Alamrain Abdulwhhab Abu, Halimy Mohammed, Toman Hitham, Kassab Alaa, Alkhaldi Majdi, Alderdasawe Yosef, Abuaita Mahmoud, Alzayyan Ahmed, Tahir Mohammed, Harb Ayman I
Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
Orthopedic Department, Al-Aqsa Martyrs' Hospital, Deir Al-Balah, Palestine.
Front Public Health. 2025 Jul 2;13:1595477. doi: 10.3389/fpubh.2025.1595477. eCollection 2025.
The war in Gaza has triggered an unprecedented humanitarian crisis and severely impacted the healthcare system. It has overwhelmed orthopedic care at Al-Aqsa Martyrs' Hospital, the only public hospital serving the middle region of the Gaza Strip. With over a million displaced individuals and a sharp rise in war-related injuries, the department has been operating under extreme constraints, including shortages of medical supplies, staff, and infrastructure. The orthopedic department, initially small and under-equipped, has rapidly expanded and adapted to handle mass casualties. This has involved restructuring staff shifts, implementing a three-team 24-h rotation system, and repurposing existing facilities to accommodate the influx of patients. Emergency care evolved around a fluidic triage system, and surgical capacity was extremely strained. The repurposed obstetrics and gynecology theaters and delivery rooms became primary operating rooms, with two-thirds of all surgeries being orthopedic-related. Innovative solutions, such as field hospitals and tents for dressing, have helped alleviate some of the pressure. The introduction of the Dressing Under General Anesthesia (DUGA) system has improved wound care for severe injuries. International collaboration, particularly with Médecins Sans Frontières (MSF) and other NGOs, has played a critical role in supplementing medical services and expertise, providing medical and surgical supplies, and facilitating certain procedures. Despite these adaptations, the department remains overwhelmed. Resource limitations have caused delays in essential procedures, leading to complications such as non-union fractures and infections. Additionally, coordination between local and international teams has been challenging, underscoring the need for a more structured response to improve efficiency. The study highlights the adaptation and resilience of the orthopedic department at Al-Aqsa Martyrs' Hospital. It underscores the urgent need for policy reforms to enhance emergency preparedness, expand surgical capacity, and develop a sustainable, resilient healthcare system. Key recommendations include standardizing clinical protocols, strengthening supply chains, and supporting overburdened and burnout medical staff. Addressing these challenges is crucial to sustaining orthopedic care in Gaza's war-torn healthcare system.
加沙战争引发了一场前所未有的人道主义危机，严重冲击了医疗体系。它使阿克萨烈士医院的骨科医疗不堪重负，该医院是加沙地带中部唯一的公立医院。由于超过100万人流离失所，与战争相关的受伤人数急剧上升，该科室一直在极端受限的条件下运作，包括医疗用品、工作人员和基础设施短缺。骨科科室最初规模小且设备不足，现已迅速扩大并调整以应对大规模伤亡情况。这包括重新安排工作人员轮班，实施三班制24小时轮班系统，并重新利用现有设施以接纳涌入的患者。急诊护理围绕着一个流动分诊系统展开，手术能力极度紧张。重新启用的妇产科手术室和产房变成了主要手术室，所有手术中有三分之二与骨科相关。诸如野战医院和换药帐篷等创新解决方案有助于缓解一些压力。全身麻醉下换药（DUGA）系统的引入改善了重伤伤口的护理。国际合作，特别是与无国界医生组织（MSF）和其他非政府组织的合作，在补充医疗服务和专业知识、提供医疗和手术用品以及协助某些程序方面发挥了关键作用。尽管做出了这些调整，该科室仍然不堪重负。资源限制导致基本程序延误，引发了诸如骨折不愈合和感染等并发症。此外，当地和国际团队之间的协调一直具有挑战性，这凸显了需要采取更有条理的应对措施以提高效率。该研究突出了阿克萨烈士医院骨科科室的适应能力和韧性。它强调迫切需要进行政策改革，以加强应急准备、扩大手术能力并建立一个可持续、有韧性的医疗体系。关键建议包括规范临床方案、加强供应链以及支持负担过重和疲惫不堪的医务人员。应对这些挑战对于在加沙饱受战争蹂躏的医疗体系中维持骨科护理至关重要。
