In the middle of a pitched battle in Iraq came a call for help: Members of Staff Sgt. David Bellavia’s platoon of soldiers were pinned down in a dark house under intense close-range machine-gun fire.

Bellavia stepped into a doorway and squeezed the trigger of his belt-fed M249 squad automatic weapon until it ran dry of ammunition. The Americans, including Bellavia, retreated from the house successfully into the night as insurgents continued to fire on them. But that was just the beginning of Bellavia’s valor on Nov. 10, 2004, according to Army accounts of the battle and those of veterans who served with him.

On Tuesday, Bellavia, 43, of Lyndonville, N.Y., became the first living American to receive the Medal of Honor for actions in the nearly nine-year Iraq War. President Trump draped the award around his neck during a White House ceremony as friends and family members as well as 32 people who served with Bellavia in Iraq watched and then cheered.

Bellavia, who left the Army in 2005, is credited with braving enemy fire to free fellow soldiers from the kill zone, and reentering the house in the city of Fallujah to chase down and kill other insurgents, including one in hand-to-hand combat with a knife.

“Alone in the dark, David killed four insurgents and seriously wounded a fifth, saving his soldiers and facing the enemies of civilization,” Trump said.

Bellavia, who was previously awarded the Silver Star for his actions that day, is among a group of service members who fought in Iraq and Afghanistan whose awards for valor were upgraded after a review launched by then-Defense Secretary Ashton B. Carter in 2016.

In March, on the basis of the same review, Army Staff Sgt. Travis Atkins was posthumously awarded the Medal of Honor for smothering a grenade in Iraq in 2007 to save the lives of fellow soldiers. More than 100 awards have been upgraded.

The awarding of the Medal of Honor, the nation’s highest recognition for valor in combat, to a living recipient comes after years of frustration among veterans over the lack of such recognition. How, they wondered, could no one be worthy of such recognition after all of the intense urban combat of Iraq?

In a meeting with reporters at the Pentagon on Monday, soldiers who fought alongside Bellavia credited him with saving their lives.

“He put himself in the line of that fire and laid down a base of fire, overwhelmed the enemy long enough for me to get myself and the members of my squad out,” said retired 1st Sgt. Colin Fitts, one of the soldiers pinned down in the house. “Were it not for David Bellavia, I wouldn’t be sitting here today.”

Bellavia was fighting in Operation Phantom Fury, in which more than 10,000 U.S. troops took back from 3,000 to 4,000 deeply entrenched insurgents what had once been a city of more than 350,000 people. The intense clash, commonly known as the Second Battle of Fallujah, included scores of close-quarters gun battles in house-to-house fighting.

“I never thought I would see love on a battlefield," said Bellavia, speaking at the Pentagon on Monday. “It’s horrible, it’s ghastly, it’s ghoulish. But you see people doing things for each other that they would never, ever do in any other circumstance, and it is a sight to see.”

In the latter half of the battle, Bellavia reentered the house after a U.S. Bradley Fighting Vehicle pounded it with 25 mm cannon fire, with other soldiers covering him. The building was filling with slick, noxious water after the plumbing was destroyed by gunfire, but insurgents inside were still alive.

Bellavia pursued them, he said, because they had a rocket-propelled grenade launcher that could have killed numerous U.S. troops.

At one point, an insurgent burst out of a wardrobe, and Bellavia shot him multiple times as they exchanged fire, according to an Army account of the battle.

When the enemy fighter began running away, Bellavia followed his blood trail up to the second floor, slipping in the blood. He threw a grenade into the room where the enemy fighter was hiding. The two men then grappled in hand-to-hand combat, with Bellavia killing the man, according to Bellavia’s Silver Star citation.

“I walked into situations that were happening in real time, and I just had to react to it," Bellavia said. "And that’s exactly what I did.”

Col. Douglas Walter, Bellavia’s former company commander, said he nominated Bellavia for the Medal of Honor early in 2005. Walter knew that senior military officials would scrutinize his recommendation, and “initially we weren’t sure what happened to it."

Bellavia said Trump notified him late last year that he had been approved for an upgrade.

“I always felt that there was the opportunity to have it reevaluated and looked at, and obviously, apparently that did happen,” Walter said. "So regardless of the process, we’re sitting here today and we’re honoring a great soldier and a great American for some pretty incredible things.”

Bellavia’s actions took place on his 29th birthday in the midst of a dangerous deployment for his unit, the 2nd Battalion, 2nd Infantry Regiment of the Army’s 3rd Brigade Combat Team, 1st Infantry Division. Thirty-seven people from the brigade died that year, including Capt. Sean Sims, Bellavia’s company commander.

“These were not random splashes of misfortune," Bellavia said. "These were men who saw the enemy, made contact with the enemy and gave their lives for this country.”

Bellavia has been a talk-show host in Buffalo and ran for Congress as a Republican. But he indicated Monday that he is now interested in helping the Army in some capacity to find the next generation of soldiers.

“Look, there is a million and five reasons why we are divided in this country," he said. “I never cared what your skin color was, who you worshiped or who you loved. If you are willing to get shot at for me and my buddies, I will follow you, and I will lead you anywhere.”