In five years’ time, Gaza will be the land of the disabled, says Rami Hessi, 34, as he struggles in pain to pedal a stationary bike.

The quietly spoken fisherman is receiving physiotherapy at a Medicins Sans Frontieres (MSF) clinic in Gaza City where thousands of patients with lower-limb bullet injuries like him have been treated.

A metal cage drilled into his bone encloses his withered left leg like a steel trap. The bullet wound has healed into a snarl across his calf.

According to Gaza’s ministry of health, more than 6,800 Palestinians have been injured by live fire shot by Israeli soldiers during regular rallies held at the border fences since March 2018. Over 260 people have been killed.

Nearly half the wounded have been referred to MSF clinics. A thousand of them, like Hessi, are still receiving long-term care.

One year on from the start of the so-called Great March of Return, MSF is warning of a “slow-motion emergency” unfolding across Gaza.

Gaza protests: Wounded patients being treated at MSF clinic Show all 9 1 /9 Gaza protests: Wounded patients being treated at MSF clinic Gaza protests: Wounded patients being treated at MSF clinic Palestinian patients wounded during Gaza-Israel border protests at a clinic run by medical charity Doctors Without Borders (MSF) in Gaza City Bel Trew Bel Trew/The Independent Gaza protests: Wounded patients being treated at MSF clinic 'I was a fisherman before, but I now can’t do anything, I have no work. I can’t walk. I’m struggling,' says Rami Hessi Bel Trew/The Independent Gaza protests: Wounded patients being treated at MSF clinic According to Gaza’s ministry of health, more than 5,800 Palestinians have been injured by live fire shot by Israeli soldiers during regular rallies held at the border fences since March 2018 Bel Trew/The Independent Gaza protests: Wounded patients being treated at MSF clinic Sabreen al-Najjar, left, the mother of Razan, a 20-year-old medic who was shot dead on the Gaza border last year Bel Trew/The Independent Gaza protests: Wounded patients being treated at MSF clinic Palestinian patients wounded during Gaza-Israel border protests at a clinic run by medical charity Doctors Without Borders (MSF) in Gaza City Bel Trew Bel Trew/The Independent Gaza protests: Wounded patients being treated at MSF clinic Palestinian patients wounded during Gaza-Israel border protests at a clinic run by medical charity Doctors Without Borders (MSF) in Gaza City Bel Trew Bel Trew/The Independent Gaza protests: Wounded patients being treated at MSF clinic Palestinian patients wounded during Gaza-Israel border protests at a clinic run by medical charity Doctors Without Borders (MSF) in Gaza City Bel Trew Bel Trew/The Independent Gaza protests: Wounded patients being treated at MSF clinic Palestinian patients wounded during Gaza-Israel border protests at a clinic run by medical charity Doctors Without Borders (MSF) in Gaza City Bel Trew Bel Trew/The Independent Gaza protests: Wounded patients being treated at MSF clinic Palestinian patients wounded during Gaza-Israel border protests at a clinic run by medical charity Doctors Without Borders (MSF) in Gaza City Bel Trew Bel Trew/The Independent

MSF staff told The Independent that the besieged enclave of Gaza does not have enough facilities to manage the number of wounded, or the cumulative needs of the patients who are suffering complex and serious gunshot wounds.

Without adequate care, these injuries will lead to lifelong disability for many. Untreated infections, in particular, can result in amputations or death.

“I was a fisherman before, but I now can’t do anything, I have no work. I can’t walk. I’m struggling,” Hessi says, explaining how he has already had eight surgeries.

His brother, meanwhile, was shot in the leg just last week at a similar protest.

“I’m in pain all the time now, my bone is 15mm shorter on one side than the other, so walking is hard,” he adds.

“I’m worried that there will be a generation of us, that the majority of Gaza’s youth will be disabled.”

Since 30 March 2018, hundreds of thousands of Palestinians have marched on the border with Israel, protesting against an 11-year blockade and demanding the right to return to the ancestral lands they were forced from during the conflict which surrounded the creation of Israel in 1948. Israel has categorised the protesters as a security threat.

The 25-mile-long enclave has been under an Israeli and Egyptian-imposed land, air and sea blockade since Hamas forcibly took control of the Gaza Strip in 2007.

At some points last year electricity was so intermittent that homes were only receiving four hours of power a day. The entry of goods is also strictly controlled.

The UN has warned the enclave will be completely uninhabitable by next year amid intensifying clean-water shortages, pollution and a sewage crisis.

Gaza’s youth unemployment stands at 65 per cent, one of the highest in the world. Over half the 2.2 million-strong population live under the poverty line.

And so it is no coincidence that the majority of the wounded are the youth. MSF said the average age of their patients is just 25 years old.

“All my friends are being treated at the moment, everyone I know is injured from going to the protests,” says Nassar Khan, 17, who was shot in the leg in January.

