The Ghassan Abu Sittah Children’s Fund is based in the Blue Building, a medical center across from the American University of Beirut, in the city’s Hamra district. Many of the children whose care it sponsors have come to Lebanon from Gaza, mostly by way of Egypt, after an intensive vetting process involving the Israeli state and the Palestine Children’s Relief Fund. They require surgeries currently unavailable in Gaza, where Israel’s genocide has obliterated large swaths of the health care sector. Some have lost limbs; others have neurological injuries; most have lost family; all carry the effects of the violence that has fractured their worlds.

Israel has created something unprecedented: the largest population of traumatic pediatric amputees in modern history. (A traumatic amputation is one caused by the force of an accident or attack—say, that of a blast.) These children’s injuries—physical, mental, emotional—are complex, and require a complex response; there are many hospitals in the United States that would be unable to tend to them. Waking up from hemorrhagic shock to find yourself maimed, to watch your sister bleed out in front of you, to learn your whole family is gone, to try to fathom what this means when you cannot yet steady a pencil enough to write out your name—all of this takes a psychological toll, by design. The mission of the fund is not only to gather the necessary medical experts, both surgical and nonsurgical, but also to ensure that the child is cared for as a whole human being, by people with whom they feel safe.

When a person has been permanently disfigured, Dr. Ghassan Abu Sittah explained to me, the goal of surgery isn’t to make them look how they did before, which is often impossible, but to restore a kind of recognition—to make them feel once again that their body belongs to them. Abu Sittah is a plastic and reconstructive surgeon who, before 2023, was mostly based in London, traveling to Palestine, Lebanon, Iraq, Yemen, and elsewhere to see patients wounded in various wars. Since the start of the genocide in Gaza he has focused his attention on treating children injured by Israeli attacks. In 2024 he cofounded the fund in Beirut, historically a hub for medical care in the region. With the extension of Israel’s ethnic cleansing campaign into Lebanon, the fund has begun providing this care to Lebanese children as well.

Two days before I sat down with Abu Sittah, I spoke to a boy from Gaza with a spinal cord injury that had left him unable to move his legs. He was staying with his mother in a hotel a short distance from the fund that hosts many of the families who are in Beirut for treatment. At one point he pulled up a photo on his phone of what looked like the inside of a tent and a mattress covered in blood. This was where he’d been when the missile struck. His mother told me that others had taken him to the morgue and pronounced him dead. She had found him there and insisted that no, her son was alive.

Later in our conversation the boy talked about how he had been super into cars, fixing them, driving them, everything. He showed me a video of a boy driving a car, shot from the passenger seat. The face on the screen was full, looking from road to camera with a relaxed smile. I asked the boy earnestly who that was in the video. That’s me, he answered, beaming. I felt uncomfortable, as if I had inadvertently pointed out how much he had changed, and in an attempt to redirect his attention I said that I meant who was recording and talking in the background, who had added those two heart emojis to the corner of the frame? My friend took it, he answered, and then: he’s a martyr.

Abu Sittah had just seen the boy in clinic the day before; he was happy with how much weight he had gained. He was skin and bones when he got to Beirut, he said. The boy was, as far as I could tell, still quite thin. Still, the fact that he had shown me that video indicated that he was beginning to be able to recognize himself again.

I spoke with Abu Sittah about an aspect of the conversation with the boy and his mother that weighed on me. In an effort to begin with an open-ended question, I had asked the mother to tell me what happened to them, how they ended up in Beirut. She responded with her own question: “What hasn’t happened to us?” I didn’t know what to say, so we waited in silence until she was ready to pick up the conversation again. At some point I asked her if she was still in touch with family in Gaza and she responded that, really, they had no one left.

Was Abu Sittah familiar with this kind of strained communication, I asked, with what felt like the lack of a common scaffolding on which to build a conversation? The architecture of their lives is totally gone, he said. In a recent essay for The London Review of Books, the human rights researcher Eyal Weizman writes about the disorientation imposed by Gaza’s total destruction, how it leaves people with no point of reference. Weizman quotes an Israeli bulldozer operator who says that if a Palestinian tries to return home, they “will be returning to nowhere…. They will not know where their home is. All they will find is sand.” He then writes of one Palestinian asking another, “If we survive this war…what would be our meeting point?”

Reading the article, I recalled a family friend’s description of her return to southern Lebanon at the end of 2024, after the cease-fire that wasn’t—how she arrived in Bazouriyeh, the town where she grew up, and found that everything familiar was gone. Not just her parents’ house but the other houses, the street signs, the shops, the trees, anything that could tell her she was here and not there. She called out for help orienting herself. Someone from the town whose eyes had already adjusted came to her side and guided her.

