OCCUPATIONAL THERAPY AMIDST THE RUBBLE.

This interview was meant to happen live. Haya Hamdan and I had planned to meet online, but the connection failed. Haya asked whether we could continue through WhatsApp instead. Over approximately one hour, we exchanged written messages about traumatic amputation, rehabilitation and the role of occupational therapy in Gaza.

The format matters. What follows is not a reconstructed audio interview and it does not place another voice over Haya's words. It is an edited written conversation, published with her explicit consent. Her responses have been shortened and lightly formatted for clarity without changing their intended meaning.

The scale beyond the injury

NAMIYou chose to discuss traumatic amputations caused by the war in Gaza and the role of occupational therapy throughout rehabilitation. From what you are seeing, what is the wider impact on people's everyday lives?

HAYAThe ongoing war has led to a significant increase in traumatic amputations. Many result from blast injuries, collapsed buildings and delayed access to treatment. Hospitals are dealing with complex trauma under extremely limited resources.

Beyond the physical loss, people face challenges with mobility, livelihood, mental health and social reintegration. Families and the healthcare system also carry a long-term burden.

The World Health Organization estimated in May 2026 that more than 5,000 limb amputations had occurred in Gaza since October 2023 and that one in five amputees was a child. The same analysis described major constraints affecting equipment, supplies, assistive products and specialist rehabilitation services.

Those figures provide context, but occupational therapy asks what injury means within the shape of one person's day: washing, dressing, playing, learning, working, caring for family and participating in community life.

Childhood, development and disrupted occupation

NAMIChildren are not only adapting to limb loss. They are still growing and developing, and some are simultaneously experiencing the loss of family, home, education and their usual routines. What does this mean for a child's occupations and development?

HAYAAmputation is not only a surgical procedure; it is a permanent change in a person's life trajectory. For children, physical growth can bring further surgical and prosthetic challenges. Limb loss may happen alongside the loss of parents, homes and schools, compounding psychological trauma.

From an occupational therapy perspective, recovery cannot be reduced to wound healing, muscle strength or mobility. The questions also become: Can this child play? Can they learn, participate, make choices, contribute to family life and experience themselves as capable again?

An anonymised case example

Haya described a child she had treated following a traumatic lower-limb amputation. He was living in displacement without access to the equipment and prosthetic pathway that would ordinarily support rehabilitation. Her occupational therapy goals focused on restoring routine, adapting everyday activities, supporting play and learning, involving his caregiver and reducing preventable complications.

HAYAThe occupational therapist works with the family to create a simple visual daily routine covering hygiene, contribution to family life, play, learning and rest. Giving the child a meaningful role can help rebuild a sense of responsibility, capability and identity.

"A routine is not merely a timetable. It can create opportunities for the child to reconnect with agency: I can do something. I contribute. I still belong."

Play is not an optional extra

Haya described adapting dressing using the stable positions and materials available. She also placed play at the centre of intervention, both to develop physical capacity and to reconnect the child with other children.

HAYAPlay can challenge sitting balance, core strength and reaching without feeling like a medical exercise. Low-mobility group games can also support participation with peers, so the child feels included and valued.

The therapeutic value is not only in the movement being practised. It is in what that movement makes possible: play, interaction, enjoyment, confidence and belonging.

Supporting families through 'Smart Help'

NAMIAfter everything a family has experienced, a parent's instinct may naturally be to protect and do more for their child. How can occupational therapy help families balance protection with rebuilding independence and confidence?

Haya used the phrase 'Smart Help' to describe proportionate caregiver support: stepping back during activities the child can safely complete while assisting where the risk is higher. Between sessions, the family might agree one everyday activity for the child to practise independently.

The aim is not independence at any cost. It is safety where it is needed, opportunity where it is possible and respect for the child's voice throughout.

From movement to meaningful occupation

Haya described a collaborative physiotherapy and occupational therapy approach using the phrase 'Movement for Life'. Physiotherapy develops physical capacity, including strength, balance and mobility. Occupational therapy helps translate that capacity into the occupations the person needs or wants to perform.

HAYAThe occupational therapy phase bridges physical capacity into real-life functional tasks, play and peer participation.

Movement matters, but participation gives movement its context. The outcome is not simply that somebody can stand or reach. It is that they can use that ability to wash, play, learn, contribute and take part in a life that has meaning for them.

Occupational therapy under extreme constraint

NAMIWhat is it actually like trying to deliver occupational therapy and rehabilitation in Gaza when standard resources are unavailable?

HAYAThe scarcity of standard assistive technology, splinting materials and rehabilitation equipment has forced us to shift towards 'frugal innovation': low-cost, high-utility adaptation. We do not only ask what the textbook says. We ask what materials are physically available in the immediate environment, whether in a damaged home, a tent or a displacement camp.

Improvisation should not be romanticised. Professional creativity cannot cancel the need for safe equipment, prosthetics, medicines, specialist rehabilitation, surgical care and sustained humanitarian access. What Haya's account demonstrates is occupational reasoning under severe constraint: analysing the person, task and environment, then finding the safest workable route to participation using what is available.

A message to the profession

Before finishing, I asked Haya what she wanted occupational therapists and students outside Gaza to understand.

"In an environment like Gaza, we learn every day that occupational therapy is not just text in books, but a tool for resilience and reclaiming life amidst the rubble. The message I hope reaches my colleagues and the rising stars in this field is that hope is crafted by our own hands, and that human dignity is worth every effort we make, no matter how limited the resources are."

Hope is not always a huge or abstract idea. Sometimes it exists in the smallest everyday victories: a child being able to play again; somebody washing and dressing; returning to learning; or reclaiming a role within their family.

As occupational therapists, we speak often about meaningful occupation. Hearing what occupational therapy and rehabilitation can look like in Gaza places those words in a profoundly different context. Enabling participation is not simply about rehabilitation. It is about independence, identity, belonging and human dignity.

Haya, thank you for your time, your professional perspective and your trust in OT, Actually™.

Editorial and clinical note

This written conversation was edited from a WhatsApp exchange with Haya Hamdan and published with her approval. Haya consented to the use of her name, professional title, location description, written responses and the clinical approaches discussed. The case example uses a pseudonym and has been further generalised to reduce identifiability.

Contextual sources

• World Health Organization. Estimating Trauma Rehabilitation Needs in Gaza. May 2026.
• World Health Organization. Rehabilitation fact sheet. 22 April 2024.
• WHO Eastern Mediterranean Region. Meeting the rehabilitation needs of children with debilitating injuries and disability in Gaza. 2025.