More than 1,000 Children Are Now Amputees.
What Do Their Futures Hold?

Eliza Griswold / The New Yorker

(March 25, 2024) — 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 1500 wounded Gazans in urgent need of medical care, it has begun to fill.

The new residents are 815 medical evacuees from the ongoing war, along with 542 of their relatives. Most are women and children.

One afternoon in February, a rambunctious swarm of thirty or so children raced around a large plot of AstroTurf. Some rode bikes and scooters. One toted a set of “PAW Patrol” golf clubs. Small children pushed larger ones in wheelchairs at worrying speeds, caroming off the green and brown beanbag chairs that dotted the plot of artificial earth.

Many were missing limbs. As the boys began to squabble with the girls over who had more space to play, workers dragged what looked like a deflated rainbow into the square. A whoop went up. The afternoon’s entertainment had arrived: a bouncy slide, along with food carts offering ice cream, hot chocolate, popcorn, cotton candy, and falafel.

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 43 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.

Israel’s Attacks Force Doctors to Amputate
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.

The Compromised Lives of Child Amputees
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.

To fill the empty hours at the compound, volunteers and government employees from Qatar’s Ministry of Social Development and Family were creating art, music, and sports-therapy classes for children. Still, many residents spent late afternoons milling about the AstroTurf.

Women shepherded children to a folding table where a face painter sketched Spider-Man masks and Palestinian flags on their cheeks. Then the women wandered over to the beanbags and pulled them into circles, where most sat staring into the distance, until a crying child arrived, demanding attention.

The Tales of Wounded Children
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!”

Smaller ones clambered into our laps, demanding in Arabic that Soufan translate their stories. They’d heard me asking other wounded children questions, and now they wanted their chance.

Muhanad, who was eight, with two buckteeth poking out of his mouth, had rolled himself over in his wheelchair. He’d lost his right leg when a ceiling collapsed on him during an Israeli strike, he said, after following his dad on a trip to buy sugar. He mused aloud that he’d made a mistake by leaving the house. (His father, Muhanad said, had also been severely injured. He was stuck in Gaza, without permission to evacuate.) I asked him what his favorite thing was in Qatar. “I’m glad to be able to meet the people who helped me in person,” Muhanad said, smiling. He cupped his hands and brought them together in front of his chest, making a heart.

Dina Shahaiber, who was four-year-old Gazal’s long-suffering neighbor, sat listening nearby in her wheelchair. Clad in a matching velour tracksuit, which read “Perfect” down its sleeve, she swung her left stump over her wheelchair’s arm distractedly. “If you think that story’s sad, you have to hear mine,” she offered. Dina didn’t remember how she got injured, only that she, like Muhanad, believed that it had been her fault.

“If I’d only stayed inside that day,” she told me. Before losing her leg, she’d been largely responsible for getting fresh water for her family, running up and down the stairs to refill a large tank on the roof. “I was my mom’s right hand,” she said proudly. “My uncle asked if he could trade me for his son. But now my cousin is dead, and I’ve lost my leg. I feel so useless.”

Later that afternoon, I met with Gazal’s mother, Ridana Zukhara, who is twenty-four with a childlike face, in the white-tiled living room of their pristine two-bedroom apartment. Ridana’s husband, Bilal, and her three-year-old son, Yusef, are trapped in a refugee camp in Rafah. To keep herself from constant worry, Ridana, who rarely leaves the apartment, scrubs the brand-new appliances in the modern kitchen. She is still devastated by the choice she made to evacuate with Gazal and her newborn daughter, Aileen, while her son remained in danger.

“Yusef can’t understand why I took Gazal and left him behind,” she said. She tipped the dining-room chairs on top of the farm table to sweep underneath and made up the platform beds topped with fluffy white duvets.

Gazal played on the apartment’s immaculate floor with Aileen, now three months old, looking on from a car seat. Chubby and about the size of a loaf of bread, Aileen squawked good-naturedly from under a pink Hello Kitty blanket while Gazal jabbered to a wild-haired imitation Barbie doll dressed as a bride. She folded the doll’s plastic left leg behind her and marched her around the floor on her right. “This is Gazal when she gets married,” she announced. Ridana tut-tutted. She didn’t want Gazal fashioning the doll as an amputee. She reminded Gazal that soon she would have a new leg, although that seemed nearly impossible for the four-year-old to comprehend.

