\n<\/p>\n
Bleeding and crying, Dr. Hani Bseso\u2019s teenage niece Ahed called out for him as she slipped in and out of consciousness.<\/p>\n
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.<\/p>\n
So he grabbed a kitchen knife, scissors and sewing string \u2014 then amputated Ahed\u2019s leg on the kitchen table, where her mother had just made bread.<\/p>\n
\u201cShe was badly hit,\u201d he recalled. With \u201cno tools, no anesthetic, nothing,\u201d he explained, \u201cI had to find a way to save her life.\u201d<\/p>\n<\/div>\n<\/div>\n
The crude surgery was captured in a video<\/a> shared widely online, a grim emblem of the agonizing choices that have been repeated countless times in a war that has ravaged Gazans\u2019 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.<\/p>\n Israel\u2019s 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 wounded. Local health authorities say that number is more than 85,000 \u2014 and aid workers say that includes an outsize number of amputees.<\/p>\n Gaza\u2019s health care system is ill-equipped to cope. Many of the territory\u2019s hospitals have been knocked out of service completely while others scrape by with severe shortages of supplies like anesthesia and antibiotics.<\/p>\n 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\u2019s a lose-lose situation, they say, because amputations require close care and, frequently, further surgeries.<\/p>\n<\/div>\n<\/div>\n \u201cThere\u2019s no good options there,\u201d said Dr. Ana Jeelani, an orthopedic surgeon in Liverpool, England, who spent two weeks at Al-Aqsa Hospital in central Gaza in March. \u201cEverything requires follow-up that we do, and there is none.\u201d<\/p>\n Complete sterilization is difficult. Bandages and blood bags run out. Patients lie on filthy beds. It\u2019s \u201ca perfect storm for infection,\u201d Dr. Jeelani said.<\/p>\n According to Dr. Jeelani, patients who would have survived their injuries are dying from infection. But, \u201cWe have no choice, right?\u201d she said. \u201cWe\u2019ve got no choice.\u201d<\/p>\n<\/div>\n<\/div>\n That has led to \u201ca hellscape full of nightmarish scenes,\u201d 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\u2019t get images from her two weeks in Gaza out of her mind.<\/p>\n<\/div>\n<\/div>\n 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 \u2014 and he hadn\u2019t been given anything for his pain.<\/p>\n An orthopedic surgeon stopped the bleeding but didn\u2019t take the child to the operating room because he said there were more urgent cases.<\/p>\n \u201cI tried to imagine what is more pressing than a 1-year-old with no hand, no leg, choking on his own blood,\u201d she said. \u201cSo that gives you a scale, or an idea of the scale, of the kind of injuries we are seeing.\u201d<\/p>\n