[News] Maggot infestations and wounds that never heal for Gaza’s malnourished

[Anti-Imperialist News]

 Maggot infestations and wounds that never heal for Gaza’s malnourished

*Growing rates of malnourishment are compromising the health of a people
battered by Israel’s war, preventing them from ever fully recovering.*
[image: A Palestinian woman Kholod Al- Masri looks after her children
Mohammed and Maram, who suffer from malnutrition, at al-Awda health centre,
amid widespread hunger, as the conflict between Israel and the Palestinian
Islamist group Hamas continues, in Rafah]
Palestinian mother Kholod al-Masri looks after her children, Mohammed and
Maram, who suffer from malnutrition, at al-Awda Hospital, in Rafah, in the
southern Gaza Strip [Mohammed Salem/Reuters]
By Urooba Jamal
<https://www.aljazeera.com/author/urooba_jamal_200403132107947>
Published On 22 May 2024 -
https://www.aljazeera.com/features/2024/5/22/maggot-infestations-and-wounds-that-never-heal-for-gazas-malnourished
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Dr Mohammed Harara, 28, had barely begun working as a general practitioner
when he was thrust to the front lines of a warzone, forced to become a
jack-of-all-trades.

In the nearly eight months since Israel launched its offensive on Gaza,
Harara has seen more than he thought he ever would.

Like the maggot-infested wounds of the maimed that he has had to stand by
and helplessly look at.

Lacking medication and even basic hygiene materials, Harara and his
colleagues are not able to clean – or keep clean – festering wounds.

Also complicating their struggles are the patients’ severely compromised
physical conditions, which are slow to heal and can make such an
infestation lethal.

“Slowly, these unhygienic conditions caused the body to go into sepsis and
people were dying,” he told Al Jazeera.

The displaced, the wounded, the frail

Experts say growing rates of malnourishment are compromising the health of
a people battered by Israel’s war, preventing them from ever fully
recovering.
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British vascular surgeon Mahim Qureshi could tell that the Palestinians she
treated during her two weeks of volunteering in Gaza were severely
undernourished.

As she and her colleagues from British charity Medical Aid for Palestinians
entered the besieged territory from Egypt, through the Rafah crossing,
Qureshi remembers a welcoming atmosphere.

An “I love Gaza” sign greeted the team and the April weather was “perfect”,
she recounts.

“I remember staring at that [sign], realising just how privileged I was to
have been able to come to Gaza,” Qureshi told Al Jazeera.

But as they rolled out on the crossing’s other side, the devastation of
Israel’s assault was everywhere, she said.

On the drive to Deir el-Balah, in central Gaza, the surgeon saw thousands
and thousands of displaced Palestinians, many of whom were very frail and
thin.

Once they arrived at Al-Aqsa Martyrs Hospital, Qureshi saw hundreds more
frail, wounded displaced Palestinians crowded in every available space – in
the reception area, on every floor, in the stairwells.

She was particularly pained to see children whose clothes were hanging off
their small frames, the opposite of a healthy child steadily outgrowing
their clothes, she said.
[image: Malnourished Palestinian boy Fadi al-Zant lies on a bed at Kamal
Adwan hospital, amid the ongoing conflict between Israel and Hamas, in
northern Gaza, March 10, 2024]Fadi al-Zant, a malnourished Palestinian boy,
lies on a bed at Kamal Adwan Hospital in northern Gaza [Osama Abu
Rabee/Reuters]

Over the coming days, she would see dozens of patients who, due to
starvation, had worsening health conditions.

“People that would have had very treatable or curable conditions several
months ago, are presenting with very advanced disease,” said Qureshi.

For these individuals, their immunity and their ability to heal were
reduced, she added.

“The ability for cells to divide in the absence of vital nutrients that
come from fresh food – and they have had no intake of such fresh foods for
such a long period of time – [makes it] extremely difficult for the mind
and the body to recover and regenerate,” Qureshi said.
[image: Mahim Qureshi spent two weeks volunteering at Gaza's al-Aqsa
Hospital]Britsh surgeon Mahim Qureshi spent two weeks volunteering at
Gaza’s Al-Aqsa Martyrs Hospital [Courtesy of Mahim Qureshi]

Before the war, Palestinians in Gaza were already suffering from
micronutrient deficiencies, largely due to the Israeli blockade, according
to Amber Alayyan.

But since October 7, rates of acute malnutrition are rising rapidly, the
malnutrition expert, paediatrician and deputy manager for Doctors Without
Borders (Medecins Sans Frontieres, or MSF) in Palestine, said.

