Yahya Shamali's mother stands at the entrance of a worn-out tent in a displacement camp in Al-Saraya, central Gaza City. She scans the road anxiously, terrified her 16-year-old son might slip away again. For Yahya, who is on the autism spectrum, wandering is no minor risk. Each disappearance triggers hours of frantic searching as he walks kilometres with no sense of danger, while his family lives in a constant state of terror for his life.
"We now have to lock the tent door," his mother, Islam Shamali, tells The New Arab .
"We're terrified he will wander into dangerous areas, because he can no longer perceive danger the way he used to," the 35-year-old adds. Islam explains that the lack of treatment has made him lose his sense of danger entirely. "He doesn't know what is going on around him," she says. When his therapy stopped suddenly, his behaviour and awareness were impacted. He became hyperactive and lost focus, so every step outside the tent became dangerous.
Before Israel's genocide in Gaza , Yahya's life was structured around a rehabilitation routine that helped him progress and learn gradually. This included speech therapy, behaviour modification sessions and regular visits to specialised educational centres.
He was also on a specific medical protocol, which involved check-ups every six months and precise medication. This routine was the foundation of his development and his ability to learn and interact.
During his treatment journey, the family travelled to Egypt twice. He was making steady progress, learned to write, acquired new skills, and lived a relatively normal life compared to his peers.
"He was self-aware, he slept and behaved normally," his mother said. "Now, all the effort of those years has gone to waste."
The family, including his three siblings, now lives in a cramped tent with no safe space for him to expend energy and no sensory tools to help him stay calm. "When an autistic child completely loses his treatment and rehabilitation, what do you expect his condition to be now?” asked his mother. "I am exhausted and defeated. I can no longer control or help him," she continued. Every single day is an ongoing battle for the family just to manage his behaviour and keep him safe. Islam is also anxious about his educational and social future and has left no stone unturned in her search for local initiatives or community efforts that could help reintegrate him into rehabilitation programmes.
But she is often confronted with a grim reality. "These initiatives are scarce and are unable to guarantee the continuity of his treatment or meet his complex needs," said Islam. Stability and expression shattered Yahya's story is far from unique. Thousands of autistic children across Gaza are experiencing the same collapse in care.
Pre-war local estimates place the number of autistic children in Gaza between 3,000 and 5,000. Accurate figures are now impossible to verify; several children have died, and new cases go undiagnosed amid the destruction of health services.
In the Sheikh Radwan neighbourhood of northern Gaza, 16-year-old Layan Qousa sits in a wall-less apartment, clutching a pencil that no longer moves across the page as it once did. Drawing was never just a hobby; it was how she understood the world. "The signs of her condition appeared when she was one and a half years old," her father, Hammad Quosa, told The New Arab. After a long journey of medical and rehabilitation trials, Layan started a regular programme at age three. Over more than a decade, her family relied entirely on their own efforts, spending over $10,000 on therapy, specialised centres, and schools to help her integrate. "There was no official support… everything depended on us as a family," Hammad, a 55-year-old employee at Gaza's Ministry of Health, added. Drawing emerged as one of the most vital anchors in her life. What started as a struggle just to hold a pen transformed into her main outlet. She would draw incredibly detailed routes to her therapy centre, capturing courtyards, markets, schools, and even side streets and handrails. She drew not just what she saw, but how she understood the world. She would spend hours watching educational videos on a phone and copying them into her notebooks. "She found herself in drawing," Hammad said.
But Israel's genocide slowly destroyed this world. Financial burdens halted her therapy, and repeated displacements — roughly ten times — wiped out whatever stability remained.
With each move, they lost belongings, and Layan's art supplies were often the first to be left behind. "Many times, we couldn't find pens or colours, so she could no longer draw," Hammad added.
The loss of drawing wasn't a minor detail; it directly impacted her mental and behavioural state. Stripped of her primary means of expression, Layan became increasingly anxious, nervous, and almost constantly hyperactive. Compounding this, Layan has specific dietary needs. The starvation conditions during the war hit her especially hard. When hungry, she falls into fits of screaming and distress, unable to comprehend her surroundings. "Her movements dictate every detail of our lives. We can't take our eyes off her for a second," Hammad said. "During bombings she panics, points to her head, and stammers, 'I'm scared… scared.'"
Across Gaza, Israel's bombing of rehabilitation centres has ended tailored programmes in physical and occupational therapy, behaviour modification and specialised education. Therapy systems collapse Dr Arafat Abu Mashayekh, the head of the mental health department at Al-Aqsa Martyrs Hospital, describes the situation as "tragic and extremely bitter."
He explains that these programmes were tailored to build life skills, communication, and fine motor control. "This trajectory has turned into a massive regression," Dr Arafat told The New Arab. The sudden halt has triggered spikes in anxiety, emotional outbursts, loss of communication skills and physical risks like muscle atrophy, which are nearly impossible to recover from. "The longer therapeutic intervention is delayed, the lower the chances of recovery," he warned, adding that treating these cases requires a multidisciplinary team of doctors, occupational therapists, and psychologists, something that is now almost impossible to assemble.
The war environment itself is punishing for autistic children, who struggle to adapt to sudden changes. Repeated displacement, tent life, and the constant roar of bombings and drones "directly impact them, given the high sensitivity of their nervous systems," Dr Arafat said. Currently, the intervention is limited to advising parents on how to calm their children, regulate their sleep, and practise simple home exercises, such as squeezing dough, to maintain fine motor skills.
Despite the collapse, the Dolphin Association for Development has launched emergency initiatives. Reem Ja’arour, director of its autism programme, told The New Arab that these efforts focus primarily on emergency relief and awareness. Working with the UNRWA operations room in southern Gaza, they organise educational workshops for parents and distribute food and health parcels. They also offer limited financial aid and psychological support sessions to help parents act as temporary substitutes for missing specialists.
However, Reem says the impact of these initiatives remains "very weak". As an emergency response, it simply cannot replace a comprehensive rehabilitation system. She attributes this limitation to the ongoing trauma of the war, the loss of safety, and the repeated displacements that severely limit follow-up care. A shortage of specialists, many of whom were killed during the war, meant that implementing real rehabilitation programmes was virtually impossible, said Jarour. Disconnected communications, restricted movement, and collapsing living conditions further obstruct these efforts.
Parents were forced to become substitute therapists without training or resources. An attempt to survey autistic children via an online link failed due to technical issues and an inability to verify the data.
"Even before Israel's war and siege, we had success stories in integrating children," Reem said. "But the war was like an earthquake; it changed everything." Ismail Nofal is a Gaza-based journalist specialising in human interest stories This article was done in collaboration with Egab