RAFAH CROSSING, Egypt — A group of 50 sick and wounded Palestinian children began crossing to Egypt for treatment through Gaza’s Rafah crossing on Saturday, the first opening of the border since Israel captured it nearly nine months ago.

The reopening of the Rafah crossing represents a significant breakthrough that bolsters the ceasefire deal Israel and Hamas agreed last month. Israel agreed to reopen the crossing after Hamas released the last living female hostages in Gaza.

Egypt’s Al-Qahera television showed at least two Palestinian Red Cross ambulances pulling up to the crossing gate. Several children were brought out on gurneys and transferred to ambulances on the Egyptian side. From there, they were rushed to hospitals in the nearby Egyptian city of el-Arish and elsewhere. Footage showed one young girl whose foot had been amputated.

Zaher al-Wahidi, an official with Gaza’s Health Ministry, said 37 of the children had crossed into Egypt by Saturday evening.

The Health Ministry said around 60 family members were accompanying the children.

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Regular Evacuations Planned

The children are the first in what are meant to be regular evacuations of Palestinians through the crossing for treatment abroad.

Over the past 15 months, Israel’s campaign against Hamas in retaliation for the militants’ Oct. 7, 2023, attack on southern Israel has decimated Gaza’s health sector, leaving most of its hospitals out of operation even as more than 110,000 Palestinians were wounded by Israel’s bombardment and ground offensives, according to the Palestinian Health Ministry.

Remaining facilities are unable to perform many crucial treatments or specialized surgeries for wounds or diseases. Mohammed Zaqout, the director of hospitals in Gaza’s Health Ministry, said more than 6,000 patients were ready to be evacuated abroad, and more than 12,000 patients were in urgent need of treatment. He said the small numbers set to be evacuated will not cover the need, “and we hope the number will increase.”

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Diplomatic Efforts to Reopen Crossing

Rafah is Gaza’s only crossing that does not enter into Israel. Israeli forces closed the crossing in early May after seizing it during an offensive on the southern city. Egypt shut down its side of the passage in protest.

Even before the Gaza war began, the Rafah crossing represented a crucial escape valve from the territory, where a 15-year Israeli-Egyptian blockade aimed at containing Hamas undermined health facilities and impoverished the population. Palestinians routinely applied for permission to travel outside the territory for lifesaving treatments not available in Gaza, including chemotherapy.

It took some diplomatic gymnastics to reopen the crossing and overcome security disputes between Israeli, Egyptian and Palestinian officials. Hamas had overseen the border since 2007, when it took control of Gaza from its rival, the internationally recognized Palestinian Authority, or PA, after winning parliamentary elections in 2006.

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New Management at the Crossing

Israeli troops remain at the Rafah crossing and in the Philadelphia Corridor, a band of land running the length of the border. Israel has refused to allow Hamas to resume management of the crossing, accusing it of smuggling weapons through tunnels under the border, though Egypt says it destroyed the tunnels from its side and stopped smuggling years ago. Israel also refuses to allow the Palestinian Authority to officially run the crossing.

Instead, the crossing will be staffed by Palestinians from Gaza who previously served as border officers with the PA, but they will not be allowed to wear official PA insignia, a European diplomat said, speaking on condition of anonymity because the official was not authorized to brief the media. Israel has screened the officers to ensure they have no affiliation with Hamas, the European diplomat added.

European Union monitors will also be present, as they were before 2007.

Negotiations on the second phase of the deal — which calls for a permanent ceasefire, full Israeli withdrawal from Gaza and the release of any remaining hostages — are supposed to begin Monday. Israel has resisted the notion that the PA would control postwar Gaza.