Dr Hani Bousseso’s teenage niece, Ahed, was bleeding, crying and in a daze as she continued to call for the doctor.
That December day, with Israeli forces besieging their house and shells pounding it, and fighting raging outside, it was too dangerous to make the five-minute drive to Al Shifa Hospital, where Dr Buceso, 52, works as an orthopedic surgeon.
So he grabbed a knife, scissors and sewing thread and amputated Ahed’s leg on the kitchen table, where his mother was baking bread.
“She was badly beaten,” he recalled. “We had no tools, no anesthesia, nothing,” he explained. “We had to find a way to save her life.”
This crude surgery video The video has been shared widely online as a somber symbol of the countless painful choices made in a war that has destroyed lives and limbs in Gaza. Doctors say they are shocked by the number of amputations in Gaza, where access to medical care and even clean water is limited, putting patients at risk of infection.
Israel’s war against Hamas has killed more than 37,000 people in the Gaza Strip, according to Gaza health officials, a figure that does not distinguish between civilians and combatants, and it also says many more have been wounded in the conflict. Local health officials put the figure at more than 85,000, and aid workers say that includes a huge number of people who have lost limbs.
The Gaza health system is ill-equipped: Many of the area’s hospitals are completely overwhelmed, and others are struggling to cope with severe shortages of anaesthetics, antibiotics and other supplies.
Surgeons say a lack of supplies and the number of injured is forcing them to amputate limbs that could have been saved elsewhere — a lose-lose situation, they say, because amputations are delicate and often require further surgery.
“There are no good options out there,” said Dr. Anna Geelani, an orthopedic surgeon from Liverpool, England, who spent two weeks at Al-Aqsa Hospital in central Gaza in March. “Everything requires the kind of follow-up that we do, and there’s just not there.”
Complete sterilisation is difficult, bandages and blood bags run out, patients lie in filthy beds – “the conditions are conducive to infection,” Dr Geelani says.
Dr Geelani says patients who would have survived their injuries are dying of infection, but “we don’t have a choice, do we?” she says. “We don’t have a choice.”
That has led to “a hellish landscape of nightmarish scenes,” said Dr. Seema Jilani, a former senior emergency medical adviser to the aid group International Rescue Committee, who has worked in several war zones but said the scenes from the past two weeks in Gaza remain haunting.
There was a six-year-old boy whose leg had been amputated and who was burned all over his body. A girl who had lost both legs. A toddler whose right arm and leg had been ripped off and who appeared to be bleeding. He needed a chest tube but couldn’t get one. There were no stretchers. No painkillers or anything.
Orthopedic surgeons stopped the bleeding but did not take the child to the operating theatre, citing more urgent matters.
“I tried to imagine something more dire than a 1-year-old with no arms or legs choking on his own blood,” she said, “so I think that gives some idea of the scale or extent of the injuries that we’re seeing.”
There are no exact figures for the number of Gazans who have lost limbs in the war. UNICEF estimate The UN said in November that around 1,000 Palestinian children had had one or both legs amputated, and recently said that “it is highly likely that this figure has been much higher in the past four months.”
Dr. Marwan Al-Hamaneh, director of Abu Yousef Al-Najjar Hospital in the southern Gaza city of Rafah, who has treated Gaza’s wounded for two decades, said that while traumatic amputations of multiple limbs outside of hospitals were rare in previous conflicts, “we are now seeing a lot more cases.”
Saber Ali Abu Jiba’s left leg was instantly amputated when his donkey cart collided with his cart on March 1. His right leg was also severely damaged and doctors say it may have to be amputated as well.
“I’m scared to lose my other leg,” he said, lying in bed at Al-Aqsa Hospital in Deir al-Balar, his amputated leg propped up on pillows and a metal pin embedded in his right leg.
Abu Ziba, 21, said he felt dire when he thought about his future: What kind of girl would want to marry him? How would he get a job?
“I’m still at the beginning of my life and I’m very sad about what happened to my leg,” he said.
He hopes to be allowed to leave Gaza for treatment, “and to save my leg before it’s too late.”
Many amputees in this war face a similar uncertainty, not knowing when they will receive the additional surgeries, prosthetics or rehabilitation they would have received before.
On a recent spring afternoon, at least three amputees were in Room 1 of the European Gaza Hospital, some of them taking advantage of the free Wi-Fi to watch TikTok videos as young girls arrived to sell chocolates and homemade goods.
Shadi Issam Al Daya, 29, was one of them, having lost both legs and his left hand.
“Thankfully, I still have one hand so I can pick up and carry anything,” he said. “I don’t think I’ll ever have a job.”
Al-Daya, who worked as a DJ in Gaza hotels before the war, is married and has a nine-month-old daughter, Alaa, and said his family were devastated by his injuries.
“My life is over. My wife is very sad about what happened to me,” he added.
Visiting foreign doctors performed the surgery, but Al Daya said he not only needed surgery on his left shoulder, but also on his leg.
Dr Busceso failed to sterilise the knife he used to amputate his niece’s leg that December day – he only used water and soap.
It was four days later before it was safe enough to take Ahed to a hospital, where she underwent “several surgeries,” Dr. Buceso said. The girl was eventually evacuated to Egypt and then treated in the United States with the help of an American charity.
“If things had gone differently, she probably had about a 20 percent chance of surviving her leg,” Dr Busceso said.
“In our situation, her chances were literally zero,” he added.
