Methodical shooting of limbsIntroduction

The deliberate injury of the limbs of 23 boys by high velocity weapons has been logged and described by Defence for Children International – Palestine Branch (DCI-P) since March 2010. (1) Some of the facts have been published in national newspapers. These barbarous acts contravene international and national law but there are no judicial responses. The caring professions see the physical and mental pain of those who suffer and they should be in the vanguard in calling for this great cruelty to cease forthwith. Political leaders have failed to act. The Geneva Conventions Act 1957, which is of central importance in holding war criminals to account in the jurisdiction of the UK, is being emasculated.

Context

Most of the 1.5 million population of the Gaza strip is impoverished. Half are refugees from Mandate Palestine or their children. 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. The isolation and the hobbling of its commerce was increased by a siege which was started in March 2006 in response to the election of a majority of Hamas members to the legislature. It was further tightened in June 2007 after the Hamas government pre-empted a coup by the Fatah faction that was led in Gaza by Mohammad Dahlan.


The misery was further deepened with 'Operation Cast Lead' that was unleashed 27/12/08. This was promised 29/02/08 (2). "The more Qassam fire intensifies and the rockets reach a longer range, [the Palestinians] will bring upon themselves a bigger shoah (holocaust) because we will use all our might to defend ourselves.” - Matan Vilnai Deputy Defence Minister to Israeli Army Radio. There was a massive bombardment which killed 220 adults and children in the first 15 minutes. This was followed by a full scale invasion. 1400 humans were killed and approximately 5000 injured physically. The minds of very many more were injured too. 4000 homes were totally destroyed, almost all the factories and 40 mosques. The two gleaming science blocks of the Islamic University of Gaza were flattened by very powerful thermobaric bombs, the blasts being heard throughout the 360 square kilometres of the Gaza 'Strip'. The siege has been even more draconian since. Cement, ballast and steel rods are only let in at about 5% of the rate needed for rebuilding, the pretext being that 'bunkers' could be constructed. At the present rate it will take 78 years to rebuild Gaza. (3) Chocolate, writing paper and all manner of things have been blocked. The 1000 tunnels at Rafah have provided a way in for goods but in the face of bombing and roof falls.

The lack of any work and the extreme poverty of the large extended families has drawn the boys and men to scavenge for broken concrete ('gravel') in the evacuated Eli Sinai 'settlement' and in the industrial zone by the Erez border control post at the northern limit of the 'Strip'. The factories of the industrial zone have been progressively demolished by Israeli shelling etc. They are seen to the west as one enters Gaza through Erez. A donkey and cart, shovel, pick, sieve, muscles and courage are the tools. The rubble is used to make blocks and poured concrete with the cement that is imported largely through the tunnels. Many dozens of men and boys do this work for precious shekels in the shadow of manned watch towers and under 'drones' above.

The 23 boys who have been shot between 26/03/10 (Said H) and 23/12/10 (Hatem S) are listed in the table below with skeletal facts. These points are made:-
  • In 18 there were single shots and not automatic fire
  • The reported range in most cases confirms that the weapon was a sniper's rifle in the hands of a sniper
  • Almost always there were many dozens of other men and boys at work; these victims were picked off
  • A leg was the target in most cases. Where the leg was not the target it is likely the sniper was 'aiming up' so the flank, elbow etc was hit instead.
  • No weapons were being borne by the gravel workers so they posed no threat to the Israeli Occupation Force personnel. Instead they were bending their backs to their menial work within their internment camp
  • The histories refer often to the recovery of the injured boy by friends and relatives under fire. This was a feature during 'Cast Lead' or instead the paramedics were barred from getting to the victims so they died without care.
The history of the injury and sequel for each boy are linked to in (1). It has been done meticulously and the translation into English is perfect. The pain, and often the terror, felt by the boy as the bullet struck home are vividly recorded. No bullets have been recovered yet so the calibre/type is unknown.
  • How many boys will regain full, or nearly full function is difficult to judge without the radiographs. 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 to a. the possible inclusion of fabric b. the high energy injury causing irregular and wide devitalisation of the tissues c. 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 shooting to wound and kill Palestinians is relentless. DCI-P notes that according to a UN study, between January 2009 and August 2010, at least 22 Palestinian civilians in Gaza have been killed and 146 injured in the arbitrary live fire zone adjacent to the border with Israel and imposed at sea. At least 27 of these civilians were children. It also notes that the targeting of civilians is absolutely prohibited under international law, regardless of circumstances.

