Every current exit from Gaza for medical treatment runs through an Israeli approval, and on World Health Organization figures relayed in a 2026 peer-reviewed brief report, 7,841 patients had been evacuated between October 2023 and 29 September 2025. Nearly two-thirds of them left before Israeli forces took the Rafah crossing on 7 May 2024. Israel’s coordinating body, COGAT, reports on its own count approving over 98% of the evacuation requests submitted to it. The two figures measure different stages: completed exits at one end, approvals of submitted requests at the other. Between them sit the criteria Israel has published, receiving states, Egypt’s side of Rafah and the fighting itself.
Key Findings
- 7,841 patients were medically evacuated from Gaza between October 2023 and 29 September 2025, on World Health Organization figures relayed by Ismail and colleagues (2026) in a peer-reviewed brief report.
- About 63.8% of those exits took place before 7 May 2024, when Israeli forces took the Rafah crossing, and a further 21.7% during the ceasefire of 19 January to 17 March 2025 (Ismail and colleagues, 2026).
- COGAT’s June 2026 FAQ states it has approved over 98% of submitted medical evacuation requests, a share of requests that reached COGAT and Israel’s own figure, not of patients who needed care or who left (COGAT, 2026).
- Israel’s published evacuation mechanism sets four criteria: written consent of a destination state, security screening of patients and escorts, a three-part test of medical necessity, and adult accompaniment for children (COGAT, 2024).
- COGAT’s permit instrument, updated to 8 February 2022, states that Gaza residents are as a rule not granted departure through Ben Gurion Airport, with a humanitarian “monthly quota of 20” (COGAT, 2022).
How many patients have left Gaza for treatment since October 2023?
7,841 patients had been allowed medical evacuation and referral from Gaza between the start of the war in October 2023 and 29 September 2025, according to statistics published by the World Health Organization’s office for the occupied Palestinian territory. The count reaches this report through a peer-reviewed brief report by Anas Ismail, Muhammed Abu Salmiya, Motasem Salah and Craig Jones, published on 19 March 2026 (Ismail and colleagues, 2026).
The figure is a count of completed exits. It is not a count of requests, of patients assessed as needing care abroad, or of refusals, and the brief report does not publish those denominators. It is also WHO’s count on WHO’s definitions, relayed rather than measured by the authors, so it carries the agency’s scope: patients evacuated and referred, not the relatives who travelled with them.
Israel’s own counts use other units. COGAT’s Gaza Aid Data portal states that “close to 5000 ill and wounded individuals, along with escorts” have exited Gaza for treatment abroad, and Israel’s Ministry of Foreign Affairs reported in December 2023 that “over 750 patients” had left for care overseas by 16 December 2023 (COGAT, 2026; Israel Ministry of Foreign Affairs, 2023). The COGAT figure folds escorts into patients and carries no date. The Ministry figure is a floor at an early point in the war.
The three counts therefore cannot be summed or subtracted. The WHO figure counts patients only to a stated date, COGAT’s counts patients and escorts together with no date, and the Ministry’s is an early cumulative floor. That COGAT’s total including escorts is lower than WHO’s total of patients alone is not reconciled by either publisher. The broader permit system behind the exits is covered in the Institute’s report on Palestinian freedom of movement and the permit instrument.
When did most medical exits take place?
About 63.8% of the 7,841 evacuations, some 5,000 patients, took place before Israeli forces took the Rafah crossing on 7 May 2024, on the WHO figures that Ismail and colleagues (2026) report. The count runs from the start of the war to that date, a span of seven months.
The second concentration came later. A further 1,702 patients, 21.7% of the total, left between 19 January and 17 March 2025, during the ceasefire agreement of that year, a window of eight weeks. The two periods together account for 85.5% of the total. Subtracting them leaves about 1,139 patients, roughly 14.5%, for the rest of the period to 29 September 2025: the months from May 2024 to mid-January 2025 and from mid-March to the end of September 2025. That remainder is the Institute’s arithmetic on the report’s published counts, not a figure the report states.
The pattern is a record of timing, and the timing coincides with changes in route and in fighting. Before May 2024, exits ran through Rafah into Egypt, as COGAT’s own medical response page states; from August 2024, the same page says, “patient exits were conducted via the Kerem Shalom Crossing” (COGAT, 2026). The brief report’s authors read the low volume outside the two periods as the product of Israeli policy. That is their characterisation, taken up in a later section. The counts show when patients left; they do not by themselves assign the gaps to a single cause. They also record completed exits only, so a quiet month in the series may reflect fewer requests, fewer approvals, fewer receiving places or a closed route, and the published figures cannot distinguish among them.
