Coming to America

Story by Rhana Natour
Photographs by Eman Mohammed

Dina Assaf sat in her car outside Chicago’s O’Hare International airport watching the terminal’s sliding doors open and close, open and close. She and her husband, Baha, had been scrambling to prepare for this moment and were exhausted, but in the back seat their three daughters were restless with excitement. Sara, Salma, and Sereen had circled this day—March 17, 2024—on their calendars weeks ago and were giddy that it had finally come. They jostled one another for the best view of the doors, hoping to be the first to spot the person they were there to pick up. She was a young girl like them—she had turned 14 just three days before—and from what the sisters had been told, she was very important.

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The girl’s name was Layan Albaz, and she had a button nose and a soft voice. What the Assafs knew of her life came mostly from videos on the internet. In one clip, Layan described how she had lost two sisters, a niece, and a nephew in an Israeli air strike in Gaza. She used a wheelchair because injuries she sustained during the attack had forced doctors to amputate her legs. In another video, filmed by Agence France-Presse not long after the air strike, Layan’s face was mottled with burns. “I want them to give me real legs,” she whimpered, clutching an oxygen mask in one hand. “I don’t want fake legs.”

But if Layan was ever to walk again, prosthetics were exactly what she would need, and to get them she was coming to the United States. Shriners Children’s Chicago, a hospital specializing in pediatric orthopedics, had offered to provide her with free medical treatment. And despite being perfect strangers, the Assafs were opening their home to Layan for the duration of her stay.

Sara, the eldest Assaf daughter, was 12, which meant that Dina and Baha had firsthand experience with an adolescent girl navigating a swirl of transitions. But Layan was also grappling with a new and permanent disability. Over the months of Israel’s brutal siege on Gaza, she had lost people she loved and seen horrors one would expect only a frontline soldier to witness. Dina was under no illusion that hosting Layan would be easy. “But I expected more of, like, sadness,” she told me.

When Layan was finally rolled through the doors at O’Hare, Baha stowed her wheelchair in the trunk and placed Layan in the back seat of the car with his daughters. Dina, who was sitting in the driver’s seat, was shocked when Layan first spoke.

“What’s that beeping noise?” Layan asked in Arabic—she had come to America without a word of English. Her voice was laced with annoyance.

“Dina just needs to put her seat belt on,” Baha replied.

“Well, what the hell are you doing?” Layan yelled, locking her eyes on Dina. “Put the damn thing on. You’re giving me a headache.”

Sara, Salma, and Sereen’s eager smiles curved into frowns of concern. Dina thought, What did I get myself into? The Assafs were already learning that their guest was too angry to be sad.

In Arabic, the root of the word for “amputated,” mabtur, can mean “incomplete.” This feels like a nod to the idea that it’s possible to sever something so essential to a person that they can no longer be considered whole. Someone who has lost a limb has experienced a deviation from the blueprint of the body; like a novel with chapters ripped out, something crucial is missing.

In Gaza, all we have to go by are amputated stories, fragments of the whole truth. Even that most fundamental data point of any war—the death toll—is incomplete. As of this writing, Gaza’s health authority has tallied more than 39,000 fatalities, but with the devastation inflicted on the region’s health care infrastructure, and with many bodies buried too deep in the rubble to be counted, officials emphasize how deficient their figures are every time they issue a report. In early July, an article in The Lancet estimated that Israel’s siege could result in 186,000 deaths, or 7.9 percent of Gaza’s population. But it may be years before we know the true toll—if we ever know it at all.

As for the children, here is some of what we know: As of May, approximately 15,000 were dead, 12,000 were injured, and 21,000 were missing. Among the wounded, doctors have described treating children “shredded” by bombs, crushed by collapsing buildings, and suffering from gunshot wounds to the head. Many pediatric patients have lost arms or legs. For now we have only a single statistic when it comes to these young amputees: Between October 7 and November 29, 2023, Unicef reported that more than 1,000 children had lost one or more limbs. A spokesperson told me in June that the agency had been unable to gather more recent figures, “given the challenging circumstances on the ground.”

This isn’t unusual—authoritative, countrywide figures on the number of pediatric amputees in most conflicts are generally rare. What seems clear is that we are witnessing one of the fastest and most intense mass-disabling events of children in our lifetimes. When the dust settles, relative to population size, Gaza may be left with the largest cohort of children who’ve lost limbs in any war in modern history.