These quotations from the available stories convey a little of the poverty, the suffering and the courage:-
  • '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
  • 'They 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
Silence is complicity

References
1.http://www.dci-pal.org/english/doc/press/UA_4_10_Children_of_the_Gravel_UPDATE_29_DEC_%202010(b).pdf
2.http://www.haaretz.com/news/barak-hamas-will-pay-for-its-escalation-in-the-south-1.240417
3.http://www.amnesty.org.uk/uploads/documents/doc_21083.pdf

I thank Gerard Horton and DCI-P for the availability and excellence of this information, and for supporting publication in a medical forum. I also thank Dr Khamis Elessi in Gaza for information.

Conflict of interest: I founded the Dove and Dolphin Charity 110119 with a voyage to Palestine 8 years ago and chair its trustees. It attends to the welfare of children in Gaza in the main. No pecuniary benefit is derived from this charity.

FOOTNOTE

This paper was submitted to the Lancet and the British Medical Journal 4 January 2011 under the title 'Ethical' with the following cover letter:

4 January 2011
To the editor of the British Medical Journal, Ms Fiona Godlee

Dear Fiona,

I wish you well for the new year.

I spent some time on the editorial board of the Journal of Bone and Joint Surgery so I have insights into review and publication. However, having been fully retired for about 7 years now I am a bit out of touch with how one should present material now. I have been involved with teaching and writing about essential clinical skills in Gaza. I have a good knowledge of the tremendous pressure the caring professions are under there and of the chaos that ensues.

The paper that I have written, and which is based on the reports from DCI-P that I follow carefully, should be put in front of doctors. I read the Christmas appeal to BMJ readers is for Save the Children. This link speaks of their rights denied. I know from previous correspondence that you would agree that intentions and words are alone insufficient. As I say in my paper, the professions should be in the vanguard of exposing the violation of children worldwide and insisting that it stop. I speak simply of healing.

http://www.savethechildren.org.uk/en/child-rights.htm

There is this side too. The professions are always picking up the pieces. I can think of the 5 million orphans in Iraq and the thousands of ex-servicemen with PTSD (three-quarters of a million in the US) whose GPs are powerless to help.

I attach the paper and table in pdf. I should be grateful to know as soon as possible. If this is highlighted in the BMJ, it is highly unlikely another child will be shot deliberately.

For truth, reason and justice

David Halpin

The refusal from the latter is here:

BMJ/2011/850099

The methodical shooting of boys at work in Gaza by snipers of the Israeli Occupation Force by 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

The methodical shooting of boys at work in Gaza by snipers of the Israeli Occupation Force

Number

Name

Age

Date of injury

Distance

from

border

metres

Injury

Activity

Single shot heard?

Hospital

Rx

Outcome

?Work again near Erez

or other

Date report made - Arabic to English

1 Said H

15 yrs

26/03/10

100

Deep and tranverse, lower L thigh

Searching for brother

Y

3 days

'Toe will not work' Persisting pain

Nerve injury

Lost 2 months training as plumber and car sprayer

27/10/10

2 Hasan W

17 yrs

22/05/10

300

Below R knee. 'Shattered'

2 months in plaster

Gravel

(G)

Y then

repeated

shooting

Home same day

(HSD)

Cannot walk. Pain on movement.

'.. not be able to collect gravel though family needs money'

01/09/10

3 Awad W

17 yrs

07/06/10

350

Shot in R knee

G

Y

HSD

Numbness Cannot walk as he used to.

Therapy from Doctors without Borders. Cannot work.

