In March 2018, the Great March of Return demonstrations began along the Gaza Strip perimeter fence, protesting against Israel’s siege and calling for the realization of the right of return. As documented by B’Tselem previously, the unlawful open-fire policy Israel is using against these demonstrations, allowing soldiers to shoot live fire at unarmed protesters who endanger no one, has led to horrific results: in addition to more than 200 Palestinians who were killed, by the end of January 2020, some 8,000 demonstrators were wounded by live ammunition, including 1,500 minors and 150 women. According to World Health Organization (WHO) figures, by the end of 2019, physicians had to perform limb amputations on 155 protesters, including 30 minors. Twenty-seven demonstrators are paralyzed as a result of spinal injuries.

The severe injuries are only the beginning of a torturous journey which includes treatments, tests, surgeries, and adjusting to a new reality. In the Gaza Strip the situation is even more complicated: any health system would be hard-pressed to cope with such a scope of injuries, but Gaza’s was already crippled by a shortage of medications, physicians, equipment, and professional training, because of the Israeli siege policy. As a result, many of the injured do not manage to receive the medical treatment they need, which in some cases exacerbates their condition, especially considering the shortage of rehabilitation centers in the Gaza Strip.

A small number of those injured manage to receive the medical care they need outside the Gaza Strip – in hospitals in the West Bank (including East Jerusalem), but only in the rare cases that they manage to receive Israeli entry permits, which Israel declared, at the outset of the demonstrations, would be given sparingly. According to WHO figures, from the start of the demonstrations through January 2019, 604 applications to exit Gaza via Erez Crossing for medical treatment in the West Bank (including East Jerusalem) or Israel had been submitted. Only 17% of the requests were approved, while 83% were rejected – directly or by delaying the issuance of a response. In other cases, the wounded are forced to travel to other countries, such as Egypt or Turkey, sometimes at their own expense.

Fathi Abu M’awad, from Jabalya Refugee Camp told B’Tselem field researcher Olfat al-Kurd about the day his 15-year-old grandson Muhammad was wounded:

When the doctor told me Muhammad was going to be paralyzed from the waist down, I was in shock. I went out to the hospital courtyard and burst out crying, especially because Muhammad is my first grandchild and very close to me. When they took him into surgery I cried and could barely say goodbye to him. I stood outside the door and waited for Muhammad to come out of surgery, with his father, my son Ramzi, who stood next to me and was deeply distressed about his son. It was one of the hardest days of my life.

Some of the wounded described how they were hurt, and the unbearable difficulties they have had to cope with since in testimonies they gave B’Tselem’s field researchers in Gaza:

Muhammad a-Za’im, 26, from Gaza City, wounded on 6 April 2018:

Muhammad a-Za’im. Photo by Olfat al-Kurd, B'Tselem, 17 Dec. 2019 On 6 April 2018, the second Friday of demonstrations, Muhammad a-Za’im, owner of a stationery store, came to the demonstration that was held next to the perimeter fence east of Gaza City. At around 5 P.M., soldiers shot live ammunition and hit him in both legs. He was evacuated to the first aid tents and from there to a-Shifaa Hospital in Gaza City. After being treated for 10 days, a-Za’im was transferred to Istishari Arab Hospital in Ramallah, to which he was accompanied by his grandfather, and where physicians had to amputate his left leg. In a testimony he gave B’Tselem field researcher Olfat al-Kurd on 17 December 2019, he spoke about his life since his injury: When I found out my leg had been amputated, I was in shock. I am young, at the beginning of my life. How could my leg be amputated? After I got home, I also had to have a nerve implant in my right leg, nerve and bone implants in my left leg, and other treatments. I asked to exit for treatment at the hospital in Ramallah again, but I kept getting told that my request was under consideration. I was desperate and frustrated and refused to receive treatment in the Gaza Strip because I was afraid they would harm my leg. In October, I traveled to Egypt with my father for surgery and to receive a prosthetic for my left leg, and I stayed there for nine months. I had to pay by myself both for the trip and for the prosthesis. Now I need another surgery on my left leg. Now I am in a bad mental state. I spend the day sleeping or in front of the computer. I don’t want to see people and don’t get together with my friends very much. I feel I’m a big burden on my family, and especially on my mother, who takes care of me and doesn’t leave the house very much to stay with me. Sometimes I have fits of rage, break things in the house, and feel like I’m suffocating. I can’t ride my motorcycle or play soccer anymore, like I used to. I was offered to participate in swimming competitions and soccer games run by an association for the rehabilitation of people with disabilities, but I refused. I don’t want people to feel sorry for me. That’s why I also don’t leave the house too much with my crutches during the day, only at night, in the dark. Since my father has a heart condition and can’t work alone in the store, we had to close it. Maybe one day I will go to school, and I’m also thinking about marriage and starting a family. At night I have a hard time sleeping because of the pain, and all I think about is my injury and treatments. I can only fall asleep after taking painkillers. The pain gets worse in the winter because of the cold. Sometimes I can hardly stand to look at my artificial leg and it depresses me. Israel destroyed my life physically and mentally.

