Sitting on his hospital bed, with external fixators screwed into his right leg, Mohammed al-Mughari has been in pain and on medication since he was shot in the leg more than three years ago.
You live with a chronic bone infection, from bacteria that are now resistant to most antibiotics. Doctors, including in Jordan and Egypt, where he previously sought treatment, have recommended that an amputation could end his suffering in the long term, but he has steadfastly refused.
“I’m determined to save my leg,” he says, despite knowing that recurring infections could lead to life-threatening sepsis. The 31-year-old chef has been unable to work since he was injured and is barely sleeping due to painful bone and nerve pain, which no medication can relieve, and the accessory attached to his leg.
Doctors at Nasser hospital, where Mughari is being treated, say they have encountered dozens of such cases in which patients staunchly resist amputation.
Dr. Mohammed Qumboz, who works at Nasser, a clinic in the southern Gaza Strip supported by Doctors Without Borders (MSF), says: “For many, amputation is a last resort that is seen as a kind of failure, although it could improve the quality of life of men “.
Mughari was hit by a bullet in April 2018 while participating in the Gaza border protests, known as the Great March of Return. During weekly demonstrations, protesters called for an end to the 2007 blockade of Gaza and the return of more than 1 million displaced people from what is now Israeli territory. Hamas, the militant group that rules Gaza, did not initially participate, but later supported the protests, with the participation of some of its members.
Israel used tear gas and live ammunition as the protesters headed toward the border.
According to the UN, more than 36,000 people were injured during the 18 months of protests, 22% with live ammunition. There were more than 7,000 limb injuries, resulting in 156 amputations.
With the limited health services available in Gaza, complex wounds were referred to hospitals in the West Bank and Israel, but exit permits were not always granted. Of 604 requests, 17% were approved and 28% rejected, while the rest did not receive a response in time for their medical appointments, the UN documented.
The need for specialized treatment due to the severity and complexity of the protesters’ injuries far exceeds the capacity of local authorities and the few organizations working in Gaza, according to MSF.
Doctors say that even now amputations could help patients. “I have worked with patients from the Great March of Return from the beginning,” says Qumboz, who has seen at least 50 patients in situations similar to Mughari’s.
“Those who are still receiving treatment today suffer the most – the longer their recovery journey, the more likely they are to become infected,” he says.
A. MSF report found that such infections were now resistant to many of the common antibiotics used to treat them, which is because antibiotics have been overused in recent decades.
While many patients develop antibiotic-resistant infections, others become addicted to pain relievers they take regularly.
Mahmoud al-Haq, a 35-year-old father of six, says that he has become used to taking medication regularly, trying to ease the burning sensations and sharp pains caused by nerve damage.
Last month, after more than three years in place, the external fixator that stabilized his bone was removed from his left leg, but it soon became reinfected. He rests in his hospital bed, hoping and praying that the strong antibiotics prevent a life-threatening sepsis reaction.
“I remember seeing the bullet fly,” he says, recalling the 2018 protest he participated in. “They took me in an ambulance with 17 other wounded. I was hit by a butterfly bullet that expanded on impact. “
Haq’s injuries are permanent: After more than 30 surgeries and four different types of fixators, doctors had to remove parts of his infected bone, leaving his left leg 4 cm shorter. They told him that his leg would not regain its function. In recent years, this has made it impossible for him to work and he spends most of his time at home in persistent pain.
“I’ve been told twice to consider amputation,” Haq says. But it will not consider it. Not until your usual infections stop responding to the medication. “Even if I’m in pain, I can’t give up my leg,” he says.