Intifadah toll: disabilities at alarming rate

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Intifadah toll: disabilities at alarming rate
Blindness, paralysis the cost of 'eye for eye'
By Charles M. Sennott, Globe Staff, 5/3/2001

GAZA - The X-rays of 16-year-old Mahmoud Sarham's spine show exactly where the Israeli sniper's high-velocity bullet entered his neck, tumbled, and fragmented, severing his spine between the first and second thoracic vertebrae.
Sarham lay in Gaza's El Wafa Rehabilitation Center last week, unable to lift his head from the pillow. Both legs are paralyzed. He is incontinent. He has some slight ability to move his left arm, and he feebly tried to show how he had twirled a leather sling to hurl stones at Israeli troops stationed near his home before he was shot.
''I was good,'' said Sarham, the sparkle of teenage bravado somehow not yet drained from his eyes by the pain of the injuries he suffered 11 weeks ago.
Behind the steadily mounting death toll in the Palestinian intifadah, or uprising, against Israeli occupation, there lies another staggering statistic of suffering: the number of permanently disabled.
Of the estimated 13,000 Palestinians injured in the seven-month spiral of violence, an estimated 1,500 have suffered disabling wounds, according to the Health, Development, Information, and Policy Institute, a Palestinian public health research organization based in the West Bank town of Ramallah.
Twenty percent of the 13,000 injured were shot with live ammunition, mostly the high-velocity, full-jacketed bullets from M-16 rifles, which have been criticized internationally because of the extensive injuries they cause. Many will never walk again. The luckier ones will limp.
About 40 percent were hit by so-called rubber bullets, steel pellets coated in hard plastic, which can be lethal at close range. Many have suffered mental disabilities from head wounds caused by the rubber bullets. The other 40 percent were wounded by tear gas, shrapnel, and stun grenades.
In a land where the biblical call of ''an eye for an eye'' is practiced daily by Israelis and Palestinians, a lot of people are losing eyes. Some 200 victims of rubber bullets have been treated at St. John's Eye Hospital in East Jerusalem. At least 25 victims have lost eyes, said the hospital's director, Dr. Tim Lavy.
Lavy said he personally removed seven eyes in one day, adding that the hospital is ''grossly understaffed.'' The most recent victim was a 4-year-old girl from Bethlehem, who lost her right eye during a gun battle near her home.
A 24-year-old Hebron man who lost his left eye in 1990, during the first intifadah, lost 65 percent of his sight in the right eye in October, Lavy said.
About three-quarters of the disabling injuries occurred in the first two months of the intifadah. Now, a grim reality has set in, as patients seek help at inadequate and overcrowded medical facilities in the West Bank and Gaza.
The most acute need is physical rehabilitation, according to a study released this month by Bir Zeit University near Ramallah. For Gaza's population of 1 million, of whom 3,000 have been seriously injured in the intifadah, there are only two professionally trained rehabilitation specialists.
Hundreds go without proper rehabilitation, not only because of inadequate facilities, but also because Israeli blockades around Gaza and the West Bank often cut off patients from health care, the study found.
At least 438 Palestinians, including 13 who were Israeli citizens, have been killed in the intifadah, along with 72 Israelis.
By April 15, 855 Israelis had been injured, according to the Israeli human rights organization B'tselem. Of those, 66 were moderate to severe injuries; the rest, light injuries.
While there are no statistics on how many Israelis have been permanently disabled, one of the most searing cases occurred on Nov. 20, when a roadside bomb tore through a bus carrying children to school from a Jewish settlement in Gaza. Shrapnel killed two people and injured nine, including three childrem from one family. Orit Cohen, 12, had her right foot severed. Her sister, Talia, 8, lost both legs, and a brother, Yisrael, 7, lost his right leg.
The young Israeli victims will also face the pain and suffering and the long process of physical rehabilitation, but they will not have the added burden of inadequate medical and rehabilitation services.
The children's father, Ophir Cohen, 33, said the family has temporarily relocated to Jerusalem to be closer to a world-class rehabilitation center, where the children are still undergoing surgery and will eventually be fitted for prostheses. But Cohen said the family will return to live in the settlement of Kfar Darom in Gaza.
Human rights groups have condemned the Palestinian Authority for failing to prevent bombings, such as the attack on the school bus, and for failing to stop Palestinian gunmen from shooting at Israeli forces when Palestinian civilians, including youths throwing stones, are present.
Colonel Daniel Reisner, head of the Israel Defense Forces international law department, said in an interview that: ''Any injury to children is abhorrent, and, aside from that, it doesn't look good. ... The situation the Palestinians have put us in is not an easy one.''
But the same human rights groups that have criticized the Palestinian Authority have condemned what they see as Israel's excessive use of force in firing live ammunition when soldiers' lives are not in danger and for shooting indiscriminately at stone throwers.
The Boston-based Physicians for Human Rights completed an extensive report in November, and Dr. Robert Kirschner, the team's forensic pathologist, said: ''We found a deliberate policy by the IDF of shooting people to maim them. And now that policy has wrought a nightmare of rehabilitation. The amount of cases would tax our system in America, never mind in Gaza.''
Kirschner said the high rate of crippling injuries is due in part to Israel's use of the American-designed M-16 assault rifle. Because of the damage it does, use of the weapon for crowd control has been criticized by groups including the International Red Cross and the government of Switzerland, which called for an international ban on M-16 ammunition. After entering the body, the bullet's metal jacket often fragments and then the bullet tumbles, causing complex fractures and severe muscle and nerve damage.
At the El Wafa Rehabilitation Center, Dr. Ibrahim Gazal, the director, held up to the light X-rays of a dozen of his young patients, all of them paralyzed. Each one showed a ''lead storm,'' a spray of bullet fragments that tore through bodies, lodging around vital organs and in many cases damaging the spinal column, in one case causing brain damage.
The grimy ward's eight beds were full last week with young victims. Flies buzzed around plates of half-eaten food. Palestinian television blaring a ''martyr's'' funeral competed with sounds of construction on a new wing, which will add a dozen beds.
Slurring his words and barely audible, 16-year-old Sarham said, ''If I can walk again, I will go back'' to throw stones at Israeli soldiers.
But Dr. Nim'r Daloul stood over him and said flatly: ''He will never walk again. Never.''
Daloul assumed that his patient did not understand English, but the boy understood the word ''never.'' And something, perhaps hope, washed from his eyes as he stared straight ahead, despondent. Daloul tried to comfort him.
''These young people are not facing their own grief,'' said Dr. Eyad Sarraj, director of the Gaza Community Mental Health Program, which provides counselors to work with the youths. ''When they do, they are going to be very angry, and where that anger will go, how it will come out, is a big question.''
Sarraj suggested that the long process of recovery facing the youths reflects the collective process of recovery ahead for the Palestinians, who have seen their society and economy crippled and their hopes maimed.
''Everyone is in Gaza is in as much denial as these kids,'' he said.

Charles M. Sennott can be reached by e-mail at sennott@globe.com.
This story ran on page A01 of the Boston Globe on 5/3/2001. © Copyright 2001 Globe Newspaper Company.