http://online.wsj.com/articles/israel-hamas-clash-takes-high-toll-on-gazas-young-1406560028

Conflict in Gaza Takes Toll on the Young

With Hospitals Short of Supplies and Equipment, Prospects for Severely Wounded are Gloomy, Doctors Say

By Tamer El-Ghobashy

July 28, 2014

BEIT LAHIYA, Gaza Strip--Mostafa Masood doesn't remember much about the Israeli strike a week ago that left him with severe burns and shrapnel wounds in both legs. The blast knocked him unconscious as he sat with a cousin outside his home on a sweltering evening.

When he woke up, he was in a hospital in the north Gazan city of Beit Lahiya, in pain but grateful his injuries weren't worse.

"It's normal," said Mostafa, 17 years old, with an uneasy smile. "There was a strike and I got hurt." He then paused and reconsidered his words. "It's not normal, but it has become normal."

At least 236 Gazans under the age of 18 have been killed and about 2,000 others wounded during three weeks of fighting between Israel and the Islamic movement Hamas, according to Gaza's Health Ministry.

People under 18 represent about one-fifth of the overall Palestinian death toll of 1,216 as of Tuesday and about half of Gaza's 1.8 million population.

As the casualty toll rises from the third major military confrontation between Israel and Hamas in six years, so does concern about the physical and psychological toll of the conflict on these youth.

The United Nations agency in charge of coordinating aid for humanitarian emergencies said 194,000 young Gazans have suffered wounds ranging from broken bones to severe head injuries and damaged limbs that require amputation. Many have lost relatives and homes, and are in need of psychological care.

"The physical toll is obvious. There will be chronic complications changing these children's lives forever," said Dr. Saeed Salah, a pediatrician at Kamal Odwan Hospital in Beit Lahiya, where Mostafa is receiving treatment. He added: "The psychiatric effect, we won't know for a long time."

Doctors in Gaza said the shock waves and shrapnel from the high-tech bombs and missiles that are used in today's wars are especially destructive in Gaza, where the houses and people are typically packed tightly together.

After Israeli forces entered Gaza on July 17 and added tank and artillery fire to the aerial and naval bombardment, the casualty toll soared. The U.N. Office for the Coordination of Humanitarian Affairs, which also monitors casualties, calculates that one child per hour was killed in Gaza on July 22 and 23.

"These weapons are designed to destroy tanks," said Dr. Ayman Farrah, the chief of emergency medicine at Nasser Medical Center in the southern Gaza city of Khan Younis, scene of some of the heaviest fighting.

Foreign governments and human-rights groups have condemned the high number of civilian casualties, urging Hamas and Israel to accept a cease-fire.

A total of 388 Palestinian children were killed in the two previous Israel-Hamas conflicts, in 2008-09 and 2012, the ministry said.

Fifty-three soldiers and three civilians on the Israeli side have been killed in the current fighting, medical workers in Israel said. Rockets fired by Gaza militants with the explicit aim of inflicting pain and causing disruption to Israeli communities have caused injuries, including shock, to nearly 600 civilians, the workers said.

Israel's military says it uses precision weapons to try to avoid civilian casualties and urges civilians to leave combat areas. Human-rights groups say civilians in Gaza have few avenues to escape heavy aerial and naval bombardment.

Dr. Salah said serious physical injuries to children--and in some instances, the chronic, lifelong complications of those injuries--pose an acute challenge to Gaza's health-care system.

Medical equipment and supplies are in short supply because of Israel's economic blockade on Gaza, and hospitals and clinics simply can't handle the burden of long-term care for amputees and those afflicted with intestinal injuries and brain trauma, he said.

Seven-year-old Maha Sheik Khalil is one such victim. She lay inert in a bed in the pediatrics ward of Gaza City's Al Shifa Hospital, a brace around her neck and her eyes fixed on an open window. She didn't respond to words whispered into her ear by members of her family.

Maha's spinal cord was severed on July 20 when an explosion demolished her family's home in the Gaza City neighborhood of Shujaiyah. She and other family members were trying to escape down a stairwell when the blast went off.

Two of Maha's sisters, aged 3 and 13, were killed in the attack, along with her mother, a grandmother, an aunt and an uncle. A seriously injured 10-year-old sister managed to get on a rare medical convoy to Egypt, where she is receiving treatment.

Doctors hope that Maha's paralysis isn't permanent, so they have hesitated to clean the mud off her feet, fearing the jostling might worsen her condition.

Her surviving relatives say they are awaiting permission from Israel to let her leave Gaza to receive medical treatment in Germany. Due to the fighting, they aren't holding out much hope.

In addition to crippling physical injuries, doctors say the trauma caused by years of conflicts, the violent deaths of loved ones and the destruction of their neighborhoods can drive children to depression and, in some cases, desire for violent reprisal. "Psychologically, these children will be handicapped for the rest of their lives," Dr. Salah said.

For now, Mostafa Masood displays no evidence of psychological trauma. He is looking forward to the start of Spain's soccer season to root for his favorite team, Real Madrid. He said he wants to be a doctor because the job carries prestige. But Mostafa has experienced enough war and bloodshed for doctors here to wonder how it will effect him.

Mostafa was 12 when the windows his home were rattled by Israeli airstrikes during the clash between Israel and Hamas during the winter of 2008-2009. He remembers being terrified but said Israeli attacks since then have made him "used to it." He has seen friends of his killed but said had never really occurred to him that he might be killed, too.

"I'm just a normal citizen," Mostafa said. "What would I do to deserve a bombing?"

He said he can't stop thinking about another 17-year-old. His friend from the neighborhood, Annas Yousef Kandil, was killed by an Israeli strike five days into the conflict.

"I found out on Facebook," Mostafa said.

Write to Tamer El-Ghobashy at tamer.el-ghobashy@wsj.com