Disturbing medical findings in war-related traumatic amputation patients: a clinical descriptive study from Gaza

Abstract

ObjectivesThe aim of this study was to explore possible long-term negative health effects of injuries sustained by modern weaponry.SettingThe study was conducted in Gaza’s main hospital, Al-Shifa Hospital.ParticipantsDuring 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.ResultsNine 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.ConclusionNearly 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.

The Beirut ammonium nitrate blast: A multicenter study to assess injury characteristics and outcomes

“…Similar to explosion events occurring indoors such as the Texas Fertilizer Plant Explosion, shattered glass and flying particles resulted in a higher number of facial and open globe injuries 23 . These trends are also seen in war-dominant regions, where debris and shrapnel-related injuries are the most commonly reported injury mechanism 24 . While the types of fragments were not reported in medical charts explored in the study at hand, different materials can lead to complications in soft tissue, and injury management largely depends on the type of metals, bacteria, and other materials penetrating the damaged soft tissue 25 …”

“…23 These trends are also seen in war-dominant regions, where debris and shrapnel-related injuries are the most commonly reported injury mechanism. 24 While the types of fragments were not reported in medical charts explored in the study at hand, different materials can lead to complications in soft tissue, and injury management largely depends on the type of metals, bacteria, and other materials penetrating the damaged soft tissue. 25 The study results corroborate the implication of multiple forces in the debilitating effect of the blast, whereby the majority of mortality cases sustained multiple primary, secondary, tertiary, and quaternary forces.…”

“…14 Its validity and discriminatory ability have been replicated in various populations. 15,16 There is evidence for analytical advantages of the ISS as a categorical variable; 14 hence, it was categorized into minor (1-8), moderate (9)(10)(11)(12)(13)(14)(15), severe (16)(17)(18)(19)(20)(21)(22)(23)(24), very severe (25-49), critical (50-74), and not survivable (75). 17…”

The geontological time-spaces of late modern war

“…This exchange is indicative of not only contested truth claims but also of a domain of knowledge whose power issues from absented information. As Skaik et al (2010: 1) stress, in the treatment of war’s wounded, it is the ‘ undisclosed ’ nature of materials used in weapons’ manufacture that presents ‘difficulties with clinical management’ and thus exacerbates ‘ unknown long-term risks’ (emphasis added; see also: Heszlein-Lossius et al, 2020). That is, the absented information – or ‘anti-transparency stance’ on the toxicity of munitions (Logan, 2018: 257) – built into a military-dominated knowledge economy impedes health provision (Zwijnenburg, 2013; Zwijnenburg and Weir, 2016).…”

“…The deployment of the bombs is secretive, but it is widely reported that IDF jets dropped DIME during its 2006 and 2008–9 assaults on Gaza (Al-Haq, 2014; JoPS, 2009), causing instant effects such as dissolved limbs that confounded medical specialists and were the subject of high-profile calls for further research in the British Medical Journal (Dyer, 2009) and The Lancet (Wolf et al, 2009). Of subsequent concern has been the indication that the effects of DIME might be just as devastating in the long-term: it ignites through a process of fission, making residues potentially radioactive (DemocracyNow, 2009); exposure to weapons-grade tungsten is connected to lung metastases, polycythaemia, and a form of muscular cancer called rhabdomyosarcoma (Kalinich et al, 2005; Schmidt, 2005); and DIME deposits specifically have recently been linked to hepatic steatosis, or fatty liver (Heszlein-Lossius et al, 2020; forthcoming). A team of doctors is currently examining the effects of DIME in Gaza but not without difficulty, as one of its senior physicians explained in personal correspondence: “it’s almost impossible to do research in Gaza, Israel doesn’t allow you to take out any biological material and the facilities aren’t there to do analysis in-country because Israel won’t allow equipment to be imported”.…”