patients

Khan Younis, Gaza – The headlines read that Israel has finally reopened the Rafah crossing between Gaza and Egypt, allowing injured Palestinians desperate for medical aid to leave.

However, the reality is that on the first day of the opening, on Monday, Israel only allowed five patients to exit Gaza via the crossing, forcing hundreds, if not thousands, of others to wait.

Mohammed Abu Mostafa is one of the lucky five. The 17-year-old travelled on Monday with his mother, Randa, to southern Gaza’s Khan Younis, and then on to Rafah, which has been closed by Israel for two years as it waged its genocidal war on Gaza, killing more than 70,000 Palestinians.

Randa told Al Jazeera that she had received a phone call on Monday morning informing her that Mohammed had been included in the first list of wounded patients scheduled to travel, and that they were instructed to head immediately to the Red Crescent Hospital in Khan Younis.

The reopening of Rafah, Gaza’s only land crossing that does not go through Israel, has been much touted as evidence of the progress of the second phase of the United States-backed Gaza “ceasefire” deal.

But events on Monday revealed a different reality, marked by strict security restrictions, complex procedures, and limited numbers being allowed to cross, falling far short of expectations and the scale of Gaza’s accumulated humanitarian needs.

Each of the five patients being allowed to leave was accompanied by two people as per Israeli orders, bringing the total number of travellers to 15, according to information provided to Gaza’s health authorities.

Mohammad Abu Salmiya, the director of Gaza’s al-Shifa Medical Complex, told Al Jazeera that this was the only group that departed, despite prior plans with the World Health Organization (WHO) – the body overseeing coordination between Egypt and Israel – for the departure of 50 patients daily.

Egyptian official sources have told Al Jazeera that 50 Palestinians were also permitted to return to Gaza via the Rafah crossing, though no information is yet available on whether they have actually reached the Palestinian side.

Ismail al-Thawabta, the director of Gaza’s Government Media Office, highlighted just how low these numbers are compared with the approximately 22,000 people needing to leave Gaza for treatment abroad. Meanwhile, about 80,000 Palestinians who left Gaza during the war want to return, he said.

Eye injury

Mohammed was injured in an Israeli air attack a year and a half ago, near where his family had been displaced in al-Mawasi, Khan Younis, Randa said. He sustained a direct injury to his eye, severely affecting his optic nerve and ability to see.

“My son has been suffering immensely since his injury. Day after day, his condition kept worsening, and there is no treatment available for him in Gaza,” Randa said, while waiting in the hospital courtyard alongside other patients and their relatives.

Despite her joy at finally being able to accompany her son on his journey, Randa feels a sense of anguish at having to leave four of her six children behind, as she was only permitted to take one child as a second companion.

“What matters to me now is that my son regains his sight and can see again with his own eyes. That is my only concern at the moment,” Randa said.

“I also hope to return to Gaza soon after my son recovers, that the blockade will be lifted, and that all patients will be able to travel, just like my son.”

Israeli restrictions

In the Red Crescent Hospital courtyard, dozens of patients on travel waiting lists expressed frustration over the first-day restrictions at Rafah.

Several patients, including those with amputations, gathered at the hospital, hoping to be permitted to travel to Egypt for treatment.

Despite patients and their families arriving early in the morning with high hopes, Israeli authorities refused to permit more than five patients to leave, leading to widespread dissatisfaction with the complex mechanisms accompanying the crossing’s partial reopening.

The multi-stage security procedure of Palestinians moving through the Rafah crossing begins with the preparation of daily lists of candidates for travel, which are then referred to the Israeli side for pre-travel security screening.

No one is allowed to pass through the crossing or enter it without explicit Israeli approval. The European Union Border Assistance Mission deployed to Rafah is limited to monitoring the process and verifying identities.

Arrivals in Gaza, after initial identity verification at the crossing under European supervision, are subject to additional inspection procedures at checkpoints located in areas under Israeli military control.

Raed al-Nims, the Gaza Red Crescent’s head of media, told Al Jazeera that the organisation was still waiting for updates regarding the transfer of more patients for treatment through the crossing.

He added that a group of patients was successfully transferred to Israel on Monday through the Kerem Abu Salem crossing, in coordination with the WHO.

