DaysofPal – Seven-year-old Anwar al-Ashi died only two days after the partial reopening of the Rafah border crossing, while his family waited for permission to leave the Gaza Strip for urgent medical care.
The crossing had remained closed for 21 months. Doctors said prolonged malnutrition linked to Israel’s two-year siege of Gaza worsened Anwar’s metabolic acidosis, eventually leading to kidney failure.
“During the war he suffered from metabolic acidosis twice, especially during displacement, but he recovered each time without intensive care,” his father, Nayef al-Ashi, told Middle East Eye.
He said the latest episode followed months of severe shortages of safe food and drinking water. Bottled water was often unavailable, forcing the family to rely on tap water.
Doctors later explained that malnutrition disrupted the child’s pH balance, increasing acidity in his blood. Soon after, Anwar developed abdominal pain, diarrhea, and vomiting. Tests revealed critically low pH levels, and he was transferred to intensive care.
“In the days before his death, he fell into a coma and underwent dialysis several times,” his father said. “He needed lab tests and medicines that did not exist in Gaza, including vitamins and nutritional supplements that might have stopped his condition from getting worse.”
Patients Waiting for Medical Evacuation
Anwar became one of 1,360 patients who died while waiting for permission to travel for treatment after Israeli authorities closed the Rafah crossing in May 2024.
More than 18,500 others remain in urgent need of medical evacuation, including about 4,000 children.
When the crossing partially reopened, authorities said up to 50 patients per day could leave Gaza for treatment. Between February 2 and February 18, only around 260 patients were allowed to travel.
The crossing shut again after the outbreak of war involving Iran and operations launched by the Israel Defense Forces with support from the United States.
Nayef al-Ashi believes the closure of crossings and the humanitarian conditions inside Gaza led directly to his son’s death.
“I consider the main cause of my child’s death to be the closure of the crossings, the denial of medical referrals, the malnutrition, and the displacement,” he said. “Watching your son die while you are powerless to help is unbearable.”
Health System Under Severe Strain
Hospitals across Gaza face severe shortages of medical supplies despite the ceasefire announced in October.
Health authorities reported that by late December, 321 essential medicines had completely run out, while 710 types of medical consumables were unavailable. Laboratories also lack testing materials, and blood banks face critical shortages.
Health facilities have suffered extensive damage during the war. Dozens of hospitals were hit or destroyed, leaving doctors unable to treat complex conditions such as metabolic acidosis.
When Anwar’s condition became critical, specialists concluded that treatment outside Gaza offered his only chance of survival. His family and doctors attempted to secure a medical referral abroad, though permission never arrived.
“If the equipment and medicines had existed here, I could have treated him in Gaza,” his father said. “There were no supplies, no laboratory tools. His health collapsed quickly. First his liver failed, then his brain.”
Kidney Patients in Growing Danger
Patients suffering from kidney disease face particularly severe risks. About 650 people across the territory live with life-threatening conditions due to the blockade, the destruction of dialysis machines, and the lack of medical equipment.
Ghazi al-Yazji, head of the dialysis department at Al-Shifa Hospital in Gaza City, said the death rate among kidney patients has increased by 41 percent during two years of war.
“Many dialysis units were destroyed or stopped functioning,” he said. “Patients often could not reach treatment centers, which led to complications and higher mortality.”
The kidney treatment unit at Al-Shifa Hospital was destroyed during attacks and later partially rebuilt. The department now operates with about 50 dialysis machines, though more equipment and chairs remain urgently needed.
Al-Yazji added that no clear mechanism currently exists to allow travel for patients requiring kidney transplants or specialized procedures such as biopsies.
Families Still Waiting
The demand for medical evacuation continues to grow. Authorities prioritize the most critical cancer cases, though the referral process remains complex and slow.
Warda al-Batrikhi has waited more than 18 months for cancer screening for her 14-year-old son, Siraj al-Muzaini.
“There are no cancer screening services in Gaza,” she said. “Doctors keep telling me he needs specialized tests outside the territory to determine how serious his illness is.”
She continues to move between clinics and hospitals searching for answers.
“I go from doctor to doctor to feel that I am doing something,” she said. “Deep inside I know he needs urgent treatment abroad.”
Around 4,000 cancer patients already hold official referrals for urgent treatment outside Gaza yet remain unable to travel because of border closures and the ongoing blockade. Overall, about 11,000 cancer patients lack access to diagnostic services or specialized treatment.
When news of the Rafah crossing reopening briefly circulated, al-Batrikhi felt a moment of hope.
“I thought my son would finally receive proper treatment,” she said. “Now it feels as if the crossing never reopened. It seems we will wait forever before he is allowed to leave.”
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