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.