James Elder, a Unicef spokesperson, reported that children in Gaza were enduring “10 weeks of hell and not one of them can escape”.

Elder, who has recently returned from the besieged enclave, reported that the few remaining hospitals in Gaza are overwhelmed with children and their parents, all of whom are bearing “the ghastly wounds of war”. He said that many of them were child amputees.

“As a parent of a critically sick child told me: ‘Our situation is pure misery… I don’t know if we will make it through this’,” he said.

Due to the “total” blockade imposed by Israel on the enclave, and a dearth of anaesthetic, electricity and running water, health workers are forced to perform these surgeries in unhygienic conditions without painkillers.

“It’s not as if there’s… a natural disaster preventing anaesthesia [from entering] Gaza,” Palestinian Children’s Relief Fund (PCRF) founder Steve Sosebee said in an interview with Democracy Now.

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“It’s absolutely unimaginable that this is happening in our modern world,” he said.

He added that the number of child amputees was likely to grow “because a lot of these kids have significant injuries [that mean] they’ll need amputations in the coming weeks and months”.

“Not only were they amputated without anaesthesia, but many of them were amputated in a very quick fashion,” he said.

“Around half of my operating list, which was around 10 to 12 cases every day… were children,” Dr Ghassan Abu Sitta, a London based surgeon who travelled to Gaza to treat patients amid the ongoing Israeli onslaught, said in a press conference in November.

“One night, at Al-Ahli Hospital I performed amputations on six children,” he recalled.

In an interview with Middle East Eye, Sittah said that having to perform these operations without anaesthetic was “one of the most difficult things I’ve had to do in my career”.

An amputee crisis

Prior to the current war on Gaza, 12 percent of Palestinian children aged two to 17 faced one or more functional difficulties, while 21 percent of households in Gaza include at least one member with physical or mental disabilities.

According to PCRF, prior to the current hostilities, Gaza was already suffering from an “amputee crisis”.

The ongoing Israeli siege on the enclave, which tightly controls the flow of people, medical equipment and pharmaceuticals in and out of the area, means timely evacuation of the wounded to better equipped hospitals in the occupied West Bank is often impossible.

The barriers to healthcare access are such that the UN defined “individuals in need of medical referrals” as a vulnerable group within the Palestinian population.

According to PCRF, many Palestinians are at risk of osteomyelitis (bone infection) following injury if medical treatment is delayed. The dearth of medical resources and restrictions on movement in the besieged strip means that many treatable injuries require amputation.

Furthermore, accessing prosthesis after amputation was extremely difficult in Gaza even prior to the current hostilities, with only one prosthetic limbs centre operating in the besieged enclave.

In 2018-19, Israeli forces fired at thousands of Palestinians during the Great March of Return protests, killing 214, including 46 children, and injuring over 36,100, including nearly 8,800 children.

Over 7,000 of the live ammunition injuries (88 percent) were limb injuries, with amputations required in 156 of these cases.

In the aftermath of the assault on the March of Return protesters, Israel denied most injured protesters’ medical permit requests to access specialised treatment in the occupied West Bank, East Jerusalem and Israeli hospitals.

According to Ghada Majadi and Hadas Ziv, if the patients had access to this specialised treatment, many amputees could have rescued their limbs.

The confirmed Palestinian death toll from ongoing Israeli attacks on the Gaza Strip has surged to 21,110, the health ministry in the territory said on Wednesday, with 70 percent of the casualties women and children.

An additional 54,536 have also been wounded in Israeli attacks on the besieged enclave.