Paramedics evacuate a critically injured protester during Great March of Return demonstrations on 5 October. Mohammed Zaanoun ActiveStills

Palestinians have paid a great price for their call for life with dignity during mass protests held along Gaza’s boundary with Israel over the past eight months.

Some 180 Palestinians have been shot dead by Israeli occupation forces and nearly 6,000 others injured by live fire during the Great March of Return.

“The vast majority of casualties were unarmed, and were fatally shot from a distance while in the Gaza Strip itself,” according to a new report by the Israeli group B’Tselem, confirming previous findings by other rights organizations.

“As a general rule, the protectively clad troops sniping at them from other side of the fence were not in any real danger,” B’Tselem added.

In addition to injuries by live fire, 2,000 cases of injury by tear gas inhalation have been recorded, along with hundreds of injuries by rubber-coated metal bullets.

Injuries to 90 protesters – 17 of them children – have resulted in amputation, nearly all of the lower limbs.

Altogether, a staggering 24,000 Palestinians have been injured during the Great March of Return protests – more than one percent of the territory’s population.

Around half of those injured were treated at field clinics at protest sites. The rest were transferred to hospital for treatment.

“The mass influx of casualties has disrupted an already fragile health system,” according to the World Health Organization. “In the hospitals, trauma patients are prematurely discharged to make room for new patients.”

Hundreds of Palestinians require long-term limb reconstruction involving multiple surgeries and extensive rehabilitation, according to the organization.

Shot in lower limbs

B’Tselem surveyed more than 400 protesters who were wounded by live fire, including 63 children.

The vast majority – 85 percent – were shot in their lower limbs.

Some 40 percent were hit while they were in the immediate vicinity of the Gaza-Israel boundary fence. Around a third were up to 150 meters away from the fence. Just over 20 percent were more than 150 meters away when they were shot.

Forty-one of the children surveyed said they were “injured while they were watching the protest, waving a flag, photographing or filming the protest, moving away from the protest, or treating the wounded,” B’Tselem stated.

Nearly all of the protesters wounded by live fire surveyed by B’Tselem require prolonged, medical treatment. More than half require rehabilitation and physical therapy. Ten percent are permanently injured.

Being shot by occupation forces is only “the first chapter in a prolonged ordeal,” according to B’Tselem.

“Even a superbly functioning healthcare system would be sorely tried when faced with such a large number of casualties,” the group states.

“Yet in Gaza, even before the protests began, the healthcare system was already on the brink of collapse.”

The dire state of Gaza’s healthcare system is a result of the 11-year Israeli blockade at the center of the protests that have met with brutal violence.

Medicines depleted

At the beginning of the month, Gaza’s central pharmacy “was completely out of 226 essential drugs, and had only a one-month supply left of another 241,” B’Tselem states.

Stocks of more than 250 types of medical disposables had been depleted.

“The blockade places restrictions on replacing worn-out, broken medical equipment, on importing advanced medical equipment and drugs, and on travel by physicians for professional training outside Gaza,” according to B’Tselem.

“In addition, Gaza’s intermittent power supply, again largely Israel’s doing, also disrupts hospital functions.”

Israel meanwhile denies or delays permission to medical patients to travel outside Gaza via Erez checkpoint for treatment unavailable in the besieged territory.

Others have been referred to hospitals in Egypt but cannot afford the treatment.

Gaza’s sole prosthetic limbs workshop “can provide only the most basic prosthetic legs with limited range of motion,” according to a recent media report.

The cost of going abroad for prosthetic limbs is prohibitive in impoverished Gaza where the blockade has pushed unemployment rates to over 50 percent.

In addition to physical harm, Israel’s crackdown on the protests has increased symptoms of post-traumatic stress in children who find themselves reliving trauma from previous military assaults on Gaza.

“Deliberate policy”

“The high number of casualties at the protests is not an unavoidable fact of life,” B’Tselem states.

“It is the result of a deliberate policy by the Israeli security establishment.”

“Manifestly unlawful” open fire orders “permit the use of live fire against unarmed protestors who pose no danger to anyone and are on the other side of the fence, inside the Gaza Strip.”

Israeli forces have shot bystanders standing hundreds of meters away while “doing nothing to jeopardize the troops,” as stated by B’Tselem.

These open fire orders – kept secret by the state – have been rubber-stamped by Israel’s high court.

A lower court recently ruled that Palestinians in Gaza are not entitled to seek compensation for damages from Israel because the state has declared the territory an “enemy entity.”

“Banned from redress”

That was the argument made by the court as it rejected a case filed on behalf of a boy in Gaza who was left quadriplegic after Israeli forces opened fire on him in November 2014.

With the court upholding a 2012 law barring residents of an “enemy entity” from receiving compensation, all Palestinians in Gaza “are now banned from redress and remedy in Israel, regardless of the circumstances and the severity of the injury or damages claimed,” according to the rights groups Al Mezan and Adalah.

The new law “introduced criteria that are nearly impossible to meet for victims from Gaza,” leaving Palestinians in Gaza who suffered injury or damage during military operations ineligible to seek compensation. A narrow window of time in which Gaza residents initiate claims in Israel – at significant financial cost – and other restraints effectively bar anyone there from seeking justice.

But even in the case of the child represented by Adalah and Al Mezan, “who was shot in the absence of military activity and his family complied with all of the … stringent criteria,” the state argued that the boy was ineligible for compensation with “the simple justification that he is a resident of Gaza.”

According to the rights groups, “With this message, Israel declared that it absolves itself from the responsibilities, as a state, to investigate, deter, and take responsibility for violations by its armed and security forces.”

The ruling “grants comprehensive immunity to the Israeli military and the state for illegal, reprehensible, and even criminal actions” in the occupied West Bank and Gaza.

With no way to fulfill their right to effective legal remedy from Israel, the occupying power, “the only legal options currently available to Palestinians in Gaza are limited to international judicial mechanisms,” Adalah and Al Mezan state.

The International Criminal Court’s chief prosecutor has warned Israeli leaders that the shooting of unarmed Palestinians along the Gaza boundary could be considered a crime under international law within the court’s jurisdiction.

Palestinian and international nongovernmental organizations have called on the International Criminal Court to “urgently” open an investigation into alleged Israeli war crimes.

The situation in Palestine has been under preliminary examination by the prosecutor’s office since 2015.