Ahmad Faleh Warsh Agha, a 14-year-old boy from Gaza, once dreamed of becoming a football player. Today, his aspirations have been reduced to a singular hope: he just wants to live.
Ahmad’s right hand was amputated after he was severely injured in an Israeli airstrike, which also left him with a pelvic fracture, a serious head injury, and intestinal damage requiring an external colostomy bag.
Shrapnel remains lodged in his body, and he endures chronic pain that prevents him from moving or sleeping normally.
His family tells TRT World that they sought a medical evacuation form from Gaza’s Al-Shifa Hospital. They were told that as many as 17,000 children were awaiting evacuation from Gaza on medical grounds, with registration on hold due to overwhelming demand.
Ahmad’s life hangs in the balance as his family jumps through administrative hoops for medical evacuation, a process subject to the political whims of Israeli bureaucrats.
Dr Hani Isleem, project coordinator for medical evacuation at international NGO Doctors Without Borders (MSF), tells TRT World the medical situation in Gaza is “beyond catastrophic”.
After 21 months of incessant Israeli bombing that has killed nearly 59,000 people across Gaza, the health system in the besieged territory is in ruins.
WHO data shows only 2,481 patients – along with 3,752 attendants – have been evacuated from Gaza on medical grounds since July 2024. The top three case categories were trauma, cancer and eye surgeries.
No hospital is functional in northern Gaza, while the southern part of the besieged territory has only one fully operational major hospital. A few remaining hospitals in Gaza City continue to operate but only at “minimal capacity”.
Isleem points out the staggering toll of Israel’s war on Gaza: nearly 200,000 people, or 10 percent of Gaza’s population, have been killed and wounded.
But the crisis extends far beyond war injuries, he says. Thousands more, including those with cancer, cardiac conditions, and kidney failure, require urgent care that is unavailable in Gaza.
Isleem says that at least 15,500 patients need medical evacuation, a conservative estimate that is likely two to three times higher because of underreporting by the Palestinian Ministry of Health in Gaza, which lacks the capacity to account for all patients in the heavily bombed territory.
With only 50 to 55 patients currently being evacuated from Gaza on a monthly basis, it would take more than three years to address the “most urgent” 2,000 cases, a timeline many patients in Gaza simply cannot survive, he adds.
Bureaucratic hurdles abound
Based in Jordan, Isleem is originally from Gaza, where many of his family members have died since October 7, 2023. His role as the coordinator of medical evacuations involves crossing bureaucratic obstacles to ensure the timely exit for patients in desperate need of surgical procedures.
The process is fraught with bureaucratic, logistical and ethical challenges, ranging from identifying countries willing to accept patients to obtaining clearance from Israeli authorities via the Coordination of Government Activities in the Territories (COGAT).
Before the Trump administration came to power in the US in January, many countries were motivated to accept cases, while COGAT would block approvals or refuse to let companions leave Gaza at a relatively high rate.
In those days, the seemingly whimsical refusals by the Israeli authorities led to repeat applications and appeals, Isleem says.
However, after Donald Trump became US president and flirted with the idea of forced Palestinian immigration, many countries grew hesitant because of political repercussions, he says.
This has led to a reduced number of available destinations for medical evacuees, even though COGAT approval rates have “slightly improved”.
Still, only 70-80 percent of planned evacuees make it abroad, while many others wind up dead in makeshift facilities within Gaza while waiting for COGAT approvals, he says.
The case of Amran, a nine-year-old boy, haunts Isleem. Severely injured in an airstrike, it took Isleem weeks to secure a receiving country for Amran. By the time approval was granted, he had died.
“Every other case in Gaza is like Amran’s,” Isleem says, highlighting the extreme vulnerability of injured children.
The evacuation process involves multiple stages, including identifying a host country, meeting their medical and demographic criteria, securing hospital placement, and coordinating flights. But all these stages precede the final hurdle: approval from the all-powerful COGAT.
Meanwhile, receiving countries impose their own restrictions, such as age, gender, or attendant limits. This creates ethical dilemmas for MSF, which must prioritise patients.
Even when every single requirement is fulfilled, Israeli authorities often deny exit permits days before departure, leaving patients stranded, Isleem says.
A rapidly worsening health crisis
The story of Ahmad Al-Ghalban, another teenage boy caught in the bureaucratic red tape, shows the human cost of Israel’s war on Gaza.
Ahmad and his twin brother Mohammad, both from northern Gaza, were critically injured when an artillery shell struck their home in Beit Lahia. Mohammad’s body was reduced to “a mass of flesh” with severe brain bleeding and amputated limbs, his mother tells TRT World. Hours later, he died in a hospital.
Ahmad, also an amputee with multiple injuries, survived three agonising months before being evacuated to Italy.
His mother, accompanying him while the rest of the family remains displaced in Gaza, recalls being told that immediate travel was “impossible”.
Doctors told her that Mohammad could have been saved with prompt evacuation to stop his bleeding, but the lack of open crossings sealed his fate.
“I lost one flower, and the other suffered severe injuries,” she says.
Yusuf Omar Hasan Al-Samri, a 16-year-old, faces a similarly dire situation. Injured by a missile from an Israeli drone while searching for food, Yusuf lost both legs, part of his liver and spleen, and sustained severe intestinal damage.
His chronic pain and need for constant assistance make his condition severe. But his evacuation remains uncertain, Yusuf tells TRT World.
Classified as a priority case, doctors estimate he may travel within one to two months, depending on the reopening of border crossings.
Yusuf’s family demands that Israel, responsible for his injuries, grant immediate travel permission. Once a teenager with dreams, Yusuf now hopes only for treatment, clean water, and a chance at a “normal life”.
Isleem says Gaza’s shattered health system means that even if a ceasefire were declared today, the need for evacuations would persist for a decade. The blockade and restrictions on medical supplies and food have worsened the health crisis, leaving patients malnourished and vulnerable to infections.
Ahmad Faleh Warsh Agha, for instance, risks severe infections and weakened immunity without urgent intervention for his colostomy bag and other injuries.
Isleem says the obstacles are systemic and deliberate. COGAT approvals are inconsistent, as it often denies attendants or rejects cases without clear reasons. He recounts instances where patients, initially refused, were later found evacuated to another country under unclear circumstances.
The process gets further complicated by security checks implemented by the receiving countries. These checks duplicate COGAT’s screenings, adding unnecessary delays, he points out.
Isleem says authorities should simplify criteria, open more destinations, and end duplicative security checks to ease the suffering of severely injured Palestinians.
Most importantly, he calls for an end to the Israeli policy that blocks medical supplies and food, and for open corridors to allow patients to leave.
Ahmad Al-Ghalban’s mother, grieving Mohammad’s death, questions why children bear the brunt of this crisis.
“The doctors told me this was not the first case where a mother lost her child after being prevented from travelling to receive treatment…,” she says.
“Why is all this happening to civilians? I ask Israel…to do justice to children.”
