Humanity & Inclusion’s inclusive education project in Gaza, in the Palestinian Territories, provides Nermeen and her daughter Shahed with personalized support and counseling at school and at home.

Shahed, 13, has a physical and learning disability. In the past, her mother, Nermeen, was not closely involved in her daughter's education and found it hard to convince her family to accept invitations from the school. "I didn’t take part in outdoor activities because I was afraid of the negative attitude of my family and friends,” says Nermeen. “I avoided situations where people might make comments or give me accusing looks. I had to stay at home.”

Perceptions of disability

A support group for parents of children with disabilities helped Nermeen overcome her concerns. “I made my daughter my priority. I chose to be strong and with support from the school and the group, I finally convinced my family. I’m free to take part in lots of different school activities now," she explains.

Bringing families out of isolation

The group gives parents a chance to share their daily experiences and problems. This successful initiative provides them with a support network inside and outside meetings. Mothers like Nermeen no longer feel alone: "If I have a problem, I know where to go.”

Looking forward to school

Teachers are in regular contact with Nermeen. They update her on her daughter's progress and use a liaison diary to exchange ideas with her, as they do with other parents. As a result, Shahed and her mother communicate with each other more, and she is more fulfilled. "She feels comfortable at school—she’s happy. She has made a lot of friends. When she wakes up, she can’t wait to go to school.”

Executive Summary

This baseline assessment was undertaken by Handicap International in October 2014 in all five governorates of Gaza. The focus of the survey was to collect baseline data related to the knowledge, attitudes, and practices regarding Explosive Remnants of War (ERW) contamination in communities impacted by the recent conflict.

The survey consisted of two parts: quantitative data collection comprising 459 individual questionnaires and qualitative data collection of 4 focus groups. The questionnaire targeted men, women, and children over 10 years old, while the focus groups targeted adults with disabilities, children, and adolescents. Quotas based on the age and gender in the five governorates sought to represent a proportionate cross-section of the population in impacted communities.

The survey showed that 45% of the overall population surveyed had received Risk Education (RE) messages in the past, with a lesser proportion of respondents in the governorates of North Gaza and Middle Area. The most common means of receiving the RE messages were through a school teacher, television, leaflets, radio, NGO worker, and posters.

Despite high levels of education in the population surveyed, significant gaps remain in knowledge of ERW. When asked which groups in these communities need more RE, the common response was young boys and girls. Regarding attitudes, most respondents are worried about ERW contamination and believe ERW should be reported to authorities. Overall, about half of respondents had seen ERW during or after the recent conflict. Gender was a key factor in this; males were much more likely to have reported seeing ERW than females. Of those that had seen ERW, 5% of respondents admitted to tampering with the ERW. Although 70% of the population were able to give the correct answer about how to report ERW (by dialing 100), only 29% of those that had seen ERW had actually reported it. Of those who had entered an area suspected to have ERW (28%), the most common reasons mentioned for doing so were curiosity, returning to collect items from a home that was damaged, farming, and visiting friends and family.

This baseline assessment shows the continued prevalence of high-risk attitudes and practices in Gaza, demonstrating a need for additional campaigns that deliver safety messages to the entire population. This report also highlights issues that could be improved and makes the following recommendations:

• Ensure that resources are allocated to make RE a priority for children
• Designate the entire front line of rubble removal and reconstruction as a target for RE and other support
• Prioritize RE to high-risk governorates
• Increase cooperation among RERE actors and standardize RE messages, monitoring, and evaluation
• Develop more inclusive Information Education and Communication (IEC) materials and RE activities
• Integrate RE across humanitarian and development interventions (with a focus on protection and health sectors)
• Ensure continued support is provided to clearance and victim assistance efforts

TO READ THE FULL REPORT, DOWNLOAD IT HERE:

Bombs under the rubble — Study of awareness of explosive remnants of war among the populations of Gaza (2015)

Zena lives in the south of the Gaza Strip, in the governorate of Rafah. Trained in first aid, she was among the first to help the injured when demonstrations began last March. On May 13, she was assisting three people when a bullet hit her in the face, causing her to lose 70% of her vision. She also fractured her right wrist as she fell to the ground.

A housewife and mother of eight children, her injury has had a serious impact on her daily life. She is now highly sensitive to light and noise–even the television is too loud for her. "I want my sight back,” she says. “I’m a housewife, so it makes life very hard. I shouldn't be exposed to heat, but I have to cook. And I get tired very easily.”

Zena, who has a graduate degree, planned to become a teacher. But the violence in Gaza has cut her ambitions short. "My dream was to be a teacher. Because of what I am and how I look, there’s no way I can do it now. Physical appearance is very important when dealing with children.”

HI's support

A few days after her injury, Zena met a mobile HI team who identified her needs. Medics cleaned her eye and she spent eight days in hospital due to her fracture. To help her recovery both physically and emotionally, HI provided her with physical therapy care and psychological support. She will need additional surgeries to fully restore her sight.

The Gaza crisis and HI’s response

• HI and its local partners have set up 12 mobile teams. These teams include rehabilitation professionals, psychologists, and social workers. They visit individuals who have been injured in their homes, as there is not enough space in hospitals to see patients, as well as, to ease the burden of travel costs.
• HI’s mobile teams have provided services such as rehabilitation care, post-operative care, psychosocial support, assistive devices to more than 900 injured patients and will reach hundreds more in the coming weeks.
• HI also prepared contingency stocks in each governorate, including mobility aids (crutches and wheelchairs), emergency wound management, and kitchen kits, which have reduced waiting times for these resources.

"I felt like I had been electrocuted,” Mohammed explains. “My leg bulged, and then I lost consciousness.” On April 6, 2018, Mohammed was shot in the leg during demonstrations at the Gaza border. His story is one of many. At least 15,000 people have been injured since the start of the demonstrations last March, of whom nearly 3,000 have severe lower leg trauma, similar to Mohammed’s.

Since his injury, Mohammed has undergone two major surgeries, resulting in a large metal frame around his leg. "I am bedridden now, I can't hold my kids like before. And I am always frightened to move.” He will need further bone reconstruction surgery in the coming months, but this is a specialist procedure that can only be carried out in hospitals outside of Gaza. It is not clear whether he will be allowed to leave.

Limited resources

Mohammed lives in Gaza with his wife, two children, and other members of his extended family. "I don't have this amount of money. My family is poor and we can't afford it for long," he continues. Mohammed used to bring in a small, but essential income, delivering vegetables at the market. But now, he's unable to work. His family is currently paying 45 euros—equivalent to $52.50—each week for painkillers and transportation to and from the hospital.

Rehabilitation care from HI

"I used to love playing football in my neighborhood, but now I can only hope to start using my crutches as soon as possible." HI staff provides Mohammed with post-operative care, including wound dressing. They aim to improve his living conditions by providing a mattress to prevent bedsores. HI physical therapists will soon start a physical rehabilitation plan when his condition improves. Recovery will take many months of hard work and patience. During this time, psychologists, specially-trained by HI, will help Mohammed to deal with the psychological and social impact of his injuries.

The journey to recovery

"Before the injury, I was hoping to have my own private house for my small family. Now, I just hope to find a way to make my kids happy." Mohammed is determined to recover, but will need sustained medical and psychological support to avoid developing a permanent disability. HI’s mobile team of nurses, physical therapists, and psychologists, will accompany him throughout his journey, giving him the very best chance of a full recovery.

