Israeli weapons packed with shrapnel causing devastating injuries to children in Gaza, doctors say

Surgeons who worked in European and al-Aqsa hospitals describe extensive wounds caused by ‘fragmentation’ shrapnel experts say are designed to maximize casualties

Israeli-made weapons designed to spray high levels of shrapnel are causing horrific injuries to civilians in Gaza and disproportionately harming children, foreign surgeons who worked in the territory in recent months have told the Guardian.

The doctors say many of the deaths, amputations and life changing wounds to children they have treated came from the firing of missiles and shells – in areas crowded with civilians – packed with additional metal designed to fragment into tiny pieces of shrapnel.

Volunteer doctors at two Gaza hospitals said that a majority of their operations were on children hit by small pieces of shrapnel that leave barely discernible entry wounds but create extensive destruction inside the body. Amnesty International has said that the weapons appear designed to maximise casualties.

Feroze Sidhwa, a trauma surgeon from California, worked at the European hospital in southern Gaza in April.

“About half of the injuries I took care of were in young kids. We saw a lot of so-called splinter injuries that were very, very small to the point that you easily missed them while examining a patient. Much, much smaller than anything I’ve seen before but they caused tremendous damage on the inside,” he said.

Weapons experts said the shrapnel and wounds are consistent with Israeli-made weapons designed to create large numbers of casualties unlike more conventional weapons used to destroy buildings. The experts question why they are being fired into areas packed with civilians.

The Guardian spoke to six foreign doctors who have worked at two hospitals in Gaza, the European and al-Aqsa, in the last three months. All of them described encountering extensive wounds caused by “fragmentation” weapons, which they said have contributed to alarming rates of amputations since the war began. They said the injuries were seen in adults and children but that the damage done was likely to be more severe to younger bodies.

“Children are more vulnerable to any penetrating injury because they have smaller bodies. Their vital parts are smaller and easier to disrupt. When children have lacerated blood vessels, their blood vessels are already so small it’s very hard to put them back together. The artery that feeds the leg, the femoral artery, is only the thickness of a noodle in a small child. It’s very, very small. So repairing it and keeping the kid’s limb attached to them is very difficult,” Sidhwa said.

Mark Perlmutter, an orthopaedic surgeon from North Carolina, worked at the same hospital as Sidhwa.

“By far the most common wounds are one or two millimetre entry and exit wounds,” he said.

“X-rays showed demolished bones with a pinhole wound on one side, a pinhole on the other, and a bone that looks like a tractor trailer drove over it. The children we operated on, most of them had these small entrance and exit points.”

Perlmutter said children hit by multiple pieces of tiny shards often died and many of those who survived lost limbs.

“Most of the kids that survived had neurologic injuries and vascular injuries, a major cause of amputation. The blood vessels or the nerves get hit, and they come in a day later and the leg is dead or the arm is dead,” he said.

Sanjay Adusumilli⁩, an Australian surgeon who worked at the al-Aqsa hospital in central Gaza in April, recovered shrapnel made up of small metal cubes about three millimetres wide while operating on a young boy. He described wounds from fragmentation weapons distinguished by the shards of shrapnel destroying bone and organs while leaving just a scratch on the skin.

Explosives experts who reviewed pictures of the shrapnel and the doctors’ descriptions of the wounds said they were consistent with bombs and shells fitted with a “fragmentation sleeve” around the explosive warhead in order to maximise casualties. Their use has also been documented in past Israeli offensives in Gaza.