapid spread of infections and gangrene of wounds, prompting the amputation of otherwise salvageable body parts. Gaza’s blood banks, depleted by years of blockade and violent assaults, have been targeted by Israeli forces, narrowing the margin of maneuver of medical teams by precluding limb-saving, and often life-saving, transfusions. The World Health Organization has reported that the near-absence of remaining vascular surgeons within the strip, that was already suffering from severe restrictions impeding specialized medical training, significantly decreases the chances of responding to severe trauma injuries in due time.
Medical evacuations requests have routinely been denied by Israel with less than 20 children able to leave per day
The short supply of material and human resources also forces doctors to operate in suboptimal conditions. Many children have undergone invasive surgeries without anesthetics, rendering already distressing procedures excruciatingly painful physically. With many hospitals severely damaged, children have been amputated outside of the surgical bloc, in overcrowded waiting rooms, on hospital floors, and sometimes even outside of healthcare facilities. After she was severely injured by an Israeli shelling, 17-year-old Ahed Bseiso underwent a traumatic amputation with a kitchen knife and sewing kit on her own family’s dining table, less than five minutes away from the then-besieged, and hence inaccessible, Al-Shifa hospital.
To make matters worse, many have undergone these surgeries with little emotional support from their primary caretakers. During the besiegement of Al-Shifa, many children were isolated from their families during their recovery under the threat of impending violence. A meager number of children have been able, or rather allowed, to leave the strip to get the adequate care elsewhere. Medical evacuations requests have routinely been denied by Israel with less than 20 children able to leave per day. Only 35 percent of the close to 14,000 applicants since October 7 received approval. Since then, the closure of the Rafah crossing in early May has completely prevented critical patients from being evacuated, significantly reducing chances of survival. As an example of such measures, after the strike in the occupied Golan Heights which killed 12 children in Majdal Shams, Israeli Prime Minister Netanyahu undertook punitive measures to deny 150 sick children from leaving to the UAE for medical treatment.
Caring amidst genocide
Even after surviving these traumatic procedures, the children of Gaza struggle to receive the required post-operative care, as following-up with individual patients in a context marked by constant displacement is near-impossible. These logistical challenges are compounded by the extent to which current medical needs within the strip outweigh the limited capacity to provide prolonged care. Specialized rehabilitation services, which patients need to regain a certain mobility range and prevent irreversible impairment, are scarce and inaccessible for many patients, due to the destruction of major rehabilitation centers and the death, injury, or displacement of specialists. Israeli defense forces (IDF) have also bulldozed warehouses storing rehabilitation equipment, destroyed the offices of NGOs providing care to disabled Palestinians, and killed their staff members.
The lack of ongoing medical care hampers the recovery of recently amputated children, especially as prosthetic limbs and mobility aids are no longer available. The Israeli army has prohibited such medical devices from entering the strip, under the pretense that they could be employed for military use.
Even with disability aid devices, navigating a now obliterated Gaza is arduous. The pervasive destruction of public infrastructure and transportation systems has created a hostile environment, littered with an estimated 40 million tons of war rubble that could take up to 15 years to clear up. War remains include unexploded ordnance, harmful substances, and the bodies of thousands of Palestinians that could not be retrieved, dignified, and buried.
The absence of accessible pathways and reliable transportation is a critical barrier severely impeding mobility to not only access essential services, but also flee violence when possible. The IDF’s repeated evacuation orders to displace the population to ever-shrinking designated humanitarian safe zones, which in many cases turned out to be death traps, are inaccessible to patients with vision, hearing, or intellectual disabilities due to informational barriers. They also leave little time to organize logistically the evacuation of physically impaired children and adults. For instance, on July 22, Israel’s military launched artillery and airstrikes on eastern Khan Younis, only a few moments after dropping evacuation leaflets in a supposedly safe zone where over 400,000 people sought shelter.
In addition to difficulties escaping military airstrikes, patients with disabilities are also more vulnerable to other types of violence, as exemplified by the tragic death of Muhammad Bahar. Suffering from cognitive and physical impairment, the 24-year-old man was unable to escape as he was mauled to death by a combat dog in the eastern parts of Gaza city. Even when they manage to flee to and seek refuge in camps, Palestinians with disabilities have to survive in overcrowded shelters without necessary accommodations. This significantly deteriorates their overall well-being.
A generation lost
Whether by losing a limb or vital sensory sense, Palestinian children suffering from life-altering injuries will face difficulties in adjusting to their new condition without physical and psychological support. Previous research shows that children with disability in Gaza already faced a multitude of institutional, infrastructural, environmental, and attitudinal barriers that curtail their ability to engage socially, economically, and politically. With high death rates amongst parents, orphaned children with disability will be uniquely vulnerable to exploitation and abuse.
If Gaza’s present is inescapably violent for children, its future is unlikely to reverse any of the damage inflicted
These children’s future is further jeopardized by exclusion from educational and employment opportunities. While education has been interrupted for all of Gaza’s children, the chances of resuming schooling are even slimmer with recently acquired impairments. The lack of income from future employment is likely to compound the financial strain imposed by the medical and adjustment expenses, including the acquisition of assistive devices, imposing severe economic hardship well into adult life.
If Gaza’s present is inescapably violent for children, its future is unlikely to reverse any of the damage inflicted. The crippling of a significant share of Gaza’s youth epitomizes the multi-generational trauma Israel has inflicted on Palestinians ever since the Nakba, condemning many generations to a life of violence and loss. By amputating children of their sense of safety, of their homes, of their families, and of their limbs, Israel is amputating Palestine of its youth and future.
Salma Daoudi is a Nonresident Fellow at TIMEP focusing on health and conflict in the MENA region. Her research primarily revolves around the weaponization of health in Syria and its repercussions beyond the locus and temporality of violence.