War—and the influx into hospitals of casualties in different degrees of extremis—taxes a country’s medical system. When patients come in unresponsive, doctors must decide at what point to give up on resuscitation, a judgment call that is harder to make the younger the person is. A patient with complex injuries requires consultation with multiple surgical and nonsurgical teams, and interventions must be triaged based on acuity, which increases the possibility of delays. This comes at a cost to the hospital, which only has so many beds to offer to those who need them. And it has implications for the patient, who grows more prone to infection, delirium, and physical deterioration the longer they remain in the hospital. Healing happens best in the outside world. But what about when the outside world, or more specifically Israel, is hostile to the body trying to heal?

The wars in southern Lebanon and Gaza are exceptional in the degree to which Israel has been directly targeting medical infrastructure—not to strain it but to literally flatten it. In Gaza this pattern was noted early on: Israel dropped its bombs closer and closer to medical facilities, then switched to carrying out direct strikes with impunity. When I sent in the first draft of this essay less than a month ago, Israel was already bombing in the immediate vicinity of hospitals in the south. Since then the radius these attacks leave around health facilities seems to have narrowed further, judging by the rising number of casualties from inside medical centers, and the gravity of the damage done to them. In one recent attack near a hospital in Lebanon, in Sur on June 1, thirty-nine health care workers were injured from the force of the blast.

Another way to neutralize a hospital is to keep people from being able to reach it. At the time of writing Israel has martyred 130 first responders in Lebanon. They are targeted for saving lives. One medic with whom I spoke in Nabatiyeh had lost his forefoot; the bomb landed on his dispatch facility in the middle of the night while he and his colleagues were asleep. We were not even going to help anyone, he clarified. Despite their injuries, many paramedics who have been targeted continue to volunteer if they are able, moved by a sense of commitment to their people and their land.

There are strains on the social infrastructure as well as the medical. Injured children who arrive in Beirut from Gaza are accompanied by someone—sometimes a parent, sometimes a more distant relative if the parents have been killed or refused exit by Israel. The caregiver has left behind everything and everyone remaining to them in order to be here. Often they have children who are still in Gaza, and they struggle to parent remotely; I spoke with a social worker at the fund who told me that she and her colleagues counsel caregivers on how to be present for their loved ones via Facetime and Zoom.

The children who make it to Beirut are the lucky few. When I was working on this essay, I read about a boy who died of leukemia while waiting for permission to leave Gaza for treatment, as the chemotherapy he needed was not allowed in. Anyone who has passed their eighteenth birthday has an infinitely harder time getting care. The boy with the damaged spinal cord told me that his mother was helping a relative in Gaza manage a similar injury by sharing what they were learning in Beirut; because the relative was an adult when a missile fell on him, he was stuck.

Meeting the needs of any single person who has been severely wounded requires reorganizing the world around them, sometimes for a short time, sometimes for longer. Abu Sittah and I discussed the case of my cousin, on whom he had recently performed an initial reconstructive surgery to cover exposed skull. This intervention, this hospital stay, was the first of many to come. Israel had bombed my cousin’s home and destroyed his face. He had lost his eyes. He was a medical student before, and now he was lucky to be alive. An injury like this permanently alters not just the life of the injured person, but those of the people who will become their caregivers. At the hospital at least one or two members of my cousin’s family were at his bedside every day, often for the entire day. Where their days were once governed by something like the sun’s progression across the sky, for the foreseeable future he would be their center.

My father, a surgeon, has traveled back and forth to Lebanon since my cousin’s injury to help coordinate his nephew’s medical care and to support his brother and the rest of our family. He told me how a family friend visited my cousin in the hospital and wondered aloud whether it might have been easier if he had been martyred. I found the man’s statement crass, but I have not lived as close to the possibility of earth-shattering loss as he has. I imagine it hardens you, changes the way you measure what is unsayable and what has to be said. Still, my father disagreed with him about my cousin: it will be the honor of our lives, he said, to take care of him.

Those who love the injured person will sacrifice their time. Sometimes they sacrifice their careers or choose new paths: my cousin’s sister, also a medical student, recently decided to pursue ophthalmology. Among the goals of using permanent disfigurement as a weapon of war is to induce ihbat, a sort of psychological collapse, and to isolate the person from their social world. It falls to that same world, then, to make sure there remains room for them.

Israel’s assault on Palestine and Lebanon has reconfigured how our children understand their lives. I interviewed a clinical psychologist who works with many of the children treated through the fund. One day, she said, a boy asked if she had toy soldiers, the little plastic figures. She promised him she would get some. The following week the request had slipped her mind but not his; he asked again, and again she promised. By the next session, she had gotten toy soldiers in several colors. From then on, in all her sessions, all the kids—boys and girls—reached for them. The blue ones signified the same thing to everyone. The children attacked the blue soldiers with the red and green and brown ones, with toy dragons and trucks and helicopters, with everything they could reach. Sometimes the kids gave the other soldiers names and sometimes they didn’t; sometimes they made some of the other soldiers die; always the focus was on defeating, by the end, the blue soldiers.

