Dcotors treat a patient suffering from severe burns at the Al-Shifa hospital in Gaza City, on August 3, 2014
Gaza City (Palestinian Territories) (AFP) - Still in shock weeks after an Israel shell blast shredded his arm and killed four members of his family, Ahmed Ayyad is one of many wounded Gazans now needing long-term care.
But many of the organisations charged with rehabilitating Gazans like him are struggling to cope in the wake of an Israeli offensive in which the United Nations estimates that more than 10,000 Palestinians were wounded, with up to 1,000 likely to suffer permanent disability.
Staring blankly ahead and speaking softly, 23-year-old Ayyad sits in the waiting room for Gaza's only prosthetics centre as he recalls the day that shrapnel raked his chest and his left arm, now amputated above the elbow.
"The shelling started at dawn prayer in areas far away but we heard the sound of it coming closer to us at six in the morning, and we were forced to leave our homes," he says.
Israel launched its campaign on July 8 with the aim of destroying militant tunnels it said were used to launch attacks. The Shejaiya neighbourhood where Ayyad was wounded on July 20 suffered intense shelling.
His family and dozens of his neighbours were 50 metres (yards) from their house when shells hit nearby, killing two of his nephews and two other members of his extended family.
"As soon as I was hit I lost consciousness, I was hit in my hand, in my leg and my chest. There were body parts in the area and bodies and people who had lost limbs," he says quietly.
Ayyad was evacuated to the West Bank city of Nablus, where his arm was amputated. Unlike some of the wounded, who are staying in Jordanian, Egyptian and Turkish hospitals for treatment, Ayyad returned home after 14 days to start treatment at Gaza's Artificial Limbs and Polio Centre.
A doctor gently leads him to a gurney in the corner of the small clinic. He massages the stump where Ayyad’s left arm was to desensitise the skin, the first of many sessions the young man will need before his prosthesis can be fitted.
The ALPC has no shortage of equipment for prosthetics, provided by the Red Cross, but the dire financial situation of the Gaza municipality, provider of the 25 employees' salaries, threatens their ability to keep working, says Hazem Shawwa, the centre’s director.
"This is the third month without salaries for the centre's employees," he says
The Gaza Strip has been under an intense financial squeeze since Israel imposed a blockade in 2006.
"We agreed with the employees that we will keep offering services even if there are no wages, for as long as possible," Shawwa says, but admits he does not know how long they can hold out.
- No psychological care -
Since Tuesday's start of the Gaza ceasefire, aid groups have started offering help to residents who suffered life-changing injuries in the conflict.
In Shejaiya, a team of nurses supported by staff from NGO Handicap International, that has been working in Gaza since 2007, was visiting 28-year-old Nahaya al-Angar.
When a shell hit her house on July 20, she and her three children were buried beneath the rubble.
Her children suffered burns but the debris that fell on her caused pelvic fractures that have left her unable to walk unsupported.
Sitting in a bed in her father's house, a few streets away from her ruined home, crutches on one side of her and her 10-year-old daughter Nur on the other, she is still in shock.
"The house collapsed on us. I couldn't hear anything apart from the shaking and the buzzing sound, a buzzing sound. The first time I saw how I was under the rubble, I said to myself: 'That’s it, we’re going to die'."
As she speaks, Angar and her daughter cry. She says she called frantically called from beneath the rubble for her neighbours to look for her children, before realising she could not stand. One of the nurses visiting says she may never walk on her own again.
Handicap International and its Gazan partners have been visiting casualties at home to dress wounds and provide therapy.
But the group’s project manager Samah Abu Lamzy says the NGO still faces challenges in carrying out its work in Gaza.
"We are facing difficulties in distributing supplies like nappies and treatments as a result of shortages in the Gaza Strip".
Health workers from Gaza also suffered heavily themselves in the conflict.
Teams working in the field "did not receive the psychological support services they need after the suffering they have lived through during more than 50 days of the crisis in Gaza," she says.