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In a modest tent in the town of az-Zawayda in the central Gaza Strip, 37-year-old Samah Afana lies on a worn wooden bed, her body heavy with pain. Her right arm has been amputated, and she cannot move her injured leg. Beside her, her infant son sleeps in a metal crib, yet she cannot carry him, breastfeed him, or even hold him close to her chest. She is waiting for the chance to continue her treatment outside Gaza, after receiving a medical referral.
In need of a prosthetic limb
On September 16, 2025, when she was six months pregnant, Samah was injured in an Israeli airstrike that targeted the residential block where she lived, in the al-Shati refugee camp in western Gaza. The strike resulted in the amputation of her right arm, severe injuries across her body, facial wounds, and fractures in both legs. She underwent several surgeries and now needs a prosthetic arm, as well as treatment for her broken right leg.
“My treatment journey has been incredibly difficult,” Samah says. “I kept thinking about my injuries, about the condition of my baby inside me—was he healthy? Would he have deformities because of the bombing? After giving birth, I received a medical referral allowing me to travel abroad for treatment, but I’m still waiting for that to happen. I want to hold my son in my arms, change his clothes, prepare his bottle myself, kiss his forehead to help him fall asleep in my arms. I have been deprived of all of this.”
Twenty days after giving birth, Samah suffered another accident that compounded her suffering: while preparing milk for her baby alone, as her family was away, boiling water spilled on her, causing further burns.
Samah’s condition reflects the collapse of Gaza’s healthcare system, where the blockade and lack of resources intensify the suffering of the wounded. As the number of injured people needing treatment outside the Strip rises, survival becomes an unequal race against time.
On February 2nd of this year, the Rafah border crossing, Gaza’s only exit to the outside world, partially resumed operations at a very slow pace after being closed for over a year and a half. Only a limited number of patients and wounded people have been allowed to travel, under strict Israeli restrictions, in what has been described as wholly insufficient in the face of the worsening humanitarian catastrophe in the Strip.
The lives of the wounded are now held hostage by an Israeli decision that determines who is allowed to travel through the Rafah border crossing.
Freedom of movement: A fundamental right
According to UN statistics, some 18,500 patients and wounded individuals in Gaza, including 4,000 children, are enduring a bitter wait to travel outside the Strip to receive treatment that is locally unavailable, amidst dire health and humanitarian conditions.
The number of casualties since the ceasefire on October 11, 2025 reached 784 dead and 2,214 wounded, while the overall death toll since the start of the Israeli war on Gaza on October 7, 2023 has risen to approximately 72,560.
The lives of the wounded are now held hostage by an Israeli decision that determines who is allowed to travel through the Rafah border crossing, turning their right to treatment into a daily battle without any guarantees.
In this context, human rights activists warned that the experimental and partial opening of the Rafah crossing, without a clear mechanism, raises serious concerns and reflects a fragile process marked by delay and obstruction. In media statements, the Euro-Med Human Rights Monitor, through its chairman Ramy Abdu, stressed that the absence of travel criteria, registration mechanisms, and safe passage routes entrenches full Israeli control over the crossing.
Abdu stressed that the occupation has no legal or sovereign right to manage the Rafah crossing, which is supposed to be operated by a Palestinian-Egyptian mechanism. He called on Egypt to ensure stable operation that preserves human dignity and urged the European border assistance mission not to become a cover for the occupation. He also affirmed that freedom of movement is a fundamental right that must not be subjected to bargaining or temporary arrangements.
Different faces, same story
There are hundreds of stories like that of Samah. Seventeen-year-old Farah al-Kahlout is also waiting for the Rafah crossing to reopen so she can receive treatment abroad. She makes her way through the piles of rubble in the Jabalia refugee camp in northern Gaza in a wheelchair pushed by her brother. She wears dark glasses—she lost her sight and leg from injuries sustained a year and a half ago when an airstrike targeted her family home, killing her parents and 25 of her relatives.
“Everything changed in a single moment,” Farah says. “I was left with my sister and brother, just us three. I was severely injured. I was in a coma for a week at the al-Shifa Hospital in western Gaza. When I woke up, they told me I had lost my sight and my leg. I couldn’t understand what had happened. I felt like I had woken up to a life that had nothing to do with my own.”
Farah received a medical referral months ago, but her treatment has yet to begin. One of her eyes needs to be removed, and the other could still be saved if she receives treatment outside Gaza, as it isn’t available locally.
“When I heard the crossing was going to reopen, I felt hopeful. But that hope quickly faded,” Farah shares. “The number of people allowed to travel is minimal. My biggest fear is that I will lose my sight completely. I don’t want to live in total darkness.”
Before the war, Farah lived a simple life with her family, dreaming of completing her secondary education, which was cut short by her injuries.
“I used to love drawing,” she says. “Before I got injured, it was my way of expressing myself. If I can travel and recover, maybe I’ll regain sight in one eye, and then maybe I could reclaim one part of the life I lost. That’s my only hope. I won’t give up on it,” Farah concludes.
No clear mechanisms for Rafah crossing operations
From inside the al-Shifa Medical Complex, one of the most overcrowded medical facilities, Dr. Mohammed Abu Salmiya, director of the complex, addresses the issue of medical evacuations as one of the gravest unresolved humanitarian crises to date.
According to information available to Abu Salmiya, there is no clear officially adopted mechanism allowing patients and wounded people to leave through the Rafah crossing, leaving thousands of critical cases hostage to time and a deteriorating health situation. He points out that thousands of patients and injured individuals have medical referrals requiring immediate travel for treatment abroad, but the occupation authorities continue to delay and limit the number of people permitted to travel, without any transparency.
The greatest concern, according to Abu Salmiya, is a return to the previous mechanism that was applied during past ceasefires and that only complicated the evacuation process instead of expediting it. This mechanism, he explains, slowed the departure of patients through deliberate delays in approvals and reductions in the number of people permitted to travel. The outcome was catastrophic: approximately 1,280 people died while on waiting lists, never getting the opportunity to access treatment outside Gaza.
