Doctors say 2-year-old Habiba al-Askari has days to live as gangrene creeps up her arms and legs, and only an urgent medical evacuation out of Gaza may save her life.

She has a rare genetic condition: a protein C deficiency which causes excessive blood clotting and can lead to a slow death. The condition is highly treatable – but not in Gaza, where healthcare institutions and supplies have been decimated by Israel’s yearslong war in the Palestinian enclave.

Earlier this month, international aid groups worked through the complex process of obtaining permission from Israeli authorities to allow Habiba to leave Gaza for treatment.

Habiba is one of at least 2,500 children in Gaza in urgent need of medical evacuation, according to the UN. Under the recently signed ceasefire and hostage release deal between Israel and Hamas, which controls Gaza, Israeli authorities are supposed to increase the number of Gaza residents allowed out for treatment.

But no medical evacuations from Gaza have taken place for two weeks. The last evacuation was on January 16, when just 12 patients were evacuated to European countries, according to the World Health Organization. Approximately 12,000 people in Gaza are still awaiting medical evacuation, according to the UN.

Doctors warn of amputation

On Thursday morning, Habiba was admitted to an intensive care unit in Gaza with a suspected lung infection. Surrounded by foreign and local doctors scrambling to keep her alive, she lay barely conscious, moaning in pain between each labored breath.

Gangrene can lead to sepsis — an infection spreading to the bloodstream — that raises the risk of rapid organ failure and death.

Dr. Kuziez first treated Habiba several weeks ago, in Gaza City, and oversaw her care as medics waited for Israeli permission to move her south, a first step in the evacuation process.

But as soon as he landed back in the US, he received news of the dramatic deterioration in her condition. “I’m trying to be there to support the mom, to try and provide whatever medical advice we can provide,” he said, choking back tears.

“But in the back of my mind, I am worried it may have gotten too far. There’s still hope for her, but it’s just decreasing by the minute.”

He’s tormented by the knowledge that Habiba’s condition could have been treated in time, if she had had access to the right facility. When Dr. Kuziez left Gaza, he recalled, “my heart wanted to just take her with me in my arms and run across the border with her.”

Blocking her evacuation will be a death sentence, he warned. “For anybody with medical knowledge, it seems like a deliberate push to essentially kill this child. There’s no other way to describe it. This child needs emergency critical care.”

Khamis and Ahmad Imarah knew they wouldn’t find much more than rubble when returning to their home in northern Gaza. But they had to go. Their father and brother are still buried under the debris, more than a year after their home was struck by Israeli forces.

“I don’t want anything else. What I am asking for is to find my father and brother and that’s it, that’s all.”

The Gaza Government Office said Wednesday that some 500,000 displaced Palestinians — almost a quarter of the enclave’s population — had made the journey to the decimated north in the first 72 hours after Israeli forces opened the Netzarim corridor, which separates it from the south.

The two Imarah brothers walked 11 kilometers (6.8 miles) to reach Al-Shujaiya, a treacherous journey they made with several small children. They found their home almost completely gone, with just one room still partially standing.

Rummaging through the rubble, Khamis came across his mother’s green knitting bag, with a couple of balls of yarn and two crochet hooks still inside, as if she had only just put it down.

Khamis and Ahmad’s mother was injured in an Israeli strike and was later evacuated to Egypt, one of the few Palestinians allowed to leave the strip to get medical treatment before Israel closed the Rafah crossing between Gaza and Egypt in May 2024. The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) said that only 436 patients, most of them children, had been allowed to be evacuated since May, out of the estimated 12,000 who urgently need medical evacuation.

Israeli military strikes have turned most of Gaza to rubble. According to the UN, some 69% of all structures in the strip have been destroyed or damaged in the past 15 months, with Gaza City the worst hit.

Returning after more than a year

Israel forced most residents of northern Gaza to leave the area early in the war, issuing evacuation orders and telling people to move south. Once people left, return was impossible, meaning that most of those coming back this week are doing so for the first time in more than a year. And while nine in 10 Gaza residents have been displaced during the war, those forced to flee the north have been homeless for the longest.

“You enter from one neighborhood to another and it’s all mounds of rubble that have not been cleared … and there were martyrs on the way, on the road where, until today, no one has picked them up. There are fresh bodies and bodies that have (decomposed) as well,” Khamis said.

He urged others looking to make the journey back north to reconsider. “Because there is no water, no electricity or even food, no tents, you sleep in the rubble,” he said.

Mohammad Salha, director of Al-Awda Hospital in Tal Al-Zaatar, said there is currently no space in northern Gaza to establish camps for displaced people returning home. The area was densely built-up before the war and the enormous scale of damage means there are now huge mountains of rubble and debris everywhere.

The situation in the north is so dire that some of those who have made the journey have had little choice but to turn back and return to the refugee camps down south.