Is it often said that Israel blocks medical evacuations?
It is often said that Israel blocks medical evacuations from Gaza, and the claim has named holders in the peer-reviewed literature. Ismail and colleagues (2026) title their brief report “The weaponization of medical referrals and evacuations during the genocide in Gaza: a brief report and call to action,” and write that “a clear Israeli policy emerged since occupying the Rafah border crossing, which weaponized healthcare by preventing patients from Gaza from being medically evacuated.”
The report is explicit about its register. Its title calls itself a call to action, and its conclusion asks host countries to “put more pressure on Israel to facilitate the safe evacuation process.” The characterisations, including the word genocide in the title, are the authors’ own. Its figures are WHO’s, which the authors relay.
Israel’s account runs the other way. COGAT’s June 2026 FAQ states that it approves “over 98% of all submitted medical evacuation requests,” and ties the outcome of an approved request to a third country agreeing to receive the patient and, for Rafah exits, to Egyptian scheduling (COGAT, 2026). That is a party describing its own process; no independent body has published an audit of it.
What the combined record shows is narrower than either framing. Exits were concentrated in two periods, and far fewer left in between. Every exit under the current mechanism requires COGAT’s approval. COGAT’s approval share is a share of requests that reached it, so it cannot speak to requests stalled before submission, such as those without a receiving state. The absolute form of the claim, that no evacuations took place, does not match any of the counts: WHO records 7,841 patients and COGAT, on its own count, close to 5,000 people with escorts. The dispute is over why so few left outside the two periods, and no published source separates the causes.
What does Israel require before a patient may leave Gaza?
Four criteria must be met under COGAT’s “Medical Evacuation Mechanism of Gaza Residents to Third Countries Through Israel,” a procedure document created in December 2024 that states it “may be subject to updates or modifications” (COGAT, 2024). All requests, it says, “are subject to COGAT approval.”
The criteria, in the document’s own terms:
| Criterion | What the text requires | Source |
|---|---|---|
| Destination state | Patients and companions “will not be allowed to exit without the written approval of the destination country” | COGAT’s own mechanism, 3(a) |
| Security evaluation | All patients and escorts screened; exit refused where “security reasons” prevent passage, save exceptional cases | COGAT mechanism, 3(b) |
| Medical necessity | Three conditions together: a complex condition, no treatment available in Gaza, travel medically feasible | COGAT mechanism, 3(c) |
| Children | Evacuation only with an adult family member, or another approved adult | COGAT mechanism, 3(d) |
The request itself cannot come from a patient. It must be sent “by a country/known international organization working in the Gaza Strip,” with a written commitment on the route: an official approval from Egypt or Jordan for a land exit, or a dedicated aircraft for an exit through Israel’s Ramon airport. The Hebrew text adds a step the English omits: each patient’s original medical documents go to Israel’s Ministry of Health, through COGAT, for the assessment of medical necessity.
The document states the criteria but publishes no count of applicants who failed any one of them. The ladder is checkable; the attrition at each rung is not.
How long does Israel’s procedure take to run?
Two weeks before the planned evacuation date is the deadline COGAT’s mechanism sets for submitting the lists of patients and companions, with “additional time” possible for large groups “based on the need for comprehensive security and administrative checks” (COGAT, 2024). The procedure then sets further lead times for each leg of the journey.
On COGAT’s own procedure, coordination inside Gaza, with the Gaza Coordination and Liaison Administration, must take place at least 48 hours before movement. All patients and companions gather at a medical facility the day before, and the convoy’s movement is “logged in the IDF’s operational systems to protect the convoy.” Coordination of the crossing and of traffic inside Israel, with COGAT’s Civil Department, must take place at least 72 hours before movement. At the crossing, “a security check will be carried out and the people who have left the Gaza Strip will be registered.”
The exit points named are the Nitsana crossing and the Allenby Bridge, each requiring approval and coordination with Egypt or Jordan by the requesting organisation, and Ramon airport, where patients and companions “will undergo an additional security check.” Baggage is limited to one small soft bag per person; liquids, including water, and food are not allowed.
