Limb reconstruction in Gaza

Posted on Apr 28, 2017

Limb Reconstruction at Al-Shifa Hospital in Gaza


In 2015, NORWAC partnered MAP UK and Ideals in one coordinated effort to establish a specialized Limb Reconstruction Unit (LRU) at Al-Shifa; specializing in war and war-like injuries. The aim is to ensure that the LRU is capable of providing safe and efficient treatment to war-injured patients and to handle massive patient influx in a war or an emergency. NORWAC and Ideals have interchangeably sent expert teams to Al-Shifa to train a team of orthopaedic surgeons, OT nurses and physiotherapists in advanced surgical procedures, infection control, limb reconstruction, safe surgery protocols and post-operative treatment and follow up.

Norwegian and British surgeons see progress in the surgical skills of the local surgeons. As a result of the training, they now handle more advanced war and war-like injuries adequately than at project start. Norwegian OT nurses see improvement in systems for patient care, infection control, sterilization routines and post-op care. If a war occurred today, the local team would be better prepared and equipped than in the war of 2014. However, the surgeons are still not confident in the treatment of advanced injuries; as there is still a long way to go before a culture change in patient care, infection control and sterilization routines is in place. There is also a need to stabilize and institutionalize cooperation within the LRU team members (surgeons, OT nurses and physiotherapists) to avoid infection and other post-operative complications and enhance timely and correct rehabilitation.

The project will therefore continue in order to consolidate the LRU and increase technical expertise and improve systems and protocols at department level. This will be done through medical missions to Al-Shifa by Norwegian orthopaedic surgeons, OT nurses and physiotherapists, in cooperation with Ideals, who also send medical missions, and MAP UK, who oversee the local team between missions and procures equipment.

Increased technical skills of a specialized limb reconstruction team decreases the number of referrals outside, which is cost saving for the PA. Furthermore, correct and coordinated care decreases chances of post-operative complications, hence enabling recovery and more patients get back quickly to their daily lives. During an eventual war, the increased competence of the LRU will be essential for safe treatment of war-injuries within Gaza.

Establishing solid routines at department level is essential for making sure implemented routines are maintained and knowledge disseminated after the end of the project. NORWAC and MAP-UK/ Ideals coordinate all efforts closely with the appropriate local authority to ensure ownership and dialogue on sustainability.


  • Before operation
  • After operation
  • Shifa Hospital in Gaza
  • The Project team from NORWAC John Williksen, Ole Rasmus Robak and Hilde Vollan in the Library at the hospital together with local staff Sahdi and Mahmoud.
  • Orthopedicians John Williksen and Ole Rasmus Robak together with local nurse Nasser ready for operation.