When the Gaza war began, Ismail Abu Naji was just 18 months old, his small body covered in swollen, bleeding lesions. Months earlier, doctors had diagnosed him with a rare blood cancer, one that, if untreated, is often a death sentence.
In the weeks before the war, Ismail’s family had arranged for him to be transferred to Al-Makassed hospital in Jerusalem, a charitable institution for Palestinians, for specialised care. But the blockade Israel imposed on Gaza after Hamas’s 7 October 2023 attack that triggered the conflict meant Ismail could not leave the territory.
He is now one of thousands of cancer patients in Gaza who the UN says require medical evacuation for urgent treatment.
The Guardian has spoken to dozens of Palestinian cancer patients trapped in Gaza, where doctors say cancer-related deaths have tripled since the war began, as Israel continues to hinder patients from leaving and restricts the entry of chemotherapy drugs. While some patients have left, they are far outnumbered by those deemed in medical need who have not. The Israeli NGO Physicians for Human Rights Israel (PHRI) says evacuation routes to third countries have become “near impossible” to operate, especially since the closure of the Rafah crossing in May 2024, and that Israel is failing to meet its obligation to provide medical care to populations under its control. The crossing between Gaza and Egypt is due to open for traffic next week, the Palestinian technocratic committee leader, Ali Shaath, said on Thursday, although Israel did not immediately confirm that would be the case.
With even basic painkillers having become unattainable under the blockade, there is little else Ismail’s mother, Aya Mohammed Abu Hani, who is living in a tent in a school, can do but try to ease his pain, gently dabbing the wounds with a cloth soaked in salt water.
“Ismail’s life before the war was already difficult, and it has become even harsher since. He cannot sleep due to severe pain, high fever and cries constantly,” she told the Guardian. “We were displaced many times from one place to another, which worsened his condition. I could not even provide him with enough clothing. Before the war, hospitals were able to offer antibiotics and painkillers. But now, they can’t even provide a single painkiller.”
Israeli airstrikes on hospitals have reduced the Palestinian healthcare system to ruins. In March 2025, Israel destroyed Gaza’s only specialised cancer treatment hospital, the territory’s sole provider of oncology care. Since then, doctors have been pushed into makeshift clinics, operating with almost no resources, including the tools needed for diagnosis.
“As for cancer diagnosis, we have reached an extremely critical stage,” said Dr Saleh Sheikh al-Eid, a specialist physician in haematology and oncology at Nasser medical complex in Khan Younis. “Basic diagnostic tools, such as biopsy needles, are unavailable. Patients come to us with obvious cancerous masses, yet we lack the means to take samples and examine them. As a result, we have lost many patients without even being able to properly diagnose or treat them.”
Despite recent ceasefire agreements intended to facilitate the entry of aid, essential medical supplies remain restricted.
“We receive repeated warnings from the pharmacy that essential chemotherapy drugs are close to running out,” al-Eid says. “The resources available to us do not exceed 5% of those available in hospitals in the West Bank, and in many cases they are almost nonexistent.”
Living with a cancer diagnosis and the uncertainty of survival is, in itself, a traumatic experience. Going through such an ordeal while trapped in a war zone, cut off from essential medication and under constant Israeli bombardment, can be unbearable. While airstrikes have slowed since the US-brokered ceasefire in October, they have not stopped. Israeli forces have killed at least 466 Palestinians in the last three months.
All the while, friends and family members of cancer patients have died during the bombardments.
The pain of losing her granddaughter, killed in an Israeli bombardment, accompanies Fathiya Abu Frieh, 65, every day. Abu Frieh, who has been living in a tent in the city of Deir al-Balah since the start of the war, was diagnosed with uterine cancer last year.
“A short while ago, I lost consciousness because I had nothing to eat for breakfast,’’ she says. ‘‘The treatment I am currently receiving is nothing more than an anaesthetic injection – just enough to keep me alive.”
Islam Al-Naour, a 40-year-old with testicular cancer, is living displaced in Gaza City. “Due to my weakened immune system, even minor illnesses had a severe impact on my health.
