A small girl in a pink sweater waved goodbye through the smudged window of a bus as it prepared to depart Gaza on Saturday, packed with 37 ill and injured patients, most of them children with cancer, in need of medical treatment that Gaza's war-ravaged hospitals cannot provide.
It was the first time in nine months that medical evacuees have been able to leave Gaza by the Rafah border crossing, and outside Nasser Hospital in Khan Younis, weary mothers held their sick and listless children wrapped up in coats, anxiously waving their documents at officials to confirm their place.
But their departure was bittersweet — only a few patients made the list that day, and each could bring only one companion.
A small boy who tried to squeeze his way onto the bus with his sick brother and mother was escorted off.
“They did not allow me to pass,” Khalil, 8, still sobbing from being separated from his family, told NBC News' crew. “My brother went with my mom; he is sick.”
The evacuees left by the Rafah crossing into Egypt, which has been reopened as part of the ceasefire agreement between Israel and Hamas.
Under the deal, 50 patients and wounded are set to be evacuated every day under the supervision of the World Health Organization.
While much of the attention on the ceasefire has focused on the hostage releases, the daily medical evacuations will be chipping away at a mountain of need.
“We need to speed up the pace, because, again, we estimate between 12,000 to 14,000 critical patients are needed to medevac,” Rik Peeperkorn, the World Health Organization representative for the occupied Palestinian territories, who was overseeing the evacuation, told NBC News' crew in Gaza.
“Trauma injuries, think about amputees, many of them children. Spinal cord injuries, burns, which need multiple different specialized operations and rehabilitation, which they currently cannot get in Gaza. The other is patients for oncology, cancer patients, chronic diseases and cardiovascular diseases, which need to be medevaced out of Gaza.”
The conflict has destroyed much of Gaza’s infrastructure, causing its health system to collapse. Beyond the enormous needs of the skyrocketing number of war wounded, hundreds of thousands of people with acute and chronic illnesses were left with limited or no access to medicine and treatment.
According to the WHO, from the start of the war on Oct. 7, 2023, to when the ceasefire began on Jan. 19, Gaza's health care system sustained more than 1,200 direct attacks, including at least 660 on health facilities, and over 1,000 attacks that affected health care workers.
The Israel Defense Forces says Hamas operates command centers at hospitals, uses ambulances to transport fighters and diverts fuel aid intended for hospital use to military purposes, charges that Hamas and hospital staff members deny.
The scale of the crisis for patients remains overwhelming, and for some children, it is too late.
Dr. Muhammed Abu Salmiya, the director general of Al-Shifa Medical Complex, once Gaza's top hospital, said two of the children scheduled for evacuation Saturday died before they could make the journey.
Last week, U.N. Secretary-General António Guterres called for 2,500 children to be “immediately evacuated with the guarantee that they will be able to return to their families and communities.”
Medical evacuations were rare even before the Rafah crossing closed. From October 2023 to May, the United States, hospitals, various nongovernmental organizations and local officials in Gaza were able to quietly move just 150 patients, most of them children, out of Gaza for lifesaving care.
After the Rafah crossing shut down when Israeli forces captured it in May, the improbable became nearly impossible.
The last significant evacuation appeared to have been in June, when 21 critically ill children were evacuated from the Gaza Strip.