Limbs lost, lives changed: The unprecedented limb amputation crisis in Gaza

Historically in armed conflicts, traumatic amputations result in long-term impacts on individuals, healthcare systems, and society. Though amputations are not new, the ongoing conflict in Gaza has resulted in an unusually high number of amputations. The scale of conflict-related amputations in Gaza, accompanied by systemic barriers to acute and rehabilitative care, necessitates feasible rehabilitation-focused responses relevant to physiatrists and global health stakeholders. The World Health Organization documentation reflects between 3105 and 4050 amputations between January 10 and May 16, 2024. Ongoing data are limited due to infrastructure damage, but available estimates indicate a scale of limb loss that is disproportionately high compared with recent conflict settings. Gaza's population density, targeting of healthcare infrastructure and workers, and supply disruptions contribute to high levels of conflict-related limb loss. Further compounding these concerns, delays in care result in undesired outcomes with medical, economic, and social consequences. Though conflict-related amputations concern all age groups, the lifetime burden of care is particularly striking for pediatric amputees. Based on literature from high-resource settings, estimated costs are approximately $90,000 USD per limb for immediate healthcare needs and $500,000 USD for lifetime care. With 3578 estimated cases in Gaza in a period of four months, this translates to $322 million for immediate treatment costs and $1.79 billion in projected lifetime care. The scale of limb loss among all age groups in Gaza has resulted in long-term rehabilitative care needs within a severely resource-limited environment. Physiatrists' skill sets in rehabilitation-informed planning and coordination of international rehabilitation efforts uniquely position them to help. This article is structured as an international perspective synthesizing reports from humanitarian organizations, global health agencies, and published literature.