Arwa Al-Masri, who was displaced from Beit Hanoun in the northeastern corner of the strip, said the men from her family went home in the past few days to see what is left of their houses.

But while she and her children cannot yet go back to her home in the north — or what remains of it — Al-Masri’s stay at the shelter is also uncertain, because of impending bans on UNRWA operations within Israel and on the prohibition of Israeli authorities from cooperating with UNRWA.

‘No one is left’

Discovering that the place they once called home was almost completely gone was just the latest in a series of heartbreaks Khamis and Ahmad Imarah have suffered over the past 15 months.

The two brothers said that of the 60 members of their extended family, only 11 have survived the war.

The family fled Al-Shujaiya after receiving text messages from the Israeli military telling them to leave the area. Khamis said the whole family — his brother and sisters and their in-laws — went to his brother’s house in Al-Mughraqa, just south of the Netzarim corridor.

“It was afternoon prayers time when our house in Al-Mughraqa was hit by a strike. I still don’t know how I got out of the house,” he said.

At one point during the interview, Ahmad’s son Walid came by. Asked by his father where his mom was, the child pointed up to the sky.

“Why did they tell us to go south? Imagine a four-year-old boy telling you here is my mother and here is my aunt, (their bodies) all ripped in pieces in front of him. I covered his face and he was screaming. His aunts, and uncles, his grandfather and an uncle, no one is left,” he said.

“We were very happy. I wish I had a picture of my newborn but I don’t have any. I waited a long time to have my daughter and then her and her mom vanished together,” he said, adding that their graves were destroyed by the Israeli military just days after the family buried them.

“You take them and bury them in the cemetery and then when you go a few days later to see the cemetery, you don’t find them because they have been erased by the bulldozers. The (Israeli forces) didn’t leave anything. Even the martyrs and the bodies they have dug up. They didn’t leave a thing,” he said, looking around the destroyed neighborhood.

“We came back to the north for nothing,” he said. But he quickly added that he was determined to stay and rebuild. “I am from Gaza and I won’t leave. Even if it was harder and more difficult than this, I want to live in Gaza and I won’t leave it. I will only leave Gaza to go to Heaven,” he said.

US President Donald Trump last week suggested Gaza should be “cleaned out” by removing Palestinians living there to Jordan and Egypt — either on a temporary or permanent basis.

The comment sparked outrage and rebuke across the Middle East, with both Egypt and Jordan rejecting the idea.

“This is ingrained in our minds, we will stay. We will not leave this place, because this land is not ours but our grandparents’ and our ancestors’ before us. How am I supposed to leave it? To leave the house of my father, and grandfather and brothers?” he said.

Secretary of State Marco Rubio embarks soon on his inaugural trip as the United States’ top diplomat. His first stop, Panama could prove to be the most contentious on the itinerary following President Donald Trump’s repeated demands for control of the Panama Canal.

“Panamanian sovereignty over the canal is clear. There is no discussion on this issue. The soul of a country is not up for discussion,” Panama President José Raúl Mulino emphasized on Thursday, just days ahead of his scheduled meeting with Rubio.

Yet the Trump administration doesn’t seem to be letting this go. In his inauguration speech, Trump mentioned Panama six times, more than any other foreign country. He and Republican allies are increasingly painting a dark scenario where the Panama Canal has secretly fallen under Chinese military control – arguing that’s why the US needs to seize the canal back from Beijing’s clutches.

“A foreign power today possesses, through their companies, which we know are not independent, the ability to turn the canal into a choke point in a moment of conflict,” Rubio himself insisted during his Senate confirmation hearings this month.

“That is a direct threat to the national interest and security of the United States,” he added.

As ominous as it all sounds, the reality is not so straight forward. Here is a fact check about claims Trump’s administration has made about the Panama Canal.

Is the Panama Canal under Chinese control?

Trump has long complained about the “bad deal” Jimmy Carter made when he returned the canal to Panama in 1977. But he’s been ratcheting up the rhetoric and falsehoods from the very start of his second term.

“Panama’s promise to us has been broken,” Trump said during his inaugural speech. “Above all China is operating the Panama Canal and we didn’t give it to China, we gave it to Panama and we are taking it back!”

On his Truth Social network, Trump has also claimed – without proof – that Chinese soldiers have been deployed to the canal and that “Panama is, with great speed attempting to take down the 64% of signs which are written in Chinese. They are all over the Zone.”

But the “Zone” – a former American enclave bordering the canal – hasn’t existed since 1979.

And if the scenario Trump describes sounds like the plot of a movie, well, it was. In the 2001 movie “The Tailor of Panama,” which starred Pierce Brosnan and Geoffrey Rush, the US invades Panama after receiving bogus intelligence that China is trying to secretly buy the canal.

