Against All Odds: Manufacturing External Fixators in Gaza

In August of 2025, I was invited to go to Gaza and work on a 3D printing project. Although it had been a long-time dream of mine to go there to help the Palestinian people in whatever way I could, I was afraid. The genocide being perpetrated by Israel, ramped up significantly since October 2023, and it was an active war zone. But there was important work to do there, and I was the right person for the job.

I work at Glia, an open-source company that researches and manufactures quality medical devices that can be made in low-resource settings. We also publish all the information and instructions in a GitHub repository so that anyone in the world can make them. I’ve been the director of manufacturing and design for three years. Dr. Tarek Loubani is a Palestinian who immigrated to Canada as a child, and he started this company. My invitation came from him in a text asking if I would come to Gaza for a month and work on the external fixator project. He was there working in the emergency room of Nasser Hospital for the summer. He told me my role would be to help 3D print parts, test, number, take inventory, and create a distribution tracking system with our Gazan staff.

External fixators are surgically-implanted medical devices used on patients with broken limbs. Pins are drilled into the patient’s bones to hold the broken pieces together, and these pins are held together with a rod that is outside of the body so that injury sites can remain accessible for monitoring and care during healing. They’re important in Gaza because fractures, combined with open wounds from shrapnel injuries, are common. Not only is their medical system running on fumes, but there is also a substantial shortage of medical equipment. When external fixators aren’t available, patients usually need to have their injured limbs amputated. Glia’s project uses 3D printers in Gaza to make the parts that hold the pins and rods together, while all the other materials are locally sourced. When these devices are manufactured in Gaza, they can always be available even when medical equipment can’t be imported.

My journey started in October when I flew to Jordan. The day after I landed, together with a throng of international aid workers, I entered Gaza in a United Nations armoured vehicle convoy. The landscape was bleak. Broken concrete and twisted rebar was all I saw, but I had no capacity to be afraid. I was simply in awe of the sheer destruction that was everywhere I looked. I didn’t realize it until a month after I left Gaza, but all my emotions were suppressed, and when I arrived at my destination, I simply got to work.

Glia’s Gaza engineer, Badar, and I 3D printed the plastic external fixator parts and tested their strength. We bolted them together to see if they would hold the rods and pins under force. Here we met one of our challenges: acquiring proper nuts for the bolts we were using. My Gazan colleague could only source “nylock” nuts – these are nuts that have a nylon insert which requires more force to tighten and loosen. During testing, we found that they were not appropriate for this project. We had to wait until the shop in Gaza City had regular nuts in stock again so that we could make the exchange. This meant we had to travel from the office in Deir al Balah which was difficult with no infrastructure and poor roads. Another challenge was conducting testing at all. The only power supply came from solar panels which stopped working when the sun went down. Unlike here in Canada, the testing environment can’t be controlled. In Gaza, resources are precious and strictly limited. Not only were materials difficult to source, but they were scarce. We continued to test as much as we could to make sure the materials were sound and sturdy. However, any tests that stressed material supply and electrical usage had to be done in Canada.

The external fixator is Glia’s most complex project. There are many parts to a kit, including 3D printed parts, rods, pins, nuts and bolts. All materials need to be sourced, tested, inventoried, and numbered. This isn’t easy with a strict blockade in place and a chaotic environment. Despite the ceasefire, I heard bombs, shelling and gunfire regularly, day and night. Most of it was “behind the yellow line”, an arbitrary line decided by Israel, running north to south, cutting Gaza in half. The west half was supposedly safe, but there were still combat events happening there too. An app on my phone alerted me to most of them. It was unsettling, but I took my cues from the locals and didn’t worry. Most of the sounds were too far away to care.

With such a complex project, there were also many team players involved. There was the core Glia team in Gaza, and the virtual team in Canada. Then a volunteer base helping with project management using open source applications. They were responsible for maintaining clear communications and transparent change management. If anything in the project changed, even a little, everyone had to know about it and discuss it to make sure it wasn’t going to cause any problems. Various tools were used for this, and all players had to be aware of the process. Next, there was the hospital staff in Gaza who were onboard for using our device, especially Dr. Fadl Naim and Dr. Ghassan Abu-Sittah. They were the real champions open to using our device, especially since they had been patiently waiting for this project to come to fruition for many years. The ceasefire didn’t make anyone relax into complacence. They all felt it wouldn’t last, and wanted to be prepared. Manufacturing locally means that good quality devices will be available despite what happens with the border, materials will move through the local economy, and hope for survival continues.

