Children with pre-war chronic illnesses are falling through the cracks in Gaza

Hassan Abed Raboh has undergone more than 25 surgical interventions inside Gaza during his short life.

As a result of a congenital condition, Hassan suffers from frequent, stabbing abdominal pain due to a permanently enlarged bladder. He cannot relieve himself without agony, in an act most people take for granted. 

Multiple videos of Hassan in hospital have been shared with Middle East Eye, in which he is visibly and audibly in pain, shouting for his parents and struggling to take breaths in between his tears. He has known little else as a six-year-old. 

The images are not out of place in Gaza, where Israel's 15-and-a-half-month-long assault has wounded tens of thousands of children who were then subjected to treatment without anaesthetics. The United Nations relief and works agency (Unrwa) said that for every day of the war, 10 Palestinian children had to undergo amputations. 

Hassan's case is different but no less urgent.  

His family has requested that his condition, which was only realised at birth, remain confidential.

MEE has reviewed his medical records and spoken to multiple people familiar with his case, including his father Wesam, who shuttled Hassan between medical treatments in Deir al-Balah in central Gaza throughout the Israeli bombardment. 

“He goes to sleep screaming and wakes up screaming,” Wesam Abed Raboh told MEE in conversations over WhatsApp. “He sits urinating for a quarter of an hour or more, and while he is urinating, he keeps screaming and crying.”

The pain little Hassan has endured is “more than grown men can bear”, his father said. 

Wesam and his wife Amany, both lawyers, ran two legal offices in Gaza before the war. They lived in what he described as a modest home that felt like a palace in the north.

Now, he told MEE, all of his worldly possessions are reduced to rubble, and all he has left is Hassan.

“I beg you to save my son.”

The Abed Raboh family is appealing for a medical transfer for Hassan so that he can receive treatment abroad - a project that multiple case managers with the non-profit Save Gaza’s Children have been trying to do since at least July, especially with the collapse of Gaza’s healthcare system under the Israeli assault. 

The group, made up almost exclusively of volunteers from around the world, facilitates the medical evacuations of sick and injured children from Gaza using a vast network of international government contacts and in consultation with health specialists.

All cases must, of course, be cleared by Israel's Coordinator of Government Activities in the Territories (Cogat). 

From robust to dilapidated

Before it was largely razed to the ground, the Gaza Strip and its population of 2.1 million people had 38 hospitals and clinics under the purview of the health ministry.

Despite being under an Israeli military blockade for 17 years, as well as crippling western sanctions, the medical system was, as Doctors Without Borders described it, “robust and functional”.

Gaza, with its particular focus on medical schooling, had long offered “advanced surgical care, research, and stewardship on antimicrobial resistance, among other critical medical needs”, the organisation said on its website.

Still, for those with rare diseases or severe complications like Hassan, a difficult and drawn-out request process is usually initiated for transfer to an Israeli facility for the newest forms of testing or treatment. 

According to Gisha, an Israeli non-profit that tracks freedom of movement for Palestinians, some 3,000 people a month crossed into Israel from Gaza for medical reasons in 2023, before the 7 October 2023 attacks on southern Israel. Israel had not granted this many Palestinians an exit since early 2020 before Covid-19 ushered in lockdowns. 

That monthly figure includes patients as well as usually one companion that is allowed to travel with them. 

Today, and for almost 16 months, the Erez crossing between Gaza and Israel has been closed to Palestinians except in rare instances where the World Health Organisation (WHO) and foreign governments have organised evacuation flights for the war wounded - the children with some of the most traumatic injuries from Israeli air strikes. 

“In recent months, 25 medical evacuations from Gaza through Israel to various receiving countries around the world have been coordinated. These efforts enabled 1,122 Gazans to travel abroad for medical treatment in countries including Jordan, the United States, the United Arab Emirates, Romania, and others,” a spokesperson for Cogat told MEE. 

Cogat is the unit within the Israeli military that oversees movement logistics between Gaza and Israel, meaning it is the body that grants or refuses transfers to Palestinians. 

The vetting criteria is, at best, unclear and, at worst, nonsensical, as several non-profit medical evacuation facilitators told MEE. 