Desperate need

Ibrahim Abu Thuraya was also one of the five patients allowed to leave Gaza on Monday.

Ibrahim was injured in the early months of the war, sustaining wounds that led to the amputation of his left hand and an injury to his left eye, where shrapnel is still embedded.

“Day after day, my eye condition is deteriorating, and I feel severe pain, especially since the shrapnel is lodged behind it and there are no medical capabilities in Gaza to deal with it,” he said from Khan Younis, before he travelled to Rafah. “Doctors told me that I need to travel abroad.”

Ibrahim was informed on Monday morning by the WHO and Gaza’s Ministry of Health that he had been approved for travel. He will be accompanied by his wife, Samar, and their son.

“I have suffered greatly for two full years just to be able to leave for treatment, and there are thousands of wounded like me,” he said. “I hope the crossing will be opened permanently.”

Gaza City – With what remains of her wounded forearms, Nebal al-Hessi scrolls on her phone to follow news updates on the reopening of the Rafah land crossing from her family’s tent in an-Nazla, Jabalia in the northern Gaza Strip.

Nebal’s hands were amputated in an Israeli artillery attack on the home where she had taken shelter with her husband and her daughter in the Bureij refugee camp in central Gaza, on October 7, 2024.

More than a year later, the 25-year-old mother is one of thousands of wounded people placing their hopes on the reopening of the Rafah crossing between Gaza and Egypt as they seek access to adequate medical treatment outside the besieged Palestinian territory.

“It’s been a year and five months since I got injured … Every day, I think about tomorrow, that I might travel, but I don’t know,” Nebal tells Al Jazeera in a quiet voice.

Recalling the attack, Nebal says she was sitting on her bed holding her baby daughter Rita, trying to communicate with her family in northern Gaza, when the shell hit suddenly.

“I was trying to catch an internet signal to call my family … my daughter was in my lap… suddenly the shell hit. Then there was dust; I don’t remember anything else,” Nebal says.

“It was the shell fragments that amputated my hands,” she recounts.

‘Life is completely paralysed’

Nebal was taken to the hospital with severe injuries, including complete amputation of both upper limbs up to the elbows, internal bleeding, and a leg injury. She underwent two abdominal surgeries.

She spent about 40 days in the hospital before beginning a new stage of suffering in displacement tents, without the most basic long-term care.

Today, Nebal, an English translation graduate and mother to two-year-old Rita, relies almost entirely on her family for the simplest daily tasks.

“I can’t eat or drink on my own … even getting dressed, my mother, sister, and sister-in-law mainly help me,” she says sorrowfully.

“Even going to the bathroom requires help. I need things in front of me because I cannot bring them myself.”

Nebal talks about the pain of motherhood left suspended, as her daughter grows up before her eyes without her being able to hold her or care for her.

“My little daughter wants me to change her, feed her, give her milk, hold her in my arms like other mothers… she asks me, and I can’t,” Nebal says with sorrow.

“My life is completely paralysed.”

Doctors tell Nebal that she urgently needs to travel to continue treatment and have prosthetic limbs fitted, emphasising that she needs advanced prosthetics to regain a degree of independence, not just cosmetic appearance.

“Doctors tell me that I need a state or an institution to adopt my case so I can gradually return to living my normal life,” she adds.

With Palestinian authorities announcing arrangements to open the Rafah crossing today for batches of wounded people and medical patients, Nebal, like many others, lives in a state of anticipation mixed with fear.

According to Gaza’s Ministry of Health, thousands of wounded still require specialised treatment unavailable inside the Strip, while the scheduling of names depends on medical lists and complex approvals, amid the absence of a clear timetable or publicly announced priority criteria.

Nebal says she received repeated calls over the past months from medical organisations informing her that she would be among the first on the travel lists.

“They contacted me more than once, told me to prepare… they gave me hope,” she adds. “But this time, no one has contacted me yet.”

Today, Nebal fears her case might be overlooked again, or that the crossing’s opening could be merely a formality, disregarding the urgent needs of patients like her.

“I die a little every day because of my current situation … not figuratively. I’ve been like this for a year and four months, and my daughter is growing up in front of me while I am helpless,” she says.

Uncertain future

Nada Arhouma, a 16-year-old girl whose life has been completely altered by a single injury, is also hoping the crossing opens as soon as possible.

