‘As if the border never reopened’: Gaza patients die waiting under Israeli siege

Two days after the Rafah border partially reopened last month for Palestinian patients in Gaza, seven-year-old Anwar al-Ashi died while waiting for permission to leave for treatment.

The border’s 21-month closure, coupled with prolonged malnutrition caused by Israel’s two-year total siege of Gaza, worsened the boy’s metabolic acidosis and triggered the collapse of his health.

“During the war, he suffered from metabolic acidosis twice, especially during displacement. But each time, he recovered without needing intensive care,” the child’s father, Nayef al-Ashi, told Middle East Eye.

“This time, it was caused by malnutrition, contaminated and unsafe drinking water. Many times, there was no bottled water available, so he had to drink tap water.”

Doctors said malnutrition disrupted Anwar’s pH balance, increasing acidity in his blood and leading to kidney failure.

“Suddenly, he developed abdominal pain, diarrhoea and vomiting. We took him to the hospital and were shocked to learn his pH levels were dangerously low. His acidosis was severe, and he was immediately transferred to intensive care,” Nayef continued.

“In the days before his death, he fell into a coma and underwent dialysis four or five times. He needed lab tests and essential medications that were unavailable in Gaza, including nutritional supplements and vitamins that might have prevented his deterioration.”

'It is incredibly painful to watch your son die before your eyes and be powerless to help'

- Nayef al-Ashi, Palestinian father 

Anwar was one of 1,360 patients who died while waiting to travel for medical treatment after Israeli forces closed the Rafah border crossing in May 2024.

More than 18,500 others, including 4,000 children, remain in urgent need of medical evacuation.

Although the border reopening aimed to allow up to 50 patients per day to leave for treatment, only around 260 were permitted to travel between 2 and 18 February.

The border was closed again on Saturday after the US and Israel launched the war on Iran.  

“I consider the main cause of my child’s death to be the closure of the crossings, the denial of medical referrals, the malnutrition and the displacement, which is catastrophic for children,” Nayef said.

“It is incredibly painful to watch your son die before your eyes and be powerless to help. 

“I cannot understand how these factors are allowed to cause a child’s death, leaving him to suffer from kidney failure and other complications.”

Lack of medical supplies 

Despite the ceasefire agreement in October, Israel has continued to severely restrict the entry of medicines and medical supplies into the Gaza Strip.

By late December, 321 essential medicines were completely out of stock, while 710 medical consumables were unavailable. There were also acute shortages of laboratory testing materials and blood bank supplies.

In addition to these restrictions, Israel has systematically targeted health facilities and staff during the two-year genocide in Gaza, directly bombing and destroying dozens of hospitals.

These attacks have left doctors unable to treat critical conditions such as acidosis.

When Anwar’s acidity levels reached a critical point, he required treatment outside Gaza. 

In a desperate attempt to save his life, doctors and his family sought permission for him to travel abroad, but he died before it could be granted.

“If the resources had been available in Gaza, I could have treated him here,” Nayef said.

“But there were no supplies, no medicines, and no laboratory equipment. His health deteriorated rapidly - first his liver failed, then his brain - and then he died.”

Kidney failure patients are particularly at risk.

Around 650 patients across the Gaza Strip face life-threatening conditions due to the Israeli blockade, critical shortages of medical supplies and equipment, and the destruction of dialysis machines during Israeli attacks.

Dr Ghazi al-Yazji, head of the dialysis department at al-Shifa hospital in Gaza City, said the death rate among kidney patients has risen by 41 percent over the two years of war.

“Most dialysis units were destroyed or went out of service. Many patients were trapped in their homes and could not reach dialysis, which impacted their lives, caused complications, and increased mortality rates,” Yazji told MEE.

He explained that the war affected the health system’s capacity because all units were destroyed. 

“For example, at al-Shifa hospital, the entire kidney treatment unit was destroyed and gradually rebuilt. We are currently operating at the required efficiency with 50 dialysis machines, but we still need more dialysis machines and chairs for the devices.”

The doctor reported that despite the partial reopening of the Rafah border, there is currently no mechanism in place to allow travel for patients requiring kidney transplants or kidney biopsies, leaving them trapped and slowly dying.

‘As if it never reopened’

Due to the high number of patients awaiting urgent medical evacuation, priority is currently being given to critical cancer cases.

However, even for cancer patients, the referral process remains unclear and complex.

Warda al-Batrikhi, 44, said she has been waiting for cancer screening for her 14-year-old son, Siraj al-Muzaini, for more than 18 months.

'It is as if [the Rafah crossing] never reopened'

- Warda al-Batrikhi, Palestinian mother 

“There are no screening services available in Gaza,” she explained. 

“Doctors have repeatedly told me that my son requires a medical referral for specialised cancer screening to determine the extent of his illness. However, priority in referrals is given to patients who have already been diagnosed.

“I keep taking him from one doctor to another and from one hospital to another, just to feel that I am doing something. But deep down, I know it is all in vain because he needs urgent, proper treatment outside Gaza.”

Among patients awaiting medical evacuation, roughly 4,000 cancer patients have already obtained official referrals for urgent treatment outside Gaza but remain unable to leave due to ongoing border closures and the blockade.

Overall, an estimated 11,000 cancer patients in Gaza lack access to specialised or diagnostic cancer services, with many in urgent need of treatment that is not available within Gaza.

“When I heard that the Rafah border would reopen, I felt relieved, believing that my son would finally be able to access proper treatment,” Batrikhi said.

“But now, it is as if it never reopened. It seems we will be waiting forever before he is finally allowed to travel.”