06/09/10

4 Ibrahim K 16 yrs

16/06/10

400

Shot in R knee

G

Y after

shooting

2 days

Pain in R leg

Forbidden by father to return to same work

16/09/10

5 Abdullah

M

16 yrs

22/06/10

60

Shot in R ankle

G

Y

HSD

Painful. ?Will be able to walk normally again

'I will never collect gravel again.'

08/09/10

6 Mohammad

M 16 yrs

23/06/10

500

Shot in R flank

G

3 days

Very tired when he runs

Cannot work or play

30/09/10

7 Arafat S

16 yrs

10/07/10

50

Shot in R ankle

G

Y

HSD

Still some pain and a little limp

18/09/10

8 N'uman A

14 yrs

10/07/10

300

Shot R lower leg – not deep

G

Y

HSD

Forbidden by grandfather to return

20/09/10

9 Hameed O

13 yrs

14/07/10

50

L arm – not deep

G

Y

HSD

Occasional pain

No work. Forbidden by father to return

26/09/10

10 Khaled I

16 yrs

31/07/10

600

L thigh. 'Cut artery and vein

G

Y

?Heavy machine gun

15 days

'Considering what happened, not going to collect gravel again

27/09/10

11 Mohammad S

17 yrs

25/08/10

800

L thigh

G

HSD

Pain 'I have nightmares about being shot by Israeli soldiers'

‘I don’t think of going to the dangerous places anymore'

30/09/10

12 Mahmoud J

16 yrs

07/10/10

450

R thigh. Bled profusely. Exit wound diameter 5 cms.

G

Y

?From tank or jeep

'I wanted to buy two pigeons and raise them on the rooftop of my house. I will never go back to that place.'

27/10/10

13 Ahmad H

17 yrs

13/10/10

600 -

700

R foot/sankle 'Big hole in my foot – 4 cms with small hole other side

G

Y

16/10/10

14 Yahia Z

16 yrs

14/10/10

450

R lower leg

G

Y

HSD

‘I will never go back to the industrial zone even if I starve to death.'

16/10/10

15 Shamekh D

15 yrs

27/11/10

150

L foot

G

Y

Operated

BK cast

Awaited

02/12/10

16 Mokhles M

15 yrs

28/11/10

500

L lower leg

G

Y

?Op

BK cast

‘I’ll wait for my wound to heal before I go back to collect gravel.’

02/12/10

17 Belal L

16 yrs

04/12/10

600

L leg

G

Y

plus a second shot into the L leg of his 22 yr old cousin

Fractured in two places. External fixation above and below knee

‘I still feel pain in my leg,’ says Belal, ‘and I don’t know whether I will walk again or

not.’

‘I have come under fire several times from Israeli soldiers guarding the border. Once they shot and killed our horse.’’ Belal’s older brother Nedal (24) has been shot four times whilst collecting gravel,

‘three times in the left leg and once in the right leg,’ says Belal.

08/12/10

18 Suhaib M

16 yrs

10/12/10

250

Through and through,

just below L knee. Exit wound 5 cms diameter

Wood

Y

'Bullet exploded in leg.'

Long cast.

'I don’t know if I

will be able to walk again,’ says Suhaib, ‘but certainly I will never go back to collecting gravel.’

18/12/10

19 Rasmi G

15 yrs

10/12/10

200

R lower leg. Fractured tibia

G

Y

External fixation

In Kamal Udwan hospital

‘I still feel great pain in my leg and don’t know whether I will walk again or not.'

15/12/10

20 Fadi H

17 yrs

13/12/10

500

Below L knee

Goatherd

4 shots

HSD

Moving about at 2 days

28/12/10

21 Rami

17 yrs

21/12/10

400

R lower leg

G

Y

HSD

Will collect G again. 'What can I do?' Disabled

father. Large family

28/12/10

22 Mahmoud S

17 yrs

23/12/10

400

R elbow

G

Gun-shots

HSD

'For the record, I will never go back to collecting gravel for it's a death profession.'

29/12/10

23 Hatem S

17 yrs

23/12/10

800

Head – back of.

Embedded 'shrapnel' from bullet

Collect

'straws'

Gun-shots

HSD

Headache plus nausea

29/12/10