“If we do not receive a circular external fixator for Rami as soon as possible we will offer him a referral for treatment outside Gaza,” says Dr Mahmoud Matar, an orthopedic surgeon at Shifa hospital. But to receive health care abroad, Palestinians must apply for Israeli security permits. The approval rate for those injured in demonstrations near the fence is significantly lower than the overall approval. Only 8 out of 52 applications were approved in October.

Another option for Rami is to go through a complex surgery in Gaza, but it can result in deformity, limping and persistent pain.

“Do you know what is the hardest feeling for me as a doctor?” Dr Matar says. “To be unable to serve the patients. It is an internal disaster. Every time I can’t provide needed care for my patients, I feel like a criminal.”