The Impact of Structural Ableism on Child Amputees in Gaza

Disability scholarship and activism teach us that people with disabilities (PWDs) can experience suicidality, self-harm, trauma, and distress due to structural ableism.

Structural ableism encompasses physical barriers, social norms, and paternalistic attitudes that stigmatize disability. The concept also extends to systemic or institutional laws and policies that discriminate overtly, or simply favor able-bodiedness, neurotypicality, or lack of chronic illness.

A general example of structural ableism — according to the American Counseling Association’s Disability-Related Counseling Competencies — is when “ignorance about or prejudiceagainst disability tend[s] to influence authorities and others to make discriminatory decisions, either conscious or unconscious, that limit opportunities for PWDs within the social, familial, vocational, housing, and healthcare environments.”

The “unconscious” aspect is relevant to situations when politicians and diplomats seem to render people with disabilities an afterthought in policymaking, especially amidst war.

Currently, this seems to be the case for Gazan civilians, who, since 2023, have been caught in the crossfire between Hamas and the Israeli government, enclosed with no escape route.

Along the Israel-Gaza perimeter, for instance, barbed wire and a 325-foot no-go zone make it physically impossible to evacuate as a refugee with disabilities. Legal barriers also exist, given that Israel and Egypt have instituted blockades preventing Gazan-operated flights, ships, or caravans from relocating refugees abroad via air, land, or sea. These blockades also complicate importing prosthetics, mobility aids, and assistive devices.

Further, Amnesty International and Human Rights Watch reported that Israel has indiscriminately attacked Gaza repeatedly, resulting in war crimesand crimes against humanity, war methods “consistent with genocide,” famine, high casualties for journalists and aid workers, 697 attacks on medical infrastructure, and a disability crisis.

Consequently, Gaza now has “the highest number of child amputees per capita in the world,” according to the UN, OCHA, and UNICEF. More than 10 Gazan children lose one or both of their legs every day.

The Trauma of Child Amputees in Gaza

Shaza, a 7-year-old Gazan amputee, shared, “My father asked (me) to join him for a walk, before shells began falling on us like rain. One hit my leg and cut it off, and another hit my father’s arm…I became dependent on my mother. She does everything for me. My life is worse than before. Before I was injured, I could play.”

Her father commented that the extended wait for a prosthetic leg from abroad has worn on Shaza’s mental health, saying, “There are no artificial limbs in Gaza, and the only solution is to go for treatment outside Gaza. The girl has grown impatient, asking many questions, and she cries every day. She wants to feel a bit normal.”

Yet Shaza’s father cannot answer her questions with any honest reassurance, since the surge in child amputees does not seem to have expedited the timeline for a ceasefire deal. Even worse, this neglect, if prolonged, may engender learned helplessness, a common trauma response among children of war.

This real-life example demonstrates how structural ableism is about more than personal reactions to stigma. It also concerns laws and policies that dictate the timeline, terms, and options of one’s survival plan, often without any sense of urgency.

Relatedly, a scarcity of medical infrastructure drives childhood trauma.

Four-year-old Gazal, for example, had her left calf pierced by shrapnel. A doctor cauterized the wound’s profuse bleeding with all that was at their disposal, a kitchen knife, without any antiseptic or anesthesia.

We can presume this procedure traumatized Gazal, considering that holding down a typical 4-year-old who is afraid of a vaccination needle can result in medical trauma and, more specifically, there are higher rates of PTSDamong amputees who have experienced major burns.

Sealing the wound with a burn was supposed to be the end of it, until gangrene set in. Then, what could have been a less damning wound escalated to amputation above the hip. This is the case for many Gazan children who undergo otherwise preventable amputations to avoid ill-tended wounds spiraling into bacterial infection, blood poisoning, or inflammation.

Gaza’s precarious medical infrastructure — 94% of hospitals have been destroyed, along with Gaza’s only prosthetics manufacturer — also increases the risk that child amputees are re-traumatized by chronic pain due to substandard care post-surgery. Sadly, at least 41% of amputees are at risk for PTSD, and chronic pain following surgery is associated with anxiety and depression in children and adolescents.

Ghassan Abu-Sittah — author of The War Injured Child and a doctor who performed as many as 6 amputations per day in Gaza — says each amputation usually requires 8 to 12 subsequent surgeries. Additionally, “child amputees need medical care every six months as they grow.” This degree of follow-up care is impossible in much of Gaza, yet research associates suicidality with child amputees who are denied continuity of care.

So, child amputees simply wait as patiently as they can for a ceasefire deal.

As time passes, adults search for age-appropriate language to guide child amputees through grieving their stolen autonomy and innocence, and to discuss body image issues that correlate with post-traumatic limb amputation.

“How many days, Mom, until my hand grows back?” asked 6-year-old Sidra, who was wounded in a bombing at Gaza’s Nuseirat shelter, according to the UNRWA.

As research shows, innocent questions like these illustrate how experiencing amputeeism can outstrip a child’s capacity to reason, self-regulate, and develop resilience. The basic criteria for trauma — “too much, too soon, too fast,” or “not enough for too long” — undoubtedly applies here.

On top of their physical disabilities, child amputees in Gaza are also struggling to process the psychological trauma of the war itself.

Salsabeel Zaeid, a Qatari psychologist working with child amputees from Gaza, stated that the children suffer from “depression, anxiety, trouble concentrating, restlessness, nausea, trouble sleeping, anxiety attacks, hopelessness” — standard PTSD symptoms. Some of the children are even “guilt-ridden,” suffering from survivor’s guilt.

Psychiatrist Yasser Abu-Jamei, who lives in the Rafah refugee camp and heads The Gaza Community Mental Health Programme, saidthat a collective mental health crisis forced G.C.M.H.P to resume services after an initial suspension due to safety concerns.

Now, the program floats around Gaza’s 8 refugee camps, helping children identify nearby places that are safe. In glaring the absence of hideouts and secure shelter, that often looks like encouraging the children to creatively imagine safe havens just to self-regulate a little longer, until a ceasefire finally comes.