External fixators need to be implanted by orthopaedic surgeons and their surgery team. After this, the patients need physical rehabilitation so that they can walk with the fixator installed. There are multiple check-ups and x-rays. It takes months for the bones to heal. Then there is another surgery to remove the device. Glia closely monitors all these steps with the hospital staff and documents the progress. Good coordination and clear communication are essential.

By the time I entered Gaza, one successful surgery had been done using Glia’s external fixator. The patient had a check-up while I was there and he could now walk. His leg was healing. The device was made with bright orange plastic holding the pins and rods together. It almost looked like a toy poking out of his shin, but it saved him from an amputation. He was overjoyed.

I was fortunate to arrive a few days after a ceasefire came into effect, and I took the opportunity to see as much as I could while I was there. Although there was a lot of instability and an ever present threat, there was a certain amount of freedom to move around west of the yellow line, even though there really is no safe zone there. However, I took advantage of this.

My first trip was to Gaza City during my second week. This is the epicenter of the strip being the most developed and populated area. What I saw was a crippled metropolis. Buildings were reduced to rubble. Multiple floors collapsed onto each other while a group of men sat nearby chatting and smoking. Market stalls were set up around the destruction as if it was a mess to be ignored. It was an odd mix of annihilation and business-as-usual. They simply don’t have the capacity to deal with it, so people continue living around it, and in it. Many times I witnessed families camping in the fallen remains of their bombed homes; devastation all around. Behind my stoicism, my heart broke.

We were going to Gaza City to visit Al Shifa Hospital, which was heavily bombed and besieged the year before. Two large buildings were hollow and blackened. We entered the hospital director’s office, where he sat behind a broad desk. Turkish coffee and chocolate bars were quietly served. Formal and polite, we introduced ourselves and talked about how the hospital was functioning under such difficult circumstances. Since January 2024, Glia has worked with the World Health Organization to bring in medical staff from all over the world to help with the crisis. One doctor with us who specialized in neonatal care was seeking a place to train local staff.

After our meeting, we went to the local market. It was busy, but most people there cannot afford to buy anything. It’s a way that they can socialize and continue to function despite the enormous catastrophe threatening to swallow all hope. If you closed your eyes, you could pretend everything was normal. One of the most shocking things to witness was the traffic. At every intersection there could be trucks, donkey carts, cars with a house worth of goods strapped to the top, stalls selling plastic bottles of diesel, and cyclists all congregating towards each other, wanting to get through the mayhem. There are no stop lights, no system, no control.

Next, we made our way through the crowds to Al Ahli Hospital, a private hospital that’s turned public to help the general population during mass casualty events. We had five external fixator kits to deliver to an orthopaedic surgeon. Bader spoke with the hospital staff to make sure we were informed of any surgeries scheduled to use our devices. We were assured we would be notified 24 hours in advance. On the night we returned to our guest house in Deir al Balah, the ceasefire broke and Gaza City was heavily bombed, yet again. I heard those bombs, about an hour or so away. Our guest house shook. The doctors we had dropped off at the hospitals earlier in the day were texting us about what they were witnessing. How much more could these people and this place take?

I also had the chance to spend several nights in Khan Yunis, where Glia’s Head of Mission, Moureen, rents a house with a tiny hobby farm on the beach. We ate fresh eggs with hummus and pita, and slept outside to the sound of the Mediterranean waves. Despite these simple luxuries, sometimes late at night there was a pungent smell of burning garbage reminding us of the situation. The multitude of tents on the beach, as well as everywhere else, was constant evidence of the mass displacement of people. There are simply not enough buildings standing anymore to house everyone. I had the rare opportunity to enter one of the tents on the beach to meet a newborn. It was dark and cozy, but it was also fragile and exposed. Although the walls were slightly protective, the floors were just carpets over sand. It was obvious that it was not a long-term solution for living. When we drove the bumpy, narrow dirt paths in and out of that neighbourhood, all I saw were people making do however they could with what little they had.

