Médecins Sans Frontières - INTERVIEW: Ana Nery, med co, back from Gaza (INT)

Unique Identifier Code / URN MSF256396

Date taken / Date Recorded 20/12/2018 12:00 AM

Country Palestinian Territories

Commissioning section MSF-FRANCE

Photographer / videographer / producer Mohammad Ghannam

Copyright MSF

Usage Rights (MSF) Social Media

Formal Consent Copy available yes

Editor's rating ★★★★★ (C)

Video format h264 (Main) (avc1 / 0x31637661)

Duration 4m31s

Maximum Size 1920px × 1080px 441.50 MB

Additional Information / Shotlist This cohort of patients, the number of patients, even in normal setting, would completely overwhelm the orthopedic system of any country.

Ana Nery, medical coordinator for Palestine

SLATE
Since 30 March 2018,
when protests began in Gaza,
MSF teams have treated over 3,000 patients
who have been shot near the Israeli border

There are a lot of uncertainties of the outcomes of these patients but a few things are pretty clear. We know that they have received sustained complex gunshot injuries with extensive damage. So, these are patients with open fractures with a high risk of infection that will demand a long long-term rehabilitation, long prolonged surgical and medical follow-up and who may end up with disabilities that are permanent.

I think the main priority is to save those limbs. It's to ensure that those patients are free of infection, that the open wounds are covered and clean and that we can start the rehabilitation process. After that the big question is, how do we do for patients who need reconstruction of the bone, of the limb, to be able to be functional.

SLATE
Up to 40% of these patients
are at risk of developing bone infection

So, in rough numbers, we're talking about 700 to 1,000 patients. This cohort of patients, the number of patients, even in normal setting, would completely overwhelm the orthopedic system of any country. In Gaza, where the healthcare system is already super fragile from before, from the years of blockade, from the lack of supplies, of capable human resources, from the very frail situation of the healthcare in Gaza in general, this burden is just completely overwhelming. (36 secs)

What we need to respond to this overwhelming burden is to increase the surgical capacities in Gaza, meaning to increase the number of operating theatres that are managing trauma patients, the beds in the hospitals that are treating these cases, the human resources and the supplies, in a global way.
But then at the same time there will be a few patients that we'll be unable to treat because of the nature of their injuries, because of the complex process of reconstruction and rehabilitation of those limbs. To avoid permanent disability, those patients will need to be sent abroad. And this carries its own challenges, knowing the difficulties of arranging for permits for patients from Gaza to exit the Strip. (46 sces)

SLATE
Thousands of patients
are still in need
of surgical and post-surgical care

So, there is a patient that I saw, and this is a 21 -year-old boy, who went his friends to the protests. He was shot in his leg and he's had, so far, five surgeries with MSF. We have really attempted our best to save his limb and we have succeeded to a certain good extent. The problem is that this patient had infection on his bone so we had to remove several pieces of bone, and now there is a big gap in his leg that we cannot cover. He also had nerve injuries and he has severe neuropathic pain which is the pain related to nerve injury. Because of the nerve injury, he cannot lift his foot. He's a disabled person. He has now two choices: either we are able to reconstruct this limb and it has to be done in a timely manner because the more it takes, the longer and harder it will be to reconstruct up to the point it will be impossible. Or if he's unable to access such care, there is no choice for him other than delayed amputation.

It makes me feel frustrated. How do I explain to him the situation? How do I talk with his family? If it’s in a war situation, which I’ve had before, when you have somebody who's dying and you have to make a choice - limb or life? It’s much clearer. But here, you have to choose between disability or something that's out there that we just cannot reach. And I think that's the frustration of the physicians who are working in Gaza today.

CLOSING SLATE
MSF teams continue to assist
victims of gunshot wounds in Gaza
and are seeking to improve
the medical capacity on site