Mohammad al-Ajouri is a lanky teenager who loves to run, a medal-winning track star with ambitions to compete abroad.
But last month, while participating in a protest along Gaza’s border, he was struck by a bullet fired by an Israeli soldier. It penetrated his calf, shattering his leg before exiting the shin. Doctors tried to save the limb, but an infection soon spread. The leg had to be amputated.
During the past month of demonstrations along the border between Gaza and Israel, at least 17 Palestinians have suffered gunshot wounds that ultimately cost them their legs, according to the Palestinian Health Ministry in Gaza.
In at least three of the cases, Israeli authorities rejected the transfer of wounded Gazans to the West Bank, where they could receive medical care that might have saved their limbs, according to lawyers and one of the patients’ families.
Since the protests began, Israeli troops have killed 43 Palestinians and wounded more than 3,500 with live ammunition, rubber bullets or shrapnel, the Health Ministry said. Of those, about 2,200 have suffered injuries to the legs.
Israeli officials say the protests along the border fence are violent and provide cover for militant attacks. Israeli media report that troops have been ordered to initially fire warning shots at demonstrators, after which they should target protesters’ legs.
“IDF troops act according to clear rules of engagement that are tailored to the scenarios they are contending with,” a spokesman for the Israel Defense Forces said. The spokesman declined to detail those rules but said live fire is a last resort.
The United Nations, however, says Israel is engaged in an “excessive use of force,” and human rights groups point to cases where soldiers have fired at unarmed protesters or at those who didn’t pose an immediate threat.
“The deployment of snipers, careful planning and significant number of injuries to the lower limbs does reflect an apparent policy to target [those] limbs,” said Omar Shakir, Israel-Palestine director at Human Rights Watch in New York. But targeting protesters’ legs “does not make the policy any less illegal,” he said. “The use of live ammunition to any part of the body invariably causes serious injury and even death.”
Doctors in Gaza are often unable to deal with such traumatic injuries, medical groups say, because hospitals there are overwhelmed and understaffed.
“Even at the most advanced hospital in Gaza, it felt like the 1970s,” said Salah Haj Yahia, mobile clinic director for Physicians for Human Rights in Israel. He recently visited Gaza as part of a medical delegation. “If things remain this way, most gunshot casualties will have to undergo amputation,” he said in an email.
Some of the amputations were carried out immediately after victims were shot because of the severity of the injuries, doctors said. In other cases, victims were stabilized but needed treatment outside Gaza if the limbs were to be saved.
Israeli authorities, which tightly restrict the movement of people in and out of the strip on security grounds, rejected the patients’ medical evacuation across Israeli territory to the West Bank.
“It was decided that any request for medical treatment by a terrorist or a rioter who took part in violent events would be denied,” a spokesman for the Coordinator of Government Activities in the Territories, an Israeli Defense Ministry agency that oversees policy involving Gaza, said in an emailed statement.
“However, exceptional humanitarian cases are examined on the basis of an assessment of the security situation and at the discretion of the commander of the area,” the statement added.
‘My dreams vanished’
For some youths like Ajouri, the weekly protests were a welcome distraction, an escape from daily life in the Gaza Strip, where jobs and hope are both rare.
The soft-spoken 17-year-old said he was injured at a March 30 protest after he had turned to leave. The bullet tore through his right leg, which was subsequently amputated above the knee.
He still smiles, his eyes crinkling, when he recalls the medals he’d won for the 400-meter dash. “I’m fast, and I love running,” he said from his bed in a sparse room in Jabalya’s refugee camp, as friends and family held vigil. “My hope was to travel to the West Bank and to compete in international games. ”
Alaa al-Daly, 21, was also an aspiring athlete who had hoped to break free from life in Gaza. As a cyclist, he was training for this year’s Asian Games.
On March 30, he participated in a protest near Rafah, in the southern Gaza Strip. Daly said he had cycled to the border with friends, who had assured him that the demonstration would be peaceful. At one point, after gunfire had erupted, he rushed to help another wounded demonstrator. That, he said, was when the bullet ripped through his knee.
“I saw my leg, and my dreams vanished,” Daly said, as he stared at the ceiling of a hospital room in Gaza City. A single bullet had caused devastating damage. “I said to myself: This wasn’t a bullet. This was like a mini-grenade.”
Doctors performed multiple surgeries to repair his blood vessels and restore blood flow to the limb. After five operations, they amputated his right leg.
According to rights groups and health experts, the damage to protesters’ limbs has been unusually severe. Doctors Without Borders, based in Paris, has recorded “an extreme level of destruction to bones and soft tissue, and large exit wounds that can be the size of a fist.”
Human Rights Watch says it is reviewing evidence that bullets fired by Israeli forces have caused “significant bodily injury,” including “the shattering of bones. . . and severing of veins and arteries.”
Asked about the type of ammunition used, an Israeli military spokesman said, “In the context of the violent riots in Gaza, the IDF employs only standard weapons and ammunition that are lawful under international law.”
Israel says its armed response has been appropriate for the threat posed by Palestinians. Israeli officials accuse the Palestinian militant group Hamas, which controls Gaza, of using civilian demonstrators as cover to “terrorize Israel.”
Hamas are “cowardly leaders who are hiding behind women and children and sending them forward as human shields,” Israeli Defense Minister Avigdor Liberman wrote on Twitter. “So that they can continue to . . . carry out terrorist actions against the State of Israel.”
Protesters have burned tires, thrown rocks and flown kites carrying molotov cocktails over the fence.
Amputees in Gaza have few rehabilitation options. There are no doctors who can perform surgery to modify amputees’ stumps to accommodate artificial limbs, according to Physicians for Human Rights in Israel.
And at the Artificial Limbs and Polio Center in Gaza City, the only facility in Gaza that manufactures prostheses, technicians say they face crippling shortages of raw materials. An inadequate power supply also hampers production, leaving many who need limbs without them.
“Because we are operating with limited tools, we have to be creative with how we fix the prosthetic limbs,” said Abdel Karim al-Sabea, a technician at the center, which is supported by the International Committee of the Red Cross. “It’s only with luck that we end up with the materials we need.”
Youssef al-Kronz, 19, was shot in both legs at the March 30 protest. His left leg was amputated as he awaited Israeli permission to travel for treatment in the West Bank, and doctors warned he risked losing his remaining leg.
In an April 16 ruling, the Israeli Supreme Court said Kronz posed no threat and allowed him to cross to the West Bank, where he is now in a hospital. The ruling applied only to Kronz.
Kronz keeps his thick dark hair in a pompadour and has deep-set eyes that turn down in pain. He says he wants to travel to Turkey or Germany to be fitted for a prosthetic leg. Although medical care in the West Bank is better than in Gaza, the cost of a prosthetic limb is beyond the means of his family, and he hopes a foreign country would provide him with one.
At the moment, however, the top worry is his right leg.
“Our main concern now is treating his remaining leg so that he can hold up the rest of his body,” said his father, Iyad al-Kronz, clutching his son’s medical records.
Iyad was unable to accompany his son to the West Bank, instead remaining behind at their home in the Bureij refugee camp, a shantytown of dirt lanes and homes made of corrugated sheet metal.
“We cannot afford an artificial limb on our own,” he said. “He needs at least one leg to survive.”
Ruth Eglash in Jerusalem contributed to this report.