Each of the children survived horrors. Each lost relatives in the strikes that injured them. All have struggled with the emotions of what they went through and what they face ahead.

The evacuees make up only a tiny fraction of the thousands of civilians, including many children, who have suffered grievous injuries over the course of Israel’s monthslong campaign against Hamas and its bombardment of the Gaza Strip.

Health officials in the territory say that more than 31,000 Gaza residents have been killed since the war began on October 7, in response to the attack that Hamas led against Israel. Experts say that children are particularly vulnerable to burns and serious injuries from high-intensity attacks, especially in a crowded, urban environment like Gaza.

The explosion that injured Shaymaa, 5, in the southern Gaza village of Muwasi in January, killed her grandmother, badly injured her grandfather and mangled the girl’s foot, according to Lina Gamal, Shaymaa’s aunt.

Shaymaa was rushed to Nasser Hospital, where doctors quickly decided to amputate. They no longer had anaesthesia, alcohol or other means to clean the wound, forcing the doctors to rinse it with murky water. They performed a rapid surgery and hurried to help other wounded people crowding the halls, Gamal said.

For three days, Gamal said, Shaymaa was “always screaming”.

Gamal stayed at her niece’s side through sleepless nights. Like many others, she registered the injured child for a chance to evacuate, through aid groups and several governments, to a hospital abroad — maybe Qatar, the United Arab Emirates, Turkey or Italy. Gamal offered herself as a caretaker, as Shaymaa’s parents needed to look after her siblings.

It was not until February, after lengthy background checks and negotiations — between officials of those countries and Egypt and Israel, as well as aid groups — that Shaymaa learned she was in the small group selected to evacuate, Gamal said. From around Gaza, the children and their caretakers journeyed toward the border city of Rafah, facing Israeli shelling and desperate competition for food, Gamal said. From there they crossed into Egypt, where they were airlifted to Italy, on what for all of them was the first flight of their lives.

At the Rizzoli Orthopedic Institute in Bologna, Italy, though, doctors concluded that Shaymaa would need a second amputation to repair the damage from where her foot was removed and to stop an infection from spreading, Gamal said.

When Gamal heard the news, she collapsed to the floor, sobbing. She had watched Shaymaa become withdrawn and fearful after the first amputation, rarely laughing and often crying at a glimpse of her leg.

“When they change her dressing, she doesn’t like to see it. She starts to scream,” Gamal said. “Every time she sees her leg, she screams, ‘Cover me! Cover me!’ — not for people, for herself. She doesn’t want to see it.”

Shaymaa found some comfort with another evacuee, Sarah Yusuf, and her caretaker, Niveen Foad. Sarah, 5, had been badly injured in November in a strike that hit her family’s home, in Zawaida near Deir al Balah in central Gaza. The attack left her pregnant mother partly paralysed, her father missing and her two-year-old brother killed, said Foad, a cousin of Sarah’s father.

She said she had found the girl with widespread burns and a broken pelvis at the European Hospital in Khan Younis, in southern Gaza.

“When I saw her, Sarah was in a terrible state,” said Foad, 44. “The marks are still there. Her legs were all wrapped up. I decided from that moment that I will foster this child.”

By then, Foad had fled with her own family from Gaza City, seeking refuge from fighting and Israeli strikes. She instructed her children to walk at a distance from one another, as she said armies did.

“I told my children, let’s not walk next to each other, we should not walk side by side,” Foad said. “We will walk like the military — one here, one there, one there — so that if a bomb falls, we will all not die.”

Her children resisted, saying they would rather hold hands and stay close, she said.

After Sarah took shelter with them, Foad’s husband registered the girl for evacuation. Foad agreed to be her caretaker — it was unclear who else could — on the condition that she could bring her three daughters, ages 3, 9 and 13. Officials agreed, and they eventually crossed into Egypt, she said.

Gamal said she had been to Egypt before the war, but no one else in the group said they had ever left Gaza. None had ever boarded a plane, let alone flown. The pilots invited the children to see the cockpit of the military plane, and Italian medics brought toys.

Some of the women asked whether all planes looked like this on the inside — they had seen pictures of commercial flights, not cavernous military carriers — and the children stared out the windows in wonder at the waves and landscapes below.

Anxiety about the future followed. Most of the women had hoped to reach Qatar, where they might find relatives or friends. The evacuees knew little to nothing about Italy, its language or its culture. Nor did they know, on arrival, whether they would have to seek asylum, be allowed to bring family or be forced to leave.

And despite the warm welcome from Italian officials and doctors, the children could not shed memories of Gaza. One morning in Monza, Italy, the sight of a plane over the hospital room of Abdel Rahman Al Naasan, 5, filled him with fear.

“He thought it would bomb us,” said his grandmother, Rehab Al Naasan. “He closed his eyes. He put his hands on his ears and leaned on the ground. He’s terrified. This whole generation of children is terrified.”

When his family’s neighbourhood in northern Gaza was bombarded in early December, three pieces of shrapnel struck Abdel Rahman, fracturing his skull. His eight-year-old brother was killed, Al Naasan said.

The survivors raced Abdel Rahman to a hospital, where displaced people thronged and the injured screamed on the floor, she said. There was no clean water or food, and Al Naasan said they had to search for a doctor to stitch the boy’s wound and bandage his head. That was all they could do.

By the time he and his grandmother reached Egypt, small things terrified him.

At night in Gaza, he would urge his grandmother to turn off a flashlight, fearing it would lead to an airstrike, Al Naasan said. When Italian officials welcomed him in Egypt, he clutched his grandmother’s hand, frightened they were actually Israelis. When he was told about the plan to go to Italy, Abdel Rahman said: “What if there will be bombing there? I don’t want to go,” according to Al Naasan.

Italian doctors at San Gerardo Hospital in Monza, who evaluated the boy, said they were astounded by his condition: They feared he would be doing far worse with three pieces of shrapnel still in his skull. He would need intensive surgery and a lengthy recovery. Shaymaa, too, would have a long period of convalescence, growing close to Sarah at the facility in Bologna, where staff members tried to comfort them.

Many of the evacuated Gaza residents exchanged WhatsApp numbers, checking in on one another as they learned how to navigate Italy and as they weighed whether to apply for asylum — a decision that could keep them there indefinitely.

Gamal said she remained conflicted about seeking asylum, torn between hope to someday return to Gaza and the reality of what she saw. “Honestly, Gaza is destroyed,” she said. “If people want to return to their homes, there are no homes.” Al Naasan, on the other hand, was inclined to stay. “There is nothing to go back to,” she said.

“Our children can’t eat, they keep crying. No food, no flour. The rest of my family would die to come here. I hope I am able to bring them, because look at it and what it has become. It is not a place to live at all.”

For now, Abdel Rahman remains at the hospital with his grandmother.

With Sarah awaiting surgery, Foad and her children moved into an apartment for refugees in Bologna. Gamal and Shaymaa are at a women’s home, alongside refugees from Ukraine and Somalia, waiting for a prosthetic and making hospital visits for therapy.

They all feel relief to be out of Gaza and worry about everyone else still there.

New York Times News Service