DEIR AL-BALAH, Gaza Strip--The doctors gave Shaimaa Nabahin an impossible choice: lose your left leg or risk death.

The 22-year-old had been hospitalized in Gaza for around a week, after her ankle was partially severed in an Israeli airstrike, when doctors told her she was suffering from blood poisoning. Nabahin chose to maximize her chances of survival, and agreed to have her leg amputated 15 centimeters (6 inches) below the knee.

The decision upended life for the ambitious university student, as it has for untold others among the more than 54,500 war-wounded who faced similar gut-wrenching choices.

“My whole life has changed,” said Nabahin, speaking from her bed at the Al-Aqsa Martyrs Hospital in the central town of Deir al-Balah. “If I want to take a step or go anywhere, I need help.”

The World Health Organization and the Health Ministry in Hamas-run Gaza say amputations have become commonplace during the Israel-Hamas war, now in its 12th week, but could not offer precise figures. At the hospital in Deir al-Balah, dozens of recent amputees are in various stages of treatment and recovery.

Experts believe that in some cases, limbs could have been saved with proper treatment. But after weeks of Israel's blistering air and ground offensive, only nine out of Gaza's 36 hospitals are still operational. They are greatly overcrowded, offer limited treatment and lack basic equipment to perform surgeries. Many wounded are unable to reach the remaining hospitals, pinned down by Israeli bombardment and ground combat.

Sean Casey, a WHO official who recently visited several hospitals in Gaza, said the acute lack of vascular surgeons — the first responders to trauma injuries and best positioned to save limbs — is increasing the likelihood of amputations.

But also in many cases, he said, the severe nature of the injuries means some limbs are not salvageable, and need to be removed as soon as possible.

“People may die of the infections that they have because their limbs are infected,” Casey told a news conference last week. “We saw patients who were septic.”

Israel declared war after Hamas militants stormed across the border on Oct. 7, killing some 1,200 people, mostly civilians, and taking more than 240 hostages. Israel has vowed to keep up the fight until Hamas is destroyed and removed from power in Gaza and all the hostages are freed. More than 20,600 Palestinians have been killed in the fighting, about 70% of them women and children, according to Gaza's Health Ministry, which does not differentiate between civilians and combatants among the dead.

Before the war, Gaza's health system was overwhelmed after years of conflict and a border blockade enforced by Israel and Egypt in response to the 2007 Hamas takeover of the territory. In 2018 and 2019, thousands were wounded by Israeli army fire in weekly Hamas-led anti-blockade protests, and more than 120 of the wounded had limbs amputated.

Even then, Gaza amputees had a hard time getting prostheses that would help them return to an active life.

Those joining the ranks of amputees now face near-impossible conditions. Some 85% of the population of 2.3 million have been displaced, crowding into tents, schools-turned-shelters or homes of relatives. Water, food and other basic supplies are scarce.

On Nov. 13, when an Israeli airstrike hit the home of Nabahin's neighbor in Bureij, an urban refugee camp in central Gaza, her ankle and arteries in her leg were partially severed by a clump of cement that blew into her home from the explosion next door. She was the only one of her family who was injured, while a number of her neighbors were killed, she said.

She was quickly taken to nearby Al-Aqsa Martyrs Hospital, where doctors managed to sew up her leg and and stop the bleeding.

But after that, Nabahin said she received minimal treatment or attention from doctors, who were dealing with a growing number of critically wounded people amid dwindled medical supplies. Days later, her leg turned a dark color, she said.

“They discovered that there was … shrapnel that was poisoning my blood," she said.

The amputation went well, but Nabahin said she remains in acute pain and can't sleep without sedatives.

Jourdel Francois, an orthopedic surgeon with Doctors Without Borders, says the risk of post-op infections in war-stricken Gaza is high. Francois, who worked at Nasser Hospital in the southern town of Khan Younis in November, said hygiene was poor, mainly because of scarce water and the general chaos in a hospital that's overwhelmed with patients while hosting thousands of displaced civilians.

He recalled a young girl whose legs had been crushed and urgently needed a double amputation, but she couldn't be booked into surgery that day because of the high number of other critical injuries. She died later that night, Francois said, likely from sepsis, or blood poisoning by bacteria.

“There are 50 (injured) people arriving every day, you have to make a choice,” he told The Associated Press by phone after leaving Gaza.

At Al-Aqsa Martyrs Hospital, many of the new amputees struggle to get to grips with how the loss of limb has changed their lives. Nawal Jaber, 54, had both legs amputated after she was injured on Nov. 22, when an Israeli bombardment hit her neighbor's empty house and damaged her house in Bureij. Her grandson was killed, and her husband and son were wounded, she said.

"I wish I could meet the needs of my children, (but) I am unable,” the mother of eight said, with tears streaming down her face.

Before the conflict, Nabahin had started her degree in international relations in Gaza and planned to travel to Germany to continue her studies.

She said her goal now is to get out of Gaza, to "save what is left of me, and to install a prosthetic limb and live my life normally.”

At least 68 killed in central Gaza in airstrike, adding to weekend's bloodshed.

DEIR AL-BALAH, Gaza— At least 68 people were killed by an Israeli strike in central Gaza, health officials said Sunday, while the number of Israeli soldiers killed in combat over the weekend rose to 17.

Associated Press journalists at a nearby hospital watched frantic Palestinians carry the dead, including a baby, and wounded following the strike on the Maghazi refugee camp east of Deir al-Balah. One bloodied young girl looked stunned while her body was checked for broken bones.

The 68 fatalities include at least 12 women and seven children, according to early hospital figures.

“We were all targeted,” said Ahmad Turkomani, who lost several family members including his daughter and grandson. “There is no safe place in Gaza anyway.”

