Israel has barred this boy's parents from accompanying him for treatment

Hassan Abed Raboh, in his short life, has already undergone more than 25 surgical procedures in Gaza. Due to a congenital condition, Hassan's bladder is permanently enlarged, causing him frequent and severe abdominal pain. He cannot urinate easily like most people, and each time is excruciating.

Middle East Eye received several videos of Hassan in the hospital, where he was clearly in agony, crying out for his parents, and struggling to breathe through his tears. At just six years old, his life is almost entirely defined by pain. In Gaza, such scenes are not uncommon; Israel's ongoing 15 and a half-month assault has injured tens of thousands of children, who are being treated without anesthesia. The United Nations Relief and Works Agency (Unrwa) has stated that an average of 10 Palestinian children have been forced to undergo amputations every day during the war.

Hassan's situation, while different, is equally urgent. His family has requested confidentiality regarding his condition, which was discovered at birth. Middle East Eye has reviewed his medical records and spoken with several people familiar with his case, including his father, Wesam. During the Israeli bombardment, Wesam has been taking Hassan for treatment in Deir al-Balah in central Gaza.

“He screams himself to sleep, and screams when he wakes up,” Wesam told Middle East Eye in a WhatsApp conversation. “It takes him fifteen minutes or more to sit and urinate, and while he is urinating, he is screaming and crying.” His father said that the pain little Hassan endures is “more than an adult can bear.” Wesam and his wife, Amany, are both lawyers who ran two law firms in Gaza before the war. They lived in a home in the north that he described as modest but felt like a palace. Now, he told Middle East Eye, all of his possessions have been reduced to rubble, and all he has left is Hassan. “I beg you to save my son.”

The Abed Raboh family is requesting a medical transfer for Hassan so that he can receive treatment abroad. Several case managers at the non-profit organization Save Gaza’s Children have been working towards this goal since at least July, especially as the Israeli assault has caused Gaza’s healthcare system to collapse. The organization is made up almost entirely of volunteers from around the world, who use a vast network of international government relationships and consult with health experts to provide medical evacuations for sick and injured children in Gaza. Of course, all cases must be approved by the Israeli Coordination of Government Activities in the Territories (Cogat).

Before it was razed, the Gaza Strip and its 2.1 million residents had 38 hospitals and clinics under the jurisdiction of the Ministry of Health. Despite enduring a 17-year Israeli military blockade and harsh Western sanctions, the healthcare system was “robust and functioning well,” as described by Doctors Without Borders. Gaza placed a particular emphasis on medical education and had long provided services in “critical healthcare needs such as advanced surgical care, research, and antimicrobial resistance management.” Nevertheless, for people like Hassan, who have rare conditions or serious complications, a difficult and lengthy application process is typically initiated to transfer them to Israeli medical facilities for the latest testing or treatment.

According to Gisha, an Israeli non-profit that tracks the freedom of movement of Palestinians, about 3,000 people per month were entering Israel from Gaza for medical reasons before the October 7, 2023 attacks on southern Israel. Israel had not allowed that many Palestinians out since the Covid-19 lockdowns in early 2020. The monthly figure includes patients and typically one companion who is allowed to accompany them. Today, nearly 16 months later, the Erez crossing between Gaza and Israel is closed to Palestinians, except for evacuation flights arranged by the World Health Organization (WHO) and foreign governments for war casualties, mostly children who suffered severe trauma in Israeli airstrikes.

“In recent months, 25 medical evacuations have been coordinated from Gaza through Israel to receiving countries around the world. These efforts enabled 1,122 Gazans to travel to countries including Jordan, the United States, the United Arab Emirates, and Romania for treatment,” a Cogat spokesperson told Middle East Eye. Cogat is the department within the Israeli military that oversees the logistics of the movement of people between Gaza and Israel, meaning it is the body that approves or denies Palestinian transfers. As several non-profit medical evacuation coordinators told Middle East Eye, the criteria for review are vague at best, and arbitrary at worst.

