As the war escalates in Gaza – with Iran launching ballistic missiles against Israel – the Israeli military's use of explosive weapons has vastly multiplied the ranks of children with permanent disabilities, a new report finds.
Before the war began in October 2023 with Hamas-led attacks on Israel, some 98,000 children in Gaza aged two to 17 had a disability. Since then, Human Rights Watch reported, there have been "thousands of children in Gaza who have acquired a disability from injuries caused by explosive weapons." Save the Children estimates 10 children a day lose one or more limbs from the airstrikes – nearly 4,000 in a year of war.
A year into the Israel-Hamas war, Gaza lies in ruins. Over 70% of all homes are now damaged or destroyed, along with schools, hospitals, water treatment plants, and other vital infrastructure. The United Nations estimates that 42 million tons of rubble now cover the enclave — enough to fill a line of garbage trucks stretching from Singapore to New York City.
On Tuesday, Iran launched dozens of missiles into Israel, sharply escalating tensions between Israel and Iran-backed militias Hezbollah and Hamas – and edging the Middle East closer toward all-out regional war.
Air raid sirens went off across Israel as Iran retaliated for Israeli attacks in Beirut and Tehran that killed leaders of Hezbollah, Hamas and the Iranian military. Israel announced it also was carrying out "targeted operations against Hezbollah's combat compounds in southern Lebanon."
More than 90% of Gaza's 2.1 million people, including 1 million children, have fled their homes in the Hamas-controlled Gaza Strip. Many families have been displaced multiple times by the violence, as areas once deemed safe become new focal points of Israeli offensives.
After Hamas killed 1,200 Israelis in a surprise cross-border attack and took 250 hostages last October, Israel retaliated with air strikes and ground operations that have now killed 41,000 Palestinians, including 16,750 children, according to Gaza's Hamas-run health ministry.
For disabled children and their families, navigating forced displacements amid mountains of rubble is a life-or-death challenge, Human Rights Watch said in a report on Monday, based on interviews with dozens of families, medical doctors, and humanitarian workers.
The World Health Organization estimates at least 22,500 people sustained “life-changing injuries” requiring long-term rehabilitation services, while UNICEF says thousands of children lost one or two limbs just within the first three months of the war, many of them facing amputations without anesthetics due to Israel's blockade on medical supplies.
Another 20,000 have lost one or both parents or caregivers, while 17,000 are separated from their families. A new acronym, WCNSF, has become part of Gaza's daily lexicon: "Wounded child, no surviving family."
Globally, around 90% of people killed or injured in explosive weapon attacks in conflicts worldwide are civilians, according to the International Network on Explosive Weapons.
Children in armed conflicts suffer a higher risk of death from explosives, shrapnel, burns and disease, and they face additional dangers without a guardian. “These dangers are amplified for children with disabilities and their families,” said Emina Ćerimović, associate director of HRW’s disability rights division and lead author of the report.
The Palestinian Civil Defense, the Palestinian Authority’s emergency services and rescue arm, reports over 10,000 adults and children remain missing under the wreckage of Gaza's once-dense skyline. Save the Children’s June estimate suggested up to 21,000 children were unaccounted for, including those presumed dead, detained or separated from families.
France-based Humanity & Inclusion says the main injuries from explosive weapons in Gaza include traumatic amputations, fractures, nerve and spinal cord injuries, traumatic brain injuries, and burns.
Hospitals, lacking equipment and supplies, struggle to prevent avoidable amputations or provide rehabilitation. An estimated three-quarters of all hospital patients undergo amputations or suffer spinal cord injuries.
"From the day the war broke out, they destroyed what was inside us. They demolished my house and my room, which held all my memories," Ghazal, a 14-year-old with cerebral palsy, told Human Rights Watch. "They took everything that helped me to live, like my devices, my boot, and my wheelchair. How can I go back to how I was without all this?"
Her mother, Hala Al-Ghoula, said an Israeli airstrike destroyed almost everything in their home in Gaza City's Al-Shujaiya neighborhood, including Ghazal’s orthotic shoe and wheelchair. Ghazal's parents took turns carrying their daughter as the family fled south.
"Ghazal would tell me, 'Mama, it’s over, leave me alone and run away. You should leave me in the street,' " Al-Ghoula said. "It was one of the worst days of my life, with a very difficult feeling that can never be described."
Crises of health care, water and malnutrition
Human Rights Watch reports only 17 partially functioning hospitals remain in Gaza, which is "making it nearly impossible to respond to the enormous needs of the population." International humanitarian law protects medical facilities and staff during wartime.
Gaza's overwhelmed hospitals are straining to meet the critical needs of so many child patients. Israel's severe restrictions on humanitarian aid and electricity exacerbate the crisis, particularly affecting disabled children who rely on power for medical equipment and assistive devices.
The chaos also widely affects children's mental health. UNICEF estimates all of Gaza's 1 million children need some mental health support, twice the number before the war. Those with a disability suffer even more.
“The psychological trauma is massive and it’s not quantifiable,” said Dr. Ana Jeelani, a pediatric orthopedic surgeon with the International Rescue Committee. “Children are resilient to physical injuries: with adequate treatment, they bounce back. But the psychological aspect of it, I don’t know how you quantify it in a place like Gaza.”
The health of disabled children in Gaza faces further threats from water and malnutrition crises.
UNICEF reports 31% of children under the age of two in northern Gaza suffered acute malnutrition, including 4.5% with severe wasting. Many disabled children, who often need specific diets or feeding tubes, struggle to access necessary nutrition. Gaza's health ministry confirmed 38 deaths, mostly children, from malnutrition and dehydration by September.
Israel has "a policy to deny adequate access to water to civilians in Gaza, which has led to deaths from starvation and dehydration, and outbreaks of waterborne diseases," Human Rights Watch said. "The authorities’ denial of adequate water to the civilian population is a war crime."
The water crisis in Gaza intensifies the dangers. Oxfam International also has reported that Israel is "systematically weaponizing water" against Palestinians in Gaza by cutting off external water supplies, systematically destroying water facilities, and deliberately aiding obstruction.
Israel's Prime Minister Benjamin Netanyahu told the U.N. General Assembly last week his country is defending itself. "We see this moral confusion when Israel is falsely accused of deliberately targeting civilians. We don’t want to see a single innocent person die," Netanyahu said.
"That’s why we do so much to minimize civilian casualties, even as our enemies use civilians as human shields, and no army has done what Israel is doing to minimize civilian casualties," he said. "We drop flyers. We send text messages. We make phone calls by the millions to ensure that Palestinian civilians get out of harm’s way. We spare no effort."