Later I met with an epidemiologist based at the American University of Beirut who studies the causes and effects of injury in Lebanon. This includes research on things like traffic accidents, but lately much of her work has focused on how children are processing the war. Many have faced internal displacement due to Israel’s sweeping “evacuation” orders and lost loved ones as a result of its self-given right to bomb anyone who chooses to stay in their home in a part of Lebanon that it seeks to control.

One of her projects explores the importance of play in helping children make sense of their experiences. I remember a video from Gaza that shows children lifting a doll on a makeshift stretcher, mimicking a funeral procession. The ways children play reflect the things they know. In this study, Lebanese children between the ages of six and eight from areas of the country targeted by Israeli bombs were given a blank sheet of paper with a folded, colored piece attached to represent a home; they were encouraged to draw whatever they liked both inside and outside. Some children drew missiles falling from the sky; others drew themselves spending time with family in gardens overflowing with bright, thickly scribbled color. Sometimes a single depiction of home held both idyllic and menacing images. One child, asked why they’d chosen to draw themselves playing with family, responded, “We love each other.”

As part of her research, the epidemiologist had distributed disposable cameras to children from areas affected by Israeli attacks. She sent the cameras to two schools, one in the south and one in Beirut, with the instruction that the children should document whatever aspects of their lives they wanted. But she had not considered the legacy of Israel’s pager attack, and some children refused to accept the cameras, especially when they heard that the project was affiliated with an American university. If they brought the devices home, in many cases their parents threw them out, or took them apart to see what might be inside. Parents called the school, demanding to know what they were thinking. The researcher explained to me that she is herself from the south—a way of saying that she should have known better. Of course people reacted like this, she said, adding that they have every right to. She ended up redesigning the project. The older kids took pictures of their worlds using their own phones. The younger children were given the drawing exercise as a way into a series of questions—about what family means to them, what places make them feel safe, what they do when they feel unsafe, what comes to mind when they think of “hope” or “resilience.”

To the question “What makes you scared?” children said things like, “I get scared when my dad tells me we are safe, and I know we are not safe” because they could hear nearby explosions or whirring drones. Most answered the question “What makes you feel safe?” with versions of “being close to other people.” Some children defined safety in a negative sense, as the absence of violence or simply as distance from it, with statements like, “just when there’s no one dying,” or when “they are striking far away.” One child, asked who protected them, said, “God and Mom.” More often children responded “Hezbollah”—the people, they elaborated, “who defend me” or “who defend us.” (In the manuscript, the epidemiologist translated “Hezbollah” as “the resistance,” to avoid inevitable censorship by academic journals.) Several older children took pictures of their bedrooms, where photos of martyrs, some famous and others ordinary, decorated their walls. To the question “What makes you happy?” several of the younger children responded, “resistance against Israel.”

The epidemiologist told me that one child used the word baaqoon to describe his commitment to staying on his family’s land. Baaqoon means, literally, we are staying. It is different from saamidoun, the Arabic word for we remain steadfast, in that the line it draws from present to both past and future is explicitly tied to place. The child, no more than seven years old, she said, spoke on behalf of a “we” many times his size. She was taken aback by the gravity of this word coming out of his mouth. Where did he learn to speak like this—and to mean it?

I recently came across a video on X showing the child of a martyred paramedic in the south of Lebanon. The boy, who looks to be about nine or ten years old, sits on the lap of one of his father’s colleagues, a leader of the political group Amal, which oversees Al-Risala, one of the main medical rescue organizations currently serving this part of the country. The man tells the boy, “One day we’re all going to go. You? They took your dad. And me, they took my friend.” He does not have to say who “they” are. The boy knows. “I want to defeat”—bidde kassir, literally “break”—“all the Israelis,” the child says. “We’ll continue on this path,” the man responds. “Me, my son was martyred, and my brother was martyred, and my uncle was martyred. We’re in this together [Mitli mitlak]. But this path, we need to continue on it [Bidnan kamlo].” I interviewed paramedics in the south who repeated this same phrase, have heard many men and women, in the face of loss, speak it. The boy responds with words that belong to someone much older: “My heart burns knowing my dad is gone [Hara2it albi inno bayyi fal].” I wonder where he learned this phrase.

While I was in Beirut another doctor told me the story of a child from Gaza who, after coming to Lebanon, learned that a man had died a natural death. The child did not understand. He did not know that death could come this way. It had to be explained to him, that people die of old age. The only cause of death the child knew was Israel. And he knew it well.