Dr. Hani Bseso’s teenage niece, Ahed, bled and cried, drifting in and out of consciousness, calling out for him.
A shell destroyed their home on that December day, as fighting raged outside and Israeli troops surrounded it. It was too dangerous to drive the five minutes to Al-Shifa Hospital, where Dr. Bseso, 52, practiced orthopedics.
So he grabbed a kitchen knife, scissors and sewing thread and cut off Ahed’s legs on the kitchen table where Ahed’s mother had been making bread.
“She was badly injured,” he recalled. “No tools, no anesthetic, nothing,” he explained. “I had to find a way to save her life.”
The rough surgery was filmed A video The photo, which has been widely circulated online, is a horrific symbol of the painful choices repeated countless times in a war that has destroyed life and limb in Gaza. Doctors say they are shocked by the number of amputations in Gaza, where patients are at risk of infection in a place where medical resources and even clean water are limited.
The war between Israel and Hamas in Gaza has killed more than 37,000 people in the region, according to Gaza health authorities. The figures do not distinguish between civilians and combatants. The war has also left many more wounded. Local health authorities put the number of wounded at more than 85,000, including a large number of amputees, according to rescue workers.
Gaza’s health system is struggling to cope. Many hospitals in the region have completely stopped serving, while others are struggling to survive due to severe shortages of supplies such as anesthetics and antibiotics.
Surgeons say shortages and the sheer number of casualties are forcing them to amputate limbs that would be salvageable elsewhere, but they say that is a lose-lose situation because amputations require intensive care and often further surgery.
“There are no good options out there,” said Ana Jeelani, an orthopedic surgeon in Liverpool, England, who spent two weeks in March at Al-Aqsa Hospital in central Gaza. “Everything we do requires follow-up, and there is none.”
Thorough disinfection was difficult. Bandages and blood bags were all gone. Patients lay in dirty beds. It was “a perfect storm for infection,” Dr. Gilani said.
Dr. Gilani said patients who otherwise would have survived were dying from infections. But, “We have no choice, right?” she said. “We have no choice.”
That led to “a hellscape of nightmare scenarios,” said Dr. Seema Jilani, who previously served as senior emergency health adviser for the International Rescue Committee. She has worked in multiple conflict zones, but she said the images from her two weeks in Gaza haunt her.
There was a 6-year-old boy with burns all over his body and his feet cut off. A girl had lost both of her feet. A toddler had his right arm and leg torn off and appeared to be bleeding. He needed a chest tube but didn’t have one. There was no stretcher either – and no one gave him any painkillers.
An orthopedic surgeon stopped the bleeding but did not take the child to surgery because he said there were more urgent situations.
“I try to imagine what could be more urgent than a 1-year-old with no arms, no legs, choking on his own blood,” she said. “So you get an idea of the magnitude of the damage that we’re seeing.”
The exact number of Gazans who have lost limbs in the war is not yet known. UNICEF estimates that Last November, about 1,000 Palestinian children had one or both legs amputated, and recently said, “It is highly likely that the number has been far exceeded in the past four months.”
Dr. Marwan Hamas, director of Abu Yusuf al-Najjar Hospital in the southern city of Rafah, has been treating Gaza’s wounded for 20 years. He said traumatic amputations — those that occur outside of hospitals — were rare in previous conflicts, “but now we see them very often.”
On March 1, Sabir Ali Abu Jiba’s donkey cart was hit, breaking his left leg instantly. His right leg was also seriously injured; doctors said it might have to be amputated as well.
“I’m afraid of losing my second leg,” he said as he lay in a bed at Al-Aqsa Hospital in Deir al-Balah, his stump propped up on pillows and his right leg riddled with metal pins.
Mr. Abu Jiba, 21, said he was tormented by the thought of his future — which girl would marry him? How would he work?
“My life was just beginning and I felt really bad for what happened to me and my leg,” he said.
He hopes to receive permission to leave Gaza to receive treatment — “and save my leg before it’s too late.”
Many of those who have lost limbs during this war are in a similar state of uncertainty, unsure if or when they will be able to receive the follow-up surgeries, prosthetics, and rehabilitation services that were available in the past.
On a spring afternoon, at least three people who had lost limbs filled Ward 1 of the European Gaza Hospital, some of whom watched TikTok videos on the free Wi-Fi, while young girls came by to sell chocolates and homemade goods.
One of them is Shadi Issam al-Daya, 29, who lost both his legs and his left hand.
“Thank God I still have one hand to hold things,” he said. “I won’t be looking for a job again.”
Mr. Aldaya, who worked as a DJ in Gaza hotels before the war and is now married with a nine-month-old daughter, Alaa, said his injuries had left his family devastated.
He added: “My life is over and my wife is devastated by what’s happened to me.”
Visiting foreign doctors operated on him, but Mr Daya said he needed more surgeries: not only on his left shoulder, but also on his legs.
The kitchen knife Dr. Bseso used to amputate his niece’s leg that December day was not sterilized — all he used was water and soap.
It wasn’t until four days later that it was safe enough for Ahed to be taken to hospital, where she underwent “multiple surgeries,” Dr. Bessasso said. The teen was eventually evacuated to Egypt and then to the United States for treatment with the help of an American charity.
“Under different circumstances, she would have only had a 20 percent chance of saving her leg,” Dr. Bseso said.
“Under our circumstances,” he added, “her chances are virtually zero.”