Jalal Abu Hayah, 39, father of five, from ‘Abasan al-Kabirah, wounded on 14 May 2018:

Jalal Abu Hayah, a civil defense employee who used to provide first aid in the demonstrations, arrived on Monday, 14 May 2018, at around 8 A.M., to a demonstration next to the perimeter fence east of the town of ‘Abasan al-Jadidah. At around 11 A.M., a soldier shot him in the back with live ammunition. He was evacuated to Nasser Hospital in Khan Yunis, where it was determined that the bullet had hit him in the spine. He was then transferred to the European Hospital south of Khan Yunis to have the bullet extracted. After the surgery he stayed in the hospital for eight days and then was transferred to the Red Crescent rehabilitation hospital in Khan Yunis, from which he was discharged four weeks later, paralyzed from the waist down.

In a testimony he gave B’Tselem field researcher Khaled al-’Azayzeh on 22 December 2019 he said:

After I got out of the hospital I was in very bad shape. The doctors said I had to be turned over in the bed every two hours to avoid bedsores, and my wife had to get up all the time to turn me over. It was very painful. I was paralyzed and I became a burden on my wife, and my mental state was very bad. All I could think about was how to make it easier for her, and I decided to build a bed where I could turn myself over with levers. I built it with my son Muhammad, 17. It took us seven months and I bought all the parts and tools at my expense. When I started using the bed I calmed down. I didn’t need my wife’s help anymore, just an alarm clock. I have very strong pain in the paralyzed part of my body, and I take painkillers that I have to buy myself because they are not available at the public clinics. Jalal Abu Hayah. Photo by Khaled al-’Azayzeh, B'Tselem, 22 Dec. 2019 After a month in bed, I started to get around in a wheelchair. My hobby is to make knives and swords, and after my injury I decided to make swords at home and sell them to make a living. Since I can’t use a circular saw for metal, I designed a metalworking tool. It gives me a lot of satisfaction at work and really helps me make good products. Since I’m in a wheelchair I have a lot of mobility difficulties. We have steps at the entrance to the house, so I built a special passage to get in and out, but I still depend on somebody pushing me up the ramp to the door. Because it is hard to get around, I do not get out of the house much. Every time I want to visit somebody at home, I ask first if there are stairs in the building. I don’t go to a lot of social encounters so as not to be a burden on people, and also because moving from place to place causes me pain. I still receive part of my salary from the civil defense and also get help from a Qatari NGO. Before I was wounded, I sometimes worked as a plasterer, but now I can’t anymore. My condition obviously harms my income and my family’s livelihood.

Ahmad al-Khudari 21, from Gaza City, wounded on 1 March 2019:

Ahmad al-Khudari, who was a construction worker, arrived on Friday, 1 March 2019, at around 3:30 P.M., at a demonstration near the fence east of Gaza City. About an hour later, a soldier shot him in the right leg with live ammunition. He was evacuated to the first aid tent and from there to a-Shifaa Hospital in Gaza City. Two days later, the doctors amputated his leg below the knee, and he was discharged a week later.

In a testimony he gave B’Tselem field researcher Olfat al-Kurd on 16 December 2019, he spoke about his life since his injury:

Ahmad al-Khudari. Photo by Olfat al-Kurd , B'Tselem, 16 Dec. 2019 After the amputation I went through a difficult period mentally. I felt deep sadness and helplessness. People looked at me with pity because of my condition and I would look at people walking normally and cry. I felt like my spirit was shattered. Before the amputation I worked as a construction worker and helped my father support the family. I played soccer and swam in the sea. Now I use crutches and can’t work in construction anymore. About eight months ago I joined a mental rehabilitation group and we go on excursions and play sports together. I go there almost every day of the week. I’m trying to get back to myself by going back to my hobbies but it’s difficult: I’m an amputee playing soccer, and it can’t be at the level of somebody who has two legs. I also tried to swim in the sea, and I succeeded. I don’t want people to feel sorry for me and I challenge my disability. I try to manage without help in the shower and to make my own food. It’s hard, but I don’t give up. I feel like the children in the street and the neighborhood are afraid of me because of my amputated leg and it bothers me. When my two sisters, Layan, 7, and Lama, 6, saw my stump for the first time, they got scared and ran away. That hurt me deeply. Little by little I got close to them again and helped them not be afraid of me. I’m a young man at the beginning of my life, and I’m afraid I won’t find anyone who will marry me. I think about that all the time. I loved to work and now I can’t. Lately, I’ve been going to the hospital to get used to the prosthetic limb I’m supposed to get next week. I hope it fits and isn’t a problem. Even though the idea of getting a prosthesis is very hard for me, I hope I will get it and people will stop feeling sorry for me.

