Isel Dahleez, a 2-year-old Palestinian girl who lost her parents...

Isel Dahleez, a 2-year-old Palestinian girl who lost her parents and other family members. Credit: for The Washington Post/Loay Ayyoub

Gaza is the most dangerous place in the world to be a child, the United Nations says. It’s a place where thousands of children have been killed, part of the soaring death toll from Israel’s military campaign since Hamas attacked the country on Oct. 7.

But survival is no guarantee of an escape from the horror summed up by medical workers in a grim new initialism: WCNSF.

Wounded Child, No Surviving Family.

“In the emergency department after an air raid there’s so many relatives around the bed of the wounded,” said Ghassan Abu Sitta, a British Palestinian reconstructive plastic surgeon who spent weeks treating the injured in Gaza. “But there would be a stretcher where a child would be on their own, and there was no movement around them, there’s no one asking for them.”

Doctors and aid workers say these unaccompanied children often have grisly injuries: deep tissue burns, lung contusions, brain damage, lost limbs, shrapnel wounds. Some arrive unconscious. Some need immediate resuscitation.

UNICEF spokesman James Elder, who spent time in Gaza last year, described encountering children who had lost their entire families with “terrifying frequency.” Some, he said, looked as if “they’ve just been broken and badly put back together, waiting for multiple surgeries.”

Doctors at al-Shifa Hospital, Gaza’s largest medical facility before the current conflict erupted, observed during the first weeks of the war that after every air raid there were unaccompanied children in need of admission and treatment, Abu Sitta said. They came up with the WCNSF initialism to ensure that hospital staff would assign someone to look after them.

Often, Abu Sitta said, he saw relatives of nearby patients take up the duty.

About 120 WCNSF cases involving children between the ages of 1 and 14 were recorded at al-Shifa, Abu Sitta said, before most patients and staff evacuated in the wake of an Israeli raid on the facility in November. He doesn’t know where those children ended up. Doctors at al-Aqsa Martyrs Hospital in central Gaza and the Indonesian Hospital in the north say they have treated at least two dozen such children.

The 10 doctors and aid workers interviewed by The Washington Post for this report said the raging conflict made it difficult to provide a complete count of all WCNSF cases across the Strip. Amid communication blackouts and the chaos of mass displacement, medical workers said, it’s also possible that some children have been reunited with their relatives.

UNICEF estimated this month that about 17,000 children in Gaza are unaccompanied or separated from their families.

Israeli forces have destroyed more than 70,000 housing units, according to the U.N. Office for the Coordination of Humanitarian Affairs (OCHA), and damaged 290,000 others - an assault the agency describes as “domicide.” People in Gaza seek refuge wherever they believe they might be safest, Abu Sitta said; extended families often cram into a single unit. “When the Israelis would bomb that apartment,” he said, “it would wipe out three generations.”

The phenomenon, Elder said, “underlines the indiscriminate nature and the ferocity of these attacks where families sought to try to keep safe.”

In Khan Younis, he said, he met 13-year-old Mohamed from Jabalya, who survived an attack that killed his entire family in November. The boy had terrible burns on his face, Elder said, but despite the pain would lift his arm to give a thumbs-up.

The Israel Defense Forces, asked to comment, said it was not possible yet to produce an accurate count of “the degree of destruction to Palestinian homes.” The IDF said its “actions are based on military necessity and with accordance to international law.”

Pediatrician Seema Jilani, a senior technical adviser for emergency health at the International Rescue Committee, who returned from Gaza last month, said most of the wounds she saw among children were blast injuries.

She described an 11-year-old girl who was believed to be an unaccompanied child. “Her face and upper neck had been blackened and charred. Her arms were stuck in a flexed position,” Jilani said.

I would be surprised if she did recover,” she said.

Even for doctors used to the wartime horrors of mangled bodies and grievous injuries, seeing these wounded orphans has come as a shock.

Ahmed El Mokhallalati, a plastic surgeon who has worked at al-Shifa and the European Hospital in Gaza, said he treated at least 25 WCNSF cases. He tries to keep his emotions from interfering with his work, he said, but on several occasions he found himself unable to start surgery.

“It’s really hard to perform when you think about these kids, their future, their dreams, how their life is going to look like, how they are going to live the rest of their lives,” he said. “I just try to take a deep breath and say it’s [a] hard life but God will be beside them to help, and I have to work again.”

Since the start of the war, aid agencies have delivered warning upon warning about the harrowing toll it is exacting on children. Nearly 10 percent of Gazan children under age 5 are acutely malnourished, according to OCHA. About 1,000 children have lost one or both legs, according to UNICEF. Those who remain physically unscathed, Save the Children says, are experiencing grave psychological trauma.

But the heaviest burden for children, doctors and aid workers say, is losing their families. In some cases, orphans are not immediately told.

“They don’t yet know that their life is even more broken, more desperately sad than they imagine,” said Elder of UNICEF. The agency is helping to formalize legal guardianship procedures with extended family members for unaccompanied and separated children and working to create facilities in hospitals to support them. But the ongoing hostilities and the stress on the health-care system, it says, slows the process.

When an unaccompanied baby girl was brought to the al-Emirati maternity hospital in Rafah, she didn’t call out or laugh, nurse Amal Abu Khatla said. “She deserves all the tenderness in the world,” said Khatla, who went out of her way to take care of her. When no family came forward after two months, Khatla took in the child. She calls the girl Malak - Arabic for “angel.”

Jilani, a humanitarian worker for more than two decades, said responsibility for these orphans’ future lies with the international community, which must push for a “sustained cease-fire and scale up humanitarian access.”

“Otherwise, this war is generating a generation of orphans who currently have no access to education, have no access to school, have no access to play or educational development, have no access to health and hygiene services,” she said.

“It’s a very grim picture and a very bleak future.”

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