Dr. Ghassan Abu-Sittah is certain that this will be the case. A plastic and reconstructive surgeon who specializes in pediatric trauma sustained in conflict, Abu-Sittah spent more than a month in Gaza, working with Doctors Without Borders, in the early days of the war. The experience, which he also described to The New Yorker, left him determined to assess the full scale of the crisis he witnessed. “During those 43 days that I was there, I did more amputations than I’d ever done in my 20 years as a war surgeon,” Abu-Sittah told me, holding his hands to his temples during a video call from his home in London. “I just needed to understand what the bigger picture was.”

He began reaching out to other surgeons—some who had recently returned from stints in Gaza, and some who were still there. Person after person replied with details that mirrored his own experience. Abu-Sittah realized that what he and other doctors were seeing could be record setting. It was the worst kind of reality check. He now estimates the number of pediatric amputees in Gaza at somewhere between 4,000 and 4,500—so far.

To put this in perspective, the Associated Press has reported that, over two and a half years of conflict in Ukraine, some 20,000 people have lost limbs. Based on testimony from medical personnel, researchers at the Center for Pediatric Blast Injury Studies, a joint venture launched in 2023 by Imperial College London and Save the Children, believe that the number of pediatric amputees in Ukraine is around 1,200.

Here is another way of looking at Abu-Sittah’s Gaza estimate: The average U.S. public school has about 550 students. Imagine eight or nine schools in an area roughly the size of Philadelphia where every kid is missing at least one limb. Imagine also that their amputations happened alongside a torrent of other tragedies: the loss of family members, friends, neighbors, schools, houses.

Now imagine that the only hope to reclaim some semblance of physical normalcy required those children to leave home. Gaza’s sole manufacturer of prosthetics and its affiliated rehabilitation center were destroyed in an air strike months ago; as a result, many families of children who have lost limbs are trying to evacuate them so they can receive medical care abroad. Social media is brimming with their desperate pleas, and only a few get what amounts to a lucky ticket for the mortally unlucky: Countries willing to take pediatric amputees from Gaza are doing so in relatively small numbers.

The kids who do find a way out board planes for distant places. In Layan’s case, that place was more than 6,000 miles away from everything and everyone she knew.

Layan grew up in Al-Qarara, a suburb of the city of Khan Younis. She was the tenth of eleven children. Most of her siblings were much older and had kids of their own; the “little devils,” as she called her nieces and nephews, once set fire to the curtains for fun while her mom was babysitting them. Her father worked construction in Israel, a relatively well-paying job for a Palestinian in Gaza if they can obtain a permit. He stayed in Israel during the week and came home on weekends. Layan and her little brother, Waseem, battled for his attention by telling him about each other’s transgressions while he was away.

Layan began to wear a headscarf in the fifth grade at the insistence of her strict uncles—men who, in her words, “fancied themselves sheikhs.” She didn’t like being told what to do, which is one reason she clicked with her best friend, Samaa. Both girls were daring and mischievous. Samaa didn’t wear a headscarf. She liked to dress in T-shirts and tight pants, and she wasn’t afraid to return the sneers of people she passed on the street who expressed disapproval.

Sometimes Layan and Samaa went to restaurants in Gaza City where no one knew them and pretended to be young adults, just to see who would believe the ruse. They had poetry duels to determine who could write a better stanza. They once stole a teacher’s workbook and distributed test answers to classmates. To formalize their status as best friends, Samaa gave Layan a necklace with a sun pendant; Samaa wore one with a corresponding moon.

On the morning of October 7, 2023, Layan was on her way to school when a barrage of rockets pierced the sky overhead. She grabbed the hem of her dress and ran for home. When she arrived, she called Samaa.

“Are you going to school?” Layan asked.

“No, I’m too scared,” Samaa replied.

Layan’s house was close to the border with Israel, and she was used to staying with her sister, who lived deeper inside Gaza, whenever hostilities erupted between Hamas and Israel. That’s what she did on October 7, but this time there would be no going back. After several days of violence, Layan’s parents got word that their house had been destroyed. Soon, along with thousands of other Palestinians, they crammed into an overflowing neighborhood shelter.