He says he joined in because he was “bored” and wanted to see what was going on.

Gaza’s health ministry says more than 6,800 Palestinians have been injured by live fire at the border since the protests began (Bel TrewThe Independent) (Bel Trew/The Independent)

“After the injury I can’t play football, I can’t go to school. There is no future for Gaza – everything is gone.”

Gaza’s health ministry said that 267 people, including 50 children, six women, two journalists and three paramedics have been killed at the rallies. The latest fatality, occurred Saturday morning just hours before the anniversary march was due to begin. Mohamed Saad, 20 was killed by shrapnel to the head from Israeli fire. Over 30,000 people have also been wounded. Of the injured, 136 had their limbs amputated.

Razan al-Hajjar, a 20-year-old medic, was one of those shot dead. Her mother, Sabreen, says that that the Israeli forces seem intent on creating a “state of disabled people”.

Speaking to The Independent from her home in Khuza’a, just 500m from the border with Israel, she says: “They seem focused on trying to would people. They killed my daughter to scare others from going to the marches but it hasn’t deterred anyone.

“But as a mother I do worry, I feel like my children are being robbed of a childhood. They have taken one daughter and made the others old.”

A recent UN report accused Israel of being likely to have committed war crimes in its response to the rallies, citing evidence Israeli snipers shot at children, medics and journalists.

The Israeli army has denied the charges and defended its actions, saying protesters have repeatedly launched incendiary kites and explosives attached to balloons towards Israel, endangering its civilians.

On Friday morning the Israeli army said Hamas, the militant group that runs Gaza, was planning to send “terrorists … to storm Israel’s border, breach the fence and kill Israeli families” in marches expected on Saturday to mark the one-year anniversary.

“Our duty is to protect Israeli civilians. Our duty is to stop Hamas,” the Israeli army added.

After the injury I can’t play football, I can’t go to school. There is no future for Gaza – everything is gone Nassar Khan, 17

There are fears of an escalation in violence just days after a fierce flare-up in cross-border fire between Israel and the armed factions within Gaza, that many warned could descend into another war.

On Monday a long-range rocket was fired from Gaza into central Israel, destroying a family home and injuring seven people, including a baby.

Israel responded by hitting targets in Gaza which it said belonged to Hamas’s security apparatus. Gaza’s armed groups pounded south Israel with more rockets.

Egypt and the UN furiously shuttled between both sides in an attempt to nail down another ceasefire.

Egyptian security officials returned to Gaza on Friday to hold talks with Hamas and organisers of the march to ensure the rallies on Saturday would not spark another round of cross-border fire.

Sources within the march organising committee told The Independent they agreed to an Egyptian proposal that will see protesters stay several hundred metres from the border, and organisers try to stop the use of burning tyres, incendiary kites and balloons. In exchange, Israel reportedly agreed not to open fire unless people approach the fences. Hamas officials told AFP part of the deal would also see further financial aid from Qatar allowed into the Strip.



‘I was a fisherman before, but I now can’t do anything, I have no work. I can’t walk. I’m struggling,’ says Rami Hessi (Bel Trew/The Independent)

But there has been no official confirmation from the Israeli side and so aid agencies have prepared themselves for a difficult day.

MSF said it had added to its bed capacity and deployed an additional two surgical teams, including orthopaedic vascular surgeons.

It warned the healthcare system simply cannot cope with another flood of injured people. In the past, hospitals have been forced to send the wounded home early leading to bone infections worsening the wounds.

“In Gaza there is not enough bed capacity to serve 2 million people normally. If you add on top of that increased hospitalisation on the same day, there is early discharge and complications from that,” says MSF’s Carla Melki at the clinic in Gaza City.

She says even with MSF’s expanded and new programming, treatment is not available for all.

Israel-Gaza conflict: UN urges restraint after violence escalates between warring factions

“The risk is we will see more amputations and major long-term disabilities. We are working against a generation of long-term injuries,” she explains.

“We need to think about other actors coming in. At MSF we cannot treat all these patients. We need specialist technical surgeons and microbiologists,” she adds.

Despite the dangers, many of the injured are determined to attend the protests on Saturday, even if they are now unable to walk.

Anas Sobhi, 23, says that if the blockade was lifted, Gazans would be too busy working to protest.

Even if we lose our legs and hands, we will crawl there Abu Jamal, 35

“I can’t do anything, but then, even before my injuries I had no job. I have no work, nothing at all, which is why I went in the first place,” he tells The Independent.

“The situation here is zero. No work, no hope, no future. It is better to go to the border and make yourself heard, than just die at home in your house.”

Abu Jamal, 35, who admitted to trying to cut the border fences when he was shot, vowed they would keep going back to the border, even if it means going in a wheelchair.

“We don’t care if we are injured one, two three or four times, we want to be heard,” he says.