Bleeding and crying, Dr. Hani Bseso’s teenage niece Ahed called out for him as she slipped in and out of consciousness.
A shell had ripped into their home, which had been surrounded by Israeli troops as fighting raged outside that December day. It was too dangerous to make the five-minute drive to Al-Shifa Hospital, where Dr. Bseso, 52, worked in orthopedics.
So he grabbed a kitchen knife, scissors and sewing string — then amputated Ahed’s leg on the kitchen table, where her mother had just made bread.
“She was badly hit,” he recalled. With “no tools, no anesthetic, nothing,” he explained, “I had to find a way to save her life.”
The crude surgery was captured in a video shared widely online, a grim emblem of the agonizing choices that have been repeated countless times in a war that has ravaged Gazans’ lives and limbs. Doctors say they have been stunned by the sheer number of amputations in Gaza, which put patients at risk of infection in a place 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 Gazan health authorities. The numbers do not distinguish between civilians and combatants. The war has also left an even larger number of people of wounded. Local health authorities say that number is more than 85,000 — and aid workers say that includes an outsize number of amputees.
Gaza’s health care system is ill-equipped to cope. Many of the territory’s hospitals have been knocked out of service completely while others scrape by with severe shortages of supplies like anesthesia and antibiotics.
Surgeons say the lack of supplies and the scale of the wounded have forced them to amputate limbs that elsewhere would have been salvageable. But it’s a lose-lose situation, they say, because amputations require close care and, frequently, further surgeries.
“There’s no good options there,” said Dr. Ana Jeelani, an orthopedic surgeon in Liverpool, England, who spent two weeks at Al-Aqsa Hospital in central Gaza in March. “Everything requires follow-up that we do, and there is none.”
Complete sterilization is difficult. Bandages and blood bags run out. Patients lie on filthy beds. It’s “a perfect storm for infection,” Dr. Jeelani said.
According to Dr. Jeelani, patients who would have survived their injuries are dying from infection. But, “We have no choice, right?” she said. “We’ve got no choice.”
That has led to “a hellscape full of nightmarish scenes,” said Dr. Seema Jilani, who served as a senior emergency health adviser for the International Rescue Committee, an aid group. She has worked in several conflict zones, but she said she couldn’t get images from her two weeks in Gaza out of her mind.
There was the 6-year-old boy, covered in burns, whose foot had been severed. A girl missing both feet. A toddler whose right arm and right leg had been torn off and who appeared to be hemorrhaging. He needed a chest tube, but none were available. Nor were any stretchers — and he hadn’t been given anything for his pain.
An orthopedic surgeon stopped the bleeding but didn’t take the child to the operating room because he said there were more urgent cases.
“I tried to imagine what is more pressing than a 1-year-old with no hand, no leg, choking on his own blood,” she said. “So that gives you a scale, or an idea of the scale, of the kind of injuries we are seeing.”
There are no precise figures for the number of Gazans who have lost limbs in this war. UNICEF estimated in November that approximately 1,000 Palestinian children had one or both legs amputated, saying recently that “it is exceedingly likely that this number has been far surpassed in the past four months.”
Dr. Marwan al-Hamase, director of Abu Yousef al-Najjar Hospital in the southern city of Rafah, has been treating Gaza’s wounded for 20 years. Traumatic amputations — meaning those that occur outside a hospital — of multiple limbs were rare in previous conflicts, he said, “but now we are seeing this in very high numbers.”
The strike that hit Saber Ali Abu Jibba’s donkey cart on March 1 ripped his left leg off straightaway. It seriously damaged his right; doctors have said that it, too, might have to go.
“I am afraid to lose my second leg,” he said while lying on a bed at Al-Aqsa Hospital in Deir al Balah, his stump propped on a pillow and his right leg filled with metal pins.
Mr. Abu Jibba, 21, said he was miserable thinking about his future — what girl will want to marry him? How will he work?
“I am still in the beginning of my life, I feel so sad for what has happened to me, to my legs,” he said.
He is hoping he’ll be granted a permit to leave Gaza for treatment — “and save my leg before it is too late.”
Many amputees from this war are in similar states of uncertainty, unsure if or when they’ll be able to get follow-up surgeries, prosthetics and rehabilitation that would have been available in the past.
Room 1 in the European Gaza Hospital had at least three people missing limbs on a spring afternoon, some of whom watched TikTok videos thanks to free Wi-Fi as young girls came through selling chocolates and homemade goods.
Shadi Issam al-Daya, 29, was among them, missing both legs and his left hand.
“Thank goodness, I still have one hand to hold and carry anything,” he said. “I will not have any job in the future.”
Mr. al-Daya — a DJ in Gaza hotels before the war — is married and has a 9-month-old daughter, Alaa. He said his family had been devastated by his injuries.
“My life is gone, my wife feels so miserable about what happened to me,” he added.
Visiting foreign doctors performed his surgeries, and Mr. al-Daya said he would need more: Not just for his left shoulder but also for his legs.
Dr. Bseso wasn’t able to sterilize the kitchen knife he used to amputate his niece’s leg on that December day — all he used was water and soap.
It was not until four days later that it was safe enough to take Ahed to the hospital, where she underwent “a number of surgeries,” Dr. Bseso said. The teen was eventually evacuated to Egypt and then on to the United States for treatment, with the help of an American charity.
“In different circumstances, she would have had some 20 percent chance to keep her leg,” Dr. Bseso said.
“In our circumstances,” he added, “her chances were literally zero.”
