Sitting on his hospital bed, with external fixators screwed into his right leg, Mohammed al-Mughari has been in pain and on medication since he was shot in the leg more than three years ago.
He lives with a chronic bone infection – from bacteria now resistant to most antibiotics. Doctors, including in Jordan and Egypt where he sought treatment previously, have all recommended that an amputation could end his long-term suffering, but he has steadfastly refused.
“I’m determined to save my leg,” he says, despite knowing that the recurring infections could lead to deadly sepsis. The 31-year-old chef has been unable to work since he was wounded and barely sleeps due to torturing nerve and bone pain, which no medication can ease, and the fixture attached to his leg.
Doctors at Nasser hospital, where Mughari is being treated, say that they have come across dozens of such cases where patients steadfastly resist amputation.
Dr Mohammed Qumboz, who works at Nasser, a clinic in the southern Gaza Strip supported by Médecins Sans Frontières (MSF), says: “For many, amputation is a last resort that is seen as a sort of failure, even though it could greatly improve the men’s life quality.”
Mughari was hit by a bullet in April 2018 while taking part in Gaza border protests, known as the Great March of Return. During weekly demonstrations, protesters called for an end to the 2007-imposed blockade on Gaza, and the return of more than 1 million people displaced from what is now Israeli territory. Hamas, the militant group ruling Gaza, were not involved initially, but later endorsed the protests, with some of their members participating.
Israel used teargas and live ammunition when protesters surged towards the border.
According to the UN, more than 36,000 people were wounded during the 18 months of protests, 22% by live ammunition. There were more than 7,000 wounds to limbs, resulting in 156 amputations.
With limited health services available in Gaza, complex wounds were referred to hospitals in the West Bank and Israel, but exit permits were not always granted. Out of 604 applications, 17% were approved and 28% rejected, while the rest did not receive an answer in time for their medical appointments, the UN documented.
The need for specialised treatment due to the severity and complexity of the protesters’ injuries vastly exceeds the capacity of local authorities and the few organisations working in Gaza, according to MSF.
Doctors say that even now amputations could help patients. “I have worked with patients from the Great March of Return right from the start,” says Qumboz, who has seen at least 50 patients in similar situations to Mughari’s.
“Those who are still receiving treatment today are suffering the most – the longer their journey of recovery, the more likely the infections,” he says.
A MSF report found that such infections were now resistant to many of the common antibiotics used to treat them, which happens because antibiotics have been overused in recent decades.
While many patients develop antibiotic-resistant infections, others become addicted to the pain medication they regularly take.
Mahmoud al-Haq, a 35-year-old father of six, says he has become accustomed to regularly taking medication, trying to ease the sharply stabbing and burning sensations caused by nerve damage.
Last month, after more than three years in place, the external fixator stabilising his bone was removed from his left leg. But it soon became reinfected. He rests in his hospital bed, hoping and praying that the strong antibiotics will prevent a potentially deadly sepsis reaction.
“I remember seeing the bullet flying,” he says, recalling the 2018 protest he took part in. “I was carried away in an ambulance with 17 other wounded. I was hit by a butterfly bullet that expanded on impact.”
Haq’s injuries are permanent: after more than 30 surgeries and four different types of fixators, doctors had to remove parts of his infected bone, leaving his left leg 4cm shorter. He was told his leg would not regain its function. In the past years, this has made it impossible for him to work and he spends most of his time at home in nagging pain.
“They have told me twice to consider amputation,” Haq says. But he will not consider it. Not until his regular infections stop responding to medication. “Even if I’m in pain, I can’t give up on my leg,” he says.