A study conducted by neurosurgeons from the Nasser Medical Complex in Gaza, the San Olaf University Hospital (Norway), and the University of Oklahoma (United States) reveals that 45% of people treated for penetrating traumatic brain injuries in the Palestinian Strip were children or adolescents. The report was prepared based on the analysis of cases of 719 patients treated for this pathology between January 1 and September 30, 2025, in two Gaza hospitals: the Nasser complex and the European Hospital of Gaza.
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Of those 321 minors, 292 suffered shrapnel wounds. The rest, 21, had bullet wounds to the skull. According to the study data, at least one child or adolescent arrived daily at those two Gaza hospitals — the average was 1.18 pediatric patients per day. The Palestinian Ministry of Health estimates that more than 20,000 children have died in the Strip as a result of Israeli attacks, which began on October 7, 2023, following Hamas attacks against Israel.
According to the report, published this Friday in the American medical journal JAMA Network, penetrating traumatic brain injuries are characterized by a rupture of the dura mater (the outermost, thick, and resistant meninge that protects the central nervous system) caused by a projectile or fragment, and constitute one of the most deadly war wounds.
Those who survive this type of injury often present long-term neurological disorders and psychosocial complications. The purpose of this study, according to its authors, is to assess the functional status of each patient upon hospital discharge. The article emphasizes that “considerable” levels of morbidity and mortality were observed.
Of the 321 cases of minors analyzed, whose severity was assessed at admission in most cases, 30% died, while 49% showed favorable outcomes — that is, signs of good recovery or moderate disability. The outcome of the remaining 21% of children treated is unknown, but those who suffer severe traumatic brain injuries of this type sometimes end up in a vegetative state or with severe disability.
“It is completely unacceptable that children are exposed to armed conflicts that cause them bullet and shrapnel wounds to the brain that endanger their lives. Our findings clearly demonstrate that penetrating head injuries in children are closely associated with high mortality and severe, lasting disabilities,” says Dr. Joakim Stray Andreassen, from the Neurosurgery Department of San Olaf Hospital, in statements collected in the press release accompanying the study.
The dataset collected for the report is, its authors emphasize, the largest ever conducted in a war zone in the contemporary era on pediatric patients with penetrating traumatic brain injury.
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A previous analysis by the same authors examined the situation in other longer conflicts: in Iraq and Afghanistan, between 2004 and 2012. In those wars, they identified 392 cases of penetrating traumatic brain injuries in children. Independent reports raised the number of patients with this pathology to 813, including 51 children (6%). Comparing that percentage with the 45% of cases identified in Gaza shows the scale of violence in the Strip, in a conflict that is hitting the youngest particularly hard.
Unprecedented
“The magnitude of the attacks affecting children starkly reminds us that the lessons of past conflicts have not yet been fully learned. The large number of severe penetrating head injuries observed in children during this war is something that, to our knowledge, has rarely been documented before in the medical literature,” warns Dr. Mohammed Asfa, neurosurgeon at the Nasser Medical Complex in Gaza, in an email to this newspaper.
Since 2024, numerous doctors and health professionals, both Palestinian and foreign, have denounced that some of the children with these types of injuries had suffered deliberate shootings by Israeli army snipers.
In the study presented this Friday, only 17% of pediatric TBI cases received surgical care, compared to 51% in the report referring to Iraq and Afghanistan. The authors of the text argue that the high number of patients, the continuous bombings near Gaza hospitals, and the shortage of neurosurgical equipment and materials limited the available healthcare and treatment capacity.
“What we witness constitutes a blatant violation of the most basic humanitarian principles. Hostilities causing harm to children must cease immediately,” deplores Dr. Asfa in the press release.
The study emphasizes that participating professionals also faced numerous limitations during their time in the Strip, with missing or incomplete data on long-term functional outcomes, prehospital deaths, physiological parameters, and extracranial injuries.
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