The procedure is a sequence of dependent steps, several of them held by parties other than Israel: the requesting state or organisation, the destination state, and Egypt or Jordan for a land exit. The document sets the order and the minimum lead times. It publishes no figure for how long requests actually took from submission to exit, or how many were overtaken by the patient’s condition while pending.
What did Israel’s rules for Gaza patients say before the war?
20 a month is the humanitarian quota COGAT’s own permit instrument, updated to 8 February 2022, set for Gaza residents departing through Ben Gurion Airport. The rule it carves out of is stated plainly: “As a rule, Palestinians are not granted departure through Ben Gurion Airport, with the exception of BMC permit holders and extremely exceptional unique humanitarian cases (monthly quota of 20)” (COGAT, 2022).
The same Gaza section of the instrument routes departure abroad “through the Allenby Bridge Crossing, solely in escorted groups (shuttles).” The instrument opens on the legal premise behind every permit, for the West Bank: under a 1967 order, the area “is a closed military area and not to be entered or exited without a permit issued on behalf of the military commander.”
These are pre-war rules, written into a document whose latest located edition is dated February 2022. It records what COGAT authorised itself to issue, not what happened to any applicant, and it carries no count of Gaza patients who applied or left. The permit quotas it sets are ceilings, not counts of permits issued.
The wartime mechanism replaced the pre-war routes rather than extending them. The 2022 instrument routes Gaza departures abroad through Allenby and caps Ben Gurion at a humanitarian quota; the December 2024 mechanism routes them through Nitsana, Allenby or Ramon, each dependent on a third country. What stayed constant across both documents is the gate. On each, departure from Gaza is an exception that COGAT approves, and on neither does COGAT publish the number of applications it refused.
What did the World Court order about Rafah and medical care?
13 votes to 2, of a bench of 15, was the margin by which the International Court of Justice indicated on 24 May 2024 that Israel shall “Maintain open the Rafah crossing for unhindered provision at scale of urgently needed basic services and humanitarian assistance.” The measure was provisional, indicated in South Africa v. Israel under the Genocide Convention. It is not a merits ruling.
The Court’s order of 28 March 2024 is the one that names medical care. Unanimously, on a bench of 16, it indicated that Israel shall ensure “the unhindered provision at scale by all concerned of urgently needed basic services and humanitarian assistance, including food, water, electricity, fuel, shelter, clothing, hygiene and sanitation requirements, as well as medical supplies and medical care to Palestinians throughout Gaza, including by increasing the capacity and number of land crossing points and maintaining them open for as long as necessary.” The first order, of 26 January 2024, had already required measures to enable humanitarian assistance, by 16 votes to 1.
The operative clauses concern the flow of care and supplies into and throughout Gaza. None of the measures in the three dispositifs names medical evacuation of patients out of Gaza. Whether keeping crossings open for assistance reaches patient exits is a question of interpretation, and the orders do not settle it in their text.
Two limits travel with the orders. The Court stated in March that it may indicate measures “to be taken by the parties, but not by third States or other entities.” Egypt, which controls the other side of Rafah, is not a party to the case. The later orders are also expressly without prejudice to any finding on whether Israel complied with the earlier ones. The orders set a standard. They are not evidence about any individual patient’s exit.
Which parties besides Israel decide whether a patient leaves?
51% of the patients evacuated to 29 September 2025, 3,995 people, were received by Egypt, the largest single destination on the WHO figures reported by Ismail and colleagues (2026). Under Israel’s own mechanism, no patient may leave without the written approval of a destination country, so every receiving state holds a decision of its own.
COGAT’s published criteria make the dependence explicit. A request must come from a state or a recognised international organisation, not from the patient. A land exit needs an approval from Egypt or Jordan “indicating its consent to evacuate the patients through its territory,” and the coordination with those authorities is left to the requesting organisation (COGAT, 2024). COGAT’s June 2026 FAQ ties an approved request’s outcome to a third country agreeing to receive the patient and, for Rafah exits, to Egyptian scheduling (COGAT, 2026). On Israel’s own account, its approval is necessary but not sufficient.
Egypt held a second gate until May 2024. Patient exits ran through Rafah into Egypt, and the Egyptian side of that crossing is under Egyptian control; both decisions had to align for a Rafah exit. The brief report’s authors, for their part, call on host countries “to step up their efforts to receive more patients,” which records their view that receiving capacity was also a constraint.
