Doctors at a hospital near Gaza are almost overwhelmed by the number of Palestinian children needing treatment for bullet wounds to their heads.
On just one day last week staff at the El-Arish hospital in Sinai were called to perform sophisticated CAT brain scans on a nine-year-old, two 10-year-olds and a 14-year-old – each of whom had a bullet still lodged in their brain, after coming under fire during the Israeli ground assault on Gaza.
Dr Ahmed Yahia, the head of the trauma team, broke the news to the grandmother of Anas, aged nine, that the girl was not expected to live.
“Anas was deeply comatose when she came in, and she remains deeply comatose,” said Dr Yahia. “The bullet has damaged a big part of her brain. It came in, hit the skull wall and then changed direction downwards. I’ve seen a lot of gun injuries and the damage here is so extensive I think it may be fatal.”
Dr Yahia, a professor of neurosurgery who has worked in both the United States and Britain, believes that the bullet was shot from close range. “If it changes course inside the brain it has high velocity and its penetrative force is also high,” he said.
“I can’t precisely decide whether these children are being shot at as a target, but in some cases the bullet comes from the front of the head and goes towards the back, so I think the gun has been directly pointed at the child.”
But there is no disputing the scale of the suffering in Gaza, or its heavy impact on the young. The United Nations has counted 346 Palestinian children killed since the Israeli assault began, while Hamas, the radical Islamic movement that Israel has been trying to dislodge, says there are 410 children among the 1,201 Palestinian dead.
An even larger number of children have been wounded – 1,630, according to Hamas – and a disturbing number of them have suffered serious injuries to the head.
Hundreds of victims of Israel’s three-week campaign in Gaza have been transferred across the Egyptian border at Rafah for urgent treatment. They are seen first at El-Arish, nearly 40 miles from the border. For patients who are often on ventilators it is a hazardous journey across a war zone.
One of the medical team leaders at the hospital, Dr Ayman Abd al-Hadi, said that this was the worst conflict he had experienced. “We’ve had one child with two bullets in the head and nowhere else,” he said. “We think that this shows something.”
He praised the medical teams in Gaza for managing to save so many lives despite a shortage of staff, supplies and equipment. “But only a very small percentage of children can survive bullet wounds to the head,” he said. “If we see three children here who have survived bullet wounds to the head, there are probably 97 still in Gaza who have not.”
Doctors at the small but well equipped hospital do not attempt to remove the bullets, but perform a full assessment and attempt to stabilise their patients – most of whom are unconscious – before sending them to hospitals in Cairo, and in some cases abroad, for more complex treatment. Of those who survive, few are likely to recover fully. Most child victims of such injuries are likely to be paralysed for life.
Other children have different but horrific injuries – like Samer, not yet three years old, who lay playing with an inflated surgeon’s glove as her Egyptian doctor tried to distract her from the suffering he was about to inflict upon her as he inserted a drip containing painkillers into her hand.
After she was shot in the back outside her Gaza home, it took three hours for medical help to reach the captivatingly pretty child. Her uncle, Hassan Abedrabo, said that Samer was hit by an Israeli bullet which damaged her spinal cord and has left her paralysed. Her two sisters, aged two and six, were shot dead in the same close-range attack as they tried to escape from tanks bombarding their home in Jabaliya, north of Gaza City.
The girls’ mother was hit twice but survived; Mr Abedrabo said that their grandmother, waving a white flag at the front of the terrified family procession, lost an arm to another bullet.
Samer has now been transferred to a Belgian hospital but the Egyptian doctors who treated her in El-Arish believe she will never walk again. If she is too young to grasp what her future now holds, Samer thinks she knows what happened to her. “The Jewish shot me,” she said in Arabic. “And they killed my little sister.”
Mr Abedrabo, Samer’s uncle, insisted that there were no Hamas fighters in their home when Israeli tanks opened fire last week. He is a supporter of Hamas’s bitter political rivals Fatah, led by the Palestinian president Mahmoud Abbas.
“The tanks opened fire on the fourth storey,” said Mr Abedrabo, as he watched over his niece in hospital. About 30 people were sheltering on the ground floor as the tanks began pounding the third floor; then the second; then the first.
“The house began to shake and we were terrified,” he said. “The women and children were screaming as they thought the house was going to collapse.
“I speak Hebrew so I shouted to the Israelis. The officer said, ‘Come out’ so the women went first, waving a white flag. They opened fire from just 15 metres away. How could they not tell they were children? They could see them.”
Three hours later, when a cousin arrived with Palestinian doctors, eight people remained in the house. At that point, Mr Abedrabo said, missiles fired by Israeli F16 jets destroyed what was left of the building, killing those still inside.
The hospital’s psychiatrists, who see every patient, were particularly concerned about a 13-year-old boy who lay trapped, terribly wounded by shrapnel, for three days beneath the rubble of his home. Other family members lay dead around him, and he saw dogs begin to gnaw their bodies.
As international pressure grew on both sides to agree a ceasefire last week, there was little sign within Israel of public opinion turning against the campaign.
In a controversial move, the country’s Association for Civil Rights launched a protest over the plight of Palestinian children by taking out a full-page, obituary-style advertisement in the daily newspaper Haaretz. It lamented the deaths of children of various ages and featured the word “Stop” in bright red letters.
“There is little desire to address the price the civilian population in Gaza is paying,” said Nirit Moskovitz, a spokesman for the group. “Israeli society needs to be reminded that actual people and innocent children are getting hurt. Children are everyone’s soft spot and therefore we chose to focus on them.”
The doctors in El-Arish cannot independently verify the accounts given by Gazan victims. But nothing they have seen discredits claims by civilians that they have been deliberately targeted.