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Original research
Disturbing medical findings in war-related traumatic amputation patients: a clinical descriptive study from Gaza
  1. Hanne Edoy Heszlein-Lossius1,
  2. Anas Ismail2,3,
  3. Yahya Al-Borno3,
  4. Samar Shaqqoura3,
  5. Nashwa Skaik3,
  6. Iman Al Hinnawi3,
  7. Mahmoud Matar3,
  8. Mads Gilbert1,4
  1. 1The Anaesthesia and Critical Care Research Group, Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
  2. 2Faculty of Medicine, Al-Azhar University, Gaza, Palestine
  3. 3Al-Shifa Medical Centre, Gaza, Palestine
  4. 4Clinic of Emergency Medicine, University Hospital of North Norway, Tromsø, Norway
  1. Correspondence to Dr Hanne Edoy Heszlein-Lossius; hannelossius{at}gmail.com

Abstract

Objectives The aim of this study was to explore possible long-term negative health effects of injuries sustained by modern weaponry.

Setting The study was conducted in Gaza’s main hospital, Al-Shifa Hospital.

Participants During the last 10 to 15 years, thousands of civilian Palestinians in Gaza have survived numerous military incursions, but with war-related traumatic injuries caused by explosive weapons. It is unclear to which extent the injuries sustained by such modern weaponry may increase survivors’ risks of negative long-term health effects and serious illness. We have reported mechanisms and severity of injury, demographics and psychosocial status among 254 Palestinian patients in Gaza with war-related extremity amputations. Among the same amputees, subgroups of patients presented a variety of alarming symptoms and findings. 94 patients received further diagnostic clinical exploration, radiology imaging and clinical chemistry laboratory tests at the main clinical centre in Gaza, the Al-Shifa Hospital.

Results Nine out of ten of the referred patients were young (median 31.5 years) males (88/94, 92.6%). Ultrasound imaging revealed that 19 of 90 patients (20%) had fatty liver infiltration, 3 patients had lung nodules and 10 patients had lung atelectasis on chest CT. Twelve had remaining shrapnel(s) in the chest, five patients had shrapnel(s) in the abdomen and one in the scrotum. We found shrapnel(s) in the amputation stumps of 26 patient’s amputated limbs, while 8 patients had shrapnel in the non-amputated limb. Three patients had liver lesions. Nineteen patients had elevated liver enzymes, 32 patients had elevated erythrocyte sedimentation rate and 12 were anaemic. Two patients tested positive for hepatitis C virus and three were positive for hepatitis B virus (HBV). One of the 19 patients with fatty liver tested positive for HBV. Two of the patients with fatty liver infiltration had elevated glycatedhaemoglobin levels and confirmed diabetes mellitus type II.

Conclusion Nearly half (44, 8%) had remaining metal fragments from explosives of unknown composition harboured in various parts of their bodies. All patients identified with lesions and nodules are being followed up locally. As of now, we cannot anticipate the long-term health consequences of living with metal residuals from modern explosive weapons embedded in body organs and tissue.

  • trauma management
  • health & safety
  • public health
  • accident & emergency medicine
http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors HEH-L contributed study design, data collection, data entry, data analysis, interpretation of the results, the primary draft of the manuscript writing, editing the manuscript, literature search and final approval of the manuscript. AI contributed to study design, patient inclusion, data collection, data transfer, revising the manuscript and final approval of the manuscript. YA-B contributed to study design, patient inclusion, data collection, data transfer, revising the manuscript and final approval of the manuscript. IAH contributed to study design, patient inclusion, data collection, data transfer, revising the manuscript and final approval of the manuscript. MM contributed to study design, patient inclusion, data collection, data transfer, revising the manuscript and final approval of the manuscript. SS contributed to study design, patient inclusion, data collection, data transfer, revising the manuscript and final approval of the manuscript. NS contributed to study design, patient inclusion, data collection, data transfer, revising the manuscript and final approval of the manuscript. MG contributed the original research idea, the study design, interpretation of the results, revising and editing the manuscript and final approval of the manuscript.

  • Funding The Norwegian street-artist AFK provided 1500 Euros to this project, which was used to cover patient’s transportation costs.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval All patients completed written consent prior to participating. The study was approved by the Regional Ethical Committee (approval number: 2016/1265/REK Nord) in Norway and the Committee for Helsinki ethics approvals in Gaza.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data sets used during the current study are not publicly available as the authors did not apply to any ethical committees for the permission to share the data. In this particular context, sharing of data could raise safety concerns for the participants in the study and thus considered unethical.