“Life became difficult even for a healthy person, so imagine what it is like for a cancer patient like me, forced to carry water, set up tents, and secure them during harsh weather conditions.”
Before the war, hundreds of Palestinian cancer patients had been authorised to receive medical care outside Gaza because of the territory’s inadequate facilities. Dozens of patients who had been in Jerusalem for chemotherapy were then left in a state of limbo, as Israeli authorities threatened to send them back to Gaza.
In March 2024, the Guardian visited the Augusta Victoria hospital in Jerusalem where at least five children from Gaza were receiving cancer treatment. Today, all those children are dead.
The World Health Organization says about 10,700 Palestinians have been evacuated to 30 countries for specialised care since October 2023, nearly a quarter of them cancer patients. But according to UN figures, there are more than 11,000 cancer patients in Gaza requiring treatment outside the territory. Aid agencies say Israel continues to obstruct their evacuation, in breach of obligations that Israel’s high court has previously recognised.
According to health officials in Gaza, there are about 4,000 people with official referrals for treatment to third countries who are unable to cross the border. The WHO says 900 people, including children and cancer patients, have already died while waiting for evacuation.
PHRI and partner organisations filed a petition in November to the Israeli high court of justice, demanding the immediate reinstatement of medical evacuations for critically ill patients from Gaza to hospitals in the West Bank and East Jerusalem.
“Since the closure of Rafah crossing in May 2024, evacuation routes to third countries have become nearly impossible to operate,” the NGO said. “Under the Israeli and international law, and according to the high court of justice, Israel is legally obligated to ensure access to medical care for populations under its effective control. Current restrictions on patient movement violate this duty to protect the health and prevent avoidable death, given its full control over the movement of patients out of Gaza.
“This is not a political or security decision – it is a basic obligation to save human life.”
Cogat, the Israeli agency charged with the administration of Gaza, denies restricting medical evacuations from Gaza.
“Whenever a country submits a request to evacuate a patient, regardless of the patient’s underlying medical condition, the request is examined and approved subject to security screening,” it said, adding that “dozens and even hundreds of residents have been evacuated each week”.
On 12 January, for the first time since the outbreak of the war, and thanks to a prolonged legal battle by the Israeli human rights organisation Gisha, Dr Nour El-Din Abu Ajwa, 48, a Palestinian cancer patient, was allowed to leave Gaza to receive critical medical treatment at a hospital in Nablus, in the occupied West Bank.
The Guardian reached Abu Ajwa over the phone, who said he learned in the second month of the war that he had colon cancer, as well as liver and lung cancer.
‘‘Two years ago, I lost my son, who suffered from a spinal cord cancer,” he said. ‘‘I left my wife and children in Gaza. I don’t know if I am going to go back or not. I fought very hard through the Israeli court to get permission to receive treatment in Jerusalem or the West Bank. I was denied the permit five times, but at the end, the Israeli judge was fair to me and he insisted that I should be allowed to travel and to receive treatment in the West Bank.
“I hope I will be the first of thousands of cancer patients in Gaza who will be allowed to travel and receive proper treatment. I hope I am the one who opened the door for many to be treated as a human being.”
Until the last moment, the Israeli state sought to prevent Abu Ajwa’s evacuation, submitting a last-minute request to delay the implementation of the judge’s decision while he was already en route to the West Bank; a request the court rejected.
“The attempt to delay implementation of the court’s judgment illustrates the state’s insistence on maintaining a sweeping and unlawful policy at the expense of the most vulnerable,’’ Gisha states.
‘‘This case,” Gisha adds, “constitutes, in practice, an initial and important crack in this cruel policy, which must be abolished immediately.”
Inside one of the hundreds of tents at al-Shati Martyrs school, as cold weather and a storm rage outside, Ismail’s mother prepares another saline compress to treat Ismail’s lesions, while trying to distract him from the pain by handing him a notebook and coloured pencils.
“As a mother, it is unbearable to see my young child suffer without being able to help,” she says.
“I wish I had the power to ease his suffering,” she adds, “to give him the right to live without pain.”
