Joud al-Amarin, 6, was diagnosed with acute lymphoblastic leukemia in July 2020.
Before her diagnosis, she had lost weight, her limbs were swollen and she was tired all the time.
Doctors in the Gaza Strip, where Joud and her family live, said she would have to seek treatment at An-Najah Hospital in the West Bank city of Nablus.
Joud’s mother, Tahani, applied for Israeli travel permits to accompany her daughter, and the first three times, the approval process was relatively quick.
Yet the family’s most recent application – needed for Joud’s fourth appointment on 2 April – was different.
Tahani waited almost three months for approval only to be informed that her application was under review by Israel for security reasons.
“We are a poor family whose ultimate goal is to treat our daughter and get our daily livelihood, nothing else,” she said.
“Neither I nor my husband have done anything wrong. We don’t have any political interests. Why was I denied? Our life has turned into hell because of Joud’s condition.”
Israel’s 15-year siege on the Gaza Strip has had devastating effects on children, and its denial and delay of needed medical travel permits only intensifies children’s physical and mental suffering.
Yasser Abu Jamei, director of the Gaza Community Mental Health Program, said anxiety and stress rise during the waiting period to get the permit.
“They need their mothers or fathers behind them during their treatment,” Abu Jamei said.
Joud’s father, Abdallah, 34, acknowledged that these delays threaten Joud’s life, but he feels “powerless.”
He used to work in a blacksmith shop, but after he was shot in the leg by an Israeli sniper during the Great March of Return in 2018, he could no longer work.
“The Israeli siege has deprived our children and us of everything: treatment, electricity and work,” he said.
Eventually, the al-Amarin family sought help from the Palestinian Centre for Human Rights to sort out their travel permit delay.
The organization filed a petition with Israel’s high court. Only then, in June, was Tahani’s companion permit granted and Joud able to seek out the necessary treatment in Nablus.
Before that trip, Joud, who sat at her mother’s side, explained how she was behind on her reading and writing abilities and just wants to attend first grade like her peers.
Last year, she only attended kindergarten for a few weeks due to lengthy and painful bouts of treatment.
“I am tired,” she said. “There is unbearable pain in my chest. I don’t want to play to avoid any more tiredness.”
A “normal” childhood in Gaza is rarely attainable, given Israel’s 15-year siege, which strips children of not just urgent medical care, but emotional well-being.
Eighty percent of young children in Gaza suffer from emotional distress, 59 percent have had thoughts of self-harm, and 55 percent have had suicidal thoughts, according to a recent Save the Children report on the consequences of Israel’s blockade and assaults on children in Gaza.
Gaza-based psychologist and social worker Enas Faragallah said the need for psychological intervention among children in Gaza has soared due to consecutive wars and the siege.
“I worked with many children whose conditions were unbelievable and preyed on my mind,” she said. “I often feel powerless, as I can’t help them. They need government intervention, not individuals or psychologists.”
Faragallah said she commonly sees a lack of self-reliance and sense of belonging, deep sorrow, an inability to engage with society, and emotional imbalance among children in Gaza.
Ahmed al-Gharabli, 14, usually works at his father’s sewing workshop in Shujaiya – a neighborhood in Gaza City – after school.
“I don’t play with my friends so I can help my father,” he said. “Sometimes I don’t have pocket money for school and I can’t buy things like my classmates do, which hurts.”
Before the Israeli siege, Ahmed’s father, Maher, earned up to $7,100 a month. Since he can no longer export clothes to the West Bank, he now earns less than $200 a month.
Maher sold 13 sewing machines to pay his debts and provide for his family of eight, yet they still depend on monthly food vouchers and aid from Qatar and from the anti-poverty group Oxfam.
His sewing workshop used to have 20 workers. Now, it has two – and Ahmed.
Ahmed said he wants to go to university and work abroad to help his family.
“But sometimes I think I may not meet my promise because, if any war erupts, we all might be killed.”
Ahmed has never met any foreigners.
“I always dream of speaking English with foreigners. Although my English is not that good, I can make small conversations,” he said, laughing.
For fun in Gaza, Ahmed and his family go to the sea or Gaza Park, because those are the mostly free options.
His cousins in Turkey sometimes send him photos of Istanbul.
“All I want is to travel there to walk among foreigners, to go to parks and take some pictures with luxurious cars. I want to forget the wars and poverty here.”
Nour Abu Ghali, 15, also has aspirations for her future.
Recently, along with two other pupils, she made a prototype of a smart house, with a sensor lighting system and automatic irrigation. It took them three months, four hours a day to complete.
After winning a local technology competition, they were given the opportunity, along with 28 other pupils, to display their prototype at the Science House in Birzeit in the West Bank as part of a student science fair.
All they needed were the travel permits.
The night of 7 June, Nour received a text message stating that the Israeli government had denied her a travel permit, with no justification.
“I burst into tears for hours,” she said. “Why? Why was I rejected access to the West Bank? My father is a teacher with no political interests, and I am just a 15-year-old girl.”
Nour has never traveled outside of Gaza. She was excited to meet other students in the West Bank and to talk about the competition.
“All at once, I felt that my efforts were in vain,” she said. “The most significant difference between us and non-Gaza students is that they have freedom but we don’t.”
Medhat, Nour’s father, was frustrated with the entire situation.
“What security threat could a 15-year-old girl pose to Israel?” he asked. “She was born under the siege and was supposed to travel to the West Bank, to see the rest of Palestine, our country. That was her sole opportunity to see the world. Why did the Israeli government prevent her?”
Nour wants to be a doctor. She tries to stay hopeful amid the Israeli siege, but the recent permit denial was a major blow.
Nour’s 8-year-old brother Muhammad refused to go to school after Israel’s May 2021 attack on Gaza.
“My mother asked him why,” Nour said. “He replied to her, why should he wake up at 6 a.m. for 10 years and then, in the blink of an eye, he might be killed or, at best, be unemployed like our uncle.”
Ahmed Al-Sammak is a journalist based in Gaza. Walaa Sabah is a freelance writer and the community outreach officer at We Are Not Numbers.