In the year since the Great March of Return began, thousands of Palestinians, mostly young men, from the Gaza Strip have suffered life changing injuries at the hands of Israeli forces.

Now, Médecins Sans Frontières (MSF), which has been treating hundreds of Gazans wounded during protests, says it is “dealing with immense challenges” when treating patients who were shot by the army.

According to a new report released by MSF, more than 1,000 Palestinians who were shot by the Israeli army over the past year have developed “severe bone infections” that are becoming increasingly difficult to treat.

Israeli forces have injured more than 7,400 Palestinians during the protests, “with around half suffering from open fractures, where the bone is broken near the wound.” MSF said.

“Their serious and complex wounds require months – if not years – of dressing, surgery and physiotherapy,” MSF said.

The group noted that while gunshot wounds are naturally prone to infection, the nature of the injuries in Gaza — splintered bones and large wounds that stay open for longer — “drastically” increase the risk of infection.

“When you have an open fracture, you need lots of things to get better: different types of surgery, physiotherapy, and avoiding the wound becoming infected, which is a high risk with these types of injuries,” Aulio Castillo, MSF’s Medical Team Leader in Gaza, said in a statement.

“Unfortunately, for many of our patients who have been shot, the severity and complexity of their wounds – combined with the severe shortage of treatments for them in Gaza – means they have now developed chronic infections,” Castillo continued.

Additionally, many of the infections that the group is seeing are resistant to antibiotics, “adding to the already complicated path to recovery that these injured people must tread.”

The “heavy duty” antibiotics required to treat these resistant infections, the group notes, not only carry a higher risk of side effects but are also much more expensive.

MSF pointed out that while the health situation facing these gunshot victims would be tough to treat anywhere in the world, the flailing health system in Gaza is making their work significantly more difficult.

“With a health system reeling from the effects of more than a decade of Israeli blockade, Palestinian political in-fighting and Egyptian restrictions on movement, MSF is working to provide care that is otherwise unavailable,” the group said.

Over the past few years, Gaza’s hospitals have repeatedly been under threat of shutting down due to lack of fuel, finances, and sky-high drug prices, all exacerbated by Israel’s crippling blockade.

“It places huge demands on us in terms of the specialist staff we need, the drugs we have to supply and the space we need in order to treat these infections,” Castillo said.

“It’s hard but we’re trying our best to offer these people the surgery and treatment they need.”

According to the World Health Organization (WHO), between 30 March 2018 and 31 March 2019, 277 fatalities and over 28,000 injuries were recorded.

Gunshot wounds accounted for 25% of the total casualties, while an estimated 172 people were permanently disabled as a result of their gunshot injuries, including 36 children.