The Gaza crisis and HI’s response

• HI and its local partners have set up 12 mobile teams. These teams include rehabilitation professionals, psychologists, and social workers. They visit individuals who have been injured in their homes, as there is not enough space in hospitals to see patients, as well as, to ease the burden of travel costs.
• HI’s mobile teams have provided services such as rehabilitation care, post-operative care, psychosocial support, assistive devices to 661 injured patients and will reach hundreds more in the coming weeks.
• HI also prepared contingency stocks in each governorate, including mobility aids (crutches and wheelchairs), emergency wound management, and kitchen kits, which have reduced waiting times for these resources.

Photo caption: Mohammed and his two children in their home in Gaza in June 2018.

The bullet entered Alaa’s right leg just above the heel and left him with an open exit wound. His injury resulted in severe nerve damage, which makes it difficult for him to control his leg or put his foot firmly on the ground. “The pain at night is unbearable,” he says. “I don’t know when or if I’ll be able to drive again. I have a family to support, look at them, pointing to his four children.”

Alaa, along with his wife, and their four children.

Long-term medical care

Alaa was injured during demonstrations at the border between Israel and Gaza. People with gunshot wounds, like Alaa, require long-term medical care. After an operation, it can take months or even years of rehabilitation to restore their mobility. During this long period of convalescence, patients can become temporarily disabled and unable to work. Alaa is one of hundreds of people with this type of injury.

Limited resources

Alaa used to work as a taxi driver. He rented a car and his earnings varied from day-to-day, depending on how many fares he picked up. He lives in a very small, dilapidated house in northern Gaza. The ceiling is scored with holes, providing little protection from the cold and rain during the cooler months. “Fortunately, I’ve been getting help from humanitarian organizations. I need rehabilitation care and don’t have enough money to pay for them. I hope they’ll be able to help me until I get back on my feet. I need to return to work as soon as possible.”

Alaa spends his days walking on crutches between his bed, sofa, and the front door of his home, where he can see the street his neighbors. “It’s like living behind bars,” he adds. “I can’t work, so I don’t have any money. Today, it was my neighbor who brought me two chickens and refilled my gas bottle.”

Gaining strength

HI’s team has been assisting Alaa for the past two weeks. Most days, he receives a visit from an HI physical therapist and a psychologist. It takes time and determination to recover from a gunshot wound, and Alaa will need two more operations to repair the damage to his leg.

“When I’m better again, I’d like to have my own taxi. But given my current condition, I think it might be easier to set up a small business.”

The Gaza crisis and HI’s response

More than 14,600 people have been injured since the start of the demonstrations last March, of whom nearly 8,000 had to be hospitalized. Over the course of a single month, HI helped more than 500 people by providing them with follow-up rehabilitation care and psychosocial support. We also distributed mobility devices such as crutches, wheelchairs, and walkers.

Last week, more than 610 people were injured during demonstrations on the border between Israel and Gaza. A total of 250 people had to be hospitalized. Since March, nearly 15,000 people have been injured in the demonstrations. Bruno Leclercq, HI’s Director in Palestine, describes the disastrous humanitarian situation in the field.

The importance of nursing care

Most of the patients we treat have gunshot wounds to the femur or tibia. They are often young and suffer multiple and complex fractures. Nursing care – regular wound cleaning, changing bandages, and so on – is essential in order to avoid infections and complications. By definition, a gunshot wound is a contaminated injury and the risk of infection is high.

Risk of disability

Many casualties will also need more than one operation. According to the International Committee of the Red Cross (ICRC), 4,000 surgical operations will be needed in the coming weeks. Some organizations believe that one-third of lower limb injuries risk complications that may lead to amputation.

A weakened health system

Nearly 8,000 people have been hospitalized since last March. Hospitals in Gaza have had to cope with large numbers of casualties arriving in a very short period of time. And the health system have already been weakened by shortages and restrictions, particularly medical equipment and consumables. Under these conditions, dealing with such an emergency, including surgical operations and post-operative care, is a real challenge.

Postponed care for other patients is one of the serious domino effects of this crisis: many are not receiving care because hospitals and health centers are focusing on people injured in the demonstrations.

