Gaza's Child Amputees Face further Risks without Expert Care

Thirteen year-old amputee Layan al-Baz receives treatment at the Nasser hospital in Khan Yunis in the southern Gaza Strip on October 31, 2023. (AFP)
Thirteen year-old amputee Layan al-Baz receives treatment at the Nasser hospital in Khan Yunis in the southern Gaza Strip on October 31, 2023. (AFP)
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Gaza's Child Amputees Face further Risks without Expert Care

Thirteen year-old amputee Layan al-Baz receives treatment at the Nasser hospital in Khan Yunis in the southern Gaza Strip on October 31, 2023. (AFP)
Thirteen year-old amputee Layan al-Baz receives treatment at the Nasser hospital in Khan Yunis in the southern Gaza Strip on October 31, 2023. (AFP)

Eleven-year-old Noor's left leg was almost entirely torn off when her home in Jabalia, Gaza was hit by an explosion in October. Now her right leg, fitted with a heavy metal bar and four screws drilled into the bone, may have to be amputated.

"It hurts me a lot ... I'm afraid that they'll have to cut off my other leg," she said from her hospital bed, staring at her clunky fixation device.

"I used to run and play, I was so happy with my life, but now when I lost my leg, my life became ugly and I got sad. I hope I can get an artificial limb."

In bombed-out Gaza, a generation of child amputees is emerging as Israel's retaliatory blitz after Hamas' deadly Oct. 7 attacks has led to blast and crush injuries as explosive weapons tear through densely-packed high-rise housing blocks.

Israeli authorities have previously said they work to minimize harm to civilians. Israel's military spokesperson's unit pointed to what it called Hamas' strategy of the "exploitation of civilian structures for terror purposes" but provided no specific comment on child amputees.

Doctors and aid workers say Gaza's collapsed medical system is ill-placed to give children the intricate follow-up care they need to salvage their still-growing, truncated bones. Only 30% of pre-conflict medics are working due to killings, detentions and displacements, according to the World Health Organization.

More than 1,000 children had undergone leg amputations, sometimes more than once or on both legs, by end-November, according to UN children's agency UNICEF, in a conflict where Gaza health authorities say nearly a quarter of injuries are among children.

Poor hygiene and medicine shortages spell more complications and amputations on existing injuries, some of which may not be survivable, doctors say.

"Many limbs that apparently had been saved, will go on to require amputation. And many (people with) amputations and limbs that we think have been saved may still go on to die of the longer term consequences," said Dr. Chris Hook, a British emergency medicine doctor with medical charity MSF who returned from Gaza in late December.

- FLIES AND DECAY

Staff at the European Hospital in Gaza where Noor is being treated, which is running at triple capacity, cannot provide the new limb she dreams of.

Even painkillers to help amputees with chronic pain are running low, staff say. Flies were buzzing around the ward when a Reuters journalist visited.

"I try as much as I can to make things easier for them as a nurse, but no matter what you do, they have severe psychological problems, they feel incomplete with lots of pain," said nurse Wafa Hamdan.

The enclave's main prosthetic limb center, the Qatari-funded Hamad hospital in Gaza City, was shuttered weeks ago after being hit by Israel, Gaza health authorities say.

Israel's military spokesperson's unit did not immediately respond to a request for comment on Hamad hospital.

Children with war-related amputations will need up to a dozen surgeries on the limb by the time they reach adulthood because the bone keeps growing, experts say.

But even before the conflict there was a shortage of vascular and plastic surgeons, medics say, and Palestinian health authorities say over 300 healthcare workers have been killed since.

Still, Noor, whose right leg may survive intact, is luckier than some children whose limbs were amputated swiftly due to a lack of time or medical expertise, sometimes without anaesthetics.

"Unfortunately many of them are really unnecessary," said Sean Casey, WHO Emergency Medical Teams coordinator.

At other times, amputation is the only choice because wounded children arrive in hospital days after the injury.

UNICEF spokesperson James Elder said he saw a child whose injured left leg had begun to decompose because he had been stuck on a bus for more than three days due to military checkpoint delays.

Israel's military spokesperson's unit said an operational debrief was held to draw immediate lessons from the incident and that it would be further examined.

-'NOBODY'S COMING TO SEE THEM'

While Gaza health authorities do not have an official tally, doctors and aid workers say UNICEF's 1,000 figure is accurate for the first two months of the conflict but has likely been far surpassed since, making the Gaza amputation rates unusually high compared to other conflicts and disasters.

In Ukraine, where missiles have also struck residential towers during Russia's invasion, there are 30 known cases of child amputees, according to the ombudsman's office.

British-Palestinian surgeon Dr. Ghassan Abu-Sittah said he performed six amputations in Gaza in one night. Once, he had to reopen a child's thigh stump after amputation to clean out the pus.

MSF's Hook also reported many people returning to its Rafah wound care clinic with infected stumps.

The president of the International Committee of the Red Cross, Mirjana Spoljaric, said she could not forget the images of children, often orphans, with multiple amputations lying in hospital wards after visiting Gaza in December. "On top of the wounds that you see and the lack of pain medication, they are lying there and nobody's coming to see them."

In some cases, as with 10-year-old Gaza orphan Ritash, her right leg had to be re-amputated higher up and just below the knee after it became infected, according to a UN humanitarian office (OCHA) aid worker Gemma Connell who met her.

