A small girl in a pink sweater waved goodbye through the smudged window of a bus as it prepared to depart Gaza on Saturday, packed with 37 ill and injured patients, most of them children with cancer, in need of medical treatment that Gaza’s war-ravaged hospitals cannot provide.
It was the first time in nine months that medical evacuees have been able to leave Gaza by the Rafah border crossing, and outside Nasser Hospital in Khan Younis, weary mothers held their sick and listless children wrapped up in coats, anxiously waving their documents at officials to confirm their place.
But their departure was bittersweet — only a few patients made the list that day, and each could bring only one companion.
A small boy who tried to squeeze his way onto the bus with his sick brother and mother was escorted off.
“They did not allow me to pass,” Khalil, 8, still sobbing from being separated from his family, told NBC News’ crew. “My brother went with my mom, he is sick.”
The evacuees left via the Rafah crossing into Egypt, which has been reopened as part of the ceasefire agreement between Israel and Hamas.
Under the deal, 50 patients and wounded are set to be evacuated each day under the supervision of the World Health Organization.
While much of the attention on the ceasefire has focused on the hostage releases, the daily medical evacuations will be chipping away at a mountain of need.
“We need to speed up the pace because, again, we estimate between 12,000 to 14,000 critical patients are needed to medevac,” Rik Peeperkorn, the World Health Organization representative for the occupied Palestinian territories, who was overseeing the evacuation, told NBC News’ crew in Gaza.
“Trauma injuries, think about amputees, many of them children. Spinal cord injuries, burns, which need multiple different specialized operations and rehabilitation which they currently cannot get in Gaza. The other is patients for oncology, cancer patients, chronic diseases and cardiovascular diseases, which need to be med-evaced out of Gaza.”
The conflict has destroyed much of Gaza’s infrastructure, causing its health system to collapse. Beyond the enormous needs of the skyrocketing number of war wounded, hundreds of thousands of people with acute and chronic illnesses were left with limited or no access to medicine and treatment.
According to WHO, between the start of the war on Oct. 7, 2023 to when this ceasefire began on Jan. 19, Gaza’s healthcare system sustained more than 1200 direct attacks, including at least 660 on health facilities and over one thousand attacks that impacted healthcare workers.
The Israel Defense Forces says Hamas operates command centers at hospitals, uses ambulances to transport fighters and diverts fuel aid intended for hospital use to military purposes, charges Hamas and hospital staff deny.
The scale of the crisis for patients remains overwhelming, and for some children, it has come too late.
According to Dr. Muhammed Abu Salmiya, the Director General of Al-Shifa Medical Complex, once Gaza’s top hospital, two of the children scheduled for evacuation on Saturday died before they could make the journey.
Last week, United Nations Secretary-General António Guterres called for 2,500 children to be “immediately evacuated with the guarantee that they will be able to return to their families and communities.”
Medical evacuations were rare even before the Rafah crossing closed. Between October 2023 and May 2024, the U.S., in partnership with hospitals, various nongovernmental organizations and local officials in Gaza were able to quietly move just 150 patients, mostly children, out of Gaza for lifesaving care.
After the Rafah crossing shut down when Israeli forces captured it in May 2024, the improbable became nearly impossible.
The last significant evacuation appeared to have been in June, when 21 critically ill children were evacuated from the Gaza Strip.
