A senior Doctors Without Borders official is warning that thousands of severely ill and injured people in Gaza will die unless countries drastically increase the number of medical evacuations they are willing to accept.

The official says the pace has slowed so sharply that families are now watching loved ones’ condition worsen as paperwork and political hesitations drag on.

Hani Isleem, who coordinates medical evacuations from Gaza for Doctors Without Borders, known as MSF, said the need has surged far beyond what any current evacuation plan covers. He told AFP on Tuesday that the number of patients actually accepted abroad represents “just a drop in the ocean.”

The World Health Organization estimates that more than 8,000 patients have been transferred out of Gaza since the war erupted after Hamas’ October 7, 2023, attack inside Israel.

It says more than 16,500 people still need follow-up care outside the territory. But Isleem warned that the official lists capture only part of the reality.

“Our estimate is that it is three to four times that number,” he said, stressing that thousands more are unregistered because communication, travel within Gaza, and access to medical centers have become nearly impossible.

Children prioritized while adults wait

More than 30 countries have accepted patients from Gaza, but only a few have taken substantial numbers. Egypt and the United Arab Emirates remain among the largest receivers. In Europe, Italy has accepted more than 200 patients, while major nations such as France and Germany have yet to take in any.

Switzerland accepted 20 children in November, including a group of 13 who arrived last week with Isleem. The patients ranged from infants to teenagers, with conditions including congenital heart defects, cancer, and severe orthopedic injuries. Several of the babies went directly into surgery upon arrival to prevent “irreversible damage,” Isleem said. Without immediate evacuation, he added, some would not have survived.

But he warned that nearly all countries insist on accepting only children, excluding the majority of adults who urgently need care. About three-quarters of evacuation candidates are older than 18, many with complex injuries, chronic illnesses, or conditions that have worsened because Gaza’s hospitals have been repeatedly damaged or shut down.

“They are ignoring completely the adults who need support and lifesaving aid,” he said, calling on governments to stop applying what he described as “a selection shopping list” that filters patients by age, gender, or family status.

Sharp decline after Rafah closure

The pace of evacuations has slowed dramatically since Israel shut the Rafah crossing into Egypt in May 2024. Before the closure, roughly 1,500 patients a month were able to leave. Since then, the average has dropped to around 70 per month.

A U.S.-brokered cease-fire that began on October 10 has not accelerated the process. Nor has a steep decline in Israeli refusals. Isleem said Israeli denials of medical evacuation requests have dropped from about 90% earlier in the war to around 5% in recent months.

Even so, he argued, “they should not block any patients from leaving Gaza to access treatment.”

Despite these shifts, evacuations remain far below what is needed. Isleem said 148 were completed in October, 71 in November, and only about 30 are expected in December, pushing families into deeper desperation.

Delays prove deadly

More than 900 people have died while waiting for medical evacuation since October 2023, according to MSF, though Isleem believes the true number is significantly higher.

He said some patients die hours or days after being placed on waiting lists, particularly those with advanced cancer, uncontrolled infections, or serious internal injuries.

The bottleneck, he said, lies largely with foreign governments that take weeks or months to confirm whether they will accept new patients. “Countries are taking a long time to decide or allocate the budget for these patients, but they cannot wait for this discussion to happen,” he said.

Some governments reject evacuees who have accompanying family members, especially if male relatives are over 18, creating additional barriers. Others issue approvals in small batches that do little to ease the backlog.

Isleem urged governments to abandon political considerations and focus instead on urgent medical needs. “Stop this selection shopping list,” he said. “Focus only on the needs and saving people’s lives.”