They are among the most vulnerable in Gaza.

The youngest is not even a year old; the oldest is 14 years old. All are battling lymphoma, leukemia and tumors that doctors say 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 operation. But at least 30 other young cancer patients did not survive, and aid workers said that in the chaos of war they could no longer reach some families.

“It’s catastrophic,” said Dr. Bakr Gaoud, director of Al-Rantisi Children’s Specialized Hospital, which was the only medical center with a pediatric cancer department in Gaza until it was forced to close Friday during heavy fighting. Even before the hospital closed, seriously ill patients were being sent home through violent streets or transferred to Al-Shifa, a nearby hospital under siege by Israeli forces.

Hospitals have become a flashpoint in the war, with Israel accusing Hamas of turning medical facilities, including Al-Rantisi and Al-Shifa, into safe havens and command centers. Hamas and hospital officials have denied the allegations.

Efforts to evacuate children with cancer began in mid-October and required negotiations between the White House, Egypt, Israel and Palestinian health officials in Hamas-controlled Gaza.

But those involved in the evacuation said it was fully carried out.

Aid workers and doctors, who requested anonymity because of the sensitivity of their efforts, described French families who lost cell service and missed the precise days their children were allowed to cross the border. Egyptian border. Some waited hours for ambulances which never arrived at a meeting point.

A family arrived at the border to find that their child had been allowed to cross, but the parent’s name had inexplicably been 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 attack 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 Gaza health authorities.

Most children with cancer were being treated at Al-Rantisi, which had 35 pediatric cancer patients two weeks ago, Dr. Gaoud said. But when shells hit the hospital’s water tanks and electrical system over the past week, they began to empty.

On Friday, Dr. Gaoud said, Al-Rantisi was forced to close its doors completely, with staff members dragging some patients outside in their beds to wait for ambulances. Israeli soldiers provided a map showing what they consider a safe route through the fighting.

The children received a final dose of chemotherapy before leaving. Without additional care, Dr. Gaoud said, “their cases will deteriorate.”

Emergency evacuation efforts to evacuate patients were organized by the World Health Organization and St. Jude Children’s Research Hospital, which helped set up services in Al-Rantisi.

The organizations created a register of children to be moved, with the telephone numbers of their relatives. St. Jude’s also promised to arrange for their transportation to Egypt and provide medical care.

But the children’s names had to be added to a daily list of people allowed to pass through the Rafah border crossing into Egypt, no simple task. More than two weeks passed without an evacuation.

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