Context

Most of the 1.5 million population of the Gaza strip is impoverished.  Half are refugees from Mandate Palestine or their children.  About 50% of the male population is without work.  It has been isolated and occupied for decades.  A commercial port was being built in 2000 but that was bombed by Israel.  The isolation and the hobbling of its commerce was increased by a siege which was started in March 2006 in response to the election of a majority of Hamas members to the legislature.  It was further tightened in June 2007 after the Hamas government pre-empted a coup by the Fatah faction that was led in Gaza by Mohammad Dahlan.

The misery was further deepened with Operation Cast Lead that was unleashed 27/12/08.  This was promised 29/02/08.  "The more Qassam fire intensifies and the rockets reach a longer range, [the Palestinians] will bring upon themselves a bigger shoah (holocaust) because we will use all our might to defend ourselves," said Matan Vilnai  Deputy Defence Minister to Israeli Army Radio.  There was a massive bombardment which killed 220 adults and children in the first 15 minutes.  This was followed by a full scale invasion.  1400 humans were killed and approximately 5000 injured physically.  The minds of very many more were injured too.  4000 homes were totally destroyed, almost all the factories and 40 mosques.  The two gleaming science blocks of the Islamic University  of Gaza were flattened by very powerful thermobaric bombs, the blasts being heard throughout the 360 square kilometres of the Gaza Strip.

The siege has been even more draconian since.  Cement, ballast and steel rods are only let in at about 5% of the rate needed for rebuilding, the pretext being that 'bunkers’ could be constructed.  At the present rate it will take 78 years to rebuild Gaza.  Chocolate, writing paper and all manner of things have been blocked.  The 1000 tunnels at Rafah have provided a way in for goods but in the face of bombing and roof falls.

The lack of any work and the extreme poverty of the large extended families has drawn the boys and men to scavenge for broken concrete ('gravel’) in the evacuated Eli Sinai 'settlement’ and in the industrial zone by the Erez border control post at the northern limit of the Strip.  The factories of the industrial zone have been progressively demolished by Israeli shelling, etc.  They are seen to the west as one enters Gaza through Erez.  A donkey and cart, shovel, pick, sieve, muscles and courage are the tools.  The rubble is used to make cement blocks and poured concrete with the cement that is imported largely through the tunnels.  Many dozens of men and boys do this work for precious shekels in the shadow of manned watch towers and under 'drones’ above.

The 23 boys who have been shot between 26/03/10 (Said H) and 23/12/10 (Hatem S) are listed in the table below with skeletal facts.  These points are made:-

• In 18 there were single shots and not automatic fire;
• The reported range in most cases confirms that the weapon was a sniper’s rifle in the hands of a sniper;
• Almost always there were many dozens of other men and boys at work; these victims were picked off;
• A leg was the target in most cases.  Where the leg was not the target it is likely the sniper was 'aiming up’ so the flank, elbow etc was hit instead;
• No weapons were being borne by the gravel workers so they posed no threat to the Israeli Occupation Force personnel.  Instead they were bending their backs to their menial work within their internment camp;
• The histories refer often to the recovery of the injured boy by friends and relatives under fire. This was a feature during 'Cast Lead’ or instead the paramedics were barred from getting to the victims so they died without care.

The history of the injury and sequel for each boy are linked to in (1).  It has been done meticulously and the translation into English is perfect.  The pain, and often the terror, felt by the boy as the bullet struck home are vividly recorded.  No bullets have been recovered yet so the calibre/type is unknown.

• How many boys will regain full, or nearly full function is difficult to judge without the radiographs being present.  Cases 3, 4, 5, 7, 13 and 15 are likely to have joint involvement and thus some lifelong disability.
• In cases 1 and 3 there is nerve injury.  If that proves to be an axonotmesis in either, it is possible that a first class repair will not be available in Gaza.
• The fractures are open by definition and no doubt comminuted.  Delayed or non-union is possible.  Deep infection is a real risk, antibiotic therapy not withstanding.  The risk of deep infection relates to (a)  the possible inclusion of fabric; (b) the high energy injury causing irregular and wide devitalisation of the tissues; (c) the probability that these difficult bullet wounds were not laid open and a complete wound toilet performed.  One or two of these boys might end with an amputation.
• Almost all the boys have been frightened off or forbidden from gravel work.  There are few, if any, other means of earning shekels.

The shooting to wound and kill Palestinians is relentless.  DCI-P notes that according to a UN study, between January 2009 and August 2010, at least 22 Palestinian civilians in Gaza have been killed and 146 injured in the arbitrary live fire zone adjacent to the border with Israel and imposed at sea. At least 27 of these civilians were children.  It also notes that the targeting of civilians is absolutely prohibited under international law, regardless of circumstances.

These quotations from the available stories convey a little of the poverty, the suffering and the courage:-

• 'The three of us would wake up every day at around 5:30am and leave to collect gravel. We were not the only ones doing this type of work.  Hundreds of youngsters aged between 13 and 22 used to work with us, despite the danger we faced because we were close to the Israeli border.’ Awad W- 3
• The work was exhausting and dangerous. 'Israeli soldiers would sometimes shoot at us, and sometimes shoot in the air to intimidate us,’ recalls Ibrahim .  'Sometimes they would       shoot at the carts, horses and donkeys we used to move the gravel. But we had to do the work despite the dangers, because we didn’t have any other job to do.’  Ibrahim K- 4
• Mohammad was taught by his neighbours to watch for birds flying away from the watch towers, as this was a sign to start running, as it meant soldiers were climbing into the towers and the shooting would soon begin.  Mohammad M – 6
• They killed our three horses and one donkey in four months, and we had to spend the money we earned on replacing them.’ ….. 'They were down on their stomachs pointing their rifles towards us, but they didn’t shoot. We got used to such things.’  Mohammad S – 11

Silence is complicity.

• I thank Gerard Horton and DCI-P for the availability and excellence of this information, and for supporting publication in a medical forum. I also thank Dr Khamis Elessi in Gaza for information.

This paper was submitted to the Lancet and the British Medical Journal 4 January 2011 under the title 'Ethical’. The refusal from the latter is here:

BMJ/2011/850099

The methodical shooting of boys at work in Gaza by snipers of the Israeli Occupation Force

by David Sydney Halpin

Dear Mr. Halpin

Thank you for sending us your paper. We read it with interest but I regret to say that we have decided not to publish it in the BMJ.

Clearly soldiers shooting at children is awful, but we didn’t think your article gave a clear reason why we should be publishing it now. The information comes from the Defence for Children International (palestine section) website, there isn’t much context, there’s no description of the Israeli soldiers’ explanation for these events, and the article just sort of ends.

We receive over 8000 submissions a year and accept less than 10%. We do therefore have to make hard decisions on just how interesting an article will be to our general clinical readers, how much it adds, and how much practical value it will be.

I am sorry to disappoint you on this occasion.

An editor at the British Medical Journal

*****

The methodical shooting of boys at work in Gaza by snipers of the Israeli Occupation Force