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"Doctors from the United States who rushed to the Gaza Strip to help the war wounded quickly learned that their challenge went beyond treating shrapnel injuries.
The eight American specialists found themselves operating on patients who had fallen victim to the 20-month-border closure that had crippled Gaza's health care system even before Israel's offensive against Hamas.
On Tuesday, the team removed a kidney tumor the size of a honey melon from a 4-year-old boy, Abdullah Shawwa, in a five-hour emergency surgery at Gaza City's Shifa Hospital.
The tumor was advanced and without quick intervention Abdullah would likely have died, said Dr. Ismail Mehr, an anesthesiologist from Hornell, N.Y. Doctors in Gaza didn't have the expertise to operate on him and Abdullah's father had been unable to get him transferred quickly to Israel or Egypt.
Even after the surgery, Abdullah's prognosis is uncertain. He'll need followup treatment, including advanced chemotherapy or radiation, which are not available in Gaza. But it's been difficult for Gaza patients to get out, ever since Israel and Egypt closed the borders in response to the violent Hamas takeover of the territory in June 2007.
The closure also dealt a further blow to Gaza's underdeveloped health care system, which lacks sophisticated equipment and key specialists. Hospitals often operate on generators because of disrupted power supplies, and spare parts for some machines are unavailable.
On the eve of the war, Gaza's hospitals had run out of 250 of the basic 1,000 health care items, and were short on 105 of 480 essential drugs, including some cancer medications and anesthetics, said Mahmoud Daher, a representative of the World Health Organization.
In this vulnerable condition, disaster struck. On Dec. 27, the first day of the war, Israeli warplanes bombed Hamas security compounds across Gaza, killing about 220 people, most of them Hamas police, and wounding some 300 people, according to Health Ministry officials.
Shifa, Gaza's central hospital, was overwhelmed.
Its six operating theaters couldn't cope with the waves of seriously wounded. Staff nurse Jihad Ashkar, a 22-year veteran at Shifa, said he had never before seen so many people with multiple injuries that required hours-long surgeries.
"The injured people waited for many hours to enter the theater, so we lost many injured people because we haven't the equipment or operating rooms," said Ashkar."
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