LYING on his bed in a Gaza hospital, three-year-old Yamin now sees the world from behind burns which have disfigured him for life.
The tiny boy is just one of hundreds of burn victims and those wounded by Israeli shell fire, overwhelming Gaza’s sole working operating theatre for plastic surgeons.
He also has burns on his back and multiple fractures suffered when an Israeli strike decimated his family and destroyed their home in Al-Buraj, central Gaza, last week.
It was the evening – the start of Eid al-Fitr, the festival marking the end of the Muslim holy month of Ramadan.
In a single strike, the house was turned to rubble and 19 people lay dead. Yamin, miraculously, was the sole survivor but he was left an orphan and badly burnt.
He was taken to a clinic then rapidly transferred to the burns department at the Shifa hospital in Gaza, where he cries, lying naked, and where a handful of surgeons are now confronted with the endless horrors of the war.
Every day ambulances rush in with shattered lives: charred or bloodied humans who will die a few hours later on their stretchers.
The survivors transfer to an operating table, sometimes the modest one in the burns unit, the only one in the whole of Gaza that plastic surgeons can use.
Local medics say 1,829 Palestinians, mostly civilians according to the UN, have died since the latest confrontation between Israel and Hamas began on July 8th. At least another 9,000 have been hurt, many seriously.
‘There are very few light injuries in this war,’ says Ghassan Abu Sitta, a plastic surgeon from the American University of Beirut who a week ago was sent by the Medical Aid for Palestinians (MAP) organisation to help out in Gaza.
‘My feeling is around 70% would have some kind of permanent deformity, either in terms of scarring or in terms of functional deformity . . . They will never be the same again.’
His worst case? ‘An eight-year-old boy who basically lost half of his face including one eye and lost the other eye with shrapnel in. What I needed to do is reconstruct the face just to cover the wounds.
‘The eyes are lost. He lost all his family – his ability to care for himself has been completely destroyed. There is no future for him, he keeps asking why they have turned the lights off,’ Dr Abu Sitta says.
‘The size and the magnitude of the carnage that has affected Gaza is beyond the capacity of any health system, let alone a health system that has struggled with eight years of siege,’ says the surgeon, who was also in Gaza during Israel’s ‘Cast Lead’ operation at the end of 2008 and start of 2009.
This time the fighting has caused more deaths and more wounded – and worse injuries.
‘The fact that we are unable to evacuate patients outside Gaza means that all of these patients are inside the system,’ the surgeon says.
Then he turns away to perform a skin graft on a young man with a pierced foot and 10 centimetre (four inch) crater on his calf, through which his tibia is visible.
For the past month, every day brings deliveries of bodies, wounded people and trauma to Gaza’s hospitals.
‘We are now looking at a health and humanitarian disaster,’ James Rawley, UN humanitarian co-ordinator for the Palestinian territories, said at the weekend.
A third of hospitals have been hit during the fighting and the violence has prevented nearly half of medical staff from reaching the clinics and health centres that are still standing.
‘The current state of the health system is disastrous because the people are exhausted, many hospitals have been affected by the bombardments, and people are afraid to go to hospital,’ as sometimes shooting is taking place along their route, says Nicolas Palarus.
The head of operations in Gaza for Doctors Without Borders added that Palestinian medical staff, the backbone of the local health system, face ‘stress from the fighting, being far from the family, separated, widespread fatigue, lack of some medicines.
‘From primary healthcare to the big hospitals, the whole chain is disrupted. The system is in a catastrophic state,’ Palarus says.
According to the United Nations Children’s Fund, UNICEF, about 300 children have been killed since the start on July 8th of Israel’s offensive against Gaza.
Those who are still alive try not to internalise too much the violence they have experienced, seen and heard.
But ask any child in the strife-torn Palestinian enclave to do a drawing and the resulting picture is likely to be a house being bombed by a fighter plane.
UNICEF estimates that 326,000 minors in Gaza are suffering from the trauma of war and are in need of psychological help but resources to meet this demand are scarce.
At a school in the northern town of Jabaliya which has been converted into a refuge, specialist teachers hand out paper and coloured crayons to a motley band of shaken up children, asking them to draw whatever is in their head.
Jamal Diab, a nine-year-old with red flecks in his brown hair, draws his dead grandfather. Under the drawing, he writes in Arabic: ‘I am sad because of the martyrs.’
‘A few days ago, aircraft bombarded our house. We had to leave quickly and leave everything behind. It was dangerous,’ the lad breathes timidly as he shows his drawing.
Tiny seven-year-old Bara Marouf shows a drawing of his grandfather without any legs. He was seriously wounded in an air strike.
In the classroom, the same sketch comes up repeatedly: an aircraft filling the sky and bombarding a house, subtitled with the caption ‘I want to go home’.
‘Who is afraid of aircraft?’ the teacher asks the children sitting in a circle on a mat.
Immediately little hands push towards the sky and high-pitched voices clamour: ‘Me’, ‘me’, ‘me’. Me, I’m afraid of missiles and planes. Half our house was destroyed. We left it to come here,’ explains Itimad Subh, an 11-year-old girl with sparkling eyes.
Inside the school, groups of youths attend half-hour sessions one after the other. The two teachers, patient and exhausted, their faces enclosed in a tight veil, ask the children to jump on the spot and call out, then to wave their arms like someone disco dancing, to expel accumulated black thoughts, frustration and stress.
‘The children have all lived extreme experiences,’ says Dr Iyad Zaqut, a psychiatrist who manages the United Nations community mental health programmes in the Gaza Strip.
‘It is very difficult for children to grasp what is happening, why their life is at risk, why they have to leave their homes, why they have to resettle, why they witness very traumatising scenes,’ Dr Zaqut said.
‘To prevent children from processing and thinking about all these issues, we try to distract them, to help them live some joy, to have a little fun inside the shelter. Generally, when they are exposed to traumatic events, the way they perceive the incident can be very distorted.
‘They might blame themselves, they might blame their neighbours and this blaming is very harmful,’ the psychiatrist said. We try to reprocess these distorted ideas,’ he explained, noting that he has diagnosed cases of post-traumatic stress and adolescent depression.
But it is hard to make much progress with the therapy. In the Gaza Strip, 460,000 people – more than a quarter of the population – have been displaced by the fighting and have gone to stay with relatives or found refuge at UN shelters.
Fewer than 100 specialist teachers are ‘treating’ more than 100,000 children. Only in exceptional cases do the children have access to one-on-one meetings with psychologists and psychiatrists. And even fewer get a follow up.
Gaza has been in the firing line of military operations in 2008-2009 and again in 2012 but the consequences have been greater during this current war between Israel and Hamas.
The children and adolescents sheltering in the UN centres can at least attend the group classes
But hundreds of thousands of others affected by the war are left to wander unhelped through devastated neighbourhoods.
Back at the burns unit at the Shifa hospital, medical workers paint an antibacterial ointment onto little Yamin, naked, frail and frightened. It will help his skin scar over. But his cousin and her husband, now his guardians, interrupt.
Maybe the best thing for the tiny tot, they say, would be to evacuate him from Gaza – to get him far away from the horrors of the war.