Most of the 1.5 million population of the Gaza strip is impoverished. Half are refugees from Mandate Palestine or their stock. About 50% of the male population is without work. It has been isolated and occupied for decades. A commercial port was being built in 2000 but that was bombed by Israel.
How many boys will regain full or nearly full function is difficult to judge without the radiographs being present. Cases 3,4, 5,7,13 and 15 are likely to have joint involvement and thus some lifelong disability.
In cases 1 and 3 there is nerve injury. If that proves to be an axonotmesis in either, it is possible that a first class repair will not be available in Gaza.
The fractures are open by definition and no doubt comminuted. Delayed or non-union is possible. Deep infection is a real risk, antibiotic therapy not withstanding. The risk of deep infection relates toa. The possible inclusion of fabricb. The high energy injury causing irregular and wide devitalisation of the tissuesc. The probability that these difficult bullet wounds were not laid open and a complete wound toilet performed. One or two of these boys might end with an amputation.Almost all the boys have been frightened off or forbidden from gravel work. There are few, if any, other means of earning shekels.
The three of us would wake up every day at around 5:30am and leave to collect gravel. We were not the only ones doing this type of work. Hundreds of youngsters aged between 13 and 22 used to work with us, despite the danger we faced because we were close to the Israeli border.' Awad W ~ 3
The work was exhausting and dangerous. ‘Israeli soldiers would sometimes shoot at us, and sometimes shoot in the air to intimidate us,’ recalls Ibrahim . 'Sometimes they would shoot at the carts, horses and donkeys we used to move the gravel. But we had to do the work despite the dangers, because we didn’t have any other job to do.’ Ibrahim K ~ 4
Mohammad was taught by his neighbours to watch for birds flying away from the watch towers, as this was a sign to start running, as it meant soldiers were climbing into the towers and the shooting would soon begin. Mohammad M ~ 6
Killed our three horses and one donkey in four months, and we had to spend the money we earned on replacing them.' ….. ‘They were down on their stomachs pointing their rifles towards us, but they didn’t shoot. We got used to such things.’ Mohammad S ~ 11
The methodical shooting of boys at work in Gaza by snipers of the Israeli Occupation ForceBy David Sydney Halpin
Dear Mr. Halpin
Thank you for sending us your paper. We read it with interest but I regret to say that we have decided not to publish it in the BMJ.
Clearly soldiers shooting at children is awful, but we didn't think your article gave a clear reason why we should be publishing it now. The information comes from the Defence for Children International (Palestine section) website, there isn't much context, there's no description of the Israeli soldiers' explanation for these events, and the article just sort of ends.
We receive over 8000 submissions a year and accept less than 10%. We do therefore have to make hard decisions on just how interesting an article will be to our general clinical readers, how much it adds, and how much practical value it will be.
I am sorry to disappoint you on this occasion.
An editor at the British Medical Journal