Khan Younis, Gaza Strip – Fifteen-year-old Rafa al-Qudra had one hope in life: to get out of the Gaza Strip in time to save her sight. On Saturday, before Israel gave her that permission, everything turned pitch black.

Sitting in an open-sided shelter covered in thick nylon in the al-Mawasi coastal area in southern Gaza’s Khan Younis governorate, Rafa continuously pressed her hands over her eyes, either to block the light she can no longer see but still burns her eyes or to hide her falling tears.

“Is this it for me? Will I ever see again? Will I read again? Write? Draw? Or be able to walk around this tent without someone’s help?” asked the tearful teenager, the skin around whose eyes was reddened by the constant pressing of her hands.

Her father, Rafat, 57, explained that Rafa’s condition was manageable before the war with glasses and check-ups. “What followed compounded everything: months of displacement, carrying luggage she was medically prohibited from carrying, malnutrition, dust and the collapse of specialist care,” the father of five said helplessly.

In recent months, Rafa’s eye pressure – measured in millimetres of mercury (mmHg), the standard medical unit for pressure – built up: 50mmHg in Rafa’s right eye and 35mmHg in her left, compared with a normal range of 12 to 20mmHg, leaving her in unbearable pain.

She had undergone multiple laser procedures, surgery on her right eye during the first week of June and lens removal. The solution used to reduce her eye pressure had expired – out of date since July – because nothing else was available in Gaza.

Then everything went black.

Rafa is one of more than 18,500 patients the World Health Organization (WHO) says require medical evacuation from Gaza for treatment unavailable in the Strip. Israel’s bombardments in its genocidal war on the enclave, which began in October 2023, have devastated Gaza’s health sector, which was struggling long before the war, pushing it to the brink.

Queueing to die

The October Gaza ceasefire explicitly required the resumption of medical evacuations from the Palestinian enclave. Israel violated those terms almost immediately, announcing that Rafah, the main crossing for Palestinians out of Gaza, would remain closed. It permitted only limited movement months later.

On February 28, Israel closed the Rafah crossing again, and all medical evacuations have been suspended since. In April, the WHO was forced to temporarily suspend its own coordination of evacuations after a contractor working for the organisation in Gaza was killed.

Despite international calls on Israel to follow its ceasefire obligations and allow critical patients to leave the enclave, thousands remain stuck there. Gaza’s Ministry of Health said six to 10 patients die each day waiting to travel abroad for treatment and roughly 1,200 have died since Israel seized the Rafah crossing in May 2024.

According to the WHO, 50 to 100 patients exited Gaza daily for medical care before October 2023. But since then, Israel has tightened its siege on the Strip, and the flow has dropped to a trickle. The charity Save the Children estimated that at the current pace, evacuating all those in need could take more than a year.

Rafat said Rafa has had a medical evacuation referral for nearly a year but Israeli permission never came. “The lenses she needed don’t exist here,” her father told Al Jazeera, holding up his daughter’s documents. “What is happening is a crime.”

‘This is a crime’

In a nearby tent with a nylon top that makes temperatures inside the enclosure almost unbearable, five-year-old Fatima Saeed lies on her back on a mattress unable to move. Insects, mosquitoes and rodents are a constant presence. Her mother, Wafaa, spends most of her time turning her daughter’s body and fanning her with whatever is at hand – a piece of cardboard, a plastic bowl. Fatima cannot chew, so her mother prepares soft food for her.

“Fatima was born with a brain condition, but before the war, she was making significant progress through physiotherapy,” the 35-year-old mother told Al Jazeera. “She could sit up straight, showed early signs of speech and was on the path to walking. The war ended that,” Wafaa recalled, her hands fanning her child’s body while beads of sweat rolled down her own face.

“As care disappeared and conditions in displacement worsened, the convulsions began. She’s lost all ability to talk and now requires anti-convulsant medication and has been hospitalised repeatedly,” Wafaa added.

According to the WHO, 94 percent of Gaza’s hospitals were destroyed or damaged in Israel’s war, leaving thousands of patients and wounded without the essential medical care they need. International organisations have also accused Israel of blocking humanitarian aid, including medication, from entering Gaza despite the October ceasefire.

“This is a crime on so many levels,” Wafaa said. “It’s not that Fatima’s case is hopeless: doctors’ assessment says that, with proper rehabilitation, a suitable environment, clean water and adequate nutrition, recovery remains possible. None of those things exists here. To deprive a child this smart and sharp from a chance of a normal life is a crime,” her mother said.

“If the crossings were open, I would take her anywhere,” Wafaa said. “But everything is closed. What is happening to my daughter is a sentence of helplessness imposed on a child who did nothing wrong.”

‘I want to live. I don’t want to die.’

Elsewhere in al-Mawasi, Ismail al-Aqqad sits on a wooden chair. He cannot move his arms or legs, cannot walk and has lost the ability to speak. He cannot move any of his limbs – the result, his medical report states, of a degenerative neurological disease that has progressively robbed him of muscle control and movement.

Before the war, the 40-year-old father of four moved with the help of two crutches and retained limited speech. He worked in a brick factory and brought food to the table. Six months into the war, his condition began to collapse. The medication he depended on to slow the disease’s progression, some costing more than $100 per item and sourced from Egypt, stopped coming when the crossings closed. There has been no substitute available locally.

“This is a death sentence for my brother,” Khaled, 27, said. “His life depends on medication and treatment that only exist outside Gaza.”

Tests carried out at a Jordanian field hospital in mid-2024 confirmed that improvement remained medically possible if specialist care could be obtained. It has not.

“The war was a catastrophe for him,” Khaled said. “He lost access to medical follow-up, was deprived of medication, went hungry, grieved, wept. His entire life has become a hell. And he has no income.”

Ismail listened as his brother spoke. He cannot form words, but his eyes signalled that he wanted to try. With tremendous effort in broken, halting syllables, he said: “I want to live. I don’t want to die. Treat me.” His children gather around him, their father’s voice a rare occurrence.

From behind a cloth partition, his wife, Huda, 37, can be heard weeping. “Save my husband before it is too late,” she pleaded. “We are not asking for the impossible. We are asking only that he stays alive, that he can call our names, walk even a few steps. We have lost our home and our dignity. We cannot lose him too.”