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Palestine: Why so many children in Gaza need treatment for burns

18 Feb 22 | 24 Feb 22

Palestine: Why so many children in Gaza need treatment for burns

An MSF physical therapist dresses burns on the shoulder of a three-year-old patient in Gaza Caption
An MSF physical therapist dresses burns on the shoulder of a three-year-old patient in Gaza

At the MSF clinic in Khan Younis, in southern Gaza, four physiotherapists get ready for a busy day. They put on their PPE and review the list of patients – 46 in total, nearly half of them children recovering from burns.

Physiotherapist Reem Abu Lebdeh removes the pressure garments – special dressings that control scar tissue – from 21-month-old Abdallah. Next, he carefully examines the scars on the boy’s legs, abdomen and right arm.

Ten months before, Abdullah suffered a scalding burn that damaged 50 percent of his body surface area. He spent over two months in hospital and received a skin transplant from his father.

The good news is that after a few more physiotherapy sessions he could be discharged, however this is not the end of Abdullah’s treatment.

“Scars do not restrict his movement at the moment,” explains Abu Lebdeh.

“But this could change as he grows up. He’ll need to keep wearing a pressure garment until his scars stop growing and he should be reassessed regularly.”

An unsafe environment

Each year, Médecins Sans Frontières / Doctors Without Borders (MSF) clinics in Gaza treat 5,000 new burn victims – the vast majority children injured in domestic accidents.

Unsafe housing conditions are one of the main causes of these incidents. Almost 70 percent of people living in Gaza are refugees, many hosted in camps, while more than half of the total population live in poverty according to the United Nations.

As a result, large numbers of people live in overcrowded and unsafe housing, without sufficient access to electricity, heating, clean water or sanitation.

“Many burn injuries could be prevented through safer housing and through educating people about the risks,” says MSF’s burn activity manager Séverine Brunet.

Two-year-old Sham, an MSF burns patient, sits with her parents in the room where the family live at Khan Younis refugee camp Caption
Two-year-old Sham, an MSF burns patient, sits with her parents in the room where the family live at Khan Younis refugee camp

A few beds away from Abdallah, on the opposite side of the room, is Sham, a two-year-old girl who also suffered a burn from an accident at home. Physiotherapist Noura Alzaeem is giving her a scar massage.

Sham’s family of four lives in Khan Younis refugee camp inside a rented room – a small area that only has space for a bed, a mattress and two cupboards. With no kitchen, her mother cooks on the floor of the landing outside the room.

One day, Sham got caught up in the wires of the electric stove while her mother was cooking. She fell and brought the hot stove down on top of her, burning 10 percent of her body.

Three years ago, Sham’s older brother Jamal, who was also aged two at the time, had suffered a burn injury after he rolled off his bed onto a stove, burning his face. He was treated in an MSF clinic for eight months.

A complex and chronic problem

In 2021, MSF treated 5,540 new burn patients, up from 4,591 in 2020 and 3,675 in 2019.

On average, over 60 percent of these were children, with just over a third children under the age of five. Like Abdallah and Sham, many were injured in domestic accidents caused by poor housing conditions.

Correct treatment in the first 48 hours is critical for the recovery of burn patients, however most victims and their families are unfamiliar with first aid for burn injuries.

Toothpaste, coffee and tomato sauce are some of the most common home remedies, while some people resort to applying bleach or salt to the burn.

“The first thing to do is hold the burned area under cool running water,” says Brunet.

“And, if the injury is serious, you should seek medical treatment as soon as possible.”

However, reaching a hospital can be another challenge for many families.

At MSF's out-patient department in Batil refugee camp Gandhi Pant, a nurse, escorts a patient with a possible appendicitis to a waiting ambulance. 

Batil is one of three camps in South Sudan’s Upper Nile State sheltering at least 113,000 refugees who have crossed the border from Blue Nile state to escape fighting between the Sudanese Armed Forces and the SPLM-North armed group. Refugees arrive at the camp with harrowing stories of being bombed out of their homes, or having their villages burned. The camps into which they have poured are on a vast floodplain, leaving many tents flooded and refugees vulnerable to disease. Mortality rates in Batil camp are at emergency levels, malnutrition rates are more than five times above emergency thresholds, and diarrhea and malarial cases are rising.

Help us prepare for the next emergency

Four-year-old Nabeel severely burnt his lower back after accidentally leaning on an oven in which his grandmother Sana was baking bread. But, unable to afford a taxi, it took them an hour to reach the hospital on a horse-drawn cart.

An MSF-supported surgical team at Al-Shifa’s burn unit change the dressings of a young patient under anaesthesia Caption
An MSF-supported surgical team at Al-Shifa’s burn unit change the dressings of a young patient under anaesthesia

To have the best chance of recovery, patients with severe burns need frequent dressing changes, physiotherapy and follow-up treatment, but many end up skipping their appointments as the cost of transport mounts.

For this reason, MSF provides transport to and from its clinic in Gaza to avoid this happening.

“Sticking to a treatment plan is very important, but it is very challenging for our patients in Gaza,” says Brunet.

“In addition, poor hygiene due to inadequate access to clean water and sanitation increases the risk of infection and antibiotic resistance, which is prevalent in Gaza. Many patients also lack access to good nutrition or have other illnesses that slow their healing process.”

The blockade

Burn injuries can have a long-lasting impact on a person’s physical and psychological health, while treatment can require prolonged hospitalisation and months of follow-up care to avoid disfigurement and disability.

This is treatment and support that Gaza’s healthcare system – paralysed by Israel and Egypt’s blockade – cannot offer.

To improve access to quality care for burn victims, MSF provides wound and pain management, physiotherapy and psychosocial support to patients and their loved ones through four clinics in the Gaza Strip. Our teams also support the burns unit at Al-Shifa hospital – the main referral unit for all hospitals in Gaza – where an average of 270 patients are treated annually for burns.

However, as long as people continue to live in inadequate and overcrowded housing, the burden of burn injuries will continue to weigh on Gaza.

MSF in Palestine

Palestine comprises parts of modern Israel and the Palestinian territories of the Gaza Strip and the West Bank. This region, known as the Holy Land, holds religious significance for Christians, Muslims and Jews, and has been the object of conflicting claims, which has led to prolonged violence and, at times, open warfare.

Médecins Sans Frontières/Doctors Without Borders (MSF) first worked in Palestine in 1989. Today, we provide medical and psychological assistance to people affected by the ongoing conflict, continuing our long-running mental health programmes on the West Bank and support to burns and trauma victims in the Gaza Strip.