Mariam Sabbah had been fast asleep, huddled under a blanket with her siblings, when an Israeli missile tore through her home in Deir al-Balah, central Gaza, in the early hours of 1 March.<\/p>\n
Fatma Salman shows a photo of her daughter Mariam from her time in hospital in Gaza. Photograph: Hamada Elrasam\/The Guardian<\/p>\n
The missile narrowly missed the sleeping children but as the terrified nine-year-old ran to her parents, a second one hit. \u201cI saw her coming towards me but suddenly there was another explosion and she vanished into the smoke,\u201d says her mother, Fatma Salman.<\/p>\n
As the parents searched desperately for their children, they found Mariam lying unconscious in a pool of blood; her left arm was ripped off, shards of shrapnel had pierced through her small body, and she was bleeding heavily from her abdomen.<\/p>\n
As well as losing her arm, the blast left Mariam with severe abdominal and pelvic injuries from shrapnel tearing through her bladder, uterus, and bowel.<\/p>\n
\u201cMariam needs specialised paediatric reconstructive surgery,\u201d says Dr Mohammed Tahir, a British surgeon<\/a> who treated Mariam while volunteering at al-Aqsa hospital in Gaza. \u201cHer arm amputation is also very high and requires limb lengthening and specialist prosthesis. Without this, it will be very difficult for her to live a normal life.\u201d<\/p>\n Mariam, front, with her mother and siblings in Cairo, Egypt, in September, 2025. Photograph: Hamada Elrasam\/The Guardian<\/p>\n Mariam is one of tens of thousands of people in Gaza who have been injured and disfigured by Israeli military attacks over the past 23 months, which have also killed more than 64,000<\/a>, mainly women and children.<\/p>\n Repeated military strikes and attacks on Gaza\u2019s hospitals<\/a> and Israel\u2019s blockade of basic goods and supplies<\/a> into the territory have left the health sector devastated and doctors without the means<\/a> to treat the sick, injured, and famished.<\/p>\n Since October 2023, 7,672 patients, including 5,332 children<\/a>, have been medically evacuated from Gaza for urgent treatment abroad, but trying to get a medical evacuation organised and approved is a slow, arduous and heavily vetted process.<\/p>\n So far over 700 patients \u2013 many of them children \u2013 have died waiting for permission to be granted to leave Gaza<\/a> by Cogat, the Israeli government department responsible for approving medical evacuations, according to the WHO.<\/p>\n Doctors say Mariam needs specialised paediatric reconstructive surgery. Photograph: Hamada Elrasam\/The Guardian<\/p>\n Mariam and her family were no exception. After securing the offer of surgical care from a specialist team in Ohio, the little girl waited two months to be given permission from Cogat to leave Gaza, by which time her condition had deteriorated. She was finally evacuated to Egypt but was then stuck for months waiting for her US travel documents to be processed.<\/p>\n Monthly medical evacuations chart showing sharp decline after March peak<\/a><\/p>\n Then, just a few days before her appointment at the embassy in Cairo to approve her visa, the US suddenly stopped issuing visas for Palestinians<\/a> \u2013 including children \u2013 to be treated in US hospitals.<\/p>\n Far-right influencer Laura Loomer. Photograph: Abaca Press\/Alamy<\/p>\n The decision followed an online pressure campaign by Laura Loomer<\/a>, a far-right influencer close to Donald Trump, who had posted pictures and videos of evacuated patients from Gaza arriving on US soil on social media channels, asking \u201cWhy are any Islamic invaders coming into the US under the Trump admin?\u201d<\/p>\n Despite the rhetoric surrounding the visa ban \u2013 with Loomer hailing the move as a victory, saying it would stop \u201cthis invasion of our country<\/a>\u201d, the US has only accepted a total of 48 medical evacuations from Gaza, according to the figures provided to the Guardian by WHO. In comparison, 3,995 and 1,450 critically injured people have been evacuated to Egypt and the UAE respectively from Gaza. The UK has so far accepted 13.<\/p>\n Medical NGOs say that around 20 severely wounded children have been affected by the ban, and are now stuck in transit countries with nowhere to go and with the treatment needed to save them dangerously out of reach.<\/p>\n Since receiving the news that she had been blocked from receiving treatment, Salman has been unable to console her daughter. \u201cShe won\u2019t leave her bed or stop crying,\u201d she says. \u201cMariam had placed all her hopes of getting better on her medical treatment in the US.\u201d<\/p>\n A few wards down, and also now stuck in Egypt after the US visa ban, is 18-year-old Nasser al-Najjar, who can no longer bear to look at himself in the mirror.<\/p>\n skip past newsletter promotion<\/a><\/p>\n Sign up to Global Dispatch<\/p>\n Get a different world view with a roundup of the best news, features and pictures, curated by our global development team<\/p>\n Privacy Notice: <\/strong>Newsletters may contain information about charities, online ads, and content funded by outside parties. If you do not have an account, we will create a guest account for you on theguardian.com<\/a> to send you this newsletter. You can complete full registration at any time. For more information about how we use your data see our Privacy Policy<\/a>. We use Google reCaptcha to protect our website and the Google Privacy Policy<\/a> and Terms of Service<\/a> apply.<\/p>\n after newsletter promotion<\/p>\n Mohamed Nasser, Nasser al-Najjar\u2019s uncle, shows an MRI image of the injuries to his nephew\u2019s skull. Photograph: Hamada Elrasam\/The Guardian<\/p>\n After becoming displaced, Najjar and his family were sheltering at a school in Jabaliya, northern Gaza, when it was targeted in an Israeli airstrike in January. The 18-year-old suffered devastating injuries to his face and jaw that left him completely disfigured; he lost his left eye, his nose was severed and his jaw shattered \u2013 leaving him unable to breathe, eat or speak properly.<\/p>\n \u201cI once took pride in my appearance but now I don\u2019t even recognise myself,\u201d says Najjar, his voice raspy and breathless.<\/p>\n The teenager requires extensive reconstructive and cosmetic surgery that is not available in Egypt and doctors have warned that without the operations, his condition will deteriorate.<\/p>\n He has been offered treatment at the El Paso children\u2019s hospital in Texas, where specialist doctors are waiting to operate on him, but it is now uncertain if Najjar will ever be permitted to go.<\/p>\n Mohamed Nasser, with his nephew Nasser al-Najjar, 18, who requires extensive surgery not available in Egypt. Photograph: Hamada Elrasam\/The Guardian<\/p>\n