With blood and tears, the nephew of Dr. Hani Bseso, Ahed, called her when she entered and was unconscious.
A shell had ripped into his house, which had been surrounded by Israeli forces as fighting raged outside that December day. It is dangerous to drive five minutes to Al-Shifa Hospital, where Dr. Bseso, 52, works in orthopedics.
So he took a kitchen knife, scissors and sewing thread – and cut Ahed’s leg off at the kitchen table, where her mother was making bread.
“He hit me hard,” he recalled. With “no tools, no drugs, nothing,” he explained, “I had to find a way to save him.”
The brutal operation was captured in a video shared online, emblematic of the tough choices that have been repeated many times during Gaza’s devastating war of life and limb. Doctors say they are shocked by the number of amputations in Gaza, which have left patients with infections in places where access to medical care and even clean water is limited.
Israel’s war against Hamas in Gaza has killed more than 37,000 people in the enclave, according to Gaza health authorities. The numbers do not differentiate between civilians and combatants. The war also left more people injured. Local health authorities say the number is more than 85,000 – and aid workers say that includes an even larger number of amputees.
Gaza’s health care system is ill-equipped to cope. Many hospitals in the region have been put out of service, while others are scraping by with shortages of supplies like anesthetics and antibiotics.
Surgeons said the lack of supplies and the size of the wounded forced them to amputate limbs that could have been saved elsewhere. But it’s a losing situation, he said, because amputations require close treatment and, often, further surgery.
“There are no good options out there,” said Dr. Ana Jeelani, an orthopedic surgeon in Liverpool, England, spent two weeks at Al-Aqsa Hospital in central Gaza in March. “Everything needs a follow-up that is done, and there is none.”
Complete sterilization is difficult. Bandages and blood bags ran out. Patients lie on dirty beds. This is “a perfect storm for infection,” said Dr. Jeelani.
According to Dr. Jeelani, a patient who would have survived his injuries died of an infection. But, “We don’t have a choice, do we?” she said. “We have no choice.”
This resulted in “a hellscape full of nightmarish scenes,” said Dr. Seema Jilani, who is a senior emergency health adviser for the International Rescue Committee, an aid group. He has worked in several conflict zones, but he says he can’t take away the images from his two weeks in Gaza.
There was a 6-year-old boy, burned, his leg was severed. A girl lost both her legs. The little boy had his right arm and right leg torn off and was bleeding. He needed a chest tube, but none were available. There was no stretcher either – and he was given nothing because he was sick.
The orthopedic surgeon stopped the bleeding but did not take the boy to the operating room because he said there was a more important case.
“I’m trying to imagine what’s more exciting than a 1-year-old child with no arms, no legs, choking on his own blood,” he said. “So it gives you a scale, or an idea of a scale, of the kind of injuries we’re seeing.”
There is no exact figure for the number of Gazans who have lost limbs in this war. UNICEF estimated in November that about 1,000 Palestinian children had had one or both legs amputated, saying it was “highly likely that this number has exceeded that in the past four months.”
Dr. Marwan al-Hamase, director of the Abu Yousef al-Najjar Hospital in the southern city of Rafah, has been treating the wounded in Gaza for 20 years. Traumatic amputations — meaning those that occur outside of hospitals — of limbs were rare in previous conflicts, he said, “but now we’re seeing this in huge numbers.”
The attack on Saber Ali Abu Jibba’s donkey cart on March 1 immediately tore off his left leg. It is much broken right; Doctors have said that, well, may have to go.
“I’m afraid of losing my second leg,” he said as he lay in bed at Al-Aqsa Hospital in Deir al Balah, his stump propped up on a pillow and his right leg filled with metal pins.
Mr Abu Jibba, 21, said he was sad to think about the future – which girl would he want to marry? How will they work?
“I’m still at the beginning of my life, I feel very sad about what happened to me, my leg,” he said.
He hopes to be given permission to leave Gaza for treatment – “and save my leg before it’s too late.”
Many amputees from this war are in the same uncertain situation, not sure if or when they will be able to have the surgeries, prosthetics and rehabilitation that would have been available in the past.
Room 1 of the European Gaza Hospital has at least three people missing limbs on a spring evening, some of whom are watching TikTok videos thanks to free Wi-Fi while girls sell chocolates and homemade goods.
Shadi Issam al-Daya, 29, was among them, missing his left leg and hand.
“Thank God, I still have one hand to hold and carry anything,” he said. “I won’t have a job in the near future.”
Mr. al-Daya – a DJ in a Gaza hotel before the war – is married and has a 9-month-old daughter, Alaa. He said his family has been devastated by his injuries.
“My life is gone, my wife feels very sad about what happened to me,” he said.
A visiting foreign doctor performed an operation, and Mr. al-Daya said he needed more: Not only for his left shoulder but also for his leg.
Dr Bseso could not sterilize the kitchen knife he used to amputate his nephew’s leg in December – only soap and water.
It wasn’t until four days later that it was safe enough to take Ahed to the hospital, where she underwent “several operations,” said Dr. Bseso. The teenager was eventually evacuated to Egypt and then to the United States for treatment, with the help of an American charity.
“Under different circumstances, he would have a 20 percent chance of keeping his leg,” said Dr. Bseso.
“In our situation,” he added, “his chances are zero.”
