Warning: This story contains distressing images

To find safety from Gaza, you need first to become the victim of a catastrophic injury and then be lucky enough to be identified, selected and extracted.

That’s one of the many brutal truths from this long war.

I have followed the stories of some of the few Palestinians who have left Gaza for medical care.

Less than 100 children have been granted permissions and temporary visas for the United States to receive treatment since the war began in October 2023.

In all, several hundred children have left Gaza for treatment in that time – most to other Middle Eastern countries. It has not been possible to confirm a precise number but we do know that the UK has not accepted any.

A few weeks ago, at Chicago’s O’Hare airport, the largest single group of children from Gaza arrived in America for treatment.

Eight Palestinian children were aboard Royal Jordanian flight 263 from Amman.

The number, tiny though it is, reflects an enormous achievement by the charity that has made this happen – the Palestine Children’s Relief Fund (PCRF).

But it is also reflective of deep diplomatic and political failures; the fact that it was only possible to extract eight of many thousands who need urgent medical treatment.

The doors into the arrival hall at O’Hare opened to reveal a fleet of wheelchairs each carrying a child bearing the scars of the war they had left behind.

Among them, two brothers who survived the bombing that killed their sister.

Behind them, a boy who lost all his siblings and his arm. He is now his mother’s only child. She travelled with him. She too is now an amputee.

The last to emerge through the arrival door was a dot in her wheelchair.

Rahaf, just two, lost both her legs in an Israeli attack on her home in August, not long after she had learnt to walk.

All their stories reflect a collective horror. They are the civilian victims of Israel’s bombardment of Gaza which followed the Hamas attacks of 7 October 2023.

The children arrived in America after a massive collective effort involving the PCRF and Shriners – one of America’s largest non-profit children’s hospital networks.

Working with multiple governments they facilitated the extractions.

Israel controls all of Gaza’s borders and has only granted evacuations in rare circumstances, only in exceptional cases and only with one parent or guardian.

After their flight, the children travelled to Shriners Hospitals in different parts of the country – California, Oregon, Illinois, South Carolina, Kentucky and Missouri.

It was in Missouri this week that I spent a day with two-year-old Rahaf and her mother Israa Saed.

We met at the home of the American couple who have volunteered to be their hosts for their time in the US.

Six months since the bombing of Rahaf’s home and three weeks since she and her mother arrived in America, I’d come to see how a little life was now being rebuilt.

The first thing that hit me as we sat in the host family’s living room was how happy Rahaf now seems.

Her right leg is missing from below her knee and her left leg is almost completely gone – amputated just below her hip.

Yet she was darting around the floor in front of us chasing a blue balloon with shrieks of laughter. Her mum smiled as she watched.

The mood belied the enormity of their experience and the dilemma of their journey.

Until this month, Israa and Rahaf had never left Gaza. Now they are in America, without the language and without the rest of their family – Israa’s husband and her two young boys.

“My other two sons are still young and… do I need to stay with my other kids or do I need to come out?,” she said about her dilemma.

“Rahaf needs her mum. I could not let her go [to America] alone. And especially also with my fractures, my elbows, my arms. I was hoping for some treatment for myself.”

Israa was injured in the same attack on 1 August. Both her arms were badly damaged. New X-rays taken since she arrived in America show a section of bone still missing in her right forearm.

I asked about her family back in Gaza.

“Yes, we do talk but the internet is not the best. We still manage to have some conversations. The question that is always repeated is: ‘when can you come back? When will the little ones get you back? When can we meet again?'”

Israa sobbed. The pain was clear on her face.

“God willing, my wish is for my kids to live safely far from any conflicts and war. Safely. That is my wish.”

We looked at photographs on Israa’s phone of Rahaf in a pink dress before the attack and a video of her walking up the steps of their apartment block.

“She loved to be a princess,” Israa said.

Israa then showed me a photograph of Rahaf on a hospital bed in Gaza a few weeks after the attack looking down at her amputated legs.

I asked if she understands what has happened to her.

“She did ask ‘my legs are destroyed, what happened?'” Israa said they told her it was a rocket. Now, Rahaf avoids the subject. “If we start the conversation, she will change the subject.”

The good news is that Rahaf’s amputations were done well given the situation.

Circumstance has ensured that Gazan medics have become among the best in the world at trauma surgery. But that’s where the care ends in Gaza. The shortage of doctors, equipment and functioning hospitals makes prolonged care impossible.

Amputations require ongoing work from doctors with various skills including orthopaedic surgeons, plastic surgeons, and prosthetists.

Children with lost limbs demand a whole extra layer of care because they are still growing. Rahaf will need new prosthetic limbs frequently as she gets bigger.

Prosthetists estimate that for every death in a war, there are likely to be three times as many surviving amputees. According to the Gaza health ministry the number of dead in the war has now topped 45,000.

According to analysis by the charity Oxfam more children have been killed in Gaza by the Israeli military than in the equivalent period in any other conflict of the past 18 years.

Those numbers give a sense of the number of amputees, adults and children, still inside Gaza.

Through pressure from charities and commitments of treatment from hospitals, the United States has admitted a small number of Gazan children, but the key blocker is the Israeli government, which controls access to the strip through all the borders.

Josh Paul is a former US State Department official who resigned last year over the Gaza war.

Speaking to Sky News he said the situation with injured children represents a deep failure of American diplomacy.

“Even on something as humanitarian as saving the lives of children, getting them to critical care, it’s not that America isn’t willing to ask. It’s that America isn’t willing to press,” Mr Paul said.

“And it could be done in a second if they wanted to. If President Biden picked up the phone [to Israel] and said, ‘we are stopping our arms shipments until you let out children, until you let out critically injured children or critically sick children for care, we are not standing by you’.”

On why more hasn’t been done, Mr Paul said: “It’s the political costs… he believed he would pay. I think that is a severe miscalculation.

“I think American public opinion has shifted radically and is going to continue to shift.

“I also think that the geopolitical incentives here have also shifted and there is a cost, a clear cost, that we are paying for our unconditional support to Israel.”

Watch and read our other stories on Gaza’s children:
Stuck in Gaza with the rarest of diseases
Girl with rare disease leaves Gaza
Sky meets teenager whose uncle amputated her leg

The next step for Rahaf is prosthetics. It is the kindness of strangers and their donations that will make all this happen.

Then it will be time for her to walk again. But a reunion with family is, for now, far less certain.