Mahmoud Malakha had just arrived at Gaza’s eastern boundary during the Great March of Return on 6 April 2018, when an Israeli sniper shot him in the leg.
Malakha was one of tens of thousands of Palestinians in Gaza who participated in the demonstrations at the Gaza-Israel boundary every Friday from March 2018 to September 2019.
The protests arose as an attempt to highlight the Palestinian right to return to the land from which their parents or grandparents were forcefully expelled during the 1947-49 Nakba, when hundreds of thousands of Palestinians were driven from their homes to make way for the establishment of Israel.
In response to the protests, the Israeli military deployed snipers, live bullets, rubber bullets and tear gas canisters. Two hundred and fourteen Palestinians, including 46 children, were killed, and over 36,100 were wounded, among them nearly 8,800 children.
One Israeli soldier was killed and seven others injured during the demonstrations.
Mahmoud, who is now 34, was transferred to al-Shifa hospital in Gaza, where doctors learned that the bullet had severed an artery and destroyed some bones.
With such critical injuries, repeated attempts were made for Mahmoud to be transferred to hospitals in Jerusalem or Egypt, both better able to provide the care he needed.
But every request for a travel permit was denied by the Israeli military for “security reasons.” Israel controls who is allowed to travel in and out of Gaza, and communicates its wishes with Egypt, with whom it maintains coordination over the Rafah crossing.
“I underwent nine surgeries a few months after the injury. They told me my leg had to be amputated, but I refused, hoping I could get treatment,” said Mahmoud, a father of four.
He tried to travel to Jordan with mediation from Medicins Sans Frontiers (Doctors Without Borders). But he had to go through the Beit Hanoun (Erez) checkpoint, and Israel demanded he undergo an intelligence interrogation to pass. He was advised to refuse.
A number of patients and their companions wind up in Israeli prison in similar circumstances.
According to the World Health Organization, Israel has denied 30 percent of travel permit applications from patients in Gaza over 14 years from 2008 until 2022.
Companions are also regularly denied permits, forcing 43 percent of children who needed access to health care outside Gaza to travel without their parents.
Israel’s blockade of Gaza amounts to collective punishment, and 839 patients in Gaza have died over the 14-year period the WHO invesitgated while waiting for permits to travel.
Most patients denied permits, ostensibly for “security reasons,” reject any suggestion they are connected to any armed groups.
“I don’t belong to any party and I have no military interest. I don’t know why I have been denied,” said Mahmoud while drinking a cup of tea in front of a wood-burning stove in a small garage at his house in southern Gaza.
He was also diagnosed with cancer in the same leg in March 2021, during the COVID-19 pandemic. He was given chemotherapy in an isolation room at a hospital for nine months.
“My daughter was born the same day I entered the isolation room. Imagine, I didn’t see her or any of my family for nine months, except online. Much worse than exile,” he said.
Eventually, he contracted osteomyelitis, a serious bone infection requiring additional surgeries and intensive antibiotic therapy. Coupled with the cancer, his leg was eventually amputated under the knee in December.
“I underwent tens of surgeries since the injury,” Mahmoud said, leaving him unable to work. He had to shut the grocery store he used to run near the Gaza port, and which used to secure him a monthly income of some $1,500.
He still owes over $10,000, to traders and the landlord, and is finding it impossible to service his debt on the amount he now gets from social services.
“The ministry of social development gives me only 600 shekels [roughly $160] monthly, and I struggle to make ends meet. I also owe $200 to a nearby pharmacy as I bought my medicines at my expense.”
And his medical woes are not over. The cancer has not gone away and he also suffers a bacterial infection. He is yet again trying to secure permission to travel abroad for treatment.
“If I don’t travel, they will amputate another part of my leg soon.”
Hobbled and barred from travel
Wasim Abu Ajwa was 17 when he was shot in the leg in August 2018.
A young man sits on a bench with his leg in a splint
Wasim Abu Ajwa Ahmed Al-Sammak
“I didn’t even throw a stone,” he told The Electronic Intifada.
He underwent emergency surgery and stayed in hospital for 19 days. He then completed his treatment with help from Medecins Sans Frontieres (MSF).
The bullet had crushed 15 cm of his bone, and he underwent several surgeries in Gaza. MSF transferred him to Jordan in 2019 but he was told his bone had not grown back properly, so he went back to Gaza feeling desperate.
He managed to travel to Egypt in January 2020 for osteoplasty surgery to repair the bone. Five months later, he had to travel to Egypt for further surgery. This time, he was denied a travel permit for “security reasons,” even though he does not belong to any party.
“I tried to travel to Egypt three times but all in vain. I have been denied since then,” Wasim added.
Every aspect of his life has been affected.
“I can’t work or even walk a short distance as there is a 10-cm gap in my injured leg. My salary is 600 shekels [approx $160], which is the only income for my six siblings. I need limb lengthening surgery abroad, and after it, up to two years to fully heal.”
MSF was one of the main medical service providers for the injured in the Great March of Return, admitting nearly 5,000 patients to their trauma clinics, and carrying out some 4,000 surgeries.
However, the medical aid organization ended its services for almost all the injured in September 2019 and handed them to the Ministry of Health.
This has badly affected the casualities, many say.
“MSF’s services were VIP. They used to offer us everything; they were like a hospital, not a clinic. The governmental service is very bad,” said Wasim.
When Maysara al-Daya, 33, was shot in his leg in March 2018, he underwent a couple of surgeries during the first month. Then he started suffering from infections.
“Then I was diagnosed with cancer in my leg so I took chemotherapy and spent three months in an isolation room at hospital due to COVID-19,” said the father of two.
He applied to travel for treatment seven times in 2018, but was denied every time. After two rejections, Egypt allowed him to travel in 2019 when he had bone marrow transplant surgery. He has tried to go back, but has been denied since, he told The Electronic Intifada.
Then his condition got worse, and his leg was amputated just above the knee in March 2022. But he contracted a severe infection and other complications, resulting in another amputation two months later.
More complications and more surgeries. In all, he has had four amputations, the last in November.
He’s keeping count.
“I’ve had 89 surgeries since 2018. I’ve stayed at the hospital more than at home,” he said as he took two pills for his pain.
Maysara has suffered diabetes, high blood pressure and some issues with the kidney and liver, which he attributes to the quantity of medicine he is taking.
“If I had been allowed to travel immediately after my injury, I wouldn’t have gone through all this,” Maysara reflected bitterly. He still suffers from bacterial infection.
“If I can’t travel, I will have to amputate another part of my leg soon.”