Saber Abu al-Kas's mother Amina died in May while waiting for medical evacuation from Gaza/BBC
When Gaza's medical board approved Amina Abu al-Kas to leave the Strip for treatment abroad, her son Saber said it felt like the beginning of a new life.
"It brought life back into her. She knew there was no treatment in Gaza, so she was happy and excited," he told the BBC.
Amina was suffering from an aggressive necrotising infection that had spread to her skull. Doctors in Gaza told her they did not have the medicines or the therapies to treat it.
Saber said the pain was unbearable.
"My mother couldn't sleep day or night; she stayed awake, crying out from the pain. Painkillers caused stomach ulcers and inflammation, and the doctors banned her from taking them."
After receiving the medical referral, Saber said the family waited for news that Amina had passed security clearances and had been accepted by a foreign country for treatment - both necessary to leave Gaza.
"We knew that at any moment God might take her. And we also knew that at any moment a miracle might happen, that we might get a call saying, 'Get your bags ready and prepare to travel through the crossing,'" Saber told the BBC.
"We waited a long time, but no response came. My mother died [on 29 May], and two weeks after her death, I got a call from the hospital informing me that her paperwork was ready."
Gaza's Hamas-run health ministry says Amina is one of 300 Palestinians who have died waiting for medical evacuations since the US-brokered ceasefire between Israel and Hamas began there last October.
The figures are also used by the World Health Organization (WHO), which assists with patient transfers via Gaza's Israeli-controlled border crossings with Israel and Egypt.
Thousands of others - the health ministry currently says 15,000 - are still waiting for treatment abroad - some for war-related injuries; others for conditions such as cancer.
The list of evacuees is constantly fluctuating, as patients' conditions and decisions change, meaning not all deaths may be recorded.
Since the ceasefire began over eight months ago, the WHO says 1,977 people have left Gaza for medical treatment. Unless the process speeds up, it could take years to evacuate all those in need.
"We are talking about something that feels like a miracle," Saber said. "If a patient's name is selected and they are granted permission to travel for treatment abroad, it is almost a miracle."
After being approved by Gaza's medical referral board, patients must pass security checks by Israel, the host nation and any transit countries – and also be accepted by a host nation for treatment, which is not always a simple process.
"Many recipient countries are quite specific in the type of patients they can support - for example, some only want children; others only want patients for shorter treatments," said Dr Reinhilde Van de Weerdt, WHO Representative for the occupied Palestinian territory.
"Then patients and their companions need visas for the host country, and to pass security checks by Israel, Egypt/Jordan and the host country."
In early June, the Gaza health ministry's acting undersecretary, Maher Shamia, said the primary causes of the delays were the lengthy security screening process and the limits imposed by Israeli authorities on the number of departures.
He added that Palestinians were only allowed to leave via the Rafah crossing with Egypt three days a week, and that medical evacuations via the Kerem Shalom crossing with Israel took place only one day a week.
The Israeli defence ministry body responsible for civil affairs in Gaza, Cogat, said departures were subject to the receipt of an official request from a receiving country willing to accept a patient and the completion of security screening by relevant authorities.
The "vast majority" of requests submitted by countries and organisations had been approved since the start of 2025, it added.
Between the bombed-out buildings of Gaza City's al-Shifa hospital, dozens of people have gathered to protest against delays in the process.
Nidal al-Arir wails on the ground, pleading for his son, who needs a corneal transplant.
Raeda Nuaizi says cancer led to the removal of her breasts, ovaries, uterus and pelvic bone before the war.
"What is my treatment [in Gaza]? Painkillers!" she cried. "But what can painkillers do for a cancer patient?"
Beside them, 14-year-old Muath al-Dini, balanced on crutches after a leg amputation, is waiting for two separate medical evacuations.
His mother, Umm Samir al-Dini, told the BBC that Muath lost his leg in an air strike on their family home, which also killed another of her children, and injured her husband and younger son.
