‘Most people are just toughing it out’: shortage of drugs leaves Gaza’s wounded without pain relief | Global development

IThe Nasser Hospital of N Gaza, Mahmoud *, lies in a ball injury to its left leg. His knee is broken and the injury was infected. The boy twists for pain but doctors do not have the pain relievers to relieve his suffering. He is given a nervous block, which prevents him from feeling anything, and relief allows him to sleep for a while. But once it has dissipated, the agony returns.

More than 167,000 Palestinians have been injured in Gaza since October 7, 2023, according to the Gaza Ministry of Health. Burns and injuries by explosion to lost limbs and fractured bones, Gaza hospitals have been overwhelmed by patients with deep pain.

But a desperate shortage of drugs means that few doctors can help. Treatment and operations should be carried out without appropriate anesthetics and what analgesics should be rationed.

According to the analysis of the Bureau of Investigative Journalism (TBIJ), more than half of the WHO medical missions in Gaza since January 2024 – including the delivery of drugs and fuel for hospitals, the deployment of staff and patient evacuations – have been refused, delayed, hampered or canceled.

Meanwhile, Israeli forces have bombed storage facilities and hospitals, while international convoys of medical supplies are regularly prevented from entering Gaza or facing weeks of delays on the border.

TBIJ spoke with eight doctors of Gaza who described the terrible deficit in pain medication, including opioids, anesthetics and even paracetamol.

“Most injuries are open amputations or fractures,” said Doctor Orthopedic Abdelkareem Alsalqawi. “These are very painful and require pain relievers 24 hours a day. [But now] We say to them: one injection per day … Use it at night to be able to sleep. »»

In July, Israeli Prime Minister Benjamin Netanyahu said the country would allow “minimal humanitarian supplies” to enter Gaza. But aid agencies and doctors working on the territory report an almost total collapse of the medical supply chain.

“It is very clear that since March, we have spent months without allowing anything to enter,” explains Dr. Randa Abu Rabe of the OMS office for the occupied Palestinian territory. “It is not only the drug: it is the reagent, the diagnoses, certain instruments or equipment.”

The Israeli Government Coordinator of Government Activities in the territories (COGAT) says: “Israel allows and facilitates the entry of medical equipment and drugs, subject to prior coordination. As proof, in recent weeks, more than 3,500 tonnes of medical equipment have been transferred. ”

This is disputed by help groups and doctors who experience acute shortages. They say that shipments are delayed for weeks or months at the border and that requests are ignored.

Israel has never published a final official list of prohibited elements but circulates the travel lists to international agencies.

Tania Hary, director of the Gisha legal center, says that shortages are aggravated by the collapse of secure delivery systems inside Gaza.

“In addition to the restrictions [at the border]The rupture of public order and looting has created obstacles to obtaining aid, including expensive and sensitive articles such as medicines and medical equipment, “explains Hary.” The lack of availability cannot always be perfectly pinned over the restrictions at the entrance, but rather on the obstacles to the distribution created by a series of factors – almost all can be drawn to the conduct of Israel and its policy on access. “”

Travis Melin, an American doctor visiting Gaza, says that he is unable to understand the justification of drug restrictions. “Opioids are purely compassionate, they have no other goal than compassionate care,” he says. “They do not help you live longer, they do not make you more likely to survive your injuries, they have no advantage of mortality.”

Opioids have become closely rationed. Doctors describe the reduction of patients to one injection per day, leaving the unaltered pain for hours.

In operating rooms, morphine, normally administered as an sterile bottle by patient, is so limited that doctors must treat several people from the same bottle – a practice that involves risk of infection.

Many opioids are classified as essential drugs by WHO and their absence, according to doctors, leaves patients and medical teams without the most reliable tools to manage acute pain and to allow surgeons to work.

Gaza doctors often rely on ketamine, anesthesia with hallucinogenic effects, which they call a “drug on the battlefield”.

“If someone came with amputation, he would get an IV then a dose of ketamine. This lasts about 45 minutes, ”explains Melin. “But giving it as a single dose, with the workforce here, is not possible. And you can’t keep people [dosed with ketamine]. They cannot get up, they cannot walk, they cannot interact. It is therefore not a safe option either.

When available, doctors wear pre-filled ketamine syringes for “mass victim” events, when the bombings bring waves of patients, to inject small doses so that doctors can attend.

Patients are frequently amazing or terrified. And he wears out.

“Patients enter the emergency room and may or may not obtain a dose of ketamine. If they suffer but it is not a catastrophic injury, they often get nothing, ”explains Melin. “For a serious injury or a procedure such as the insertion of a chest tube, they will probably receive ketamine. But for something like a simple ball injury, most people harden it.”

Invited to comment on, the Israeli government spokesman said the Israeli defense forces “will continue to act in order to facilitate medical care and the ongoing functioning of medical institutions in the Gaza Strip, in cooperation with international aid organizations”.