Samaa visited Layan at the shelter. One day in mid-October, Samaa got into an altercation with a girl who’d made a snide remark about what she was wearing. Layan begged her friend to let it go, but Samaa refused. “Samaa was annoyed, and at the same time she was depressed,” Layan said. “She wanted to take all that heat out on someone.” Samaa grabbed the girl by the shoulder and pushed her into a wall, then the girl’s mother intervened and slapped Samaa across the face. Members of Layan’s family had to hold Samaa back from retaliating. Other people crowded around to watch.

Recalling the incident, Layan smiled. The Samaa she knew refused to back down.

Four days after the fight, Samaa was killed, along with most of her family, when a bomb leveled their house. After one of Layan’s sisters told her that there were martyrs at a nearby hospital with Samaa’s last name, Layan called her friend’s cell phone again and again but got no answer. She made her way to the hospital, where she saw Samaa’s mother, still alive, in the hallway. “I said to myself, Samaa is gone,” Layan recalled.

Layan heard the doctors tell Samaa’s mother that she could see her daughter one last time, but they warned her against it. Samaa’s body was in pieces, and it would be a gruesome sight. Her mother shook her head.

But Layan wanted to see her friend. “I didn’t care,” Layan said of the doctors’ warnings. “Samaa was my whole life.”

What Layan saw wasn’t a body. “It was a torso, hands,” she said. But she took some comfort from the fact that Samaa wasn’t alive nine days later—that’s when Layan lost her legs. “If she saw me like this, Samaa would have died of grief,” Layan said.

The air strike came at 4 a.m. on October 27. Layan was with several family members at the home of her sister Ikhlas, who had just given birth to a boy she named Odeh, which means “to return” in Arabic. Layan was awake at the time because she was about to help Khitam, another of her sisters, administer medicine to her five-year-old niece, Jenna. “I was getting up to go toward her, and the missile hit and I fell on the floor,” Layan said. Then a huge cement block dropped into the room—it was so big it seemed to fill the whole space. “Khitam and Jenna died right in front of me, instantly,” Layan said. “To this day it’s in my mind. Just right in front of me.”

Then another missile crashed into the building, and Layan felt herself fly through the air. She would later remember falling, falling, falling; her body dropped six floors before it hit the ground. The force of that impact is likely what mangled her legs beyond repair. All around her, shrapnel and debris fell like rain.

Eventually, an ambulance transported Layan to Nasser Hospital, where just 48 hours earlier she had witnessed Odeh’s birth. “To the refrigerators,” Layan remembered a doctor saying as she was rushed in, referring to the morgue. “No, no, she still has a pulse,” a paramedic replied. “But it’s weak.”

Layan was taken to an operating room, where her legs were amputated without anesthesia. She didn’t know what was happening; she only felt searing pain. “Do you have no mercy?” she screamed. Her cries were met with silence.

It was sometime later, while she was lying on a stretcher in an elevator, that Layan saw the stump of her right leg and understood. “My legs are cut off!” she yelled.

The next thing she remembered was waking up in a hospital room—her parents were there, along with other family and friends. “The first question I asked was about the necklace,” she said. “It was the only thing I had from Samaa.” Her friend Khoolood ran up to her bed. “I have it, Layan,” she said with a reassuring smile. “I will give it to you as soon as you get better.” Layan later learned that this wasn’t true; perhaps Khoolood was trying to comfort her with a lie. The necklace was lost amid Gaza’s rubble, along with Layan’s cell phone, which contained cherished photos and videos of Samaa, of her family, of her life before the war.

Layan asked her father what had happened to everyone in the house when the missiles hit. She didn’t trust her own memory. “May they rest in peace,” her father said. Khitam and Jenna weren’t the only ones who had died—Ikhlas was gone, and baby Odeh, too.

That night, Layan’s mother tried to wash Layan’s hair, which was matted with blood, dirt, and debris. She soon gave up. “Her daughters were killed, her grandchildren were dead. Who could expect her to sit there and clean my hair?” Layan said. Instead, her mother grabbed a pair of scissors and cut it all off.

Over the next few months, Layan endured a total of five surgeries, only one of them with anesthesia. She battled fevers, infections, and kidney issues. But her family were most concerned about her deteriorating mental health. When she left Nasser because her bed was needed amid a new wave of casualties, her parents took her back to the shelter where they’d been staying. But it was clear that Layan was in no state to be around gawking strangers. She was taken to her grandparents’ home, a multistory building full of displaced relatives, friends, and neighbors.