In 2019, Hassan's mother, Amany Hammouda, from Jabalia, was granted an exit pass from Gaza into Israel to have her then four-month-old son tested for his rare and debilitating congenital condition at al-Makassed Islamic Charitable Hospital in Jerusalem. 

While she was cleared then, Cogat now tells MEE that Hammouda is barred for “recent ties to terrorist operatives” without specifying what that means.

"This is injustice and slander," Wesam told MEE of Cogat's allegations. "If they're being honest, they should tell us who these [operatives] are."

"This is an act of harassment and revenge against us without any reason, and I am ready to challenge it and confront any party," he said. 

"The occupation treats us all as terrorists."

Neither Hassan’s father nor grandmother have been allowed to set foot in Israel either, leaving the now six-year-old in limbo. 

Hassan's days are either spent in pain or exhaustion from constantly fighting it. 

Unknown criteria

Hassan himself has been cleared to leave Gaza.

As a matter of policy, for safety reasons, Save Gaza’s Children does not facilitate travel for unaccompanied minors, especially those as young as six years old.

And Egypt was not a viable option for his family, Wesam told MEE.

“Hassan's mother and I have a very rare genetic mutation. According to doctors, there is no treatment for this mutation in the entire Middle East,” Wesam said of conversations with endocrinology specialists in Jerusalem. 

“This genetic mutation is what caused Hassan to suffer from everything that happened to him. Treating this mutation requires advanced genetic medical centres so that they can find out the reason that made Hassan suffer like this. Then they can treat Hassan.”

The matter is also far more complex than simply finding a travel companion for Hassan should he make it onto a WHO medical evacuation flight from Egypt.

“We've been told by multiple [government] ministries… if a patient leaves Egypt for treatment abroad, they cannot come back to Egypt until the Rafah border is opened and they can actually go back [into] Gaza,” Anri, a South Africa-based case manager with Save Gaza’s Children said. 

At their request, MEE is withholding the surnames of the evacuation facilitators we spoke to. 

“So, oh my god… once someone is evacuated out of Gaza, they can't come back. And so when you start thinking about the repercussions of that for a child like Hassan, it means that the person that evacuates with him needs to basically be willing to raise him,” she said. 

On Thursday, United Nations secretary general Antonio Guterres said 2,500 children must immediately be "medically evacuated" from Gaza, with a guarantee that they can return. 

Then, on Friday, the European Union announced it had restarted its civilian mission to monitor the Rafah crossing. For the time being, only one-way traffic is permitted. 

Per the ceasefire deal, the first medical evacuation convoy is now set to cross into Egypt via Rafah on Saturday, according to an announcement from the Palestinian Ministry of Health. 

As is typically the case with these evacuations from Gaza, families can be told just hours before the scheduled departure that they have been chosen to go, so advocates like the volunteers with Save Gaza's Children are hard at work, making the push for the most critically ill.

MEE has been informed that 50 civilian patients, along with their approved companions, will cross on Saturday. They will mostly be those with war injuries. 

While the Palestinian Authority is meant to assist the EU mission at Rafah, Israeli news outlet Yedioth Ahronoth has reported that the Shin Bet - Israel's internal security service - will be vetting Palestinians there. 

Since 2007, Israel has had effective control over land, sea, and air in Gaza, including the Rafah crossing into Egypt. 

With that taken into account, it is only in the rarest of circumstances that a child without a traumatic injury is evacuated in what is still considered wartime. Those limited cases have so far involved children whose chronic diseases have become life-threatening due to a lack of medication, nutrition, and supervision.

Hassan’s family feels forgotten, having fallen through the cracks.

'Once someone is evacuated out of Gaza, they can’t come back... it means that the person that evacuates with him needs to basically be willing to raise him’
- Anri, Save Gaza’s Children

“I have developed a very strong relationship with Hassan. He is a very precious boy. I honestly felt very bad for his situation because he doesn’t even know that he was born with [a congenital condition]. If this boy lived anywhere else in the world, his health issues would’ve been solved easily,” Rose, the UAE-based case manager for Hassan with Save Gaza’s Children, told MEE. 

