Abdel Karim Wahdan no longer has the energy to speak. When visitors arrive, the eight-year-old pretends to be sleeping so that no one looks at him. Between his frequent dialysis sessions, he cries. His bones hurt, he says.
Abdel Karim is dying. His death should be preventable but because he lives in Gaza he cannot access the treatment that would save his life. What started as acute kidney failure is now chronic: his small body has begun to swell and he spends his days between hospital beds and injections that he hates.
“My son suffers greatly. The hospital has become his home. The doctors stand helpless and I can only watch and pray,” said his mother, Najwa Wahdan.
As the sickness progressed, Abdel Karim was also diagnosed with malnutrition as food began to disappear from Gaza’s markets. His only hope is to be evacuated from Gaza to receive medical treatment abroad. Wahdan filed a medical referral four months ago but is still waiting.
Abdel Karim is one of thousands of people in Gaza waiting for treatment abroad. Getting approved for a medical evacuation is a long, arduous process that can take years. Zahir al-Wehadi, the head of the information department at the Gaza ministry of health, said: “We have more than 16,000 patients [in Gaza] who need treatment abroad. We have already lost more than 600 patients who died while still waiting to travel.”
Tens of thousands of people in Gaza have been wounded by Israeli strikes and gunfire over the past 22 months of a war that has killed more than 61,000 people. Disease and sickness, much of which were not present in Gaza prior to the war, are rife in the territory as solid waste accumulates and people live tightly packed together with limited access to clean water or hygiene products.
Repeated Israeli attacks on Gaza’s hospitals and Israel’s blockade of basic goods into the territory have left the medical sector devastated. Doctors in Gaza say that often they do not have the supplies to treat patients. In those cases they write a referral for the patients to be evacuated abroad.
Israel controls who enters and leaves Gaza. People who need medical treatment abroad must have their exit approved by Cogat, the Israeli military agency in charge of humanitarian affairs for Palestinians. In December, the World Health Organization said the pace of medical evacuations out of Gaza was so slow that it would take five to 10 years to clear the backlog. Cogat has been approached for comment.
Waiting for medical evacuation is torturous. Patients and their families have no ability to speed up the process and can do nothing but hope that approval comes before death does.
During their long wait, Abdel Karim’s physical and mental state has deteriorated. He has lost the ability to walk and when his blood pressure drops too low he temporarily goes blind and has seizures.
“What I loved most about Abdel Karim was his calmness; he never caused trouble like other children,” his mother said. “He loved studying Arabic and English. He once wanted to become a doctor.”
But the months of sickness have taken its toll on the once happy child. “For the last three months he has been withdrawn, irritable, yelling often and not speaking to anyone – this is not the calm son I knew before,” Wahdan said.
Many children have died while waiting for their evacuation approval.
Amina al-Jourani was not too worried when in January 2024 her 15-year-old son, Nidal, came home with a foot injury. Israel had bombed a nearby house and Nidal had gone to the scene to help transport wounded people to the hospital on his bicycle. When he returned to his home he had a small gash on his foot.
“At first we didn’t pay it much attention. It seemed like a simple, ordinary wound,” Jourani said. But in the following days Nidal developed a fever. He began to lose weight and his skin was covered with red spots.
It was a year and a half before doctors approved a request to transfer Nidal abroad, as his condition, though persistent, did not seem to be life-threatening. The hospital he was staying in, the European hospital, was bombed and he was sent home. His fever spiked and his foot turned blue. Nidal went to another hospital where they diagnosed him with kidney failure. He died two days later, on 2 June 2025.
Doctors say it is impossible to deal with the caseload, particularly as the humanitarian situation has worsened since Israel instituted a harsh blockade of aid on Gaza in March. Aid groups have said a worst-case famine scenario is unfolding in Gaza. Israel denies there is a starvation crisis in Gaza and says the UN is to blame for poor distribution of aid – a claim that aid bodies uniformly reject.
Ragheb Warsh Agha, the head of the gastroenterology department at al-Rantisi children’s hospital, said: “Many children die because of the lack of resources or the lack of response to transfer requests. In many cases the child’s treatment is simple – for example, we may need basic medicines, specific treatments that are unavailable, or to conduct tests for which the necessary equipment does not exist.”
Agha said the overcrowded hospital often had to place three children in a single bed, which encouraged the spread of disease. Gaza’s starvation crisis has also meant disease spreads more easily. Lack of food weakens people’s immune systems and makes them more susceptible to sickness. Recovery is more difficult when the body does not have food.
For parents waiting for the mechanisms of bureaucracy to give them the slip of paper that means life for their children, the helplessness is agonising.
Jourani said: “At the height of his illness, Nidal gave me 100 shekel he had saved and he told me: ‘Mom, keep this for me so I can buy lots of sweets, chocolate and snacks when the [border] crossing opens.”
Two and a half months after Nidal’s death, his mother received a message: his referral had been approved, his request to be evacuated granted.
“Nidal died and the money is still in my purse,” she said through tears. “He died waiting for the crossings to open.”