Earlier, the Health Ministry in Gaza gave the death toll as 70. The Israeli military had no immediate comment.

As Christmas Eve fell, smoke rose over the besieged territory, while in the West Bank Bethlehem was hushed, its holiday celebrations called off. In neighboring Egypt, tentative efforts continued on a deal for another exchange of hostages for Palestinians held by Israel.

The war has devastated parts of Gaza, killed roughly 20,400 Palestinians and displaced almost all of the territory’s 2.3 million people.

The mounting death toll among Israeli troops — 156 since the ground offensive began — could erode public support for the war, which was sparked when Hamas-led militants stormed communities in southern Israel on Oct. 7, killing 1,200 and taking 240 hostage.

Israelis still largely stand behind the country’s stated goals of crushing Hamas’ governing and military capabilities and releasing the remaining 129 captives. That's despite rising international pressure against Israel’s offensive, and the soaring death toll and unprecedented suffering among Palestinians.

HAMAS EXACTS A PRICE

“The war exacts a very heavy price from us, but we have no choice but to continue fighting,” Israeli Prime Minister Benjamin Netanyahu said.

In a nationally televised speech, Israeli President Isaac Herzog appealed for the country to remain united. “This moment is a test. We will not break nor blink,” he said.

There has been widespread anger against his government, which many criticize for failing to protect civilians on Oct. 7 and promoting policies that allowed Hamas to gain strength over the years. Netanyahu has avoided accepting responsibility for the military and policy failures.

“Over time, the public will find it hard to ignore the heavy price paid, as well as the suspicion that the aims that were loudly heralded are still far from being attained, and that Hamas is showing no signs of capitulating in the near future," wrote Amos Harel, military affairs commentator for the Haaretz newspaper.

The Israeli military said it had completed the dismantling of Hamas’ underground headquarters in northern Gaza, part of an operation to take down the vast tunnel network and kill off top commanders that Israeli leaders have said could take months.

Efforts toward negotiations continued. The head of the Palestinian Islamic Jihad, Ziyad al-Nakhalah, arrived in Egypt for talks. The militant group, which also took part in the Oct. 7 attack, said it was prepared to consider releasing hostages only after fighting ends. Hamas’ top leader Ismail Haniyeh traveled to Cairo for talks days earlier.

INSIDE GAZA

Israel’s offensive has been one of the most devastating military campaigns in recent history. More than two-thirds of the 20,000 Palestinians killed have been women and children, according to the Health Ministry in Gaza, which does not differentiate between civilians and combatants.

On Friday, Israeli airstrikes on two homes in Gaza killed 90 Palestinians, including dozens from an extended family, according to rescuers and hospital officials. One of the homes, located in Gaza City, became one of the deadliest airstrikes in the war after 76 people from the al-Mughrabi family were killed, said Mahmoud Bassal, a spokesman for Gaza’s Civil Defense department.

The Palestinian Red Crescent said a 13-year-old boy was shot and killed in an Israeli drone attack while inside al-Amal Hospital in Khan Younis, a part of Gaza where Israel's military believes Hamas leaders are hiding.

An Israeli strike overnight hit a house in a refugee camp west of the city of Rafah, on Gaza’s border with Egypt. At least two men were killed, according to Associated Press journalists in the hospital where the bodies were taken.

At least two people were killed and six others wounded when a missile stuck a building in the Bureij refugee camp in central Gaza.

And Palestinians reported heavy Israeli bombardment and gunfire in Jabaliya, an area north of Gaza City that Israel had claimed to control. Hamas’ military arm said its fighters shelled Israeli troops in Jabaliya and Jabaliya refugee camp.

Israel faces international criticism for the civilian death toll but it blames Hamas, citing the militants’ use of crowded residential areas and tunnels. Israel has launched thousands of airstrikes since Oct. 7. It says it has killed thousands of Hamas militants, without presenting evidence.

Israel also faces allegations of mistreating Palestinian men and teenage boys detained in homes, shelters, hospitals and elsewhere during the offensive. It has denied abuse allegations and said those without links to militants are quickly released.

Speaking to the AP from a hospital bed in Rafah after his release, Khamis al-Burdainy of Gaza City said Israeli forces detained him after tanks and bulldozers partly destroyed his home. He said men were handcuffed and blindfolded.

“We didn’t sleep. We didn’t get food and water,” he said, crying and covering his face.

Another released detainee, Mohammed Salem, from the Gaza City neighborhood of Shijaiyah, said Israeli troops beat them. “We were humiliated,” he said. “A female soldier would come and beat an old man, aged 72 years old.”

INTERNATIONAL PRESSURE

The United Nations Security Council has passed a watered-down resolution calling for the speedy delivery of humanitarian aid for hungry and desperate Palestinians and the release of all the hostages, but not for a cease-fire.

But it was not immediately clear how and when deliveries of food, medical supplies and other aid, far below the daily average of 500 before the war, would accelerate. Trucks enter through two crossings: Rafah, and Kerem Shalom on the border with Israel. Wael Abu Omar, a spokesman for the Palestinian Crossings Authority, said 123 aid trucks entered Gaza on Sunday,

The head of the World Health Organization, Tedros Adhanom Ghebreyesus, reiterated U.N. calls for a humanitarian cease-fire, adding on social media that “the decimation of the Gaza health system is a tragedy.”

Amid concerns about a wider regional conflict, the U.S. Central Command said a patrol ship in the Red Sea on Saturday shot down four drones launched from Houthi-controlled areas in Yemen, a while two Houthi anti-ship ballistic missiles were fired into international shipping lanes.

The Iran-backed Houthis say their attacks are aimed at Israel-linked ships in an effort to stop the Israeli offensive in Gaza.