"They're kids who are pretty damaged and will have long-term consequences for these wounds," said Dr. D. Holmes Morton, a pediatrician and director of the Clinic for Special Children in Strasburg.
The most seriously injured girl is being tended to by her family at home and is "not expected to recover much function, if any," Morton said.
He said her care mostly involves treating pain and making her comfortable.
Another girl who also suffered a severe head wound is expected to remain in a hospital rehabilitation facility until December. The other three have "face and limb wounds that will be disabling for a long time, if not permanently," Morton said.
The survivors were among 10 schoolgirls who were taken hostage by milk truck driver Charles Carl Roberts IV on Oct. 2 and shot. The other five girls were killed in the attack, and the 32-year-old gunman committed suicide.
Morton described the survivors' injuries to The Associated Press on Wednesday, the first time a physician with direct knowledge of their care talked about their recoveries. His clinic is about four miles from where the West Nickel Mines Amish School stood.
One surviving girl's shoulder joint was so badly damaged she might not recover the use of her arm. Another girl was wounded in the face, but did not suffer brain damage and is recovering "pretty well." There were also pelvic and hand wounds, he said.
The tragedy has been particularly difficult for the boys, whom Roberts allowed to leave the school before the shooting, Morton said.
"What kind of scars it will leave in that small group of families and the community at large, it's hard to say," he said. "But almost certainly some."
Donations to pay for the girls' treatment and to support Roberts' widow and three children have poured in from around the world.
Before he committed suicide, Roberts told his wife in letters and a phone call that he was angry at God for the 1997 death of his infant daughter and driven by memories of molesting two young relatives 20 years ago, a claim investigators couldn't substantiate. The Amish community has reached out to Marie Roberts since then.
Rich Lauer, director of the Anabaptist Foundation in Mifflinburg, said Wednesday that his organization had collected $1.4 million, much of it in donations of $50 or less and often accompanied by an expression of sympathy.
The Mennonite Disaster Service has collected $551,000, said Ron Guenther, its finance and administration director.
Herman Bontrager, a spokesman for the Nickel Mines Accountability Committee, which is coordinating the donations, did not have a total for the donations.
Five hospitals involved in caring for the shooting victims have said they would absorb treatment costs.