Within a few months, the war in Gaza had already made its own addition to the vocabulary of emergency medical assistance with the world’s most heartbreaking acronym: WCNSF, “wounded child, no surviving family”.
Over two years of bombardment and famine the problem has worsened, even though in the constant chaos created by Israeli bombing and evacuation orders, which fragment communities and scatter them around the Gaza Strip, it is hard to keep track of children separated from their families.
The UN’s child protection agency, Unicef, cited Gaza health ministry statistics from early September, recording 2,596 children who had lost both parents, and a further 53,724 who had lost either their father (47,804) or mother (5,920).
There is no data on how many parentless children have also been wounded, but, even as the first phase of a ceasefire deal to end the long war was agreed on Thursday, Gaza has the highest rate of child amputations of any modern conflict.
On 13 August, a three-year-old girl, Wesam, was asleep with her five-year-old brother, Zuheir, her pregnant mother, Nour, her father, Moatassem, and her grandparents, when the family house in Gaza City was bombed. Wesam was the only survivor, but sustained serious wounds to her leg and abdomen, including a lacerated liver and kidney, and severe psychological trauma.
Unicef said she was in “urgent need of medical evacuation abroad for advanced treatment, particularly to save her left leg from the risk of amputation”.
The Israeli onslaught on Gaza has left thousands of children like Wesam in its wake – alone and often critically wounded. There are so many such children that overworked trauma surgeons simply scrawl WCNSF on their files.
“It is the first conflict that such a term was needed,” said Kieran King, the humanitarian head of War Child, a UK-based charity and one of the organisations trying to protect and care for wounded orphans in Gaza. “It was born out of the emergency medical teams, people who have worked across every conflict since forever, and coined this term WCNSF because they’d never had to deal with the child protection challenge on this scale.”
Children in Gaza have been growing up amid the sound of bombing for two years. Photograph: Anadolu/Getty
Jacob Granger, an emergency coordinator for Médecins Sans Frontières now in Deir al-Balah, southern Gaza, said wounded children were being brought to MSF field hospitals without family members all the time.
Granger said: “We try to stabilise their situation and treat their wounds, but after treating someone, often there is no stability whatsoever for that person.
“It’s not like there is a social fabric or social institution that is able to support children. There’s a community mechanism, people who take care of children who have lost their parents, or there are other agencies who can try to find the family, if there is someone that’s left, or an institution that could shelter orphans, but it’s a drop in the ocean.”
A child boiling water in an accommodation centre in Khan Younis. Photograph: Anadolu/Getty
Unicef said it provided “short-term emergency care to children at high risk – lost, orphaned, and separated children – to provide immediate safety for children after an incident, while social workers trace family members who can provide long-term care for a child.”
War Child is one of a small number of humanitarian organisations that get calls from the emergency clinics about WCNSF cases, and its social workers comb the displaced camps looking for unaccompanied children then try to match them with people in the camps who are prepared to look after them.
Among the children in one of the community centres supported by War Child is 13-year-old Radeh, who witnessed her mother being killed by a sniper, having already lost her father in the war.
“This left her with symptoms of shock, including being withdrawn and anxious, as well as suffering from headaches, stomach pain, nightmares and anxiety,” a War Child report said, noting that Radeh was receiving support from specialists to “manage overwhelming emotions” and finding some comfort in activities such as drawing.
King said: “In a usual conflict scenario, that would involve relatives, and we would provide follow-up support and make sure that safeguarding was accounted for and assessed.
“That’s often not possible in Gaza, where children often don’t have any surviving relatives, or at least none that can be identified or found, because it is chaos. People are in displacement camps and constantly being forcibly evacuated. In the case of Gaza, you need to find alternative care solutions, and there is a database of families who are willing to take in other children, who could then be assessed and supported and monitored.”
Finding such families is extremely hard when food is in such short supply. Badly wounded children, often with amputated limbs, have little chance of making the trip south in accordance with Israeli evacuation orders issued to the roughly 1 million residents of Gaza City.
Alma Jaarour, 12, who lost her parents and siblings in an attack by Israeli forces on their home in Gaza’s Yarmouk neighbourhood, sheltering in a makeshift tent in Rafah. Photograph: Anadolu/Getty
To find a car that will take a wounded child can cost hundreds of dollars, often in cash, for which you have to pay a premium of about 40% – far beyond the means of most Gaza families. Anyone who remains in Gaza City has been deemed by the Israeli defence minister, Israel Katz, as “terrorists or terrorist supporters”, implying they are legitimate military targets.
Children, and especially boys, are increasingly grouping together for survival, looking in rubbish heaps for anything to eat or sell, or using their strength in numbers to group at food distribution points, an extremely risky tactic reflecting sheer desperation.
Displaced Palestinian children search through rubbish for items that could be used for cooking fuel next to destroyed buildings at the Bureij refugee camp in central Gaza. Photograph: Eyad Baba/AFP/Getty
“There’s a lot of children on the street during the day – whether they still have a family or not is more difficult to assess,” Granger said, noting that the consequences of childhood trauma and the destruction of families are beginning to make themselves clear. “What we see is that the behaviour of these children is abnormally aggressive. So you will find a six-year-old or an eight-year-old boy sometimes yelling at our car as if he was an angry 40-year-old man.”
The mental harm inflicted on this generation of children in Gaza is incalculable, even for those who still have a family. Before he was injured, 12-year-old Ahmad Abu Hilal supplemented his family’s tiny income by selling coffee in the sprawling al-Mawasi camp on Gaza’s southern coast.
“He had big ambitions,” his mother, Sabreen Abu Hilal, recalled. “He dreamed of becoming wealthy, buying a Jeep to give me, and becoming a great doctor who could treat the wounded. He also loved football and dreamed of becoming a talented player. He was always working hard to make his dreams come true.”
All those aspirations were ripped apart by an Israeli shell fired into a crowd in nearby Khan Younis, where Ahmad had gone to visit his aunt. Shrapnel tore off the back of one of his thighs.
A child living in an accommodation centre in Khan Younis. Photograph: Anadolu/Getty
“After the injury, Ahmad’s physical and psychological condition deteriorated severely. His health and mental state have been in decline since then,” his mother said. “At first, he was unconscious. When he woke up, he was in shock and in severe pain. He kept crying and blaming himself, asking why he had gone there, even though he had no way of knowing what would happen.”
Ahmad is still reliant on painkillers and needs his wound to be cleaned regularly.
“The doctors said his injury is extremely serious and that he will need a long time to recover,” his mother said. “My biggest fear is that he may never walk again or that his wound will not heal.”
The bewilderment and anguish accompanying serious injury is exponentially greater for children without a family support network.
“Just imagine the mental health impact on a child who, each time they try to walk again, or stand up, which is a reflex, they would recall the moment when they lost their legs and the members of their family,” Granger said. “And this is for the rest of their life, knowing that physically and mentally the prerequisites for overcoming trauma, safety and security are impossible for the people here. Nowhere is safe in Gaza.”