Does pain, psychological distress and deteriorated family economy follow traumatic amputation among war casualties? A retrospective, cross-sectional study from Gaza

Heszlein-Lossius, Hanne; Al-Borno, Yahya; Shaqqoura, Samar; Skaik, Nashwa; Giil, Lasse Melvær; Gilbert, Mads

doi:10.1136/bmjopen-2019-029892

Cited by 9 publications

(7 citation statements)

References 21 publications

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“…8 We have previously reported the mechanisms and severity of injury, demographics and psychosocial status among 254 Gazan patients with war-related, traumatic extremity amputations. [9][10][11] The patients we examined during these studies also presented a variety of medical symptoms and findings we could not ignore.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…In the wake of the GMR, a doctor in Gaza explained how the extensive resources required for the reconstruction of injuries were 'entirely beyond the capabilities of Gazan medical services already depleted by the 12-year Israeli siege' (Abu-Shaban, 2018, n.p.). Public health research corroborates these observations, a recent study finding that 'war-related injuries are a significant burden on Palestinian health facilities' (Mosleh et al, 2018, p. 8; see also Heszlein-Lossius et al, 2019a. The trauma pathway for civilians in Gaza is so lacking in resources because of the Israeli siege that acute mass-casualty events place a disproportionately chronic burden on civilian healthcare infrastructures.…”

Section: Extremities Of Violencementioning

confidence: 85%

“…These slow deaths should both count (matter) and be counted, but why should only dead bodies count? What about those who have been wounded or made sick by war, about which there is considerable and growing literature (Dewachi, 2015; Dewachi et al, 2014; Gregory, 2018; Heszlein‐Lossius et al, 2019a, 2019b; Lutz & Mazzarino, 2019; Mayhew, 2017, 2021)? In neglecting wounding, both instant and delayed, Nixon narrows and forecloses the definition of what counts as a war casualty at the very same time as he attempts to broaden the concept.…”

Section: Slow Violence?mentioning

confidence: 99%

Gaza and the Great March of Return: Enduring violence and spaces of wounding

Jones

2022

Trans Inst British Geog

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Palestinians during the GMR, but it had also injured a staggering 33,141 others (WHO, 2020, p.2).Nearly a quarter of those injured⎯over 8,000⎯were shot with live ammunition (UN, 2020).In this paper I argue that the GMR should be understood as a space of enduring violence and wounding and that these concepts can enrich political geography and cognate work on violence, war, and trauma. The paper makes two contributions. First, it offers the concept of enduring violence as a supplement to feminist political geographical work on slow violence (Cahill and Pain 2019;

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“…Previous research has shown that LLA has a signi cant and negative impact on a person's physical, psychological, social and economic wellbeing and that of their family [6][7][8][9][10][11]. Many people with chronic illness experience major nancial strain from the point at which acute medical care commences [12].…”

Section: Introductionmentioning

confidence: 99%

“…While previous studies have identi ed delays in access to rehabilitation in Bangladesh, [4,[24][25][26][27] the domains of the disability and economic and changes in work-role after LLA and their family have not been explored, [6][7][8][9][10][11]. Understanding the functional domains affected by LLA (e.g., mobility, participation, cognition etc.)…”

Section: Introductionmentioning

confidence: 99%

Disability, economic and work-role status of individuals and their families in Bangladesh, post-unilateral lower-limb amputation (LLA) and pre-rehabilitation: a cross-sectional study

Sayeed

Oakman

Dillon

et al. 2021

Preprint

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Background To quantify disability, occupation and socioeconomic status of individuals and their families in Bangladesh, post-unilateral lower-limb amputation (LLA) and pre-rehabilitation. Methods Between November 2017 and February 2018, people with unilateral LLA attending two XXX prosthetic rehabilitation centres were surveyed prior to rehabilitation, using the World Health Organization Disability Assessment Schedule (WHODAS-2.0) with additional socio-economic questions. Data was analysed descriptively, and cross-tabulation conducted with Chi-square test and Fisher’s exact tests. Results Seventy-six individuals participated. The majority had transtibial amputation (61.8%) from trauma (64.5%), were young adults (37.92 ± 12.35 years), in paid work prior to LLA (80%), married (63.2%), male (81.6%), from rural areas (78.9%), with primary/no education (72.4%). After LLA, mobility (WHODAS score 74.61 ± 13.19) was the most negatively affected domain. Most (60.5%) participants did not return to a paid or unpaid occupation. Acute healthcare costs negatively impacted most families (89.5%), and over 80% became impoverished. Nearly 70% of previous income-earners became economically dependent resulting in changes to traditional family roles. Conclusions Following LLA, most participants experienced significant mobility impairment, were unable to return to paid occupation and became economically dependent. The study population presents with many different characteristics from other people with LLA globally, which suggest with timely rehabilitation a return to paid employment is possible. The impact of LLA extends beyond the individual, including to families, many of whom face challenges with changes to traditional primary earner gendered roles. Improved access to timely and affordable rehabilitation is required to reduce the significant personal and societal costs of disability after LLA.

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Does pain, psychological distress and deteriorated family economy follow traumatic amputation among war casualties? A retrospective, cross-sectional study from Gaza

Cited by 9 publications

References 21 publications

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

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

Gaza and the Great March of Return: Enduring violence and spaces of wounding

Disability, economic and work-role status of individuals and their families in Bangladesh, post-unilateral lower-limb amputation (LLA) and pre-rehabilitation: a cross-sectional study

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