Abed Zaqout is a 3-year-old boy, whose house was bombed, recovering in Nasser hospital after the amputation of part of his right leg in December 2023. (UNICEF)

Doctors in Gaza have observed that children being treated in local hospitals tend to downplay their pain, possibly because they perceive it as insignificant compared to the broader struggle amid the ongoing Israeli genocide in their region.

A meeting of international medical professionals convened in Doha, Qatar, over the weekend to strategize the development of a new manual on trauma pain management aimed at aiding healthcare providers working with children in Gaza and similarly affected areas.

Children in Gaza witnessing trauma up close

Dr. Paul Reavley, a consultant in pediatric emergency medicine and former British Army medic, spearheads the initiative. He mentioned that individuals with ties to Gaza, who maintain close communication with their colleagues there, have relayed observations regarding the behavior of child patients.

“The children sort of underplay their pain,” he said. “There has been so much around them, that it’s almost [as if] expression of pain and complaints about pain seem trivial.”

Due to the Israeli airstrikes on #Gaza, thousands of Palestinian children have had to undergo amputation surgeries; hundreds were reported to have had these surgeries without anesthesia amid the brutal Israeli siege on the Strip.
Hospitals in Gaza are struggling to accommodate… pic.twitter.com/cFLWyZIMbJ
— Al Mayadeen English (@MayadeenEnglish) December 30, 2023

They feel “they have to be stronger," Reavley said. “They’re observing children who are being treated next to their parents who’ve been resuscitated and dying. Compared with that, they lie there and think ‘I have pain’, but if someone asked about it, they don’t want to express it.”

The upcoming manual will be released in both Arabic and English, with financial support from the World Innovation Summit for Health (Wish), the global health initiative of the Qatar Foundation based in Doha. This manual builds upon the work of Reavley and fellow members of the Paediatric Blast Injury Partnership who developed the Paediatric Blast Injury Field Manual in 2019.

Reavley noted that Palestinian medics possess significant competency in trauma management. However, not all physicians attending to children are specialized in this area, and there is frequently a psychological hurdle for professionals when it comes to caring for children.

“My daughter; I am amputating her leg without anaesthesia.”
A Palestinian doctor named Hani Bseiso was forced to amputate the leg of his 16-year-old daughter Ahed on the family's kitchen table — without anaesthesia, due to Israel's blockade — after she was severely injured by an… pic.twitter.com/gTz6kx2YUU
— TRT World (@trtworld) January 17, 2024

“When a child who is severely injured and in distress and pain is put in front of you, most adults, as a human being, have a connection that you don’t have to other patients,” he said.

“The success of treating a child well is brilliant. But when a child doesn’t do so well, it is devastating. To empower clinicians to successfully help the child is really important because they benefit from that as well,” he added.

Dr. Emily Mayhew from Imperial College London, a member of the Paediatric Blast Injury Partnership, emphasized the complexity of treating children after a blast injury due to their ongoing growth. She stressed that children cannot simply be treated as miniature versions of adults.

“Treating children after a blast injury is complicated, as they are still growing. Children are not just little adults," she said.

“This new pain manual will provide the technical information clinicians need all in one place, and the confidence to care for children,” she added.