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Gaza strip: a specialised surgical mission

Palestine / 16.07.12

In Gaza, the embargo has repercussions on both the economy and health. The arbitrary deliveries of fuel impede the smooth functioning of the only power station still running in Gaza. Daily power cuts last hours at a time. The population resorts to generators, poor quality gas bottles, candles, kerosene lamps: all sources of serious domestic accidents, involving women and children more often than not.

The damage left by burns is highly debilitating, and requires reparatory surgery offered after the initial delivery of care. For particularly complicated cases, highly specialised surgery is required. But the embargo hampers access to this type of care: few patients are allowed to leave Gaza for surgery abroad, and the local specialised surgeons are too few in number to cover the needs.

Compelled to address the situation, in July 2010 Médecins Sans Frontières opened a reparatory surgical programme in collaboration with the public hospital of Nasser, located in Khan Younis city, to the south of Gaza. This field hospital, set up in inflatable tents, is based in the hospital premises. The hospital kits, presented in modules, can be set up in just a few days and offer a full technical set up (operating theatre, recovery room, sterilisation, air conditioning/heating...)

Yussef is nearly three years old. He was burnt one month after his birth. His mother relates: "The electricity had gone off, I lit a candle in the room he was sleeping in. My other son, who was 4 years old, played with the candle and some paper. The whole bedroom caught fire. I took him to Shifa hospital, where he stayed for 35 days. They did a skin graft on him but his face became disfigured and his eyes were shut."

Dr Eric TAVERA, a French maxillofacial surgeon, examines Yussef: "The skin quality is too poor to do plastics*, so we need to rebuild the height of the lip and graft from the thick skin. We'll probably have to do the same for the eyes. Then, later on, we'll have to re-do a graft for the nasal pyramid". * repair to a lack of skin substance or a non-aesthetic scar

Yussef was operated on the following day. Dr Liliana MESQUITA ANDRADE, a Brazilian anaesthetist doctor, explains: "There are some delicate moments when we have to be fully focused and vigilant: putting the patient to sleep and when he wakes up. These are moments of tension, like a take off and landing for a pilot." Palestinian specialists take part in the surgery to view and discuss anaesthesia techniques, particularly for small children such as Yussef.

Such exchanges - encouraging the transfer of skills to local teams - are one of the main objectives of our surgical programme. These teams also suffer from the embargo. Dr Hassan HAMDAN, in Nasser hospital, testifies: "The embargo also has a major impact on us, the doctors and surgeons. It's really difficult to attend a training session abroad, for example. The expatriate's time here is more than welcome, we gain from their knowledge and experience. Things have improved and progressed over the past two years, thanks to cooperation and exchanges with the Médecins Sans Frontières international teams."

The surgery went well. After a short spell in the recovery room, Yussef moved back to his father. "He couldn't open his mouth at first. We had to help him swallow a bit of food. Then Médecins Sans Frontières operated on him, and now he can feed himself. They also operated on his nose, and he breathes better. They've done a lot for him." Burn cases represent over 60% of the patients receiving care from our surgical team. Since the programme started in 2010, 490 patients have received surgery, most of them children.

24 hours later, Eric checks on the little boy and changes his dressing. Yussef is in some pain for a few days. He will receive follow up in our Gaza dispensary, where the teams deliver post-operative care (dressings and physiotherapy). The aim: relieve pain, assist patients to recover satisfactory levels of mobility, and diminish (as far as possible) the consequences of wounds. Youssef's father knows that his son will need further surgery in the following months: "Médecins Sans Frontières told me that my son needs a complete surgical programme. Each new team operated on him, and provided follow up care."

In late 2012, two hand-specialist surgeons carried out a Médecins Sans Frontières mission in Gaza. Yussef had already been operated on for the burn damage severely handicapping his fingers. In early January 2012, Médecins Sans Frontières opened its first unit dedicated to physiotherapy of the hand so as to cover the all patients with such a need, including Yussef. Médecins Sans Frontières also delivered training to Gaza's physiotherapists on the case management of burns.

Médecins Sans Frontières has been working in the Gaza strip for over ten years. The healthcare system in the Palestinian Occupied Territories, and particularly in Gaza, is more advanced than many systems we work in elsewhere. Yet the offer of certain types of highly specialised healthcare still falls short of the mark. The situation is exacerbated by the Israeli embargo, which, introduced in 2007, has weighed heavily on Gaza's population, already sapped by years of conflict.

The Gaza embargo has repercussions on both the economy and health. For instance, the arbitrary deliveries of fuel impede the supply and smooth functioning of the only power station still running in Gaza. Power cuts occur daily, and last for several hours. The population resorts to the use of generators, poor quality gas bottles, candles, kerosene lamps - all sources of serious domestic accidents, involving women and children more often than not.

As a consequence, our teams have observed a notable rise in the number of burn cases among our patients a little over the last two years. These wounds are debilitating and require reparatory surgery, called "repeat surgery", after the initial delivery of care. For particularly complicated cases, highly specialised surgery is required. But few patients are allowed to leave Gaza for surgery abroad (Jordan, Israel, Egypt, etc), and specialised surgeons in Gaza are too few in number to cover the needs.

Compelled to address the situation, Médecins Sans Frontières opened a reparatory surgery programme in July 2010 in collaboration with the public hospital of Nasser, located in the city of Khan younis. Burn cases represent over 60% of the patients receiving surgical care from our teams (surgeons, operating theatre nurses and anaesthesiologists) who conduct short term missions in the hospital several times a year. The other patients we treat are suffering from the aftermath of accidents or congenital anomalies.

Another major objective of this programme is to encourage a transfer of skills to the local medical team. But the embargo hampers this too, as Dr Hassan HAMDAN, head of the surgical service in Nasser, testifies: "The embargo also has a major impact on us, the doctors and surgeons. It's really difficult to attend a training session abroad, for example.  The expatriates' time here is more than welcome. Things have improved and progressed over the last two years, thanks to cooperation and exchanges with the Médecins Sans Frontières international teams. We gain from each expatriate's knowledge and experience".

Since the surgical programme began in 2010, 490 patients have received surgery. In over ten years of working in this volatile context, regularly subjected to spurts of violence, our activities have evolved and our offer of healthcare diversified so as to respond to emerging new needs: psychological care, physical therapy, surgery... Thus, in early 2012, when we scaled up to two hand surgeons, Médecins Sans Frontières opened its first unit dedicated to physiotherapy of the hand so as to cover all patients with such a need.  This is how we try, as best we can, to stay in step with specific medical needs - left unattended in the local healthcare system - and the direct or indirect consequences of the violence generated by the Israeli-Palestine and inter-Palestine conflicts.