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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)
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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.

 

 

 

 

 

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North Korea Boasts of ‘The World’s Strongest’ Missile, but Experts Say It’s Too Big to Use in War

A view shows what they say is a "Hwasong-19" missile being launched at an undisclosed location in this screengrab obtained from a video released on November 1, 2024. (KRT/via Reuters TV/Handout via Reuters)
A view shows what they say is a "Hwasong-19" missile being launched at an undisclosed location in this screengrab obtained from a video released on November 1, 2024. (KRT/via Reuters TV/Handout via Reuters)
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North Korea Boasts of ‘The World’s Strongest’ Missile, but Experts Say It’s Too Big to Use in War

A view shows what they say is a "Hwasong-19" missile being launched at an undisclosed location in this screengrab obtained from a video released on November 1, 2024. (KRT/via Reuters TV/Handout via Reuters)
A view shows what they say is a "Hwasong-19" missile being launched at an undisclosed location in this screengrab obtained from a video released on November 1, 2024. (KRT/via Reuters TV/Handout via Reuters)

North Korea boasted Friday that the new intercontinental ballistic missile it just test-launched is "the world’s strongest," a claim seen as pure propaganda after experts assessed it as being too big to be useful in a war situation.

The ICBM launched Thursday flew higher and for a longer duration than any other weapon North Korea has tested. But foreign experts say the test failed to show North Korea has mastered some of the last remaining technological hurdles to possess functioning ICBMs that can strike the mainland US.

The North’s Korean Central News Agency identified the missile as a Hwasong-19 and called it "the world’s strongest strategic missile" and "the perfected weapon system." The official media outlet said leader Kim Jong Un observed the launch, describing it as an expression of North Korea’s resolve to respond to external threats to North Korea’s security.

The color and shape of the exhaust flames seen in North Korean state media photos of the launch suggest the missile uses preloaded solid fuel, which makes weapons more agile and harder to detect than liquid propellants that in general must be fueled beforehand.

But experts say the photos show the ICBM and its launch vehicle are both oversized, raising a serious question about their wartime mobility and survivability.

"When missiles get bigger, what happens? The vehicles get larger, too. As the transporter-erector launchers get bigger, their mobility decreases," Lee Sangmin, an expert at South Korea’s Korea Institute for Defense Analyses.

The Hwasong-19 was estimated to be at least 28 meters long (92 feet) while advanced US and Russian ICBMs are less than 20 meters long (66 feet), said Chang Young-keun, a missile expert at Seoul’s Korea Research Institute for National Strategy. He suggested that the missile's size likely helped South Korean intelligence authorities detect the launch plan in advance.

"In the event of a conflict, such an exposure makes the weapon a target of a preemptive attack by opponents so there would be a big issue of survivability," Chang said.

Lee Illwoo, an expert with the Korea Defense Network in South Korea, said North Korea may have developed a larger missile to carry bigger and more destructive warheads or multi-warheads. If that's the case, Lee said North Korea could have used liquid fuels as they generate higher thrust than solid fuels. He said some advanced liquid propellants can be stored in missiles for a few weeks before liftoffs.

Lee said North Korea may have placed a dummy, empty warhead on the Hwasong-19 to make it fly higher.

In recent years, North Korea has reported steady advancement in its efforts to obtain nuclear-tipped missiles. Many foreign experts believe North Korea likely has missiles that can deliver nuclear strikes on all of South Korea, but it has yet to possess nuclear missiles that can strike the mainland US.

The hurdles it has yet to overcome, according to experts, include ensuring its warheads survive the heat and stress of atmospheric reentry, improving the guidance systems for the missiles, and being able to use multiple warheads on a single missile to defeat missile defenses.

"Acquiring reentry technology is currently the most important goal in North Korea’s missile development, specifically for ICBMs, but they just keep increasing the ranges instead. This possibly suggests they still lack confidence in their reentry technology," Lee Sangmin said.

Chang said Friday's state media dispatch on the launch lacks details on the technological aspects of the Hawsong-19 and focused on publicity.

Other North Korean claims about its weapons capabilities have been met with wide outside skepticism.

In June, North Korea claimed to have tested a multiwarhead missile in the first known launch of such a weapon, but South Korea said the weapon instead blew up. In July, when North Korea said it had test-fired a new tactical ballistic missile capable of carrying "a super-large warhead," South Korea said the claim was an attempt to conceal a botched launch.

North Korea's missile program is still a major regional security concern, with the country openly threatening to use its nuclear missiles against its rivals. In a joint statement Thursday, the foreign ministers of South Korea, the US and Japan condemned the ICBM launch as a violation of UN Security Council resolutions and said they're committed to strengthening their efforts to block North Korea's illicit revenue generation funding its missile and nuclear programs.

South Korea's Foreign Ministry said Friday it has imposed unilateral sanctions on 11 North Korean individuals and four organizations for their alleged roles in procuring missile components and generating foreign currency to fund Pyongyang’s weapons program. The sanctions are largely symbolic given that financial transactions between the Koreas have been suspended for years.

Also Friday, South Korea and the US conducted their first-ever joint live-fire exercise using unmanned aerial vehicles as part of efforts to demonstrate their readiness. South Korea’s RQ-4B "Global Hawk" reconnaissance aircraft and the US MQ-9 Reaper strike drone were mobilized for the training, according to South Korea's air force. South Korea and the US have been expanding their regular military drills to cope with North Korea’s evolving nuclear threats.

Observers say that Thursday's launch, the North's first ICBM test in almost a year, was largely meant to grab American attention days before the US presidential election and respond to international condemnation over North Korea's reported dispatch of troops to Russia to support its war against Ukraine.

North Korea's reported troop dispatch highlights the expanding military cooperation between North Korea and Russia. South Korea. The US and others worry North Korea might seek high-tech, sensitive Russian technology to perfect its nuclear and missile programs in return for joining the Russian-Ukraine war.