Social cost of injuries

Many casualties come from modest backgrounds. They are bedridden and unable to move around. Some contributed to the income of families who now have to look after a dependent who has a temporary disability.

HI’s beefing up its teams

We plan to set up two more mobile teams, in addition to the ten teams that exist already. These mobile teams are include rehabilitation professionals, psychologists, and social workers. They will provide rehabilitation care and psychological support to casualties and their families.

We also plan to increase our stocks of medical kits – rubber gloves, bandages, and so on – and mobility aids, such as wheelchairs, crutches, and walkers. The needs are immense.

Fifteen-year-old Ahmed was injured in his right thigh just above the knee during a demonstration on the border between Gaza and Israel. He can remember the incident and the pain very clearly, and is still in a state of shock. “I felt something hit my leg really hard and then I saw the blood,” he explains. “I screamed and collapsed. I lost all feeling in my body for a few seconds.”

Ahmed is one of four children and lives in the Khan Younis district in the southern Gaza Strip. His father does odd jobs and his mother cleans for a living. The family lives in a disadvantaged neighborhood and doesn’t have access to public transportation. They have to pay for a taxi to take Ahmed to hospital – a considerable expense for this family on a low income.

Many of Ahmed’s cousins live with him in the apartment, so he has very little privacy. Since he was injured, Ahmed spends his time on an old settee in the living room – the same spot where he’s visited by Humanity & Inclusion’s mobile rehabilitation team.

Our team is waiting for the doctor’s go-ahead before starting his rehabilitation sessions, but we’ve already started providing him with psychological support. These sessions are important because people like Ahmed, who are disabled as a result of an injury, sometimes go through a period of depression, made worse by the fear that they may never fully recover. This psychological support is also essential when it comes to motivating patients to do their rehabilitation exercises.

“I want my old life back,” Ahmed says. “I can’t move around by myself at the moment. I can’t go to the toilet like I used to. I need to ask my brother to come with me. It’s embarrassing. I want to get rid of the external fixture on my leg.”

Assisted by HI’s mobile team for the last two weeks, Ahmed is feeling less depressed. However, he will require even more support during his recovery to ensure he receives the proper rehabilitation care needed to fully restore his mobility.

The Gaza crisis and HI’s response

Since demonstrations began last March on the border between Gaza and Israel, at least 128 people have been killed, and more than 13,900 people injured, half of whom required hospitalization, according to the World Health Organisation’s data through June 3. Among the people injured, 3,778 have live ammunition gunshot injuries, 1,191 are children, and 2,604 had lower limb injuries. 

Hospitals are overwhelmed and patients need to leave almost immediately, making it difficult to guarantee the post-operative care they need. Patients may, as a result, develop infections or complications potentially leading to the onset of disabling sequelae or a permanent disability.

To respond to this emergency, HI and its local partners have set up 10 mobile teams composed of rehabilitation professionals, psychologists, and social workers. They will provide casualties and their families with rehabilitation care and psychological support.

[1] http://healthclusteropt.org/pages/3/situation-reports

Another day of demonstrations rocked Gaza on Friday June 8, resulting in more than 500 new injuries, according to early estimates. Since demonstrations began last March on the border between Gaza and Israel, at least 128 people have been killed, and more than 13,900 people injured, half of whom required hospitalization, according to the World Health Organisation’s data through June 3. Among the people injured, 3,778 have live ammunition gunshot injuries, 1,191 are children, and 2,604 had lower limb injuries. 

Present in Gaza since 1996, Humanity & Inclusion has mobilized its local, 40-person emergency team to help injured people who are discharged early from overcrowded hospitals. These rehabilitation teams will case manage more than 1,500 casualties in the coming months. They benefit from access to medical equipment that HI pre-positioned in Gaza.

"The patients we visit at home have suffered massive tibial destruction, torn tissue and pulverized bone that are comparable to war injuries," says Bruno Leclercq, Head of HI's operations in Palestine. Recovery is long and requires months or years of surgery, physical therapy and rehabilitation.