In reality, since 2000 the canal has been operated by the Panama Canal Authority, whose administrator, deputy administrator and 11-member board are selected by Panama’s government but operate independently.

The majority of the canal’s employees are Panamanians and Panama designates which companies are awarded the contracts to run the ports near the canal. Ships transiting the 50-mile-long canal are required to be piloted by local captains that work for the Canal Authority.

While there is real concern about increased Chinese investment in Latin America, Panama included, to date there is no evidence of Chinese military activity in Panama. At his press conference on Thursday, Mulino said the US government has yet to provide his administration with any proof they had gathered of Chinese control of the canal.

So what does Rubio mean by ‘a foreign power’ in the Panama Canal?

The Trump administration seems to be pointing to the fact that Panama Ports – part of a subsidiary of the Hong Kong-based conglomerate CK Hutchison Holdings – operates terminals on the Atlantic and Pacific sides of the canal. So do several other companies.

Hutchinson was first granted the concession over the two ports in 1997 when Panama and the US jointly administered the canal. That same year, control of Hong Kong – where Hutchinson is based – was transferred from the United Kingdom to China.

While falling under Beijing’s sphere of influence, Hutchison is hardly some murky Chinese military front company. It’s publicly traded, not known to be on any US blacklists and their subsidiary Hutchinson Ports is one of the world’s largest port operators, overseeing 53 ports in 24 countries, including for other US allies such as the UK, Australia and Canada.

Crucially, Hutchison does not control access to the Panama Canal. Workers at their two ports only load and unload containers onto ships and supply them with fuel. And they’re not the only ones – three other ports in the vicinity of the canal are operated by competing companies providing similar services.

Since Trump’s comments, Panama’s government has announced an audit of the Hutchison-owned Panama Ports. The company says it is complying fully and has even invited Rubio to visit its ports.

The State Department would not comment if Rubio planned to accept the invitation to visit what the Trump administration has described – incorrectly — as a de facto Chinese military outpost in Panama.

Does the US have any legal standing to seize the Panama Canal?

Under the 1977 treaty with Panama, the US returned the canal with the understanding that the waterway remain neutral.

According to the agreement, the US could intervene militarily if the canal’s operations were disrupted by internal conflict or a foreign power. This seems to be what Trump is referencing when he threatens to “take the canal back.”

But it would be hard to argue that the waterway’s operations are disrupted or endangered. Following the expansion of the canal, which began in 2007 and Panama financed at a cost of more than $5 billion, more cargo than ever runs through the canal than it did during the years of US administration.

A US occupation of the canal would fly in the face of international law and the treaty the US agreed to.

Ok, but theoretically what would happen if the US tried to take the Panama Canal?

Since the 1989 US invasion that deposed dictator Manuel Noriega, Panama does not have an army but Panamanians are fiercely protective of the canal which is central to their national identity. And despite the saber rattling coming from the Trump administration, attempting to force the issue would pose major complications for two other top US priorities: migration and the economy.

The canal isn’t the only critical passageway that Panama controls. Threatening Panama militarily could throw open the Darien Gap, the jungle crossing where hundreds of thousands of migrants make their way north from South America to the US.

Mulino had promised to close the gap to northbound migrants with Trump’s help – but don’t count on him honoring old commitments if US boots touch Panamanian soil.

Americans would also feel the heat. At least 25,000 US citizens live in Panama who would likely be placed in harm’s way by any US military action to seize the canal. Disruption of the canal’s operations would likely send prices of US goods from automobiles to sneakers soaring – about 40% of US container traffic passes through the waterway.

And of course, backing out of a decades-old deal and trying to wrest the canal back by force from an ally would be a propaganda goldmine for Russia and China which have both called for maintaining neutrality in the canal.

Any US military action would also further inflame tensions in Latin America where mass deportations have already tested Washington’s partnerships in the region.

Trump’s dream of flying a US flag over the Panama Canal would come at a much higher cost than he appears to have calculated.

When US President Donald Trump signed a recent executive order that would deny citizenship to the children of undocumented immigrants living in the United States, he took aim at what he suggested was a peculiarly American principle: Birthright citizenship.

“It’s ridiculous. We are the only country in the world that does this with the birthright, as you know, and it’s just absolutely ridiculous,” said the 47th president of the United States as he questioned a principle that some of his opponents say lies at the very heart of what it means to be called an American. For more than 150 years, the 14th Amendment of the Constitution has granted automatic citizenship to any person born on US soil.

As the courts moved to temporarily block his order, various media outlets pointed out that the president’s remarks were not entirely accurate. According to the Law Library of Congress, more than 30 countries across the world recognize birthright citizenship on an unrestricted basis – in which children born on their soil automatically acquire the right regardless of their parents’ immigration status.