Things got worse. Just the sight of people walking could send Layan into a rage. Watching children run while playing was too much for her to bear. Her uncle Ahmed tried to take command of the situation. “No one talks to Layan,” he ordered the other young girls in the building. “Leave her alone.” Whenever Layan wanted to get some air on the roof, he’d clear the hallway and the elevator so she could get there unobstructed.

When a child loses a limb, time is of the essence. The sooner they get specialized care and rehabilitation, the better their chances of physically adjusting in the long term. Layan’s sister Areej, who lives in Europe, messaged people who she hoped might be able to help. A distant relative of Layan’s, a journalist in Gaza named Mohammad Alshaer, posted about her on Instagram, where he has more than 100,000 followers.

Soon Layan came to the attention of Steve Sosebee, an American in his forties with striking blue eyes. Sturdily built, Sosebee looks more like a former football player than a longtime aid worker. Originally from Ohio, he worked as a freelance journalist in Gaza in the 1990s, which inspired him to create a charity called Palestine Children’s Relief Fund (PCRF), to transport sick and injured children to the U.S. for free medical care. Sosebee has witnessed conflict in Gaza before, but he sees what’s occurring now as altogether different. “It’s a genocide,” he said. “In my thirty-plus years working there, I haven’t seen anything close to what’s happening today.”

Given the visual record of atrocities available online 24/7, many humanitarian advocates have said that the world is witnessing a live-streamed genocide. A growing number of legal experts agree. In January, the International Court of Justice ordered Israel to “take all measures within its power to prevent” genocidal acts, and “to prevent and punish the direct and public incitement to commit genocide.” The court issued another ruling in July, finding that Israeli settlement policies in Palestinian territory are illegal. The International Criminal Court has applied for arrest warrants for Israeli prime minister Benjamin Netanyahu and defense minister Yoav Gallant for war crimes and crimes against humanity, including “starvation of civilians as a method of warfare,” “intentionally directing attacks against a civilian population,” “persecution,” and “extermination.” The ICC has also applied for arrest warrants for three Hamas leaders.

In early 2024, as the bombardment in Gaza worsened, Sosebee launched a new NGO called HEAL Palestine. (HEAL stands for Health, Education, Aid, and Leadership.) Together, PCRF and HEAL are evacuating kids injured in the conflict to foreign countries, including the U.S. This work takes an enormous amount of effort, money, and organizational infrastructure. HEAL has evacuated nine child amputees since last fall. Layan was approved for treatment at Shriners Children’s in early 2024 and traveled to Egypt with an aunt to obtain a U.S. visa. Since then, Israel has seized control of the Rafah crossing into Egypt, stymieing medical evacuations. As CBS News reported in July, “Aid workers say that’s made rescuing children almost impossible.” Still, HEAL is currently working to transport a dozen new pediatric amputees out of Gaza.

Most of HEAL’s beneficiaries travel with a chaperone—a parent or older sibling, for example—and they stay either in hospital housing or with volunteer families who live close to where they’ll be treated. But HEAL said it would be easier to arrange accommodations for Layan if she came to the U.S. alone. Her sister in Europe, who was HEAL’s main point of contact, given communication outages in Gaza, agreed that Layan should make the trip by herself if it meant she didn’t have to wait any longer for the care she needed. Layan was livid about traveling alone. “Everyone came with someone,” she said. “Everyone except me.”

Layan arrived in Chicago determined to show the strangers she would be living with exactly what she was made of.

The Assafs are Jordanian. Dina came to the United States when she was five, Baha at 18, and they met in a community college English class. Baha, who is now 40, works as the head of finance at a car dealership, while Dina, 38, is a homemaker. They have followed the news out of Gaza closely and oppose the war. Baha has attended local protests calling for a ceasefire. He learned of Layan’s situation through a friend with a connection to HEAL. In a family vote, Dina, Baha, and the girls agreed unanimously to welcome Layan into their home.

