By Hanna Duggal, Mohamed Hussein and Soha Elghany

“No doctor wakes up in the morning and says: ‘I'm going to amputate a child's leg without anaesthesia.’

“You don't want to watch children suffer,” Dr Amber Alayyan with Doctors Without Borders, known by its French initials MSF, tells Al Jazeera.

The measured cadences of the voice of the charity’s deputy programme manager for Palestine suggests just how inconceivable it is for her, as a doctor and a mother, to cause pain to a patient and to a child.

Yet it is the moral conflict her colleagues in Gaza face daily, minute by minute, as they try to treat unprecedented numbers of injured people flooding into the Gaza Strip’s barely functioning hospitals.

Your natural instinct is to take care of people… to protect people. ... You've been trained over and over and over and over for years.

BY DR AMBER ALAYYAN

As doctors in Gaza are forced to make split-second decisions on who to save and who to let die, on whose pain to relieve and whose they do not have time to, it is that innate instinct and their Hippocratic oath that is assailed by decisions they never thought they’d have to make.

Burdened with personal losses and struggling to operate under unrelenting Israeli bombardments, this is the story of how medical workers are fighting to keep Gaza’s healthcare system going.