They are some of the most vulnerable in Gaza.
The youngest is not even a year old; the oldest is 14. All are battling lymphoma, leukemia and tumors that doctors said could kill them if left untreated.
Over the past 10 days, 21 children with cancer have been evacuated from Gaza to hospitals in Egypt and Jordan, according to doctors involved in the effort. But at least 30 other young cancer patients have not made it out, and aid workers said that in the chaos of war, they can no longer reach some of the families.
“This is catastrophic,” said Dr. Bakr Gaoud, the head of Al-Rantisi Specialized Hospital for Children, which was the only medical center with a pediatric cancer ward in Gaza until it was forced to shut down on Friday during heavy fighting. Even before the hospital closed, critically ill patients were being sent home through violent streets or transferred to Al-Shifa, a nearby hospital that is under siege by Israeli forces.
Hospitals have become a particular flashpoint in the war as Israel has accused Hamas of turning medical facilities, including Al-Rantisi and Al-Shifa, into safe houses and command centers. Hamas and hospital officials have denied the allegations.
The effort to evacuate children with cancer began in mid-October and required negotiations among the White House, Egypt, Israel and Palestinian health officials in Gaza, which is controlled by Hamas.
But those involved in the evacuation said it has proceeded fitfully.
Aid workers and doctors, who spoke on condition of anonymity because of the sensitivity of the efforts, described frantic families who lost their cell service and missed the specific days when their children had been given permission to cross into Egypt. Some waited for hours for ambulances that never made it to a meeting point.
One family arrived at the border only to discover that their child had been approved to cross, but the parent’s name had been inexplicably left off the list.
The children’s plight is a microcosm of the suffering in Gaza since the war began just over a month ago, after Hamas launched a surprise assault that Israeli authorities say killed 1,200 people. Israel’s retaliation has killed more than 11,000 people, including more than 4,500 children, according to health officials in Gaza.
Most of the children with cancer were being treated at Al-Rantisi, which had 35 inpatient pediatric cancer patients as of two weeks ago, Dr. Gaoud said. But as shells hit the hospital’s water tanks and power system over the past week, it began to empty out.
On Friday, Dr. Gaoud said, Al-Rantisi was forced to shut down entirely, with staff members dragging some patients outside in their beds to wait for ambulances. Israeli soldiers provided a map of what they said was a safe route through the fighting.
The children were given one last dose of chemotherapy before they left. Without further care, Dr. Gaoud said, “their cases will deteriorate.”
The emergency effort to evacuate the patients was organized by the World Health Organization and St. Jude Children’s Research Hospital, which had been involved in building up services at Al-Rantisi.
The organizations created a registry of children to be moved, with phone numbers for their relatives. St. Jude’s also promised to organize their transport into Egypt and ensure their medical care.
But the names of the children had to be added to a daily list of those approved to pass through the Rafah border crossing into Egypt, which was no simple task. More than two weeks passed with no evacuations.