A heartbreaking phone call came far too late. Just two weeks after Amina Abu al-Kas died, her son Saber was told her paperwork to leave Gaza for life-saving treatment was finally ready. The cruel twist has become a devastating symbol of the desperate struggle facing thousands of seriously ill Palestinians waiting for medical evacuation. While families cling to hope, many patients die before they ever get the chance to leave. Saber told the BBC his mother had suffered from an aggressive necrotising infection that spread to her skull. Doctors in Gaza said they simply did not have the medicines or specialist treatment needed to save her. The pain became unbearable. Saber said his mother spent day and night crying out in agony, while painkillers caused stomach ulcers and inflammation so severe that doctors stopped her from taking them. When Gaza's medical referral board approved her transfer abroad, the family believed a miracle might finally be coming. They waited anxiously for security clearances and confirmation that another country would accept her for treatment. Instead, the call never came. Amina died on 29 May before the process was completed, leaving her family devastated when the approval finally arrived after her death. According to Gaza's Hamas-run health ministry, Amina is among 300 Palestinians who have died waiting for medical evacuation since the US-brokered ceasefire between Israel and Hamas began last October. The World Health Organization (WHO), which helps coordinate patient transfers, also uses those figures. The health ministry says around 15,000 patients remain on waiting lists for treatment abroad. Some have devastating war injuries, while others are battling cancer and other life-threatening illnesses. The list constantly changes as patients' conditions worsen or people die while waiting. The WHO says 1,977 people have been evacuated for treatment since the ceasefire began more than eight months ago, but warns that, at the current pace, clearing the backlog could take years. Saber described receiving permission to leave Gaza as "almost a miracle". Even after medical approval, patients must clear Israeli security checks, gain approval from transit countries, secure visas and be accepted by a receiving hospital abroad. WHO representative Dr Reinhilde Van de Weerdt said recipient countries often have strict requirements, with some accepting only children or patients needing shorter treatments. Every stage creates further delays before desperately ill patients can travel . In early June, Gaza health ministry acting undersecretary Maher Shamia blamed lengthy security screening and restrictions on departures imposed by Israeli authorities. He said Palestinians could leave through the Rafah crossing with Egypt only three days each week, while medical evacuations through the Kerem Shalom crossing with Israel took place only one day weekly. Cogat, the Israeli defence ministry body overseeing civil affairs in Gaza, said departures depend on official requests from receiving countries and completion of all required security screening. It added that the "vast majority" of requests submitted by countries and organisations had been approved since the start of 2025. With international media unable to report independently inside Gaza, BBC freelance journalists witnessed dozens of people protesting outside Gaza City's battered al-Shifa Hospital over the continuing delays. Among them was Nidal al-Arir, who collapsed to the ground pleading for help for his son, who urgently needs a corneal transplant. Nearby, Raeda Nuaizi described losing her breasts, ovaries, uterus and pelvic bone to cancer before the war. She broke down as she said painkillers were now her only treatment inside Gaza, asking what such medication could possibly do for a cancer patient. Fourteen-year-old Muath al-Dini is also trapped in limbo. The teenager lost a leg in an air strike that killed one of his siblings and injured other family members, but he has also battled spinal cancer since infancy. Before the war he regularly travelled to Jerusalem for specialist treatment and surgery. That route has now almost entirely closed, with only one Gazan cancer patient reportedly travelling to the occupied West Bank since the conflict began. https://ichef.bbci.co.uk/ace/standard/1376/cpsprodpb/197f/live/948039f0-70bc-11f1-b1da-a3a610594805.jpg Umm Samir al-Dini had to resubmit documents for her son Muath (left) in May Muath's mother said four screws stabilising his spine have come loose, affecting his breathing, while doctors have also recommended another leg amputation. Although the family received security clearance and later resubmitted paperwork in May, they are still waiting for permission to leave. She said her son's childhood had been stolen, describing how he is bullied, refuses to leave home and cannot access doctors who understand his condition. Across Gaza's shattered hospitals, aid workers warn that medical shortages continue despite the ceasefire agreement calling for full humanitarian aid to enter the territory. Doctors reportedly ration life-saving medicines, share dwindling supplies and turn patients away from chemotherapy and dialysis because resources are exhausted. Pat Griffiths of the International Committee of the Red Cross said the enormous evacuation waiting list reflects patients being unable to access healthcare that international humanitarian law says should be available. He said shortages stretch from basic dressings and painkillers to advanced medical equipment, adding that preventable deaths are occurring because patients cannot receive the care they need. Cogat rejected claims of widespread shortages, saying 17,000 tons of medicines and medical aid have entered Gaza since the ceasefire. It said deliveries included cancer drugs, insulin pens, dialysis machines, CT scanners, X-ray equipment, anaesthetics, wheelchairs and other medical supplies, insisting Israel had approved every medicine request submitted by international aid organisations. Humanitarian officials disputed that assessment. One official anonymously accused Israeli authorities of highlighting isolated deliveries while broader shortages continued. Dr Van de Weerdt said healthcare should be judged by whether patients' needs are met, not simply by counting aid shipments. She warned hospitals cannot function safely without adequate reserve stocks and reliable equipment. Gaza health ministry engineering director Mazen al-Arayeshi said fuel deliveries now allow hospital generators to operate, but electricity remains too weak for many surgeries. He warned that Israel had refused requests to replace failing generators or allow in spare parts, leaving hospitals dangerously vulnerable after a major generator at Nasser Medical Complex recently failed. Several departments at Nasser Medical Complex lost power after a generator stopped working last month As desperation deepens, some patients have reportedly paid self-declared agents thousands of pounds in attempts to speed up evacuations. The WHO has responded by issuing a warning urging families not to pay anyone claiming they can fast-track the process. For Saber, whose mother never received the treatment she desperately needed, the loss still hangs over everything. He said many mourners told him that at least Amina was finally at peace, adding that being a patient in Gaza is unlike being a patient anywhere else in the world. https://www.bbc.co.uk/news/articles/cn75ex1dv61o
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