Trauma care supported through a global telemedicine initiative during the 2023-24 military assault on the Gaza Strip, occupied Palestinian territory: a case series.

BACKGROUND

Hospitals, patients, and health-care workers are legally protected by international humanitarian law and the Geneva Convention. However, since Oct 7, 2023, the health-care system in the Gaza Strip, occupied Palestinian territory, has been under unprecedented direct military attacks by Israel, with support for patients proving to be challenging for the remaining health-care workers. Peer-to-peer telemedicine holds promise for assisting surgeons in high-risk, low-resource environments, but might be of reduced utility in extremely austere settings.

METHODS

We present a patient case series of traumatic injuries shared in an international telemedicine group by the surgical team at Nasser Medical Complex, also known as Nasser Hospital, the largest remaining partially functioning hospital in Gaza. WhatsApp (Meta; Menlo Park, CA, USA), a widely available and user-friendly end-to-end encrypted smartphone application, was used to facilitate consultations for weapon-inflicted injuries. All the presented patient cases were shared after obtaining verbal consent from the patients and discussed through a multidisciplinary team approach. The group was developed into a community with more than 15 specialty and injury-oriented subgroups and over 1000 members who joined through non-targeted social media outreach followed by snowball recruitment. Prospective registration and formal ethics approval in Gaza was impossible because the Ministry of Health, including the local Helsinki Committee, had suspended all operations. In June, 2024, we obtained ethics approval from the local Helsinki committee in Gaza.

FINDINGS

We present 12 select patient case studies from a pool of hundreds of patients admitted to Nasser Hospital between Jan 28 and Feb 12, 2024. Four (33%) of the 12 patients were female and eight (67%) were male, with four patients (33%) being children (younger than 18 years). The age range was between 3 years and 70 years, with a median age of 25 years. Most patients presented with penetrating injuries (11 [92%] of 12), with six patients presenting with wounds secondary to fragment injury, and five patients presenting with wounds due to gunshots. One patient presented with a direct blast injury. The site of reported injuries included head and neck areas (four [33%] of 12), abdomen (four [33%] of 12), chest (three [25%] of 12), pelvis (two [17%] of 12), and limbs (one [8%] of 12). Most patients were lost to follow-up (11 [92%] of 12) and were affected by the invasion of the hospital by the Israeli Defense Forces, which subsequently rendered the hospital non-functional. One patient died following their injury.

INTERPRETATION

The health-care team at the now non-functioning Nasser Hospital in southern Gaza adapted their allocation and distribution of extremely low resources and relied on smartphones for specialised telemedicine outreach purposes. This enhanced the capability of the medical teams in management of mass casualties of military assaults that few are trained to work in. Nonetheless, the options available to a health-care system that is under-staffed, under-served, and under siege, are extremely constrained, regardless of such telemedicine initiatives.

FUNDING

None.

Informations de copyright

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Déclaration de conflit d'intérêts

Declaration of interests OA studied medicine in Gaza and subsequently worked in many of its hospitals, including Nasser Hospital and Shifa Hospital. After he left Palestine, he co-founded OxPal 2.0 to support medical education in Palestine through partnership with consultants from the University of Oxford, Oxford, UK, and other medical schools in the UK and the USA. MGi has been a researcher in Gaza since 2009; has had papers and abstracts with The Lancet and other journals on medical and medico-legal topics; and two books on medical conditions in Gaza published. He is a member of the Lancet Palestinian Health Alliance (LPHA; a network of Palestinian, regional, and international researchers who are committed to the highest scientific standards in describing, analysing, and evaluating the health and health care of Palestinians, to contributing to the international scientific literature, and to developing local evidence-based policy and practice), and has served as a peer reviewer for submitted papers to the annual LPHA meetings. All other authors declare no competing interests.