* Thousands wounded in worst conflict with Israel in years
* Lack of medical supplies, rehabilitation facilities
* Disabled face joblessness, isolation in blockaded Gaza
By Sylvia Westall
GAZA, Aug 10 (Reuters) - The attack came from the air in the afternoon, smashing Jamal Doghmosh's Gaza workshop to pieces, pitting his chest with shrapnel and severing his left arm.
When the 48-year-old Palestinian mechanic woke up in hospital, he could not hear properly and found that three fingers from his right hand were also gone.
"It is not possible for me to work without my hands," he said from his hospital bed in Gaza City, three days after the Israeli army bombed his district.
He is one of thousands of Palestinians who have been left physically disabled by the conflict with Israel in the Gaza Strip, which began on July 8 after a surge in Palestinian rocket salvoes into the Jewish state.
Authorities in tiny, densely populated Gaza say 1,890 Palestinians have been killed and at least 9,000 wounded by Israeli air strikes and shelling, a toll worse than the last two bouts of war combined, dating to 2008-09. Israel says 64 of its soldiers and three civilians have been killed.
Israel says Hamas, which controls the narrow coastal enclave, is to blame for the plight of Palestinians because it uses residential districts as launch pads and arms depots.
With limited access to rehabilitation facilities and prosthetic limbs, life as a physically disabled person in the impoverished and blockaded Gaza Strip is especially bleak.
The territory's crowded, uneven streets are no place for a wheelchair, there are few jobs for people with disabilities and little psychiatric support.
"The majority stay in bed, they have bedsores, they do not have sufficient medical care. They need physical and psychological rehabilitation," said Rafeek Zant, manager of a private company supplying medical equipment like prosthetics and wheelchairs in Gaza and the West Bank.
The Israeli-Egyptian blockade on goods into Gaza led to severe shortages of medical supplies even before the current, month-old war, humanitarian organisations say.
It has prevented most people with amputations from being fitted with artificial limbs because Gaza lacks the equipment for testing and making them, Zant said.
Only a small number of Palestinians manage to travel abroad to be fitted, and the process is long and difficult. Some try old-fashioned stiff limbs but give up after a couple of months and opt for a cane, walker or wheelchair instead, he added.
"The borders are closed and they stay without limbs here in Gaza forever," he said.
Handicap International, a global charity which operates in Palestinian territories including the West Bank, says Gaza's hardships make psychiatric help vital for the disabled.
"It is one thing to give someone a prosthesis and learn how to walk again but it is another to make him accept his new condition," said Guillaume Zerr, head of the charity's Palestinian operations.
"Especially with the trauma of the conflict and the trauma of war, there is a tendency to reject their situation."
Disabled people may face added isolation because there can be less acceptance of their condition than in other regions of the world, he said. The charity also worries that physically disabled people may struggle to evacuate before attacks.
"THERE WERE JUST SO MANY"
Before the conflict, there were already between 100,000-200,000 handicapped people in the Gaza Strip out of a population of 1.8 million, Zerr said, citing local and international statistics which vary depending on definition.
The latest conflict has added many more physically disabled: surgeons working in two of Gaza City's main hospitals estimate that around 80 percent of the patients they treated will not fully recover.
"There were just so many," said surgeon Masooud Haji, rubbing his forehead. He saw between two to three amputation cases per shift during the past month at Quds Hospital in Gaza City, around half of them children.
"They were nearly all civilians, 90 percent, with no connections to Hamas. One man I operated on had lost not only limbs, but his wife, his child and his house."
Upstairs at the hospital, Khalid Khattab wheeled his 8-year-old son Ibrahim into a ward. His other son was also wounded, but it was Ibrahim who was the more severe case.
"He was just playing in the street with his brother and there was an aircraft missile," Khalid said, looking down at his child, slumped asleep in the wheelchair with his amputated, bandaged left knee sticking out beneath a blanket.
Medical care staff have also been especially at risk, with bombardments on medical facilities and a centre for the disabled, making rehabilitation even more difficult.
A small number of wounded Palestinians have been able to cross into Israel for treatment. There have been 144 ambulance transfers into Israel through the Erez border crossing since July 8, the Israeli Foreign Ministry said.
Palestinian ambulance driver Akram al-Awour hopes to go abroad for treatment. He was trying to collect injured civilians in Gaza late last month when he was caught in a missile strike.
"When the projectiles fell, I saw bodies on the ground...There were a lot of shouts and calls for help. But I felt immediately that my leg was amputated and that I had other injuries and deep wounds," the 39-year-old said.
He tried to administer first aid on himself, making a tourniquet out of a bandage from his pack. "I was very shocked," he said, his voice breaking.
"I hope to go abroad because my injuries are bad and my mind is also damaged," he said as his 6-year-old daughter and 4-year-old son played around his hospital bed.
"I was saved from death, in the same incident more than 20 were killed and more than 170 wounded," he said.
Across town, Jamal Doghmosh, the mechanic, echoes this sentiment. He is weak and will be handicapped for the rest of his life but he is grateful it was not worse. "When I awoke I thought, praise to god I am still alive, despite my injuries." (Editing by Mark Heinrich)