A photograph showed her frowning from a wheelchair on a dirty hospital floor, her stump jutting up in the air. "I think what I have seen would break anyone's heart," said Connell.

 

 

 

 

 



Iran’s Centrifuges: The Long Road Towards a Nuclear Bomb

This photo released on Nov. 5, 2019, by the Atomic Energy Organization of Iran shows centrifuge machines in the Natanz uranium enrichment facility in central Iran. (Atomic Energy Organization of Iran via AP, File)
This photo released on Nov. 5, 2019, by the Atomic Energy Organization of Iran shows centrifuge machines in the Natanz uranium enrichment facility in central Iran. (Atomic Energy Organization of Iran via AP, File)
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Iran’s Centrifuges: The Long Road Towards a Nuclear Bomb

This photo released on Nov. 5, 2019, by the Atomic Energy Organization of Iran shows centrifuge machines in the Natanz uranium enrichment facility in central Iran. (Atomic Energy Organization of Iran via AP, File)
This photo released on Nov. 5, 2019, by the Atomic Energy Organization of Iran shows centrifuge machines in the Natanz uranium enrichment facility in central Iran. (Atomic Energy Organization of Iran via AP, File)

The UN nuclear agency has confirmed that Iran plans to install around 6,000 new centrifuges to enrich uranium, according to a report seen by AFP on Friday.

“Iran informed the Agency that it intended to feed” around 6,000 centrifuges at its sites in Fordo and Natanz to enrich uranium to up to five percent, higher than the 3.67 percent limit Tehran had agreed to in 2015.

The Iranian decision came in response to a resolution adopted on November 21 by the UN nuclear watchdog that censures Tehran for what the agency called lack of cooperation.

On Thursday, Iran had threatened to end its ban on acquiring nuclear weapons if Western sanctions are reimposed.

The country’s foreign minister, Abbas Araghchi, said in an interview that the nuclear debate inside Iran is likely to shift towards the possession of its own weapons if the west goes ahead with a threat to reimpose all UN sanctions,

What are centrifuges?

They are precise devices with cylinders that rotate much faster than the speed of sound, to collect enriched uranium atoms.

To explain how centrifugation works, rotating cylinders are much like medical laboratory equipment used to test blood.

The high rotation speeds exert a rotational force that separates the various components of blood as a function of their density and quantity in the sample.

In the case of uranium, the centrifuge operates using the familiar principle of centrifugal force. This force separates two gases of unequal masses in a spinning cylinder or tube. The heavier uranium-238 isotope collects at the outer edges of the cylinder while the lighter uranium-235 collects near the axis of rotation at the center.

Around 20 kg of uranium enriched to a 90% purity level would be needed for a single nuclear weapon. It would take about 1,500 SWU to produce a weapon-equivalent of 90 percent-enriched uranium from this enriched uranium.

At Fordo, Iran is currently using the two only operating cascades of IR-6 centrifuges there to enrich to 60% from 20%.

There are 1,044 centrifuges active at the Fordo uranium enrichment plant, Iran's President Masoud Pezeshkian said.

He had earlier asked the Iran Atomic Energy Agency to begin inserting uranium gas into newly activated advanced centrifuges.

Early this month, a spokesperson for the US State Department said Iran's expansion of uranium enrichment activities in defiance of key nuclear commitments is "a big step in the wrong direction”.

His statement came after Tehran announced it would start injecting uranium gas into centrifuges at Fordo.

Dispute

The Nuclear Non-Proliferation Treaty, signed in 2015 between Tehran and Western countries, says advanced centrifuges for uranium enrichment could operate until January 2027.

The difference between the first generation of centrifuges (IR-1) and the other generations is speed. The latest generation, IR-6, could enrich uranium up to 10 times faster than the first-generation IR-1, according to Iranian officials.

During the heyday of its nuclear program, Iran operated a total of 10,204 first-generation IR-1 centrifuges at the Natanz and Fordo facilities. But under the deal, Iran's commitments included operating no more than 5,060 IR-1 centrifuges for a period of 10 years.

Although the centrifuges that Iran installed before the 2015 nuclear deal were of the first generation, Tehran’s recent uranium enrichment activity at nuclear sites has reached disturbingly advanced levels, potentially increasing the nuclear proliferation risk.

Major centrifuge activities in Iran

May 2008: Iran installed several centrifuges including more modern models.

March 2012: Iranian media announced 3,000 centrifuges at Natanz.

August 2012: The International Atomic Energy Agency announced that Iran had installed large parts of the centrifuges at Fordo.

November 2012: An IAEA report confirmed that all advanced centrifuges had been installed at Fordo, although there were only four working centrifuges, and another four fully equipped, vacuum tested, and ready to go.

February 2013: IAEA says Iran has operated 12,699 IR-1 centrifuges at the Natanz site.

June 2018: Iran’s supreme leader revealed Tuesday that it ultimately wants 190,000 nuclear centrifuges — a figure 30 times higher than world powers allowed under the 2015 deal.

September 2019: Iran mounted 22 IR-4, one IR-5, 30 IR-6, and three IR-6 for testing, outside the treaty boundaries.

September 2019: Iran announced it started operating advanced and fast centrifuges to enrich uranium.

November 2024: Iranian Foreign Minister Abbas Araghchi announces that his country will operate several thousand advanced centrifuges.

November 2024: Iranian state television broadcasts AEOI Chief Mohammad Eslami announcing that “gasification of a few thousands of new generation centrifuges has been started.”