Kids in need of cancer treatment evacuated from Gaza with help from Trump, Biden

Two children arrived in Washington Wednesday for treatment of the cancers that threaten their young lives − evacuated from Gaza, a place with grave dangers of its own.

The girls are the final patients in an extraordinary multinational operation that has moved nearly 240 children from Gaza to hospitals elsewhere in the world − an effort that began with the help of then-President Joe Biden and was completed, 18 months later, with the help of President Donald Trump.

The quiet effort, organized on the ground by St. Jude Children's Research Hospital and the World Health Organization, involved negotiations with Israeli, Palestinian, Egyptian and Jordanian officials. Top aides of both U.S. presidents played key roles in keeping it on track, pressing for permission to move the children and their companions, often just a few at a time, through armed checkpoints into Egypt and Jordan.

"It was a big coordination effort and deliberate diplomacy from the White House, a lot of pushing and cajoling and difficult conversations, reminding people that these are children with cancer and we need to figure out a way to get them to the right place for care," Jeff Zients, White House chief of staff for Biden, told USA TODAY. "It was dire."

"We kept hitting roadblocks and there were, I would say, more than anything I've ever been involved with," Health and Human Services Secretary Robert F. Kennedy Jr., the point person on the project for Trump, said in an interview. "There were days that we said, 'OK, this is all done,' and then the next day it would all fall apart."

St. Jude had been building partnerships in the region over several years, including with the Al-Rantisi Specialized Hospital for Children, which had Gaza's only pediatric cancer ward. A week after the war began, an effort was launched to transfer 237 children who had been diagnosed with leukemia, lymphoma and brain tumors and needed medical treatment that was impossible amid the devastation at home.

Most eventually were sent to hospitals in Egypt and Jordan. Some went to the United Arab Emirates, Turkey, Europe and Qatar.

"Our main objective here and always has been to keep most of these patients in the region, so they're closer to Gaza, closer to home in a culturally sensitive environment where they have family," said Dr. Carlos Rodriguez-Galindo, chair of the Department of Global Pediatric Medicine at St. Jude and director of St. Jude Global. But capacity in the region is now strained, he said, and these patients would benefit from specific treatments available in the United States.

The children and a handful of family members arrived Wednesday afternoon at the National Institutes of Health in Bethesda, Maryland. Their chartered flight from Cairo to Dulles International Airport outside Washington, provided by Pfizer, lasted nearly 12 hours. Officials asked USA TODAY not to release any identifying information.

The campaign is a point of light in a conflict that has been brutal on children. The Hamas attack on Israel on Oct. 7, 2023, killed 38 children, and another 42 were taken hostage, according to a report by Israel's Child Safety Council. The bodies of two of the youngest hostages, Ariel and Kfir Bibas, were returned to Israel last month.

In the Israeli bombardment of Gaza that followed the Oct. 7 attack, more than 13,000 children have been killed and 12,000 injured, according to the relief group Save the Children. On Tuesday, renewed Israeli attacks shattered a fragile ceasefire with Hamas.

Ukraine operation had come first

The Gaza evacuation was built on a similar effort in Ukraine.

St. Jude, the pediatric cancer center in Memphis, Tennessee, already had been working with hospitals in Ukraine when Russia invaded in 2022. With help from the Biden White House, more than 1,700 children in Ukraine were moved to partner institutions in Europe and North America for treatment.

First lady Jill Biden traveled to Tennessee in 2022 to meet with some of the Ukrainian children and their families.

However, the landscape in Gaza was much more complicated, requiring approval from Palestinian and Israeli authorities to leave Gaza and permission from Egyptian or Jordanian authorities to enter those countries. The bombardment of Gaza closed most of the hospitals and displaced families, often making it difficult to keep in touch with them.

To leave, each child had to be accompanied by a parent or guardian, and the Israelis and the Egyptians blocked some adult companions when security concerns were flagged. That created more delays in finding another relative who could make the journey.

"Where the numbers were a little smaller, definitely smaller, the complexity was much higher (than Ukraine) because we needed to work with a multi-government engagement," Rodriguez-Galindo said. The biggest hurdle arose when Israel shut down the key gate at Rafah last May. "For nine months, there was no way for these patients to move out of Gaza into Egypt through the normal crossing paths," he said.

Instead, the evacuation effort organized convoys of patients, families and security forces that would drive through Israel to Jordan until Rafah reopened last month.

The evacuation involved the time of officials in Washington and at U.S. embassies in Jerusalem, Cairo, Amman and elsewhere, but not federal funds.

Biden's national security adviser, Jake Sullivan, and Mideast coordinator Brett McGurk repeatedly called their counterparts in the region to ask for help and push for the necessary approvals. About 190 children were evacuated during the Biden administration.

An offer from RFK Jr. to help

Just before the November election, Kennedy called Lawrence Horowitz, a California physician and veteran medical consultant who was working on the project, and offered to help. They knew one another: Horowitz had served in the Senate as chief of staff for Kennedy's uncle, the late Sen. Edward Kennedy of Massachusetts.

Kennedy then conferred with Trump about intervening. He put him in touch with Ron Dermer, a former Israeli ambassador to Israel who is one of Prime Minister Benjamin Netanyahu's closest advisers. Trump's special envoy Steve Witkoff and his staff also stepped in when problems arose.

Among other things, Kennedy worked with Secretary of State Marco Rubio to make sure that he United States Agency for International Development, or USAID, officials involved in the project continued to work even as the Trump administration was dismantling much of the agency.

While relations between the outgoing and incoming White House administrations have often been fraught, on this front, both sides were willing and eager to cooperate.

"I think all of us, Democrats and Republicans, should agree on the importance of kids' lives and getting them the health care they need," Zients said.

Kennedy echoed that. "I think everybody, Democrats and Republicans, that kids who are stuck in the middle of war who have cancer − we should do everything in our power to take care of them," he said.

Kennedy met with Trump Wednesday afternoon at the White House to discuss several issues, including an update on the Gaza operation.

The medical care came too late for about 20 children, who died while waiting to evacuate or after arriving at outside hospitals for care, their conditions dire.

"We fight for every single minute of the life of these children," Rodriguez-Galindo said. "We fight for that and war, catastrophes of any kind and anywhere in the world, just erase that in a second." He said the biggest lesson of the Gaza effort is that "even in the darkest times, there is hope that we can actually come together when it's time to save the life of a child."

The rescue effort isn't over. While the backlog of children on the original list has now been accommodated, there will be additional cases of children diagnosed with cancer in Gaza.

Six new youngsters, who range in age from 5 to 16, are awaiting evacuation now.