The record documents that these other gatekeepers exist. It does not measure their share. No published source counts requests that Israel approved but that failed for lack of a receiving country, or exits held up on the Egyptian side. The destination breakdown records where patients went, not where requests stalled. The Institute’s report on aid access and the enacted standard documents a similar multi-party chain for goods entering Gaza.
What does Israel’s own record count of patient departures?
Close to 5,000 “ill and wounded individuals, along with escorts” exited Gaza for treatment abroad, according to COGAT’s Gaza Aid Data portal, which names Egypt, the United Arab Emirates, Jordan and “various other countries” as destinations (COGAT, 2026). The figure is Israel’s own count, and it mixes patients and companions into a single number that COGAT does not split.
The page carries two further limits. It gives no date, and it contradicts itself on route. One paragraph says all of these people “exited Gaza via the Kerem Shalom Crossing.” A later paragraph on the same page says patients left through Rafah until early May 2024 and through Kerem Shalom from August 2024. Both statements cannot apply to the whole total.
Israel’s own earlier count is narrower and dated. The Ministry of Foreign Affairs reported that over 750 patients had exited Gaza for care overseas by 16 December 2023, and that approximately 9,500 foreign nationals and dual citizens had been evacuated with Israeli assistance by the same date (Israel Ministry of Foreign Affairs, 2023). Both are floors, as the Ministry wrote them, and the second covers a different population from the medical evacuations.
COGAT’s June 2026 FAQ adds its own approval figure: over 98% of submitted medical evacuation requests approved. Its denominator is requests that reached COGAT. Requests stalled before submission, such as those without a receiving hospital, fall outside it. None of COGAT’s publications gives a count of requests refused, by reason or in total, and that absence is the number the next section turns on.
Where do the two accounts of the controls diverge?
Zero published records separate evacuation requests refused on security grounds from those lost to crossing closures, receiving-state limits or active hostilities. That missing breakdown is where the dispute over characterisation rests, and neither Israel’s publications nor the peer-reviewed literature supplies it.
One side is Ismail and colleagues (2026), who read the concentration of exits into two periods as evidence of a policy that “weaponized healthcare,” and conclude that it “has resulted in excess mortality that merits further research and quantification, as patients succumbed to their medical conditions or injuries while waiting to exit Gaza.” That conclusion names a consequence the report does not itself count: it calls for the quantification rather than supplying it.
The other side is Israel’s stated procedure. Its mechanism makes security screening one of four criteria and places two others, destination consent and route consent, with third states; COGAT presents its own approval rate above 98% for requests that reach it (COGAT, 2024; COGAT, 2026). On Israel’s account, the security step rarely ends in refusal and much of the attrition lies with others.
Both positions describe the same exits. What would test them is a count of refusals by stated reason, of pending cases by age, and of approved cases that never crossed. COGAT publishes approvals and a combined exit figure. WHO, through the brief report, publishes completed exits by period and destination. The steps in between are not published by any body, so the record can place the exits in time but cannot apportion the gap between need and exit among the parties that hold a gate.
Methodology and limitations
This report assembles three kinds of evidence. The first is Israel’s own published instruments and counts: COGAT’s 2022 permit instrument, its December 2024 medical evacuation mechanism, its Gaza Aid Data portal and June 2026 FAQ, and the Ministry of Foreign Affairs’ 2023 humanitarian efforts page. Each is attributed as a party’s own account, and none has been independently verified.
The second is a peer-reviewed brief report, Ismail and colleagues (2026), in the Journal of the Egyptian Public Health Association. Its figures are relayed from the World Health Organization’s office for the occupied Palestinian territory and are cited as WHO’s count; its characterisations, including the title’s, are the authors’ own, and the report describes itself as a call to action. Only its published abstract was read for this report.
The third is the court record: the International Court of Justice’s three provisional-measures orders of 2024, quoted for their operative text and recorded votes. They are not merits findings, and each later order is without prejudice to compliance with the earlier ones.
The counts use incompatible units, patients alone, patients with escorts, and approved requests, and close on different dates or none. None of them sums with another. The share of exits outside the two named periods is the Institute’s arithmetic on the brief report’s counts. No published source attributes the gap between need and completed evacuation to specific causes, and nothing in this report assigns one.
Conclusion
Is Israel preventing Palestinians from leaving Gaza for medical treatment? On the record, Israel holds a required gate on every current exit, and most patients who left did so in two windows: before Rafah was taken in May 2024, and during the ceasefire of early 2025. Israel’s own count describes that gate as approving almost every request it receives.
