In a Médecins Sans Frontières (MSF) clinic in Gaza, Palestine, the Singaporean anaesthetist uses Arabic vocabulary that is unusual for a foreigner: “electricity, knife, burning, tingling?” The patient, Murad, 26, gestured towards his left leg, encased in a metal cage, to show the doctor where the different sensations erupted. Electricity and stabbing pains were worst just above his foot, discoloured and cold to the touch, the veins constricted after a year of pain.

“The injury has destroyed me,” Murad says. “I was going out to work before, repairing satellite dishes, but now I can’t, and no one has reached out to help me.”

Murad was one of more than 1,300 people shot with live ammunition by the Israeli army on the bloodiest day of protests along the fence that separates Israel from Gaza on 14 May 2018. Sixty people were killed on that day. It was a bloodbath, with hospitals throughout Gaza overwhelmed by an incredible number of wounded. A year on and many are still suffering: legs missing too much bone to heal, infections setting in, the uncertainty and pain overwhelming.

“We protest because we are oppressed”

Ahmed, 38, explains why he went to the protest on 14 May, in which he was injured.

“I went peacefully, as a citizen. I’m from Bir al-Saba [Beersheva] originally,” Ahmed says. “Since 2000 there have been three wars, all of Gaza under fire, 13 years of the blockade, two separate states in the West Bank and Gaza. We are oppressed.”

A farmer from the far south of the Strip, he delights in describing the animals he looked after, the plants he grew, the yoghurt and cheese he made – all impossible now, with a leg still missing three centimetres of bone even after multiple operations.

“I just want to sleep, to take medication, that’s all I can do,” Ahmed says.

Hard times for Gazans – and now for those injured

Gaza’s economy has been brought to the brink of collapse by the Israeli blockade, Palestinian political infighting and Egyptian restrictions on movement. People stuck here have watched as their means of making a living have disappeared. The injuries suffered by thousands of people – more than 7,000 people have been injured by live bullets fired by the Israeli army since 30 March 2018 – have only made things worse.

Murad has lost the ability to make a living. “I taught myself how to fix things, satellite dishes, TVs,” Murad says. “I could make 15-20 NIS ($4-5.50) a day. Since my injury I’m just sat at home. I live with my mother; my father left her and we get no help from our family.”

He begins to cry as he describes how they had not been able to afford gas for their one-room house for a month and how they had been reduced to taking on debt just to buy biscuits and bread.

“You see who your friends are in hard times,” Murad says. “Now I see have none.”

An overwhelmed, under-resourced health system

The Gazan health system – crippled by the same things that have brought the economy to its knees – has been overwhelmed by the injuries. Thousands of similar wounds, all needing complex and lengthy  treatment, have placed impossibly high demands of the Ministry of Health and the few other organisations providing healthcare in the blockaded strip. Many patients are still waiting for solutions that might not come.

“To treat people in the protests we have opened two hospital wards, increased to five the number of clinics we run and added to our surgical capacity,” says Marie-Elisabeth Ingres, the MSF Head of Mission in Palestine. “However, even with all we are doing, we simply lack the number of beds and expert surgeons and antibiotic specialists needed to properly treat these injuries.”

Lucky few, but uncertainty remains

Iyad, 23, a musician, was shot but is one of the lucky few who have managed to travel out of Gaza to receive treatment. At an MSF hospital in Amman, Jordan, that specialises in reconstructive surgery for war wounded from across the Middle East, he had orthopaedic surgery and treatment for a vicious infection in his bone that required four weeks of antibiotics in an isolation room. Still, a year after he was shot, uncertainty lingers.

“All my thoughts have become about my injury,” Iyad says. “When will I be able to walk? Will I be able to walk again?”

Iyad needs another round of operations in Amman six months from now and after that, a long period of rehabilitation before he will – hopefully – walk again.

Hope, future ambitions – and despair

The burden of caring for the injured – who are overwhelmingly men – has fallen mostly on their wives and mothers.

“My wife is tired too,” says Ahmed, the farmer. “She keeps asking when I will be better. She wants to live a normal life of course, she’s human. She said she wants to go back to her family, but I need her for so many things.”

He described the pure frustration of being unable to wear trousers, to go shopping, to lift up his children for fear of the pain. “If there wasn’t the internet, you would die,” he says of his year of boredom. “Facebook, Twitter, YouTube, they let you see another world.”

Murad was trying to maintain his spirits, despite the poverty and pain into which his injury has plunged him.

“I know that my leg might be amputated, but despite that I continue trying to get it treated,” Murad says. “I refused to travel at first, but now I hope to, to wherever will take me.” His ambition for when he gets better: to open a stand that sells tea and coffee.

Ahmed, however, was finding it harder to think positively. The long months of suffering have taken their toll.

“I wish that my leg had been cut off, so that at least now I wouldn’t have any pain”, he says. A year on from his injury, no one can tell him when that pain might end.