All those we spoke to insisted that Cogat’s refusal to approve an immediate family member to travel with Hassan appears to be a form of collective punishment for Palestinians in Gaza, knowing the boy will not be sent away alone. 

Cogat does not provide specific reasons for denying entry into Israel, whether it’s to cross into the occupied West Bank, head to Ben Gurion airport, or seek services inside Israel.

But it told MEE that the denials are always on the basis of a national security concerns. 

“If your family lived in the same neighborhood [as a suspected threat to Israel], what is the minimum criteria here? What are we talking about? If it’s your second cousin that you maybe disagree with? Or… I don't know, you sold cement to someone, and they built tunnels with it?” Anri told MEE. 

“We have seen multiple times how multiple rejections suddenly become approvals, where approvals become rejections, where someone that has cleared a security point is rejected,” she said of Cogat’s policy. 

It is for that reason that she still has hope international pressure can help Hassan seek treatment.
 

The final journey

Facilitating a medical evacuation for a family requires round-the-clock logistical planning and budgeting, as well as securing the precise governmental paperwork. 

It also means knowing exactly who will receive and treat the patients. Case managers often find themselves calling hundreds of hospitals to lobby for a child, and the coveted acceptance letter is often a way of assuring authorities in Israel or Egypt, as well as the WHO, that the final destination for an evacuee is secured - and that someone, somewhere, has agreed to assume responsibility for the patient. 

MEE has been able to review the acceptance letter for Hassan from Hôpital Universitaire Robert-Debré in Paris, France, and also connected directly with the paediatric specialist involved. The doctor is, for now, choosing to remain unnamed. 

“We have accepted the management of this child… in need of specialised management in [a] highly specialised institution,” the physician confirmed to MEE via email. 

The original letter insisted that Hassan’s “care will need the presence of his parents with him during all the management period”, much as Wesam, Hassan’s father, has made clear. 

“Thanks to that, we come back to the French authorities saying, hey, this kid is approved by the Ministry of Health in Palestine to go out. He's approved by COGAT. He's approved. He's waited. He's expected in this hospital. Please try to evacuate him. So we try to push,” Hassan’s Paris-based evacuation facilitator from Save Gaza’s Children, told MEE. 

Given the delicate nature of lobbying top government officials on behalf of Palestinian children, the facilitator spoke to MEE on the condition they remain anonymous. 

Medevacs, as the flights have come to be known, have been arranged in the past by the UAE and European Union countries, among them Italy, Norway, and Romania.

Much of the rest of the world has not taken on treatment programmes for Palestinian children. The UK has yet to accept any patient from Gaza at all, with WHO confirming last month that London denied entry to a four-year-old boy who lost both legs in an Israeli air strike. 

Those arriving in the US are flying commercial and relying on private fundraisers by groups such as Heal Palestine. The US State Department has never chartered its own medevac.

‘I failed to provide my son with the most basic of his rights’
-Wesam Abed Raboh, father to sick child in Gaza

Several facilitators have expressed to MEE the added difficulty of securing a US hospital for a wounded Palestinian child. The vast majority are simply unwilling to take on what they feel is a political liability, given most hospitals are for-profit institutions. 

“I speak only for France here - yes, it's governmental. Once they decide to bring one kid, they decide to bring him for long-term establishment in France with his family, and they will pay for the treatment, they will pay for the rent, they will pay for everything,” the Paris-based evacuation facilitator told MEE. 

In November 2023, French President Emmanuel Macron pledged to bring 50 children from Gaza to be treated in France. Thus far, only 17 have arrived. 

“We are far, far from this target, so we on our side here, French citizens, [we are] trying and trying to push and push.” 

Wesam, Hassan’s father, knows he has little choice about where he might end up, but said that for his family, “Gaza has become an area unfit for human use and unfit for life,” he told MEE. 

Wesam says his son is six and weighs no more than 20 kilos. He has undergone 25 major and minor surgeries, and he is still in pain.

“I have failed as a father. I failed to provide my son with the most basic of his rights that God has given him before any international laws and norms did: the right to life and the right to health,” Wesam said.

"Perhaps this world will now hear his voice and give him his most basic right.”