The area of the family home — just a five-minute drive from Gaza City’s main al-Shifa hospital — was thick with Israeli forces. It was not safe to move.
Another family member pulled out a phone to film as Bsaiso set about doing what he could. He washed down the mangled flesh of what was left of 18-year-old Ahed’s leg with a dishcloth as she lay on his kitchen table, the suds falling into a bucket full of soapy water. She whimpered in pain.
“Can you imagine I’m amputating her leg at home?” he told the camera last month in a now widely shared video, his voice cracking from emotion. Machine gunfire rings out in the background. “Where is the mercy? Where is the humanity?”
The gruesome scene of the kitchen amputation without anesthetic — which Bsaiso told The Washington Post he carried out with a normal cooking knife, scissors and a needle and sewing thread — highlights the daily horrors facing Gazans amid the collapse in the health care system in the enclave.
Doctors say they have been forced to carry out amputations and small surgeries without anesthesia or pain relief even for those who can reach a hospital because of the shortages of essential drugs. The screams of patients fill the hallways as dressings are changed and shrapnel removed.
While new supplies of medicine made it into Gaza this week through a deal brokered by France and Qatar, some specific drugs are still missing, said Michel-Olivier Lacharité, head of emergency operations for Doctors Without Borders. “Notably pain killers,” he said. They are sorely needed. “We saw dressing done without pain killers with young children screaming,” he said.
And even once medicines arrive in Gaza, moving supplies to hospitals — particularly those in the north and central areas of Gaza — remains “a real challenge,” he said. Deliveries must be coordinated with the Israeli military and navigate fighting zones and checkpoints, often amid patchy communications. Gaza was just in an eight-day communications blackout.
Only seven out of 29 planned aid deliveries to the north have made it through, said Ted Chaiban, deputy executive director of the United Nations Children’s Fund, UNICEF, who completed a trip to Gaza on Wednesday. “If you have a drop going into Gaza, you have a fraction of that getting to the north,” he said.
UNICEF estimated that at least 1,000 children have had one or two of their legs amputated through the end of November, with an unknown number doing so without sedation or pain medication. “We’ve heard of more cases in the north of the Strip,” said Chaiban.
More than 24,000 people have been killed in Gaza during Israel’s war on Hamas, according to the Gaza Health Ministry, but it does not track numbers of amputations.
During his visit, Chaiban said he met a 13-year-old boy, Ibrahim, who had been injured by shrapnel in November. One piece had lodged near his heart, another in his hand. At the time the family had been north of Gaza City and could not find antibiotics. “He ended up having to get his arm amputated above the elbow without anesthesia,” Chaiban said. “He said it was just excruciating.”
Bsaiso said operating on his niece, Ahed Bsaiso, on his kitchen table was hard to do.
She had climbed to the fifth story of the family’s building in Gaza City when the tank shell hit, he recounted. She’d been trying to call her father, who was outside Gaza when the war began. Her uncle had raised her for the past seven years, referring to her as his daughter in the video.
His own family, who have dual citizenship because his wife is from the Maldives, managed to leave earlier in the war. But he stayed with Ahed and his extended family. “I tied my fate to the fate of this girl,” Bsaiso said. He said, “I’m thankful I didn’t [leave] for the sake of this girl.”
The Israeli tanks were still outside as he operated. Ahed was conscious, but suffering from severe shock, he said. They tried to calm her. He used regular sewing thread to tie off the severed vein in her leg.
After he performed the surgery, Ahed asked him if he’d leave her if Israeli soldiers stormed the house. “Darling, your fate and my fate are one,” he told her. “What happens to you, happens to me.”
For the following five days, she seemed to her family like she was slipping away. In desperation, Bsaiso said he thought about carrying her out to the Israeli tanks outside.
“But thank God it did not come to this,” he said, with the troops eventually withdrawing and the family making it to al-Shifa hospital.
Incidents such as Ahed’s are the “worst case scenarios,” said James Smith, an emergency medical specialist with the International Rescue Committee who spent two weeks in central Gaza’s al-Aqsa hospital before leaving earlier this month. But he said supplies of morphine dwindled even at al-Aqsa, at the time the last functioning hospital in central Gaza.
Smith said one woman was brought in whose lower limb had been almost completely “traumatically amputated.”
“I don’t think she received sedation or analgesia,” he said. “The remainder of the skin was attached by skin and tissue. They just sort of cut it off.”
A Gaza anesthesiologist who worked at al-Shifa until it was stormed by Israeli troops in November said that the hospital at times dealt with 20 amputations a day. However, operating room space generally was reserved for even more serious cases, such as internal bleeding.
“Of course we had to operate in the corridors and recovery rooms,” said the anesthesiologist, who spoke on the condition of anonymity due to security concerns. Most cases were given “light sedation” with ketamine, he said.
But in some hospitals, even that has not been available. At al-Aqsa hospital, there was no ketamine supply, said Smith. He said morphine was available only about half the time.
Seema Jilani, an American doctor with the same team, recalled a 23-year old worker for the United Nations Relief and Works Agency who died in the hospital after having his lower leg blown off.
“He died without any morphine, he was actually wearing his UNRWA vest,” she said.
“Doctors sometimes can’t do a lot, but one thing we usually can do is treat pain. To not be able to do that feels inept and cruel and inhumane,” she said.
Morris from Berlin. Claire Parker in Cairo and Hazem Balousha in Amman, Jordan, contributed to this report.