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The child Mariam had been soundly resting, huddled below a blanket with her brothers and sisters as an Israeli missile tore through her residence in a Gaza neighborhood during the night of 1 March.

The weapon barely avoided the sleeping children but as the panicked young girl ran to her guardians, a second one impacted. “I witnessed her approaching me but suddenly there was a further detonation and she disappeared amid the dust,” recounts her mother, Fatma Salman.

During the search, hunted urgently for their young ones, they discovered their daughter motionless in a bloody patch; her limb was severed, shards of shrapnel had penetrated through her small body, and she was bleeding heavily from her torso.

As well as losing her arm, the detonation resulted in the child with critical internal wounds from projectiles tearing through her bladder, womb, and intestines.

“Mariam needs specialized youth-oriented medical procedures,” explains a British surgeon who cared for the girl while offering services at a Gaza hospital in the territory. “Her arm amputation is also particularly drastic and needs limb lengthening and specialist prosthesis. Absent these measures, it will be extremely challenging for her to experience daily activities.”

Mariam is one of many thousands of residents in Gaza who have been wounded and scarred by armed assaults over the past nearly two years, which have also resulted in the death of over 64,000, primarily women and children.

Frequent military strikes and assaults against Gaza’s hospitals and the closure of essential items into the region have left the healthcare infrastructure devastated and medical staff without the means to treat the sick, wounded, and starving.

Starting from late 2023, thousands of individuals, among them 5,332 children, have been medically evacuated from Gaza for critical care abroad, but seeking to get a medical evacuation organised and approved is a protracted, arduous and strictly screened process.

To date in excess of many wounded – a significant number being youths – have passed away waiting for clearance to be granted by the Israeli authorities to leave Gaza, based on information from medical groups.

The child and her relatives were not exempt. After securing the offer of surgical care from a specialist team abroad, the young patient remained two months to be granted clearance to leave the territory, by which time her condition had declined. She was eventually relocated to a neighboring country but was then delayed for months waiting for her visa paperwork to be approved.

Subsequently, just a few days before her appointment at the consular office in Cairo to authorize her visa, the American government suddenly stopped issuing travel permits for individuals from Gaza – even youths – to be medically assisted in US hospitals.

The policy change came after an digital advocacy effort by a far-right influencer who had posted pictures and videos of wounded individuals from the region reaching American territory on digital networks and asking the arrival of affected persons.

Despite the discourse surrounding the entry prohibition, the US has just taken in a combined figure of a limited number of patients from Gaza, as per data released by international bodies. By contrast, 3,995 and 1,450 gravely harmed individuals have been evacuated to one country and the another nation each from the territory. A European nation has so far received a small number.

Aid organizations say that around 20 severely wounded children have been influenced by the ban, and are now trapped in intermediate locations with nowhere to go and with the medical care required to save them alarmingly out of reach.

Upon learning the information that she had been prevented from obtaining care, Salman has been not able to reassure her young one. “She cannot leave her bed or end her tears,” she says. “Mariam had placed all her hopes of healing on her medical treatment in the US.”

Elsewhere in the facility, and also now stranded in the transit country due to the US visa ban, is young a youth named Nasser, who can not anymore stand to look at himself in the glass.

Following their evacuation, the patient and his relatives were taking refuge at a educational facility in Jabaliya at the time it was targeted in an airstrike in the first month. The 18-year-old suffered devastating injuries to his head and neck that left him visibly altered; he no longer has his vision on one side, his nose was severed and his jaw fractured – resulting in him incapable to breathe, consume food or speak properly.

“I used to valued my looks but now I fail to recognise myself,” remarks the patient, his voice hoarse and labored.

The teenager requires comprehensive aesthetic operations that is not available in Egypt and medical experts have advised that lacking the operations, his health will decline.

He is given the opportunity at a medical center in Texas, where expert surgeons are ready to treat him, but it is now doubtful if Najjar will ever be authorized to go.

The pressure of instability causes psychological strain. Ahmed Duweik {already|already|pre