When the Rafah border crossing between Gaza and Egypt reopened this week, it was described by officials as a step forward under the ceasefire agreement reached in October. But for Palestinians in urgent need of medical care, the reopening has so far offered little more than symbolism. Only five patients were allowed to leave Gaza for treatment on Monday, prompting warnings from health authorities that Israeli restrictions at the crossing could ultimately cost thousands of lives.
Gaza’s Health Ministry says approximately 20,000 patients are awaiting medical evacuation, including about 440 whose cases are considered critical and require immediate treatment. Years of blockade, compounded by Israeli attacks that have devastated hospitals and clinics, have left Gaza’s health system unable to treat many serious illnesses and war-related injuries. Rafah is the only exit point for patients seeking advanced care abroad.
Zaher al-Wahidi said the procedures imposed at the crossing make meaningful evacuations impossible at the current pace. Egyptian officials had previously said that 50 people would be allowed to cross from Gaza into Egypt each day. But after only five patients were permitted through on Monday, al-Wahidi warned that the consequences could be catastrophic. “If the rate of crossing on Monday continues,” he said, “we would need years to evacuate all of these patients, by which time all of them could lose their lives while waiting for an opportunity to leave.”
Al Jazeera reported that Palestinians seeking to exit Gaza for medical treatment face a multi-stage screening process dominated by Israeli oversight. Names must first be registered with Egyptian authorities, who then send the lists to Israel’s Shin Bet for approval. Those cleared are required to pass through a checkpoint run by the Palestinian Authority and European Union representatives, after which Israeli officers use facial recognition software to identify those allowed to cross.
Reporting from Rafah, Al Jazeera correspondent Nour Odeh described the process as deeply degrading and obstructive, particularly for people in urgent medical distress. “There were strip searches and interrogations, but now there are even more extreme elements. We’re hearing about people being blindfolded, having their hands tied, and being interrogated,” Odeh said. “When we talk about security screening, and a person needing urgent medical care, that person is basically being denied medical attention.”
The consequences of those restrictions were visible on the Egyptian side of the border. Ambulances waited for hours on Monday, ready to transport patients to some 150 hospitals across Egypt that have agreed to treat Palestinians from Gaza. Despite that readiness, only five patients were finally allowed to cross after sunset. Al-Wahidi said the current system “will not allow us to evacuate patients and provide medical services to them to give them a chance at life.”
Restrictions have also sharply limited the return of Palestinians who fled Gaza earlier in the war. About 30,000 people have requested to reenter the territory after leaving when Israel began bombing civilian infrastructure and imposed a total blockade on humanitarian aid in October 2023. Gaza’s population of more than two million people includes large numbers of displaced families. Yet on Monday, only about a dozen people were permitted to return, well below the stated daily target of 50.
According to the Associated Press, Palestinians returning to Gaza were subjected to severe limits on what they could bring with them. “They didn’t let us cross with anything,” said Rotana Al-Regeb after returning to Khan Younis. “They emptied everything before letting us through. We were only allowed to take the clothes on our backs and one bag per person.” AP reported that disagreements over luggage allowances contributed to delays that further slowed crossings.
Testimonies collected by Al Jazeera point to intimidation and coercion during the return process. Correspondent Tareq Abu Azzoum reported accounts from Palestinians who said they were blindfolded and interrogated by the Israeli military on their way back into Gaza, while others said they were intercepted by Israeli-backed militias and questioned about armed groups. For many who had waited months or years to return, Abu Azzoum said, “the Rafah crossing has been a humiliating process instead of a day marking a beautiful reunion with family.”
Political analyst Muhammad Shehada said the system now in place effectively turns Rafah into a one-way border. “It means in practice that Israel has made the Rafah border crossing a one-way ticket,” he said. “If you decide to go to Gaza, they tell you, ‘Okay, you will be caged there permanently. Forget about being able to leave ever again.’ If you decide to leave you will have to settle with the concept of being banished and exiled again, permanently, because the queue is so formidably long.”
On Tuesday, a World Health Organization team arrived at a Palestinian Red Crescent hospital in Khan Younis to escort patients toward Rafah. Only 16 patients with chronic conditions or injuries caused by Israeli attacks were taken, far fewer than the 45 patients the Red Crescent had previously been told would be allowed to cross. Health authorities in Gaza said they are being forced to decide which patients will be given priority.
“We know that patients have died basically waiting for evacuation,” said Christian Lindmeier. “And that’s something which is horrible when you know just a few miles or kilometers outside that border help is available.”
The stalled evacuations are unfolding as violence in Gaza continues despite the ceasefire. The Associated Press reported that Ahmed Abdel-Al, 19, was shot and killed by Israeli troops on Tuesday morning in Khan Younis. Israel’s military did not immediately respond to questions about the shooting. Gaza’s Health Ministry said more than 520 Palestinians have been killed by Israeli fire since the ceasefire began on Oct. 10, contributing to a death toll of more than 71,800 since the start of the war. The ministry’s casualty records are widely regarded as generally reliable by United Nations agencies and independent experts.
For Gaza’s sick and wounded, the reopening of Rafah has so far failed to translate into meaningful access to care. Health officials warn that unless Israeli restrictions are significantly eased, thousands of patients will continue to wait for treatment that exists just beyond the border, with deadly consequences.
“We know that patients have died basically waiting for evacuation,” Lindmeier said.
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