The re-opening of the Rafah crossing in the southern Gaza Strip on Monday after more than a year is being met with both optimism and fear, a senior official with the UN agency that assists the Palestinian people, UNRWA, has said.
The sole border point with Egypt is a lifeline to the world - including for thousands of severely ill or injured Palestinians who require medical treatment outside the enclave, where last October's fragile ceasefire between Israel and Hamas continues to hold.
The development comes, however, following reports of reported deaths over the weekend, with the UN voicing concern over the killing of civilians and Israeli airstrikes.
'Competing dynamics'
"As we have seen so many times throughout this conflict, we're seeing really competing dynamics here: on the one hand, positive progress when it comes to the re-opening of Rafah, and yet over the past 24 hours, 30 Palestinians were killed in airstrikes during a ceasefire," Sam Rose, Acting Director of UNRWA Affairs in Gaza, told the BBC.
"At the same time, international organizations that are equipped and qualified and capable of doing work, which is urgently needed, are continuing to face major, major constraints."
For this reason, Palestinians in Gaza are feeling "massive trepidation - hope that people will be able to get out, but real, real fear for the future," he said.
For its part, UNRWA remains on the ground delivering life-saving assistance in where "fear and uncertainty persist," the agency said, noting that "access is limited, protection concerns persist, and humanitarian needs remain acute amid ongoing operational constraints."
Limited movement
Re-opening the Rafah crossing was an integral part of the 20-point peace plan put forward by US President Donald Trump last September, with the ceasefire announced days later.
For now, Israel will only allow some 50 Palestinians to enter and exit Gaza each day - and only on foot, international news agencies have reported.
The crossing will be coordinated with Egypt and supervised by the European Union (EU), according to the UN humanitarian affairs office, OCHA .
Returns will only be permitted for residents who left during the war and after obtaining prior authorisation from the Israeli security services, being checked by the EU at the Rafah crossing point and undergoing a second identification and control process in a designated corridor managed by the Israeli army in an area under its control.
Support for returnees
OCHA welcomed the re-opening of the key border crossing, underscoring that "civilians must be allowed to leave and return voluntarily and safely, as international law requires."
Over the weekend, the UN carried out an advance mission to assess road conditions.
The UN Development Programme ( UNDP ) is set to provide bus transportation for returnees from the internal checkpoint to Nassar hospital in Khan Younis, where several UN agencies and NGO partners have set up a reception area to provide them with support.
The reception desk is staffed by psychologists and protection specialists, while food, information materials and internet connectivity are available.
Medical evacuations
Monday also saw the World Health Organization ( WHO ) supporting medical evacuation efforts.
Some patients and their companions were able to exit Gaza directly to Egypt, while others transited through the Israeli-controlled Kerem Shalom border crossing
Israeli authorities approved the travel of only five wounded patients from a list of 27 names submitted to both the Egyptian and Israeli sides, according to Palestinian sources.
Treatment beyond borders
Families lined up in the courtyard of Al-Amal Hospital in the south of the Gaza Strip to bid farewell to sick relatives, accompanied by travel companions, heading to Egypt to complete their treatment.
A UN News correspondent was on hand as buses began preparing to depart, carrying with them the hope that the wounded would return fully recovered.
A young boy called Youssef Awad, who uses a wheelchair, was optimistic that he would be able to walk and play again.
"I hope to travel for treatment and return walking like other children," he told UN News.
'Expedite the process'
Another injured child, Ahmad Abu al-Khair, sat in a wheelchair beside his father, Iyad, awaiting his turn in the medical evacuation convoy heading to the Rafah crossing.
Ahmad's head was covered with a white bandage, and he appeared unable to move while his father tried to comfort him.
"We hope that decision-makers and the World Health Organization will expedite the process and help us get my son Ahmad to travel to complete his treatment, as every hour he spends here affects his health."
Thousands still waiting
In a protest reflecting the extent of their despair, dozens of injured Palestinians staged a demonstration near the hospital, sitting in their wheelchairs and demanding an increase in the number of people allowed to travel daily which "should be in the hundreds" instead of 50.
"We have been waiting for the crossing to open since the beginning of the war, and like many others, we have not been lucky," said Farid al-Qassas, an injured man.
"In this building alone, there are about 100 patients in need of medical referrals, and the number of wounded waiting to travel reaches about 13,000 patients and injured people. We hope that everyone will hear us and save what remains of these patients."
The last medical evacuation through the Rafah crossing was in May 2024. Overall, more than 18,500 patients in Gaza, including 4,000 children, are still waiting to access treatment abroad.
"The most effective option would be to resume referrals to the West Bank, including East Jerusalem, and rehabilitate damaged health facilities in Gaza," OCHA said.
Until then, UN Member States are urged "to accept more patients so that everyone receives the treatment that they need."
Aid delivery update
The agency also stressed that "ultimately, essential humanitarian supplies must enter in sufficient quantities and with fewer restrictions through Rafah and other crossings."
Between 23-29 January, at least 13,800 pallets of humanitarian aid managed by the UN and its partners were unloaded at crossing points.
Nearly 60 per cent of these shipments contained food, but also shelter items, school supplies, health items, fuel and nutritional kits.
Since the announcement of the ceasefire on 10 October, at least 272,000 pallets of humanitarian goods were unloaded, and 270,000 pallets were collected at the various crossing points.
