A look inside the desperate attempt to evacuate young cancer patients from Gaza

They are among the most vulnerable in Gaza.

The youngest is less than a year old; the oldest is 14. They are all battling lymphoma, leukemia and tumors that doctors said could kill them if left untreated.

According to doctors involved in the effort, 21 children with cancer have been evacuated from Gaza to hospitals in Egypt and Jordan in the past 10 days. But at least 30 other young cancer patients did not survive, and aid workers said they could no longer reach some families in the chaos of war.

“This is catastrophic,” said Dr. Bakr Gaoud, head of Al-Rantisi Specialized Hospital for Children, the only medical center with a pediatric cancer unit in Gaza until it was forced to close during heavy fighting on Friday. Even before the hospital closed, seriously ill patients were sent home through violent streets or transferred to Al-Shifa, a nearby hospital 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 between the White House, Egypt, Israel and Palestinian health officials in Gaza, which is controlled by Hamas.

But those involved in the evacuation said it was uneventful.

Aid workers and doctors, who spoke on condition of anonymity because of the sensitivity of the effort, described frantic families who lost their cell service and missed the specific days when their children had been cleared to cross into Egypt. Some waited for hours for ambulances that never reached a meeting point.

One family arrived at the border to find that their child had been cleared to cross, but the parent’s name was inexplicably not on the list.

The plight of the children 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 health officials in Gaza.

Most of the children with cancer were being treated in Al-Rantisi, where 35 childhood cancer patients were admitted two weeks ago, said Dr. Gaoud. But when shells hit the hospital’s water tanks and electricity system last week, it began to run out.

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

The children received one last dose of chemotherapy before leaving. Without further care, said Dr. Gaoud, “their cases will worsen.”

The emergency response to evacuate the patients was organized by the World Health Organization and St. Jude Children’s Research Hospital, which had been involved in building services in Al-Rantisi.

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

But the children’s names had to be added to a daily list of those allowed to cross the Rafah border crossing into Egypt, which was no easy task. More than two weeks passed without any evacuation.