This article is taken from Dispatches, MSF UK's supporter newsletter.
Marcus Dunk visits an MSF clinic in Gaza City to see how the team there treat the mental and physical problems of children scarred by violence
On 13th May last year, six-year-old Mohammed was in the kitchen of his home in Gaza City. In the semidarkness of yet another power cut, Mohammed’s mother was kneeling to light a kerosene stove. Mohammed was next to her, holding a candle to help his mother see better.
When hot candle wax dripped onto his hand, he dropped the candle on the stove. It burst into flames and, within seconds, the whole kitchen was ablaze. The flames engulfed Mohammed, who suffered third-degree burns to 73 percent of his body, along with extensive inhalation burns. His injuries were so severe that doctors held out little hope for his survival at first.
Six months on, and Mohammed is now running up the steps of the MSF clinic in Gaza City. Bounding into the reception area, he’s quickly surrounded by staff joking with him. A smile breaks out across his face. Despite the horrific scarring that covers much of his face and body, it’s clear that this is a little boy with energy to spare.
“Mohammed’s father told me last week that his son loves coming to the clinic,” says MSF’s Dr Rami Al Madhoun. “He has a real bond with the staff and he feels normal here. We make him feel comfortable.”
Making Mohammed comfortable, physically and mentally, is a treatment priority for the staff at the clinic, many of whom have become used to attending to burns victims over the past two years. Due to the Israeli embargo, as well as to inter-Palestinian disagreements, lack of fuel has curtailed production at Gaza’s only electric power plant, bringing daily power cuts that last from eight to twelve hours. The people of Gaza rely on generators, black-market gas cylinders, oil lamps and candles – all sources of serious accidents and burns.
Freed from the mask he has to wear for 23 hours a day to reduce scarring, Mohammed jokes with his physiotherapist Ihmoud Hejji. Photo by Marcus Dunk/MSF
Mohammed was luckier than many burns patients in Gaza. Due to the severity of his injuries, he was given permission to cross the heavily fortified border from Gaza into Israel to be treated by specialists at an Israeli hospital for three months. But after that, nobody – including the Palestinian Authority – was willing or able to continue paying for his $1,000-a-day treatment, so he was forced to return to Gaza. It was on his return that his father found out about the free services offered by MSF.
On a hospital bed, Mohammed jokes with physiotherapist Ihmoud Hejji as he gently puts pressure on Mohammed’s arms and legs in order to reduce scarring and enable freer movement. Their bond is obvious. For nearly 23 hours a day, Mohammed wears a translucent plastic face mask — created for him in the MSF workshop — in order to reduce his facial scarring. But while he is here, he can take it off, and his relief at this sudden freedom is obvious.
It’s a short-lived freedom – within minutes Ihmoud is helping him to insert into his mouth a strange tubelike device with two balloons attached to it.
“Because of the scarring and burns damage around his face and mouth he has been having trouble eating and talking,” says Dr Mohammed Abu Alqumboz. “His mouth just isn’t stretching wide enough. We don’t have access to the latest equipment here, so we improvised and came up with this device. We insert the tubes and the balloons into his mouth and gradually inflate the balloons so they fill his cheeks. This will help expand the scar tissue and will help him when he eats and when he talks and when he smiles and laughs. It seems to be working.”
As Mohammed’s cheeks inflate, Ihmoud passes him a red clown nose to put on, and Mohammed makes faces at us all.
Although he is all smiles today, the trauma has left its mark: Mohammed’s parents say that he is anxious and aggressive to the point that they have withdrawn him from school.
While much of this can be attributed to his accident, Mohammed has also been shaped by the conflicts around him. The Israeli military offensive of 2008-9 and inter-Palestinian clashes have had a devastating impact on the psychological wellbeing of Gaza’s children. Chronic bedwetting, anxiety and aggression are now endemic.
That is why, alongside the rehabilitation and post-operative care provided by MSF, psychologists also offer mental health support. In 2009, more than 70 percent of psychotherapy sessions conducted were with children.
“From a very early age, children in Gaza are exposed to violence, to death – the death of family, friends, people they love,” says MSF psychologist Manuel Francisco Morantes. “Here,
guns, shells, bombs, air raids and artillery fire don’t just belong to the virtual world of video games. They’re real and many children become their victims.”
Across the road from the clinic, Mohammed is with clinical psychologist Jasser Salah. Due to the age of the patients, psychotherapy sessions with these children often take the form of
drawing. Today, Mohammed is working on a picture of a fire. “This gives him a way to act out his feelings and to release some of the tension he feels,” says Jasser. “He’s had four sessions and we’ve already begun to see some behavioural improvements.
“It’s short-term therapy. We can’t do much about the difficult environment, but we can help them cope with what they’re experiencing.”
At the end of the session, Mohammed is keen to come over and shake my hand. “My one hope is that my son will recover,” his father says. We both look down at Mohammed. He is still smiling.
Galep ’s Story
Galep, seven, suffers from recurring nightmares, insomnia and anxiety. His family home, close to a hospital and police station in Gaza City, was in the middle of the shelling during the Israeli ‘Cast Lead’ military offensive of 2008-09. He has also witnessed inter- Palestinian clashes and shootings.
“In the first session I had with Galep, his body was shaking, he couldn’t focus on what he was doing,” says MSF psychologist Deborah Franco. “He wouldn’t utter a single word.”
However, watching him today is to see a child slowly opening up. His drawing revolves around his recurring nightmare about a snake that is coming to eat him and his family.
But with the help of Deborah, he can draw and talk his way through the story and even construct a plan to kill the snake. At the end of the session, he smiles, puts his school
backpack on and bounces out of the room into the sunshine of the Gaza street.
“He’s made a big step today,” Deborah smiles. “Even though he’s still having bad dreams, he was able to draw and talk about it and even make a plan to deal with it. So if he dreams about the snake tomorrow, hopefully he’ll remember his plan and he’ll be able to go back to sleep. It’s a way of helping him cope.”
For Deborah, the work is difficult, but rewarding. “I’m so impressed by the children I’ve met here,” she says. “When you hear what some of them have seen and lived through, it tears
you apart. They should be playing with dolls and having fun, not dealing with these hard things. But they are resilient.”
Dispatches is a print publication written by people working for MSF, sent out every three months to our supporters and volunteers in the field, edited in London by Marcus Dunk. It costs 8p per copy to produce and 22.5p to send, using Mailsort Three, the cheapest form of post. We send it to keep you informed about our latest activities and how your money is spent. Dispatches also gives our patients, staff and volunteers a voice to speak out about the conflicts, emergencies, and epidemics in which MSF works and about the plight of those we strive to help.