In 2019, Hassan’s mother, Amany Hammouda, obtained an exit permit from Jabalia to travel to the Makassed Islamic Charitable Hospital in Jerusalem for tests for her then four-month-old son's rare and debilitating congenital condition. While she was allowed to pass at the time, Cogat now tells Middle East Eye that Hammouda is banned due to “recent links to terrorists,” without specifying what this means. “This is unjust and slanderous,” Wesam told Middle East Eye about Cogat’s allegations. “If they are honest, they should tell us who these [operatives] are.” “This is an act of harassment and retaliation against us for no reason, and I am ready to challenge it and confront any party,” he said. “The occupation treats all of us as terrorists.” Hassan’s father and grandmother are also not allowed to set foot in Israel, which has left the now six-year-old in limbo.

Hassan's days are spent either in pain or exhausted from battling it. Hassan himself has been approved to leave Gaza. As a matter of policy, Save Gaza’s Children does not facilitate travel for unaccompanied minors, especially children as young as six years old, for safety reasons. Wesam told Middle East Eye that Egypt is not a viable option for his family either. “Hassan’s mother and I both have a very rare genetic mutation. According to doctors, there is no treatment for this mutation in the entire Middle East,” Wesam said after speaking with an endocrinologist in Jerusalem. “This genetic mutation is the reason for everything Hassan is suffering. Treating this mutation requires advanced genetic medical centers so they can find out what is causing Hassan so much pain. Then they can treat Hassan.”

The issue is also far more complex than just finding a travel companion for Hassan if he is able to board a WHO medical evacuation flight out of Egypt. “We were told by multiple [government] departments … that if a patient leaves Egypt to go overseas for treatment, they cannot return to Egypt, and they can’t actually return to Gaza until the Rafah border is open,” said Anri, a case manager with Save Gaza’s Children, based in South Africa. Middle East Eye is withholding the last names of the evacuation coordinators we interviewed, at their request. “So, oh my gosh … once someone is evacuated from Gaza, they can’t go back. So, when you start thinking about what that means for a child like Hassan, it means that the person who evacuates with him basically needs to be willing to foster him,” she said.

On Thursday, UN Secretary-General Antonio Guterres said that 2,500 children must be “medically evacuated” from Gaza immediately, with guarantees they can return. Then, on Friday, the EU announced that it had relaunched its civilian mission to monitor the Rafah crossing. For now, only one-way passage is being permitted. Under the terms of a ceasefire agreement, the Palestinian Ministry of Health announced that the first medical evacuation convoy would enter Egypt via the Rafah crossing on Saturday. As with previous evacuations out of Gaza, families may be informed hours before their scheduled departure that they have been selected, so advocates like the volunteers at Save Gaza’s Children are working hard to secure opportunities for the most critical patients.

Middle East Eye has learned that 50 civilian patients and their approved companions will cross on Saturday. They are mostly war casualties. While the Palestinian Authority is supposed to assist the EU mission at Rafah, Israeli news outlet Ynet reported that Shin Bet, Israel’s internal security service, will be there to screen Palestinians. Since 2007, Israel has had de facto control of Gaza’s land, sea, and air, including the Rafah crossing into Egypt. With that in mind, it is only in rare cases that children who have not suffered traumatic injuries are being evacuated in what is still considered a time of war. Thus far, those limited cases have involved children whose chronic illnesses have become life-threatening due to a lack of medicine, nutrition, and oversight. Hassan's family feels forgotten, and they have fallen through the cracks.

“Once someone is evacuated from Gaza, they can’t go back … it means that the person who evacuates with him basically needs to be willing to foster him” – Anri, Save Gaza’s Children. “I have a very strong relationship with Hassan. He is a very precious boy. I am really heartbroken about his situation because he doesn’t even know that he was born with [a congenital condition]. If this boy was living anywhere else in the world, his health issues would be easily addressed,” Rose, Hassan’s case manager at Save Gaza’s Children, based in the UAE, told Middle East Eye. Everyone we interviewed insisted that Cogat’s refusal to allow immediate family members to accompany Hassan appears to be a form of collective punishment against Palestinians in Gaza, knowing that the boy will not be sent away alone.