HI is alarmed by the increasingly precarious situation experienced by the most vulnerable people—women, children, older people and people with disabilities. These individuals are suffering the direct consequences of recurring conflicts, travel restrictions and run-down medical facilities. Problems accessing healthcare, medicine, drinking water and electricity—available for less than two hours a day—weigh more heavily on the most vulnerable families when the situation takes a turn for the worse.

“Restricted access to specialized services outside Gaza can lead to a deterioration in the health of many patients, with a high risk of decline or amputation in the weeks and months ahead," explains Leclercq. In recent months, out of 40 requests for medical evacuation from Gaza, only a handful have been granted.

For years, a blockade has stifled Gaza's economy, leaving the Palestinian population largely dependent on humanitarian aid. Three years ago, HI and a coalition of humanitarian organizations published a report on the incomplete reconstruction of Gaza and called on the international community to live up to its promises. The most vulnerable families are no longer able to cope with these additional medical, financial and psychological pressures.

With these new episodes of violence, Humanity & Inclusion is urging all parties and the international community to ensure the effective protection of civilians, medical staff and humanitarian workers. The organization has also stressed that the parties are accountable for violations of international humanitarian law, and invites them to work towards a lasting political solution.

More than 13,000 people have been injured since March following demonstrations in the Gaza Strip, of which 11% risk developing a permanent disability. HI recently deployed ten emergency teams comprised of 40 rehabilitation professionals (occupational therapists, physical therapists, nurses, a social worker, and a psychologist) to provide rehabilitation care and psychological support to affected people in Gaza.

“More than 5,000 people have been affected by tear gas, and more than 3,000 people have bullet wounds,” explains Bruno Leclercq, Director of HI in Palestine. “Many of them were hit in the legs, and have fractured tibias, which require several operations and long-term rehabilitation care. This care is essential and must be provided immediately to avoid the onset of disability.”

HI provides patients with essential psychological care. Casualties are traumatized, some risk losing a leg, or being unable to move around for months. These accidents cause a lot of hardship, and people affected suddenly have to rethink every aspect of their daily lives. It’s very hard.”Our teams will provide assistance to 1,500 casualties, and advise 7,000 relatives on injury management, rehabilitation, and psychological support.

“The climate is very depressed in Gaza, there’s a real sense of despair,” Leclercq adds. “The situation just makes the already very fragile social and economic situation worse. At the same time, the affected populations have shown real resilience and a lot of courage.”

An estimated 3,000 people were injured in demonstrations on May 14th and 15th at the border between Gaza and Israel. Medical services in Gaza have been overwhelmed by the sudden arrival of large numbers of casualties. Humanity & Inclusion is on the ground, ready to provide rehabilitation services to prevent patients from developing a permanent disability and support them in regaining mobility.

Since the start of the demonstrations in March, nearly 12,000 people have been injured, including more than 3,500 with bullet wounds. According to estimates by the World Health Organization (WHO), 11%[1] of people injured since the start of the demonstrations risk developing a permanent disability – more than 1,000 people.

Medical services in Gaza do not have the capacity to meet current needs. Patients must leave the hospital within a few days to vacate beds for other patients, making it hard to access necessary post-operative care.

Without proper supervision or rehabilitation care, a patient may develop infections or complications, potentially leading to a permanent disability.

Over the coming days, Humanity & Inclusion and our local partners will set up 10 mobile rehabilitation teams, including physical therapists, psychologists, and social workers. They will provide rehabilitation services and psychosocial support to the wounded and their families.

Photo: A 11-year-old boy, who lost his leg after Israeli soldiers opened fire on "Great March of Returns" demonstrations at Gaza Strip, is seen with his crutch in Gaza City, Gaza on May 12, 2018.

[1] http://healthclusteropt.org/pages/3/situation-reports