Micronutrient deficiency is the term used to describe a lack of essential
vitamins and minerals that our bodies need to function. But acute
malnutrition is a larger issue, which leads to the wasting away of one’s
fat and muscle stores, Alayyan said.

“When you’re starting to worry about a population that doesn’t have any
access to food, that’s when you start screening for malnutrition,” she told
Al Jazeera.

But the war has rendered even screening impossible. Due to destroyed
hospitals and medical labs, doctors from MSF and other aid organisations
are unable to run blood tests to confirm malnutrition among Palestinians in
Gaza as they normally would, Alayyan said.

Instead, they are making diagnoses based on clinical symptoms, she said.

Among the symptoms are fatigue, complications from injuries including the
development of chronic diseases, complications in pregnancy, and poor
healing of wounds and burns, the doctor said.
[image: A Palestinian child waits to receive food cooked by a charity
kitchen amid shortages of food supplies, as the ongoing conflict between
Israel and the Palestinian Islamist group Hamas continues, in Rafah, in the
southern Gaza Strip]A Palestinian child waits to receive food cooked by a
charity kitchen amid shortages of food supplies in Rafah, in the southern
Gaza Strip [Ibraheem Abu Mustafa/Reuters]

The inability to heal from injuries is also deepened by poor hygiene and
infection control, Alayyan said, conditions that her team, and doctors like
Harara and Qureshi, have seen firsthand in Gaza.

“You’re more at risk of getting infections when your body is not
well-nourished … tissues need to be healthy and effectively well-fed to be
able to close over a wound,” she explained.

Both Alayyan and Qureshi likened a malnourished body to one suffering from
anorexia nervosa, clarifying that the latter is a condition with a large
psychological component.

Still, while malnutrition starts as physical deterioration, Harara has
witnessed how devastating the effects of malnutrition can be on the psyche
of the people he has been treating.

“The mental and emotional state of realising what’s happening to you is
most exhausting,” he said, explaining that the body starts to feed on
itself, slowly shutting down.

“Nobody will understand the extent of this damage unless they live through
it.”
Improvisation in the time of war

Alayyan said that while malnutrition is a common, unfortunate component of
war, with food often used as a weapon in conflict, its presence is
particularly egregious in Gaza.

Sudan is experiencing higher rates of malnutrition than Gaza due to the
continuing war there, but the rate at which malnutrition has grown in the
besieged enclave over the last seven months is alarming, she said.

Accessing those in need is also uniquely difficult in Gaza when compared
with other places where malnutrition is present, such as the Central
African Republic, or Nigeria, said Alayyan.

“When your teams are afraid of being themselves attacked, bombed, shot … it
makes it very difficult for them to circulate among the population,” she
explained.

“It means that you have very small sample sizes because the only samples of
people you’re getting are the people who are coming to your health clinic.
So you can’t assess the population’s malnutrition status because you’re not
seeing the whole population. We cannot get, for example, get to the north –
no one can safely get to the north,” she added.
[image: A Palestinian child, who is suffering from malnutrition, receives
healthcare at Kamal Adwan Hospital in northern Gaza Strip,]A Palestinian
child, who is suffering from malnutrition, receives healthcare at Kamal
Adwan Hospital in the northern Gaza Strip, amid widespread hunger [Mahmoud
Issa/Reuters]

Despite these hurdles, and the inability to develop customised treatment
plans, MSF and other organisations are still trying to combat malnutrition
among the population they do have access to through nutritional supplements.

Qureshi also learned how to make adjustments in her practice due to the war
conditions.

At Al-Aqsa, she operated in a former maternity unit without the “basic
equipment that has been present in vascular surgical theatres” for decades,
she said.

The rooms had inadequate lighting and no water, there was limited ability
to maintain surgical sterility, and they had to fashion surgical drapes out
of hospital gowns.

“We had to improvise, we had to innovate, and we had to do the very best we
could with what we had available,” said Qureshi.

Harara, who has been working day in and day out since October 7, knows full
well that many of his dying patients could have been saved if there had
been supplies available.

The aspiring plastic surgeon, who has now treated patients with all types
of ailments, wishes he had a superpower to save them all.

“I’ve had the honour to serve my people, but at the same time I’m drained.
I’ve been living in hospitals for the last seven months. It’s only so much
a person can handle,” he said.

“I wish the world was able to stop this from happening before we become
history lessons.”
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