Cogat has not provided specific reasons for denying entry to Israel, whether to the occupied West Bank, to Ben Gurion Airport, or to seek services within Israel. But it told Middle East Eye that denials are always based on national security concerns. “What is the minimum standard here if your family lives in the same neighborhood [as someone suspected of posing a threat to Israel]? What are we talking about? If that’s a distant cousin you might disagree with? Or … I don’t know, you sold cement to someone and they used it to build tunnels?” Anri told Middle East Eye. “We’ve seen so many times where denials suddenly become approvals, approvals become denials, and people who have passed through security checkpoints are denied,” she said of Cogat’s policies. It is for this reason that she remains hopeful that international pressure can help Hassan get the treatment he needs.

Providing medical evacuations for families requires round-the-clock logistical planning and budgeting, as well as securing precise government documentation. It also means knowing exactly who will receive and treat the patient. Case managers often find themselves calling hundreds of hospitals, advocating for children, and a coveted letter of acceptance is often a way to assure Israeli or Egyptian authorities, as well as the WHO, that the evacuee’s final destination is secured and that someone somewhere has agreed to take responsibility for the patient. Middle East Eye has been able to review a letter of acceptance for Hassan from the Robert Debré University Hospital in Paris, and has directly contacted the relevant pediatric specialist. The doctor currently chooses to remain anonymous. “We have accepted the management of this child … he needs specialized management in a highly specialized institution,” the doctor confirmed to Middle East Eye via email. The original letter insists that Hassan’s “care requires the presence of his parents throughout his management,” as has been made clear by Hassan’s father, Wesam.

“Thanks to this, we went back to the French authorities and said, hey, this child has been approved to leave by the Palestinian Ministry of Health. He has been approved by COGAT. He has been approved. He is waiting. This hospital is waiting for him. Please try to evacuate him. So we push,” Hassan’s evacuation coordinator at Save Gaza’s Children in Paris told Middle East Eye. Given the sensitivity of advocating for Palestinian children with high-ranking government officials, the coordinator spoke to Middle East Eye on the condition of their anonymity. In the past, the UAE and EU countries, including Italy, Norway, and Romania, have arranged medical evacuation flights. Much of the world has yet to develop treatment programs for Palestinian children. The UK has not accepted any patients from Gaza, and the WHO confirmed last month that London denied entry to a four-year-old boy who lost both of his legs in an Israeli airstrike. Patients who arrive in the US travel on commercial flights and rely on private fundraising campaigns by groups like Heal Palestine. The US State Department has never chartered its own medical evacuation flights.

“I have failed to provide my son with his most basic rights” – Wesam Abed Raboh, father of a sick child in Gaza. Several coordinators expressed to Middle East Eye the added difficulty of finding US hospitals for injured Palestinian children. The vast majority of hospitals are simply unwilling to take on what they perceive to be a political liability, as most are for-profit institutions. “I only speak for France – yes, it’s the government. Once they decide to bring a child, they decide to bring him for a long-term settlement in France with his family, and they will pay for the treatment, they will pay for the rent, they will pay for everything,” the evacuation coordinator in Paris told Middle East Eye. In November 2023, French President Emmanuel Macron pledged to bring 50 children from Gaza to France for treatment. So far, only 17 have arrived. “We are very far from this goal, so we are here, French citizens, [we] are trying to try and push.”

Hassan’s father, Wesam, knows that he has no choice in where he may ultimately go, but he said that for his family, “Gaza has become a place unfit for human use and unfit for life,” he told Middle East Eye. Wesam said that his son is six years old and weighs no more than 20 kilos. He has undergone 25 surgeries, both major and minor, and yet he is still in pain. “I have failed as a father. I have failed to provide my son with his most basic rights, which God has granted him before any international laws and norms: the right to live and the right to health,” Wesam said. “Perhaps the world will hear his voice now and give him his most basic rights.”