The portrait holds across each measure the record carries. WHO counts 7,841 patients evacuated to September 2025, 63.8% of them before 7 May 2024 and 21.7% in the eight weeks of the 2025 ceasefire. COGAT approves over 98% of what reaches it, counts close to 5,000 people with escorts, and requires four criteria, two of which it does not control. Egypt received about half of all patients. The pre-war rule made departure an exception, capped at 20 a month through Ben Gurion; the wartime rule makes it an exception contingent on a third country.
The number that would settle the dispute is the one no body publishes. The approvals are counted and the exits are counted; the refusals, the requests still pending and the approved cases that never crossed are not. If that middle column were published, would it show a gate that rarely closes, or one that closed more often than an approval rate of 98% implies?
Frequently Asked Questions
Which crossing do patients leaving Gaza use now?
COGAT’s medical response page states that patient exits have run through the Kerem Shalom Crossing since August 2024, after exits through Rafah into Egypt ended in early May 2024. Its December 2024 mechanism names Nitsana, the Allenby Bridge and Ramon airport as exit points (COGAT, 2024). The page elsewhere says all exits went through Kerem Shalom, so its route statements are not fully consistent.
Do companions count in the evacuation totals?
It depends on the publisher. COGAT’s portal figure of close to 5,000 covers “ill and wounded individuals, along with escorts” in one number (COGAT, 2026). The WHO figure of 7,841 relayed by Ismail and colleagues (2026) counts patients.
Can a patient apply for evacuation directly?
No. Under COGAT’s mechanism the request must be sent “by a country/known international organization working in the Gaza Strip,” with a written commitment on the exit route (COGAT, 2024). The requesting party also coordinates the movement inside Gaza and with Egypt or Jordan.
Can a child be evacuated alone?
No. The mechanism allows the evacuation of children “only when they are accompanied by an adult family member,” with another adult approved in exceptional cases, and lets the requesting party propose an alternative adult if one is refused (COGAT, 2024).
How many foreign nationals left Gaza with Israeli help early in the war?
Israel’s Ministry of Foreign Affairs reported approximately 9,500 foreign nationals and dual citizens evacuated from Gaza with Israeli assistance by 16 December 2023 (Israel Ministry of Foreign Affairs, 2023). This is Israel’s own cumulative count, stated as an approximation, and it covers a different population from the medical evacuations.
Does Israel publish how many medical evacuation requests it refused?
No refusal count appears in COGAT’s publications. Its June 2026 FAQ gives an approval share of over 98% of submitted requests (COGAT, 2026). Requests never submitted, such as those lacking a receiving country, fall outside that denominator.
Sources
- COGAT (Coordinator of Government Activities in the Territories), 2022. Status of Authorizations for entry of Palestinians into Israel; for their passage from Judea and Samaria into the Gaza Strip; and for their departure abroad, updated to 08 February 2022. https://www.gov.il/BlobFolder/policy/authorizationsforentry/en/Status%20of%20Authorizatios%2008.02.2022.pdf. Official record (a party’s own published instrument).
- COGAT (Coordinator of Government Activities in the Territories), 2024. Medical Evacuation Mechanism of Gaza Residents to Third Countries Through Israel, English and Hebrew, file created 26 December 2024. https://www.gov.il/BlobFolder/policy/medical-evacuation-mechanism-of-gaza-residents-en/en/Medical%20Evacuation%20Mechanism%20of%20Gaza%20Residents%20to%20Third%20Countries%20Through%20Israel.pdf. Official record (a party’s own published procedure).
- COGAT (Coordinator of Government Activities in the Territories), 2026. Gaza Aid Data portal: Medical response page and “FAQ - Humanitarian efforts into Gaza - June 2026.” https://gaza-aid-data.gov.il/mainhome/. Official record (a party’s own count).
- Ismail, A., Abu Salmiya, M., Salah, M., and Jones, C., 2026. The weaponization of medical referrals and evacuations during the genocide in Gaza: a brief report and call to action. Journal of the Egyptian Public Health Association 101, article 8, published 19 March 2026. DOI 10.1186/s42506-026-00214-5. Peer-reviewed (brief report; abstract-sourced; figures relayed from WHO).
- Israel Ministry of Foreign Affairs, 2023. Israel-Hamas Conflict 2023: Humanitarian Efforts. https://www.gov.il/en/pages/israel-hamas-conflict-2023-humanitarian-efforts. Official record (a party’s own count).