Muhammad Abu M’awad, 15, from Jabalya refugee camp, wounded on 3 May 2019:

Muhammad Abu M’awad, a student at a vocational tailoring school, arrived on Friday, 3 May 2019, at around 2:30 P.M., at a demonstration near the fence east of the refugee camp, and at around 7 P.M. was shot in the chest by a soldier. He was evacuated to the Indonesian Hospital next to the refugee camp, and from there, because of the severity of his injury, to a-Shifaa Hospital in Gaza City, where he underwent surgery to remove the bullet and was diagnosed as a paraplegic. Ten days later, Abu M’awad was moved to the Hamad rehabilitation hospital in Gaza City, from which he was discharged a month later.

In a testimony he gave on 12 December 2019 to B’Tselem field researcher Olfat al-Kurd, he described what he went through:

Muhammad Abu Ma'awad. Photo by Olfat al-Kurd , B'Tselem, 26 Dec. 2019 Before my injury, I was studying tailoring at a vocational school and I was barely at home: I rode my bike, played soccer with my friends, went to play computer games, and shopped in the market for my family. My life was full, and I was happy. Now I’m confined to the house and to a special nursing bed, and all I do is play on my phone or watch videos. I don’t go to school anymore, don’t ride my bike, and don’t play with my friends. All that was taken away from me. When I see the children of the camp playing, and hear them happy and screaming at each other, I miss being with them. I feel sorry for myself, have fits, break things, and cry. We are a poor family: my father doesn’t work and there are eight of us. We rent an apartment in public housing in Jabalya Refugee Camp. I had hopes of working as a tailor and helping my father raise my siblings, but now I’m paralyzed and can’t do anything. I have bedsores that are very painful, and twice a week somebody comes over from an organization to change my dressings. I also have anemia, so I go to the Indonesian Hospital to receive blood units. I really want to have surgery outside the Gaza Strip so I can go back to walking on my feet, to the normal life I used to have, and to the games I used to play.

Muhammad’s grandfather, Fathi Abu M’awad, 62, married and father of nine, described his grandson’s condition in a testimony he gave on 15 January 2020 to B’Tselem field researcher Olfat al-Kurd:

Fathi Abu M’awad. Photo by Olfat al-Kurd , B'Tselem, 15 Jan. 2019 When the doctor told me Muhammad was going to be paralyzed from the waist down I was in shock. I went out to the hospital courtyard and burst out crying, especially because Muhammad is my first grandchild and very close to me. When they took him into surgery I cried and could barely say goodbye to him. I stood outside the door and waited for Muhammad to come out of surgery, with his father, my son Ramzi, who stood next to me and was deeply distressed about his son. It was one of the hardest days of my life. During his hospitalization, Muhammad kept asking me: “Will I be able to walk?” And I kept saying: “Yes, but you’re going to have to take medicine.” I couldn't tell him the truth about his condition. I kept telling him he would be fine. But when I helped him move his body right and left, or diapered him because he was incontinent, Muhammad would tell me: “I can’t feel the bottom half of my body.” Sometimes Muhammad would try to get out of bed and suddenly realize he couldn’t. It would make him very sad and depressed. At those moments I would go out of his room and burst out crying. After ten days Muhammad was transferred to the Hamad Hospital in Gaza for a month of rehabilitation, alone. We could only come during visiting hours. At night he would call me and say: “I’m scared. Why did they put me in this hospital?” And I would reassure him and say: “You have to get treatment and get better, Muhammad, so you can walk.” But he would say: “You’re lying, Grandpa. Nobody wants me, nobody loves me. If you loved me, you wouldn’t have left me alone at the hospital. I’ve had it, I hate the hospital." Since Muhammad was injured, he has been suffering from fits of rage, throwing and breaking objects when he is in severe pain. He stays in bed, and only occasionally goes out in his wheelchair to the camp to meet friends. I see the sadness in his eyes when his friends are playing while he is sitting in his wheelchair. His parents and I are at his side all the time. Muhammad’s mother is mentally ill, suffering from PTSD since the war in 2014. In order to function and take care of her family, she takes pills. My son, Ramzi, doesn’t work and receives a 1,800-shekel allowance from the Ministry of Welfare every five or six months. They are a family of eight and the situation is very difficult. Especially since Muhammad’s injury, because he needs medications, diapers, and food. In the winter they suffer a lot because the rain goes into their house through the roof. I pray to God for Muhammad to get better. He needs a lot of treatment and care. The health ministry refused to let him go abroad for an operation as he wanted to, because they think there’s no point. I do what I can, and I will stay at his side, give him whatever I can, and try to make him happy.

Nazih Qdeih, 39, from ‘Abasan al-Kabirah, wounded on 14 May 2018:

Nazih Qdeih, a farmer, arrived on Monday, 14 May 2018, at around 10 A.M., to a demonstration near the fence east of the town of Khuza’ah. Six hours later, at around 4 P.M., Qdeih was shot with a live bullet in her right leg and evacuated to the first aid tents, and from there to the European Hospital south of Khan Yunis, where physicians amputated her leg.

In a testimony she gave B’Tselem field researcher Olfat al-Kurd on 12 January 2020 she said: