Israel: When Aisha a-Lulu, a Palestinian preschooler, came out of brain surgery in a strange Jerusalem hospital room, her repeated cries for her parents went unanswered.

Israeli authorities had approved a stranger to escort Aisha from the blockaded Gaza Strip to the east Jerusalem hospital. As her condition deteriorated, the child was returned to Gaza unconscious. One week later, she passed away.

A photo of Aisha smiling softly in her hospital bed, swaddled in bandages, drew an outpouring on social media. Her last days have shined a light on Israel’s vastly complex and stringent system for issuing Gaza exit permits.

It is a bureaucracy that has Israeli and Palestinian authorities blaming each other for its shortfalls, while inflicting a heavy toll on Gaza’s sick children and their parents.

“The most difficult thing is to leave your child in the unknown,” said Waseem a-Lulu, Aisha’s father. “Jerusalem is just an hour away, but it feels as though it is another planet.”

So far this year, roughly half of the applications for patient companion permits were rejected or left unanswered by Israel, according to the World Health Organization. That has forced over 600 patients, including some dozen children under 18, to make the trek out of the territory alone or without close family by their side.

Aisha’s doctor in Jerusalem, Ahmad Khandaqji, said he has treated countless lone patients from Gaza over the past year, but that Aisha’s story stuck with him. “She felt abandoned and betrayed,” he said. “We saw how that directly impacted her recovery.”