\n<\/p>\n
I<\/span>n Gaza\u2019s Nasser hospital, Mahmoud* lies with a gunshot wound to his left leg. His knee is shattered and the wound has become infected. The boy is writhing in pain but the doctors don\u2019t have the painkillers to ease his suffering. He is given a nerve block, which stops him from feeling anything, and the relief allows him to sleep for a while. But once that wears off, the agony returns.<\/p>\n More than 167,000 Palestinians have been injured in Gaza since 7 October 2023, according to Gaza\u2019s health ministry. From burns and blast wounds to lost limbs and fractured bones, Gaza\u2019s hospitals have been overwhelmed by patients in profound pain.<\/p>\n But a desperate shortage of drugs means there is little doctors can do to help. Treatment and operations need to be carried out without proper anaesthetics, and what painkillers there are have to be rationed.<\/p>\n According to analysis by The Bureau of Investigative Journalism (TBIJ), more than half of the WHO\u2019s medical missions into Gaza since January 2024 \u2013 including the delivery of medicines and fuel for hospitals, the deployment of staff and patient evacuations \u2013 have been denied, delayed, impeded or cancelled.<\/p>\n Meanwhile, Israeli forces have bombed storage facilities and hospitals, while international convoys of medical supplies are routinely blocked from entering Gaza or face weeks of delays at the border.<\/p>\n TBIJ spoke to eight doctors in Gaza who described the dire shortfall in pain relief drugs including opioids, anaesthetics, and even paracetamol.<\/p>\n \u201cMost injuries are amputations or open fractures,\u201d says orthopaedic doctor Abdelkareem Alsalqawi. \u201cThese are severely painful and require 24-hour painkillers. [But now] we tell them: one injection per day \u2026 use it at night so you can sleep.\u201d<\/p>\n In July, the Israeli prime minister, Benjamin Netanyahu, said the country would be allowing \u201cminimal humanitarian supplies\u201d to enter Gaza. But aid agencies and doctors working in the territory report a near-total collapse of the medical supply chain.<\/p>\n \u201cIt is very clear that since March, we have spent months without allowing anything to enter,\u201d says Dr Randa Abu Rabe of the WHO\u2019s office for the occupied Palestinian territory. \u201cIt is not only the medication: it is the reagent, the diagnostics, some of the instruments or equipment.\u201d<\/p>\n <\/span>A patient is treated at al-Shifa hospital in Gaza City this month. There is a lack of medical equipment as well as acute shortages of pain relief medication. <\/span> Photograph: Anadolu\/Getty Images<\/p>\n The Israeli government\u2019s Coordinator of the Government Activities in the Territories (Cogat) says: \u201cIsrael allows and facilitates the entry of medical equipment and medicines, subject to prior coordination. As evidence, in recent weeks alone, more than 3,500 tons of medical equipment have been transferred.\u201d<\/p>\n This is disputed by aid groups and doctors experiencing acute shortages. They say shipments are delayed for weeks or months at the border and requests are ignored.<\/p>\n If they\u2019re in pain but it\u2019s not a catastrophic injury, they often won\u2019t get anythingDr Travis Melin<\/p>\n Israel has never published a definitive official list of barred items but circulates shifting lists to international agencies.<\/p>\n Tania Hary, director of the legal centre Gisha, says shortages are aggravated by the collapse of secure delivery systems inside Gaza.<\/p>\n \u201cIn addition to restrictions [at the border], the breakdown in public order and looting has created barriers to getting aid in, including expensive and sensitive items like medicines and medical equipment,\u201d Hary says. \u201cThe lack of availability cannot always be pinned neatly on restrictions at entry, but rather on barriers to distribution created by a host of factors \u2013 almost all of which can be traced to Israel\u2019s conduct of the war and its policy on access.\u201d<\/p>\n Travis Melin, a visiting US doctor in Gaza, says he is unable to understand the rationale behind drug restrictions. \u201cOpioids are purely compassionate, they have no purpose other than compassionate care,\u201d he says. \u201cThey don\u2019t help you live longer, they don\u2019t make you more likely to survive your injuries, they have no mortality benefit.\u201d<\/p>\n Opioids have become tightly rationed. Doctors describe reducing patients to a single injection a day, leaving pain unalleviated for hours on end.<\/p>\n skip past newsletter promotion<\/p>\n Sign up to Global Dispatch<\/span><\/p>\n Get a different world view with a roundup of the best news, features and pictures, curated by our global development team<\/p>\n Privacy Notice: <\/strong>Newsletters may contain information about charities, online ads, and content funded by outside parties. If you do not have an account, we will create a guest account for you on theguardian.com to send you this newsletter. You can complete full registration at any time. For more information about how we use your data see our Privacy Policy. We use Google reCaptcha to protect our website and the Google Privacy Policy and Terms of Service apply.<\/span><\/p>\n after newsletter promotion<\/p>\n In operating rooms, morphine, normally administered as a single sterile vial per patient, is so limited that doctors must treat several people from the same vial \u2013 a practice that carries infection risks.<\/p>\n Many opioids are classed as essential medicines by the WHO and their absence, doctors say, leaves patients and medical teams without the most reliable tools for managing acute pain and for allowing surgeons to work.<\/p>\n Gaza doctors often rely on ketamine, an anaesthetic with hallucinogenic effects, which they call a \u201cbattlefield medication\u201d.<\/p>\n \u201cIf someone came in with an amputation, they would get an IV and then a dose of ketamine. It lasts about 45 minutes,\u201d says Melin. \u201cBut giving it as a single dose, with the workforce here, is not feasible. And you can\u2019t keep people [dosed with ketamine]. They can\u2019t stand up, they can\u2019t walk around, they can\u2019t interact. So that\u2019s not a safe option either.\u201d<\/p>\n When it is available, doctors carry syringes pre-filled with ketamine for \u201cmass casualty\u201d events, when shelling brings in waves of patients, to inject small doses so that doctors can attend to them.<\/p>\n Patients frequently emerge hallucinating or terrified. And it wears off.<\/p>\n \u201cPatients come into the ER and may or may not get a dose of ketamine. If they\u2019re in pain but it\u2019s not a catastrophic injury, they often won\u2019t get anything,\u201d says Melin. \u201cFor a severe injury or a procedure like inserting a chest tube, they\u2019ll probably be given ketamine. But for something like a simple gunshot wound, most people are just toughing it out.\u201d<\/p>\n Asked to comment, the Israeli government spokesperson said the Israel Defense Forces \u201cwill continue to act in order to facilitate medical care and the ongoing operation of medical institutions in the Gaza Strip, in cooperation with international aid organisations\u201d.<\/p>\n","protected":false},"excerpt":{"rendered":" In Gaza\u2019s Nasser hospital, Mahmoud* lies with a gunshot wound to his left leg. His knee is shattered and the wound has become infected. The boy is writhing in pain but the doctors don\u2019t have the painkillers to ease his suffering. He is given a nerve block, which stops him from feeling anything, and the<\/p>\n","protected":false},"author":1,"featured_media":24579,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[51],"tags":[918,542,5761,1123,2013,1527,364,1050,9142,14903,14150],"class_list":{"0":"post-24578","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health","8":"tag-development","9":"tag-drugs","10":"tag-gazas","11":"tag-global","12":"tag-leaves","13":"tag-pain","14":"tag-people","15":"tag-relief","16":"tag-shortage","17":"tag-toughing","18":"tag-wounded"},"_links":{"self":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts\/24578","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=24578"}],"version-history":[{"count":0,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts\/24578\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/media\/24579"}],"wp:attachment":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=24578"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=24578"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=24578"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}