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When I sat in the Frontline Club on Wednesday listening to a great panel, I thought of Dima who had lost both arms in an explosion. Dima was one of the first Ukrainian soldiers fitted with a Koalaa soft prosthetic. It took less than half an hour fit both arms and straightaway he was able to feed himself for the first time in months—proof that innovation can deliver in the toughest conditions when traditional clinical models fail.
But I also thought of a cricket field in Yorkshire. In August 2021, our small team fitted prosthetic arms to over 30 children in a single morning at Cawthorne Cricket Club. We worked from a tent with no power, no water, no clinical facilities—just a few kit bags the size of shoe bag, each containing everything needed to fit three children. By lunchtime, every child was playing cricket with their new prosthetic. That morning taught us something profound: accessibility isn't just about technology—it's about reimagining how, where, and when we deliver care.
The Scale of What We're Missing
The statistics from Gaza are staggering: at least 4,000 children are known to have lost limbs, and, with 10-15 new cases daily, the true number is estimated at three or four times higher. Without Restoring Hope almost all of these children would have no chance of receiving the prosthetic limb they need until months or years after the end of the war. Such delays of months or years aren't just unacceptable—they're devastating to a child's neurological and psychological development. But Gaza isn't unique in its challenge; it's unique in its visibility.
In Sierra Leone, most upper limb amputees never reach one of the country's four prosthetic clinics due to cost and distance. In Syrian refugee camps, children grow up believing prosthetics are for other people, in other places, with other resources. Even in the UK, before Project Limitless, the NHS reported 70% abandonment rates for traditional prosthetics—evidence that our delivery models, not just our technology, needed fundamental rethinking.
What We've Learned from Five Continents
Our programmes across Syria, Ukraine, Thailand, Cambodia, Lebanon, and Sierra Leone have taught us that innovation without accessibility is privilege, not progress. The ICRC's decision to add Koalaa prosthetics to their global catalogue for 45 countries validates something we've witnessed repeatedly: soft-shell technology can transform not just individual lives, but entire care paradigms.
When Physicians Across Continents fitted nearly 100 Syrian refugees with our prosthetics, we discovered that hands-on training delivered face-to-face was more effective than online support. When H&I staff learned to fit new wearers in under 20 minutes during refugee camp training sessions, we realised speed and simplicity weren't compromises—they were requirements.
Most importantly, when Ukrainian veterans started wearing Day One sleeves immediately after amputation—going over dressings and adapting to volume changes—we understood that the traditional timeline from injury to independence could be revolutionised. After all, if even frail elderly people are expected to stand on a new hip on the day of the replacement surgery, and, if people who have had much of their bowel removed by a surgeon are expected to be on a full diet from breakfast the day after, why should someone not get straight back to upper limb functionality immediately after an amputation?
Beyond Technology: The Coalition Imperative
At the Frontline Club, I watched something remarkable unfold. Professor Shehan Hettiaratchy from Imperial College spoke about research rigour. Save the Children's Sarra Ghazi emphasised psychosocial support. Veterans David Henson and Stuart Croxford brought lived experience. Edward Hall shared operational realities from Gaza. Nicholas Mellor painted the strategic vision.
None of us alone can solve what the panel called "a generational crisis." But together—combining Koalaa's rapid-deployment prosthetics with Imperial's research excellence, Restoring Hope's field operations, Save the Children's global reach, and the wisdom of veteran communities—we might achieve something unprecedented.
This isn't about corporate social responsibility or philanthropic gestures. This is about recognising that the child amputee crisis in Gaza, Syria, Sudan and beyond demands that we find ways to work outside traditional clinical settings, and to prioritise speed and dignity over perfectionism. As a rule of thumb it costs about $1,000,000 to set up a traditional prosthetic clinic and, without this up-front investment, not a single amputee can be fitted with a prosthetic and get on with their lives. The equivalent infrastructure cost to get going with Koalaa’s ‘clinic in a bag’ is $15 to cover the bag, a pair scissors, a measuring tape and a screwdriver – training takes half a day, not several years and few cases are complex enough to require a clinician to do the fitting.
A Call to Our Industry
To prosthetic companies still designing for Western clinical settings: the future is in refugee camps, field hospitals, and cricket pitches. To researchers focused on high-end functionality: children need prosthetics they can put on themselves and that can be adapted to grow with them. To humanitarian organisations working in silos: collaboration isn't compromise—it's multiplication of impact.
The vision of a coalition emerging from LSN’s event at the Frontline Club in London isn't asking us to choose between innovation and accessibility, between quality and speed, between research and implementation. It's asking us to refuse those false choices entirely and work together towards optimising outcomes.
When a child in Gaza finally receives a prosthetic that fits properly, grows with them, and restores their ability to play, learn, and dream—that child won't care which organisation designed it, funded it, or delivered it. They'll care that someone, somewhere, decided their future mattered enough to innovate beyond the boundaries of traditional thinking.
Project Limitless proved we could reach over half the upper limb amputee children in the UK without a single clinic visit. Our global programmes have shown the model scales from Yorkshire to Yemen, from Cambodia to Cameroon.
The question isn't whether we can transform prosthetic care for conflict-affected children globally. The question is whether we have the collective courage to take that first step—and the resilience to keep innovating until every child who has lost a limb has access to the products and services to live a full life again. Join us.
Ewan Phillips is CEO of Koalaa, creators of soft upper limb prosthetics serving children and adults across all continents through programmes including Project Limitless, and partnerships with ICRC, Physicians Across Continents, and humanitarian organisations worldwide.
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