Nada, who was displaced with her family from Jabalia refugee camp in northern Gaza amid Israel’s two-year genocidal war on Gaza, was hit in the face by shrapnel while inside a displacement tent in Sheikh Radwan, Gaza City.

The incident caused the complete loss of one eye, in addition to fractures in her facial bones, orbital damage, and severe tissue tearing.

Her father, Abdul Rahman Arhouma, 49, says that her health deteriorated over time despite treatment attempts in Gaza.

“She entered the ICU at al-Shifa Hospital, then was transferred to Nasser Hospital. She stayed there for about two and a half months. They tried multiple times to graft her eye, but each operation failed, and the disfigurement worsened,” he says.

According to her father, Nada underwent three surgical attempts using tissue from her hand and other facial areas, but all failed, further complicating her medical and psychological condition.

“My daughter bleeds from her eye every day, and she has pus and discharge,” he says. “I am standing helpless, unable to do anything.”

Today, Nada needs constant assistance to walk and suffers from persistent dizziness and balance weakness. Her vision in the healthy eye is also affected.

“Even going to the bathroom, my sisters help me. I can’t walk alone,” Nada tells Al Jazeera in a soft voice.

Nada has an official medical referral and urgently needs to travel for reconstructive surgery and the implantation of a prosthetic eye. But her ability to get the treatments remains uncertain pending the reopening of Rafah – as is the case for other patients and wounded individuals.

“Since I’ve been in the hospital, I hear every week: next week the crossing will open. Honestly, I feel they are lying. I’m not optimistic,” Nada says.

Her father told Al Jazeera that the continuing wait for the Rafah crossing to reopen was “disappointing”.

“Unfortunately, we didn’t understand anything. All the reports came from Israeli sources, and it seemed Rafah looked like a gate for prisoners, not for travel,” he says.

“Our situation is difficult, and it’s clear we face a long wait to secure my daughter’s right to treatment.”

Pilot reopening

Sunday was the first pilot reopening day at Rafah, amid ambiguity and a lack of clarity about the mechanism, particularly regarding the number of patients and wounded who would be allowed to travel.

According to Gaza’s Ministry of Health, thousands of patients and wounded people require urgent medical transfers outside the Strip, amid the collapse of the healthcare system and lack of resources.

The World Health Organization has repeatedly confirmed that Gaza’s health system is “on the brink of collapse”, and that delays in travelling for critical cases threaten their lives.

Meanwhile, Israel has said it will only allow those whose names it has approved in advance to cross, without any clear announcement on daily numbers or approved criteria, leaving families of patients in constant anticipation and frustration.

For Nada’s family, this “experimental opening” means little so far.

“We can’t plan, neither to stay nor to leave,” her father says. “The decision is not in our hands. One lives in a whirlpool, unable to decide what happens. Even the Ministry of Health has not disclosed anything.”

‘Devastating’ struggle to access treatment

Raed Hamad, 52 and a father of four, is also desperate to leave Gaza in order to seek treatments and medication that are not available in the war-ravaged territory.

Hamad was undergoing kidney cancer treatment a year before the war started. He underwent kidney removal after tumour detection to prevent its spread. But the outbreak of the war in October 2023 halted his treatment protocol, significantly affecting his health.

Hamad lives in the remains of his destroyed home in Khan Younis, amid the devastation left by the war, under deteriorating humanitarian conditions.

He describes his current struggle to access treatment during the war, alongside other cancer patients he meets in the hospital’s oncology department, as “devastating.”

“The war has made it almost impossible to obtain medicines and medical supplies. Cancer treatments and known treatment protocols are unavailable,” he says.

“Food, its nature, and the harsh crises we’ve endured during the war—all of this has greatly affected my health.”

Raed’s weight dropped from 92kg (203lb) to 65kg (143lb) due to complications from the disease, lack of treatment, and malnutrition.

“I continue my treatment whenever I can at my own expense,” he says. “Every time I go to the hospital, I cannot find my treatment and see that capabilities in Gaza are extremely limited. My immunity is low, and every day I face new hardships.

“I need to complete my protocol, undergo nuclear scans, and obtain some essential medications to continue my treatment.”