But she said Muath had also been battling spinal cancer since he was a baby.
"Before the war, I used to receive treatment outside Gaza at a hospital in Jerusalem, and had surgery to stabilise my vertebrae. Here, there is no treatment for me," Muath said.
Some Gazans received permission before the war to travel to hospitals in the occupied West Bank and East Jerusalem for treatment, but Israel has since closed that route almost entirely, with just one Gazan patient travelling to the West Bank for cancer treatment.
Umm Samir said four of the screws holding Muath's spine in place have come loose and are affecting his breathing. Doctors in Gaza had also recommended a further amputation to his leg.
After being told they had security clearance for evacuation, the family have heard nothing more since they were asked to resubmit documents in May.
"We are still waiting," Umm Samir said. "My son's childhood has been lost. He is bullied and refuses to leave the house. There are no medicines, and no doctors [here] who understand my son's condition."
The desperation of patients haunts Gaza's hospitals - their exterior walls eaten away by gunfire and Israeli strikes, the health-care system inside them still unrepaired.
Eight months after the ceasefire deal instructed that "full aid" be sent into the Gaza Strip, aid workers say the continued lack of essential medicines and equipment has meant doctors are rationing or loaning each other essential life-saving drugs, or turning patients away from chemotherapy or dialysis appointments.
"The fact that the medical evacuation list is thousands long is a sign that people in Gaza don't have access to what they should have - which Israel, as the occupying power under international humanitarian law, has an obligation to allow them access to," said Pat Griffiths, spokesman for the International Committee of the Red Cross (ICRC) in Jerusalem.
Shortages, he said, run from basic consumables like gauze dressings and painkillers, all the way up to advanced medical equipment.
"There is no doubt in my mind that people in Gaza are dying because they can't receive the care they need - and that there are preventable deaths happening because of the limits on what can be brought in, in terms of healthcare."
Asked about the reports of critical shortages, Cogat said in a statement that 17,000 tons of medicines and medical aid had entered Gaza since the ceasefire, including wheelchairs, cancer medications, insulin pens, anaesthetics, X-ray machines, CT scanners, dialysis machines and medical consumables.
"Despite claims to the contrary," it said, "Israel has approved every request for medicines submitted by international aid organisations."
In response, one humanitarian official involved, speaking to me anonymously, said that Israeli authorities often used anecdotal examples to mask shortages of key medicines and equipment, and that aid supplies continued to be restricted.
"You don't count medical aid in terms of trucks and pallets; that's not a denominator we use," said the WHO's Reinhilde Van de Weerdt. "We talk about the needs patients have, and the needs that are met."
"If medical supply is unrestricted, you don't have these discussions about what is given versus what is needed," she said. "We need certain buffer stock levels of medical supplies, [and] you can't run a hospital hoping the generator doesn't break down."
Mazen al-Arayeshi, director of engineering and maintenance at Gaza's ministry of health, said Israel was now allowing enough fuel in to run the generators hospitals rely on for power, but that surgeries were still being cancelled because the power they supplied was too low, and that Israel had refused to allow them to swap in new generators for old.
"If spare parts, filters and new generators are not allowed in, we are heading towards a catastrophe," he told the BBC. "Yesterday, one of the main generators at Nasser Medical Complex [in Khan Younis] stopped working, and we had to cut electricity to several departments."
Some desperate patients on the long list of evacuees have reportedly begun paying self-declared agents thousands of pounds to try to move their cases forward.
A warning notice has appeared on the WHO website, telling patients in large red letters to "Beware of fraud", and not to pay anyone who claims to be able to speed up the evacuation process.
"During this war, we have learned everything, adapted to everything, trained ourselves to endure everything," Amina's son, Saber, said.
"Most of those who came to offer condolences for my mother said, 'At least she is at peace now.' That sentence sums up everything. Because a patient in Gaza is different from any patient elsewhere in the world."