Dina and Baha were determined to make Layan feel like she was part of their family, no different from their own daughters. They had a spare bedroom on the ground floor of their house, which would have been easier for her to access, but they opted to put her in a room upstairs, where everyone else slept, because they didn’t want her to feel isolated. They also made sure that Layan’s room had the same bed frame, vanity, and wide-eyed stuffed animals as their daughters’ rooms across the hall.

On the drive from O’Hare, Layan announced that she wanted nothing to do with the Assafs and that she planned to stay in her room all day. When she saw where the family lived, a large brick house in a Chicago suburb, she scoffed that Dina and Baha must be drug dealers to be able to afford it. “We just work hard,” Dina responded. Layan cackled so loudly that it startled Dina.

Layan refused to let Baha carry her up the stairs to her room. Instead, she pushed herself out of her wheelchair and climbed up on her own, using her arms to swing her hips from one step to the next with the dexterity of a gymnast on a balance beam. When Layan saw the room Dina and Baha had prepared for her, her eyes widened. “It’s big,” she said. In spite of herself, a faint smile appeared on her face.

The Assafs soon understood that Layan was dreading the medical treatment she had traveled so far to receive. She had already spent weeks inside a hospital and didn’t want to repeat the experience. But Shriners Children’s is used to treating kids who require lengthy hospitalizations, and it makes its facilities as welcoming as possible. The complex is decorated with bright murals and has a Ping-Pong table. It hosts a “superhero day,” when volunteers dress up and hand out capes to patients.

On her first visit to the hospital, Layan met the specialists who’d be treating her, including Dr. Jeffery Ackman, a pediatric orthopedic surgeon; certified prosthetist and orthotist Shawn Malik; and Angela Guerino, a physical therapist with strawberry blond hair and a cheery disposition. The team would work together closely to help Layan rehabilitate, monitoring every part of her body—muscles, bones, nerves, skin—to ensure that she adapted to life on artificial legs.

There is a common conviction among pediatric orthopedists who work with amputees: Sit in a chair and you’ll start to look like a chair. Doctors want kids who’ve lost limbs to begin using prosthetics as quickly as possible, and Layan had already lost valuable time. In the six months since her amputations, she’d had no physical therapy, and her hips were becoming misaligned because of her tendency to lean to one side in her wheelchair. Without intervention, she could develop a hip contracture, a tightening of joint tissue that would essentially lock her body in an unnatural position for good. During rehab, Layan would need to wear a hip and back brace to correct her alignment, along with compression socks to reduce inflammation in what remained of her legs. Frequent stretching would be necessary to straighten out her lower torso.

Meanwhile, each of Layan’s legs presented unique challenges for her recovery. Her left leg had been amputated above the knee, so the prosthetic on that side would be equipped with a mechanical knee joint she’d need to learn to use. She still had her right knee, but the surrounding skin, replete with scars and possibly with embedded shrapnel, would make fitting a prosthetic to it difficult. Ultimately, for Layan, learning to walk again would be like mastering two musical instruments and playing them at the same time.

Layan was impatient. In her first therapy session, the team put her in check-socket prosthetics—robotic-looking legs used for training purposes—and she tried to bolt over to a treadmill in the corner. “Literally day one,” Guerino said. “I’d known her for five minutes.”

But Layan was also a quick learner. Initially, her team wanted her to stay at Shriners Children’s for two weeks of intensive treatment, after which she would go back to the Assafs’ for a few months and come in to the hospital for regular appointments. But she did so well the first week, and was so upset about having to sleep at the hospital, that her team decided she could return to the Assafs’ early—on one condition. They made Dina promise to hide the test legs from Layan, because she risked serious injury if she tried to use them without supervision.

When Layan arrived at the Assafs’ after her week at Shriners Children’s, Sara, Salma, and Sereen were hiding behind the front door. They jumped out and threw fistfuls of confetti as Dina rolled Layan in. That night, Dina took the prosthetics to bed with her and slept with them between her and Baha.

As the weeks went by, the anger that Layan directed at her host family softened. Dina responded to her outbursts matter-of-factly, and Layan came to respect the boundaries set for her—even as the only English word she’d seemed to master was “no.” Layan, Salma, and Sara bonded over a love of makeup and skin care. Sereen, who at five was the youngest Assaf, was fascinated by her family’s special houseguest and had a strawberry-patterned backpack where she kept small items Layan gave her, including a whale toy and a jar of pink slime.

