In Gaza, children who survive Israel’s assault face a lifetime of trauma

Osama Muhammad Abu Mustafa was convinced he would become an international soccer superstar. Playing on a local team at the municipal stadium in Khan Younis, southern Gaza , he envisioned a future "like Ronaldo." He was 13.

Even in the midst of war, he worked hard at fulfilling his dream. He was practicing soccer with his cousins when the bombs fell.

"I had the ball — and then a missile fell," he told NBC News' crew on the ground in Gaza in an interview in his home, where he was still recovering months after the July 3 airstrike.

What happened next is a blur, he said. But when he woke up, he was in a hospital bed, where he learned that one of his cousins, his aunt and her husband had been killed.

He had also lost his left leg.

"The occupation killed my dream," Osama said. "They stole it from me."

Now, Osama struggles to find the will to leave his hospital bed, even in a wheelchair. He stays indoors watching a constant stream of "Captain Majid," a cartoon series about a young soccer player with dreams of playing in the World Cup.

Osama is one of hundreds of thousands of children whose lives have been shattered during Israel's yearlong military offensive in Gaza , which has brought on a humanitarian catastrophe. More than 41,900 people have been killed, according to health officials in Gaza, since Israel launched its assault after the Hamas-led Oct. 7, 2023, terror attacks in which some 1,200 people were killed and around 250 taken hostage, marking a major escalation in a decades-long conflict.

Like the rest of Gaza's children, who make up about half of the strip's population of 2.2 million, Osama bears no responsibility for the Oct. 7 attacks, nor the devastating war that followed. But children like him are paying a high price, with more than 16,900 killed, including dozens of infants under the age of 1, during the intensive Israeli bombing and ground operations, according to the Palestinian health ministry.

With the Israeli government's stated aim of destroying Hamas and seeing the remaining 97 hostages returned, bombs have flattened much of Gaza and driven an estimated 90 percent of the population from their homes — often multiple times. Now, hundreds of thousands live in crowded tent cities. Even designated safe zones are not safe.

Young people are especially vulnerable to disease and other health ailments ripping through Gaza. Malnutrition is rife among the young, and diseases like polio, hepatitis, and cholera are flourishing in the crowded and unsanitary conditions.

In the midst of Israel's offensive, Gaza is "not a place to be a child," James Elder, a spokesperson for the United Nations' agency for children, UNICEF, told NBC News in a phone interview while on a mission to the enclave on Sept. 31. "The suffering stretches the limits of what we thought possible, and at the same time, the bombings, they leave scars that are deeper than the physical destruction," he said. "There's an enormous amount of psychological support children will need."

Elder noted that as of late December, UNICEF estimated that around 1,000 children in Gaza had lost one or both legs, with thousands more suffering other injuries. He said the agency did not have an updated estimate of how many children had since undergone such amputations, but said the number would surely be much higher now.

He said that he had never before been in a hospital where "everywhere I turn around, there are civilians on the floor, in corridors, hallways, with horrendous wounds of war, including children everywhere."

Israel's yearlong bombing campaign has also destroyed or incapacitated hospitals across Gaza, with only 17 of 36 partially functioning, according to the World Health Organization . Even the most basic supplies are hard to find or completely unavailable, from soap to anesthetics and painkillers.

Israel has been accused in the International Court of Justice of genocide in Gaza, a charge Israel and its main ally, the United States, have deniedThe ICJ has separately said in a landmark opinion in July that policies and practices used by Israel in its occupation of Palestinian territories were in breach of international law.

In the face of the mounting death toll, Israeli military officials have said they take pains to protect civilians in Gaza and maintain that Hamas and other militants use hospitals and other non-military buildings to shelter and hide weapons and tunnel entrances. They add that Hamas could end the suffering of the population if it laid down its arms, ceded power and returned the nearly 100 hostages it still holds.

Israeli Prime Minister Benjamin Netanyahu previously said at a news conference in August that "Israel deeply regrets every civilian casualty, every single one," but laid blame on Hamas as he accused the militant group of "engaging in child sacrifice."

Hamas, which has run Gaza since winning elections in 2006 and a subsequent brutal power struggle with its main rival, Fatah, officially calls for the destruction of Israel and is considered a terrorist organization by the United States and others. It has justified the Oct. 7 attack by saying it was a last resort against Israeli crimes against the Palestinian people, including those in Gaza who have for decades lived under a crippling blockade imposed by Israel and enforced by Egypt.

According to messages reviewed by The Wall Street Journal, but not seen or authenticated by NBC News, Hamas' leadership considers civilian deaths as "necessary sacrifices ." In an interview with NBC News on Wednesday, a senior Hamas official and member of the organization's political wing, Dr. Basem Naim, stood behind the Oct. 7 attack, calling it a "strategic success" despite the suffering it has caused ordinary Palestinians.

'Beyond your imagination' Nothing prepared Dr. Ammar Darwish, a veteran of foreign medical aid missions, for what he experienced inside Gaza's shattered hospitals.

"The screams, the pain, the suffering of these kids ... it's beyond your imagination," said the trauma surgeon, who has worked in Ukraine, Yemen and Syria, among other war-torn countries.

At least 60 to 70 percent of the casualties, both killed and injured, brought to Nasser hospital in Khan Younis while he was working there were women, children and babies, Darwish told NBC News recently from Manchester, England, after a month-long stint in Gaza.

Many of the children he treated sustained life-altering injurieswith Darwish describing harrowing accounts of children burned and bloodied, including a young girl he said he would "never forget" who had survived a severe head wound and had to undergo a triple amputation before eventually succumbing to her injuries. Many, he said, would require specialized treatment and care for the rest of their lives — making him particularly worried about the long-lasting psychological and emotional trauma children across Gaza have endured.

"And it's not just this generation — it's more generations to come," Darwish said. "It will be passed on to them."

Nadine Abdulatif is only 13 but has already lost count of the number of wars she's lived through. This doesn't make her less afraid — a fact she tries to hide from her little brother, Jood.

"The thought of being killed shouldn't pass any human in their mind," she told NBC News in an interview in August from the Nuseirat refugee camp. "Here it is passing through the minds (of) millions of childhood in Gaza."

Nadine says she and Jood were especially frightened when their older brother, Ahmed, was killed in an Israeli airstrike after the family was separated while trying to flee south from their home in northern Gaza.

"I just want to see my brother again," Jood said, crying, as Nadine wiped his tears and offered him words of reassurance.

"We can see him again," she said quietly. "Just, we have to wait and be patient."

While the IDF says its offensive is protecting Israel and its citizens against Hamas' attacks by striking their military capabilities, some experts have warned that the assault and the extreme suffering it has caused risks fueling extremism and serving as a recruitment tool for Hamas.

Diana Buttu, a Palestinian lawyer and former adviser to Yasser Arafat's Palestinian Liberation Organization, said she fears children in Gaza who have been robbed of their childhoods will grow up to believe that the world has failed them.

"We have all of these conventions that talk about human rights for children," she said. "It's such a disconnect now that I'm very worried that, in the future, we're going to see a whole generation that says, 'I don't believe in this global system that you talk about because it didn't help me.'"

"I think the way to prevent it is to show the children that their lives matter and to show them that people will be held to account for the things that they've done," Buttu said.

Aid agencies struggling to provide even the basics of food and shelter say the first step in dealing with childhood trauma is to separate the child from the pain. In the midst of Israel's continued offensive, that is impossible for most of Gaza's children.