Sometimes, when Gazal got out of bed, she tried to use her missing left leg and fell. Such moments were hard, Ridana said, but Gazal cried less about her leg than about her father and brother. She asked her mother incessantly when they were coming to Doha. “They told us they could come when there’s a ceasefire,” Ridana said, of Qatari officials. “But when will that be?”

The Pain of Separataion
In Rafah, Bilal and Yusef are living in a tent near the Egyptian border. “They are freezing,” Ridana said. They have no phone signal in the camp, so, most days, Bilal walks for hours to send his wife a video of Yusef. In one that Ridana showed me, Yusef is filling his pockets with rocks, pretending they are money. In another, he lies on a muddy sleeping mat, unresponsive. “He has lost so much weight, and his face is yellow,” Ridana murmured.

While we were watching, a message arrived on WhatsApp from her sister, who’d just given birth in the Rafah refugee camp. “Habibi, my sister I hope to God you guys are good. Please send me pictures of the girls. I miss them so much. Are you in touch with your husband?”

Rafah is dangerous, but the family is most worried about the toll that separation from Yusef is taking on Ridana. When she brings black plastic trays of hummus and pita back from the food stalls, she leaves hers untouched. “How can I eat when my son doesn’t have food?” she asked me.

War Trauma and Mental Stress
For separated families, as well as for those trapped in Gaza, the mental-health toll of the crisis continues to mount. During the first several months of the conflict, the Gaza Community Mental Health Programme (G.C.M.H.P.), the leading mental-health organization in the Strip, ceased operations. Two weeks ago, in Rafah, they re-started some of their programs.

“We can’t wait any longer for a ceasefire to take place to deal with mental health,” Yasser Abu-Jamei, a psychiatrist and the head of the G.C.M.H.P., told me by phone from Rafah recently. Abu-Jamei is also displaced and living in a tent in Rafah. He and a team of mental-health providers go into camps to speak to families and perform psychological first aid. They work with traumatized children, trying to help them identify somewhere nearby that’s safe.

“If we can’t find an actual place, we help children imagine somewhere safe,” he said. They also work with parents who are baffled by their children’s misbehavior, and, with the help of the World Health Organization, they provide psychotropic medications to adults — though such drugs, like most others, are scarce.

In addition to offering treatment, the Gaza Community Mental Health Programme has conducted clinical studies of trauma among children. Samir Qouta, a psychologist who founded the research department of the G.C.M.H.P., in 1990, and now teaches at the Doha Institute, has researched subjects such as children’s dreams and the relationship between trauma and maternal attachment, as well as the core aspects of building resilience. “Traumatic experiences don’t necessarily wound children,” Qouta told me one afternoon at his office in Doha. “There are so many factors that mitigate trauma — creativity, storytelling, and, most of all, a child’s strong bond with her mother.”

Although many of the compound’s residents remain glued to their smartphones and to the large flat-screen TVs that Qatar has furnished in their apartments, following news reports from Gaza to ascertain the fate of their families, Ridana keeps their television set turned off for Gazal’s sake. “She has already seen so many traumatic things,” Ridana told me. “I try to limit how much she hears and sees.”

Gazal rarely speaks of her experiences in Gaza. Ridana doesn’t encourage it. Yet her daughter does show signs of specific anxieties and aversions. She stays away from anyone dressed in white because they remind her of hospital staff. She demands that Ridana sleep in her bed, and, even in sleep, she won’t let go of her mother. “I can’t even go to the bathroom,” Ridana said.

For children who’ve experienced extreme loss, such hypervigilance is common, Salsabeel Zaeid, a psychologist working with children and families at the compound, told me. Many of the child amputees in Doha suffer from “depression, anxiety, trouble concentrating, restlessness, nausea, trouble sleeping, anxiety attacks, hopelessness,” she said. “They’re really tearful and guilt-ridden,” she added. The children suffer from a form of survivor’s guilt, because, unlike friends and family members, “they’ve walked into another country and their basic needs are being met.”

Ridana had taken Gazal to the compound’s mental-health clinic to see whether Gazal might benefit from speaking with a therapist. But, at the appointment, Gazal broke down, crying the whole time and telling her mom to answer the questions. “It caused her more pain,” Ridana said. She recalled what the therapist told her about attachment: that maternal bonding was integral to Gazal’s ability to heal. Ridana said, “For now, what she needs is her mom by her side.”

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