Gaza was never far from Layan’s mind. She once shared with Dina a video clip she watched when she missed her sisters. It showed Layan’s father standing over their bodies, which had just been pulled from rubble and hastily wrapped in white burial shrouds. Without her cell phone and its trove of family photos, this was the only way Layan could see Khitam and Ikhlas.

On a Tuesday afternoon in early April, Layan got a phone call that plunged her back into the horrors of war. Dina was cleaning in preparation for hosting a Ramadan iftar, a dinner marking the end of the day’s fasting, when Sereen appeared before her. The little girl was wide-eyed. “Mom, I think something is wrong with Layan,” she said. Dina could hear screaming upstairs.

Dina rushed to Layan’s room and found her in her wheelchair. “Why is this happening?” Layan cried. “I’ve already lost too many people.”

Layan’s cousin had called to tell her that her father and elder brother Karam had been killed when an Israeli aircraft descended over the location where they were living in a tent and opened fire. Dina told Layan to calm down, to breathe. But Layan screamed: “Who’s going to take care of my family? Who’s going to feed them?” Her father and Karam were the breadwinners, and they had been looking after the children of relatives killed in previous air strikes. Layan cried out to God, begging to know why this had happened.

Dina ran to call Baha at work. She told him he needed to let everyone invited to dinner know that it was canceled. When Dina returned to the bedroom, Layan was hitting herself.

“Look at me,” Layan said. “I wish I would have died, not them.”

“Don’t say that,” Dina said. “Why would you say something like that?”

“Look at me,” Layan snapped, her voice dripping with contempt. “I don’t have legs.” She also had a serpentine scar running from her hairline to the bridge of her nose. “Do you see my face?” she asked.

Caught in a whirlwind of grief and self-loathing, Layan kept going. “I will never be normal again,” she told Dina. “Who’s going to want to marry somebody like me? At night when I go to sleep, I’m going to have my husband help me take off my legs when I get into bed? Who’s going to do that? Who’s going to accept that? If anyone should have died, it should have been me.”

Dina managed to get Layan to tell her who it was she’d spoken to on the phone. When Dina realized that it wasn’t an immediate family member, she called a representative of HEAL. She asked them to find someone on the ground in Gaza who could track down Layan’s family and find out what had happened.

Soon Dina learned that Karam was alive, although he’d been hit with a bullet in his shoulder. Layan’s father was in critical condition. It was another of Layan’s brothers, 17-year-old Najee, who had been killed.

Dina delivered the news to Layan. Najee had called Layan three times the day before, but she hadn’t picked up. “I should have answered. Why didn’t I answer?” Layan cried.

For a week after learning about Najee’s death, Layan was afraid to sleep after the sun set. “I hate the nighttime,” she told Dina. “I wish nighttime never came.” When it was late and quiet, Layan couldn’t stop her mind from racing.

She asked Dina and Baha to stay up with her until dawn. They did their best, playing endless hands of Skip-Bo and watching episodes of a Turkish soap opera late into the night. Baha eventually went to bed because he had work in the morning, so Dina finished out the shifts alone. Sometimes she would nod off and Layan would start to cry, jolting Dina awake again.

Only when the sun rose and the rest of the household came to life did Layan finally sleep.

When I first contacted the Assafs about interviewing Layan, Baha described her as a sweet girl. “You couldn’t tell she’s been through what she’s been through,” he told me. Layan and I spoke on the phone, and she was open to meeting with me and Eman Mohammed, a U.S.-based photographer who is originally from Gaza. It was only a few days before we flew to Chicago that the warnings began. Dunia Saad, then the patient coordinator for HEAL, told me that Layan “could be moody” and was prone to changing her mind on a whim. Dina explained that I should “not take anything she says too personally.”

In mid-April, when Eman and I arrived at the Assafs’ door, Dina greeted us wearing a pressed pink silk shirt. Her hair had blond highlights and was ironed straight. She spoke English with a hint of an accent.

Sara appeared, smiling widely as she pushed Layan forward in her wheelchair. Layan wasn’t smiling. She looked at us with a level gaze. “OK, let’s just get this over with,” she said, rolling her eyes. She whipped herself around in her chair and wheeled into the living room.