Still, presidential hyperbole aside, the data from the Law Library does seem to suggest there is something particularly American (both North and South) about the idea of unrestricted birthright citizenship, as the map below shows.

Strikingly, nearly all of those countries recognizing unrestricted birthright citizenship are in the Western Hemisphere, in North, South, and Central America.

The vast majority of countries in the rest of the world either do not recognize the jus soli (Latin for ‘right of soil’) principle on which unrestricted birthright citizenship is based or, if they do, do so only under certain circumstances – often involving the immigration status of the newborn child’s parents.

So, how did the divide come about?

Brits to blame?

In North America, the ‘right of soil’ was introduced by the British via their colonies, according to “The Evolution of Citizenship” study by Graziella Bertocchi and Chiara Strozzi.

The principle had been established in English law in the early 17th century by a ruling that anyone born in a place subject to the king of England was a “natural-born subject of England.”

When the US declared independence, the idea endured and was used – ironically for the departing Brits – to keep out foreign influence, such as in the Constitution’s requirement that the president be a “natural-born citizen” of the US.

Still, it was not until the 1820s that a movement led by Black Americans – whose citizenship was not explicitly guaranteed at the time – forced the country to think seriously about the issue, according to Martha Jones, a professor of history at Johns Hopkins University.

“They land on birthright in part because the US Constitution of 1787 requires that the president of the United States be a natural-born citizen. So, they hypothesize that if there is such a thing as a natural-born citizen, they, just like the president, must be natural-born citizens of the United States.”

The principle would be debated for decades until it was finally made law in 1868 after the Civil War, which resulted in the freedom of enslaved Black Americans, and formalized by the 14th Amendment, which states: “All persons born or naturalized in the United States and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside.”

The economic incentive

But it wasn’t just the Brits in North America. Other European colonial powers introduced the idea in countries across Central and South America, too.

Driving the practice in many of these areas was an economic need. Populations in the Western Hemisphere were at the time much smaller than in other parts of the world that had been colonized and settlers often saw bestowing citizenship as a way to boost their labor forces.

“You had these Europeans coming and saying: ‘This land is now our land, and we want more Europeans to come here and we want them to be citizens of these new countries.’ So, it’s a mixture of colonial domination and then the idea of these settler states they want to populate,” said sociologist John Skrentny, a professor at the University of California, San Diego.

Later, just as the idea of ‘right of soil’ was turned against the Brits in North America, a similar reversal of fortunes took place in the European colonies to the south.

In Latin America, many newly formed countries that had gained independence in the 19th century saw ‘right of soil’ citizenship as a way to build national identity and thus further break from their former colonial rulers, according to the study by Bertocchi and Strozzi.

Without that principle, they reasoned, Spain could have claimed jurisdiction over people with Spanish ancestry who were born in former colonies like Argentina, said Bertocchi, a professor of economics at Universita’ di Modena e Reggio Emilia.

Right of soil to right of blood

So what about all those countries in other parts of the world that were also colonized by Europeans but today do not recognize the ‘right of soil’?

Many of them – particularly those in Asia and Africa – also turned to citizenship laws to send their former rulers a message.

However, in most cases these countries turned toward a different type of birthright citizenship that has its roots in European law: jus sanguinis (‘right of blood’), which is generally based on one’s ancestry, parentage, marriage or origins.

In some cases, this system was transplanted to Africa by European powers that practiced it, Strozzi and Bertocchi wrote in their study. But in other cases newly independent countries adopted it on their own accord to build their nations on an ethnic and cultural basis.

Doing so was a relatively easy change. As Skrentny points out, in many of these places the ‘right of soil’ had never become as ingrained as it had in the Americas, partly because their large native populations had meant the colonizers did not need to boost their workforces.

Jettisoning the ‘right of soil’ sent a message to the former colonists that “they didn’t want to hear any more of it,” said Bertocchi, while embracing the ‘right of blood’ ensured descendants of colonizers who remained in Africa would not be considered citizens.

“They all switched to jus sanguinis,” said Bertocchi. “It seems paradoxical, right? This time, to build a national identity, you needed to adopt this principle.”

So long, jus soli

There’s one final twist that helps explain why the ‘right of soil’ principle seems today to be a largely American affair.

Over the years, the colonial powers that once followed the ‘right of soil’ have since moved either to abolish or restrict its use, much like some of their former colonies.

In the UK, it was scrapped by the British Nationality Act of the 1980s, which put in place several conditions to qualify for British citizenship – including some that relate to parentage, as in jus sanguinis.

Experts say the driving force for those changes – in Britain and elsewhere in Europe – was the concern that migrants could take advantage of the system by entering the country with the intent of giving birth to a child with automatic citizenship. In other words, the same concern being voiced by many of Trump’s supporters in today’s United States.