Bleeding and crying, Dr Hani Bseso’s teenage niece Ahed called out to him as she drifted in and out of consciousness.
A shell had ravaged 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 thread, then amputated Ahed’s leg on the kitchen table, where her mother had just been baking bread.
“She was hit hard,” he recalls. With “no tools, no anesthesia, nothing,” he explained, “I had to find a way to save his life.”
The gross surgery was captured in a video widely shared online, a dark emblem of the agonizing choices that have been repeated countless times in a war that has ravaged the lives and limbs of Gaza residents. Doctors say they are stunned by the high 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 Gaza health authorities. The figures do not distinguish between civilians and combatants. The war also caused even greater numbers of casualties. Local health authorities say the number is more than 85,000 – and aid workers say that includes a considerable number of amputees.
Gaza’s health system is ill-equipped to cope. Many of the territory’s hospitals have been completely knocked out of service while others are coping with severe shortages of supplies like anesthesia and antibiotics.
Surgeons say the lack of equipment and the large number of injured have forced them to amputate limbs that could have been saved elsewhere. But it’s a lose-lose situation, they say, because amputations require careful care and, often, further surgeries.
“There are 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 on our part, and there is none. »
Complete sterilization is difficult. Bandages and blood bags are exhausted. Patients lie on dirty beds. It’s “a perfect storm for infection,” Dr. Jeelani said.
According to Dr. Jeelani, patients who may have survived their injuries die of infection. But “We don’t have a choice, do we?” ” she says. “We do not have the choice.”
That 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, a humanitarian group. She has worked in several conflict zones, but said she can’t get the images of 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 of her 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 was available. There was no stretcher either – and he had not been given anything to ease his pain.
An orthopedic surgeon stopped the bleeding but did not take the child to the operating room because, he said, there were more urgent cases.
“I tried to imagine what was more urgent than a one-year-old child with no hands and no legs, choking on his own blood,” she said. “So that gives you a scale, or a sense of the magnitude, of the type of injuries we’re seeing.”
There are no precise figures on the number of Gazans who lost limbs in this war. UNICEF estimates as of November, approximately 1,000 Palestinian children had had one or both legs amputated, recently saying that “it is extremely likely that this number has been greatly exceeded in the last 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 — that is, those that occur outside of a hospital — of multiple limbs were rare in previous conflicts, he said, “but we are seeing them now in very large numbers.”
The strike that hit Saber Ali Abu Jibba’s donkey cart on March 1 immediately tore off his left leg. This seriously infringed his right; doctors said this too might have to go.
“I’m afraid of losing my second leg,” he said as he lay on a bed at Al-Aqsa Hospital in Deir al Balah, his stump resting on a pillow and his right leg stuffed metal pins.
Mr Abu Jibba, 21, said he was unhappy thinking about his future: Which girl would want to marry him? How will he work?
“I’m still at the beginning of my life, I feel so sad about what happened to me, what happened to me,” he said.
He hopes he will obtain a permit allowing him to leave Gaza for treatment – “and save my leg before it is too late”.
Many amputees from this war find themselves in similar states of uncertainty, not knowing if or when they will be able to benefit from follow-up surgeries, prosthetics and rehabilitation that would have been available in the past.
In Ward 1 of the European Hospital in Gaza, at least three people lost limbs one spring afternoon. Some of them watched TikTok videos thanks to the free Wi-Fi while young girls came to sell chocolates and homemade products.
Shadi Issam al-Daya, 29, was among them, missing both of his legs and his left hand.
“Thank God I still have one hand to hold and carry anything,” he said. “I won’t have a job in the future.”
Mr. al-Daya – a DJ in Gaza hotels before the war – is married and the father of a 9-month-old daughter, Alaa. He said his family was devastated by his injuries.
“My life is over, my wife feels so unhappy because of what happened to me,” he added.
Visiting foreign doctors performed his surgeries, and Mr. al-Daya said he needed more: not just for his left shoulder, but also for his legs.
Dr Bseso was unable to sterilize the kitchen knife he used to amputate his niece’s leg that December day; he only used soap and water.
It was only four days later that it was safe to take Ahed to hospital, where she underwent “a number of surgeries”, Dr Bseso said. The teenager was eventually evacuated to Egypt and then to the United States for treatment, with the help of an American charity.
“Under other circumstances, she would have had about a 20 percent chance of saving her leg,” Dr. Bseso said.
“In our circumstances,” he added, “his chances were literally zero.”
