A couple of weeks after the war in Gaza began, 6-year-old Solaf started complaining to her father that the right side of her hip hurt. She is normally healthy, but the 11 relocations the family has had to make to find safe housing as well as the poor conditions in refugee areas had begun to wear on her. She was partway through her first year of kindergarten when everything shut down, and she hasn’t returned to school since.
As her complaints intensified over the months, her father, Mohamad al-Hawajri, a nurse whom I previously worked with at a medical nongovernmental organization in Gaza in 2022, feared that it might be something more threatening. He coordinated with doctors in Gaza’s busy hospitals for X-rays and appointments.
The doctors diagnosed bacterial arthritis, relieving some of the infection through surgery in the spring. But the lack of supplies and poor surgical cleanliness left Solaf with a limp and a severe infection: suspected avascular necrosis of the hip, requiring another urgent, intensive surgery simply unavailable in Gaza’s nearly destroyed healthcare system. Her doctor wrote a referral for medical evacuation and sent her home.
When I spoke with Mohamad in August, it had been three months since Solaf was placed on the referral list, and she was no closer to receiving the care she needs: She has become yet one more faceless name on a stagnant, unmoving list of 12,000 patients, according to the World Health Organization (WHO), needing to be urgently evacuated from Gaza for life-saving medical care.
Some of those on the list have chronic conditions like cancer or heart failure and can no longer receive treatment in Gaza, while others have been injured in the ceaseless violence that has consumed the territory since Oct. 7. Solaf lies somewhere in between: While she was not injured by the war, the chaos, trauma and scarcity of the war contributed to her physical ailment.
Before the bombing of the Rafah crossing on May 6, the list moved ahead ever so slowly, providing up to 50 patients per day the permission and transportation to cross at Rafah and receive treatment in Egypt, representing a small window of hope as the quality of life for injured and disabled Gazans dwindled. But after the bombing, the Rafah crossing, once the only way out of Gaza, was closed and remains shuttered as Egyptian, Palestinian and Israeli officials argue over who will control the exit.
Patients like Solaf and their parents cling to their referral papers, hoping that something will change. Two small evacuations have taken place, coming together after major lobbying and planning. Physicians for Human Rights Israel (PHRI) was able to evacuate a small group of children in June to hospitals in Europe, Egypt and elsewhere, followed by a larger evacuation of 148 individuals to the United Arab Emirates by the WHO in August. The instances have involved input from several medical NGOs in addition to Gulf countries and EU member states. Some patients were not confirmed for evacuation until the morning they departed.
In June, PHRI brought a case before the Israeli courts against the Israeli defense minister as well as the ministry overseeing movement in the Palestinian territories, demanding the establishment of a clear and permanent medical evacuation system. The state has responded that an evacuation system is already in place, referencing the two ad hoc NGO-coordinated evacuations. Aseel Aburass, director of the Palestinian Territories for PHRI, says that that’s not enough, insisting that “a clear and permanent medevac system is critically needed to save the lives of innocent civilians.”
Wajd Aziz is another of the injured and is also waiting, languishing on the list. Wajd, the 3-year-old son of Mohammed Aziz, also a nurse and another former colleague of mine, is in dire need of reconstructive surgery after an airstrike left his leg pinned under debris for hours. Aziz sent me photos of his son’s small calf in the Indonesian Hospital in north Gaza, with the flesh above the ankle peeled over, exposing the bone and tendons, his foot concerningly white.
Aziz told me that on July 14, he received notice from the Israeli army that the neighborhood he lived in with his wife and three sons — Wajd, Jad, 5, and Majd, 6 — would be targeted with airstrikes. They went to stay with his sisters, who lived with their families in Gaza City about 5 miles away from the area under evacuation notice. The family had decided to stay in the north throughout the conflict, because despite the risk, his nursing work was mostly in nearby hospitals.
But it wasn’t safe. Aziz tells me, “At 5 in the morning I woke up to the sound of an explosion and the screams of my sister and her children. My wife and my little son — they were all screaming. They did not know what happened because the house was dark and the rubble kept everyone in their places; they couldn’t move.”
In the dark, Aziz says he could hear Wajd screaming, “Daddy, they bombed my leg.” But he couldn’t hear his older sons. When neighbors and civil defense volunteers finally came to the house to free them from the rubble and debris, they discovered that the two older boys had been killed, along with his sister, her husband and their 2-year-old son.
I watched a video Aziz sent me of the sunny hospital courtyard, in which he and his wife, still covered in dust and debris, are praying, weeping and rocking the bodies of their sons, wrapped in clean white linen. I recognized the gray face of one of the boys, peeking out from the linen, from a family picture Aziz had sent me earlier, of all three boys lined up in matching khaki shorts and blue button-downs.
Now, Aziz has funneled his grief into trying to get proper reconstructive surgery for Wajd. He heard that the UAE had coordinated with the WHO and other medical organizations to evacuate patients from Gaza through the Kerem Shalom crossing to fly to Abu Dhabi for medical treatment. Through his employer, another medical charity, he is trying to get Wajd evacuated if other means become available. Aziz himself had surgery for his less complex injuries at a hospital in Gaza, but the doctor declined to refer him for medical evacuation, saying he would be able to recover in Gaza.
Wajd is recovering too, but for Aziz and his wife, getting their son evacuated to receive the best care possible is the only way they can go on. They call the doctors who took care of the family after the airstrike heroes.
“They saved my son in the absence of resources,” he said, but his son as well as his family as a whole cannot make a full recovery without treatment abroad. He wants his wife to receive care too, describing her as “going through a very difficult psychological situation.” Aziz said that “wherever she goes, she remembers the kids and enters into a severe crying fit.” With psychological treatment in Gaza barely existent, I can’t help but imagine how many people like her might be experiencing a severe mental crisis, without any chance of evacuating from the traumatic context underpinning their symptoms.
Every day, the list grows longer, with little clarity on the degree to which medical evacuations have been prioritized, if at all, in cease-fire talks.
When I spoke with Mohamad al-Hawajri in late August, Solaf had been on the referral list for just over two months and is still taking antibiotics. He says that she is his most sensitive child and that even now, almost a year into the war, she still cries when she hears bombs. He tries to find dolls to comfort and distract her. They are living in al-Burj refugee camp and hoping for news of a cease-fire deal.
Until then, he says, “Every day is a new story for her, a story of fear and pain.”
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