When a patient has an external fixator implanted, they cannot put weight on their leg right away and need assistance in the form of a walker or crutches if they want to get around independently. There is a shortage of those as well. So, Glia started the local search for materials, specifically wood and aluminum, to manufacture these devices. We also met with a local physical therapist to advise us with the project. Starting manufacturing of any kind in Gaza was inspiring the team. It gave everyone purpose and drive. Something positive to focus on. Fuel to continue living and striving and building in the midst of the genocide. I was bursting with gratitude to do this work.

Time moved differently there. After my first week, it felt as if a month had gone by. But the days went fast, and before I knew it my last week arrived. I woke up one morning to a text that an operation had been done at the hospital using one of our external fixator kits. We had not been informed, and I was supposed to witness a surgery before I left. This caused some panic within the team, not just in Gaza, but in Canada as well. Everyone needed to know what had happened, so we held an emergency meeting online to establish and clarify the facts of what was and wasn’t communicated. Plans tend to go awry even in the most organized places, so in Gaza, due to the lack of cohesive systems and personnel in the hospitals, things are bound to get missed. Our team figured out a way to mitigate any more surprises and finally determined that the surgery had been a success despite not being aware of it happening. I didn’t know if it was a good or bad thing that I wasn’t present to watch.

Bader and I were printing as many parts as we could on the 3D printers and figuring out how to package them with instructions. We settled on a system that worked well. I made sure all of the steps were followed and documented with photos and videos. At one point, he asked me to stay and continue working with him. We enjoyed our time together in the office, and the work flowed well between us. But we both knew I had to leave. I had a life to get back to in Canada. I couldn’t stay in Gaza, and a heavy silence filled the space between us. He understood, even though it made him sad.

In my time there, I fell in love with the people and the place, despite the constant terror from drones and bombs and bullets. The survival instinct is strong, and perhaps that woke up a part of me that wanted to stay and resist with everyone there. But I became increasingly aware that Gaza is the largest open-air prison in the world. The border is closed to all but a few, and the way through is rife with bureaucratic militarism.

When my time to leave was coming, I realized how fortunate I was to be let in to the area, and to see so much of it. I visited many places where foreigners are simply not seen. I was met with a lot of stares and many more smiles. People who saw me blessed me and thanked me as their faces lit up. They knew I was there to help. I walked among them in places I wouldn’t have been able to go were it not for the ceasefire. I got a sense of life there. I never asked the people I met what they’ve seen or lived through because they’re still living through it. Death was always present, even when not visible. Sometimes someone would share a story with me about a horrifying experience they had, and I will hold those truths of their life as sacred.

The day I left, the sun was beaming behind the thick clouds in a peach and purple sky. I couldn’t help my tears as I said goodbye. All the aid workers boarded a bus to exit, and the journey out was sad and full of joy. Almost every person we passed on the winding roads waved, smiled, threw hearts and kisses at all of us watching from the huge lumbering windows. I don’t know if I’ll ever return, but if I get the chance to, I will. Gaza is a place of destruction and hope – fear and love. It is intense, and it leaves a mark on all who have the blessing to experience it.

Returning to Canada was not easy. All the emotions that had buried themselves in Gaza came to the surface now that I was safe at home. Sadness, grief, anger and guilt reared up like a tsunami and I had to take time to integrate what I witnessed. I am not the same as I was before.

I’ve been working at Glia for four years, and I went to virtual meetings with the Gaza team before my trip, but going to meet and work with them brought us together in a way that wasn’t possible online. So much information is communicated through embodied presence and shared experience, it’s impossible to have the same connection without this. We bonded in a very personal way, and now we’re a team unlike before because we truly know each other.

There was a press conference about our external fixator project and it was featured on many local and international news channels. The doctors involved gave presentations, as well as Glia’s Director of Development, Dorotea Gucciardo, and myself. The project is getting ready to ramp up so that large-scale manufacturing can begin and ensure hospitals have these much needed devices. This work is essential for places where resources are unpredictable. Not only does it empower the local community, it inspires others around the world to look for ways we can all contribute to the greater good.

When Dorotea was in Gaza in May of 2024, she told me that the sky was full of kites there as if to show the world that the people still existed, and hope was still alive. When she was in Gaza with me for about two weeks, she didn’t see any kites in the sky. Not one. The only kites we saw were caught in tree branches, torn and ragged with the passing of time. But the day I rode the bus on my way out of Gaza, I saw one kite in the clear blue sky, flying against all odds.