There we sat with Dina on a gray sectional while Layan dictated how the day would proceed. “I don’t want you to take photos of me that include my injury,” she declared. We had spoken about photographs on the phone, and Layan had agreed to let Eman take them, but I realized that the Layan of a few weeks ago wasn’t the Layan of right now. We had to respect—and contend with—the person in front of us.

Layan didn’t like strangers looking at her amputated legs. She didn’t want their pity. And she certainly wasn’t interested in having to glimpse their happy lives, untouched by war and loss.

It was clear Layan cared about her appearance. At 14, her self-consciousness about it would likely have been intense no matter what; because of her amputations, it was in overdrive. She was wearing a Calvin Klein tracksuit, and her eyes had been carefully rimmed with white eyeliner. Her round, pretty face reminded me of Selena Gomez. A translator at the hospital once told her that she resembled the Lebanese pop star Maritta, which seemed to make Layan happy.

Layan told us that she didn’t want to be seen as a charity case. “I have a future,” she yelled, slamming her water bottle to the ground. “I will not tolerate that when I grow up, I will google my name and all that comes up on every page is pictures of me injured.” She was demanding that she retain at least some control of her circumstances, as she had when she first met the Assafs. She was also insisting that she not be defined by her disability.

We agreed to follow Layan’s lead when it came to photos, then spoke to her about her life, October 7, and the air strike that shattered her family. At one point the conversation turned philosophical, and we discussed whether human beings are inherently good. Layan was firmly against this. As evidence, she mentioned how her legs had been amputated without anesthesia—she presumed that this had been the doctors’ choice. “I screamed so loud, I fainted from the sound of my own screams,” she told us, clicking her tongue at the memory. “And you want to say there’s good in the world?”

When we noted that the devastation in Gaza had left many hospitals without basic supplies, she clicked her tongue again. “I got injured at the start of the war. How were they out that fast?” she asked. “No, they only gave it to people with connections.”

Her words felt like an effort to make sense of the senseless, to grapple with the cruel fact that the adults in her life had been powerless to protect her from catastrophe. If she believed that the doctors chose to hurt her, at least she had somewhere to channel her rage.

We made a plan for the next day to accompany Layan to physical therapy. But when we arrived at the Assafs’ house in the morning, a crisis was unfolding. In an effort to plan ahead, Steve Sosebee had asked if a HEAL volunteer rather than Dina could take Layan to a medical appointment scheduled for a few days later. Layan was furious, and she refused to come downstairs. “Am I a product to be rented out to these people?” Layan screamed as Dina, remaining calm, stood in the kitchen filling a pink Stanley cup with water. “It’s my therapy. I don’t want strangers there.”

The conflict highlighted an uncomfortable reality that often comes with being a charity recipient. NGOs like HEAL rely on networks of volunteers and donors, people so eager to help a child who got out of Gaza that they’ll sometimes greet them at the airport with posters and balloons; they invite them to dinner, family events, theme parks. This in turn requires the kids to play a role: to smile, pose for photos, show gratitude.

Layan didn’t like strangers looking at her amputated legs. She didn’t want their pity. And she certainly wasn’t interested in having to glimpse their happy lives, untouched by war and loss.

When Dina learned that the HEAL volunteer’s own schedule would prevent them from taking Layan to the appointment, she breathed a sigh of relief. By now, though, it was nearly 11:30, and we were late leaving the house for the hourlong drive to the hospital. “Come on, Layan,” Dina called out, looking up the stairs. “This isn’t your wedding day. Hurry up.”

When Layan finally emerged, she was wearing a teal jacket and matching capri pants. Dina put two large pills in her palm, nerve suppressants to help ease phantom-limb pain; sometimes Layan felt electric shocks coursing through the stumps of her legs, as if her body were calling out to its parts that were no longer there.

At the hospital, Layan seemed pleased to see her physical therapist. She gave her a big hug and said her name, stretching it out affectionately: “Annnngeeeelllaahhh.” Then, with Dina translating from Arabic, Layan pointed out that Guerino was wearing mascara that day. She always noticed when Guerino made changes to her appearance.

“It’s my husband’s birthday,” Guerino explained.

“Ooh la la!” Layan replied with a wink.

The main goal of her therapy was to get Layan walking in prosthetics with less and less support over time. Guerino had helped her progress from a walker to two forearm crutches to just one. Now Layan was tethered by a rope to a ceiling track, allowing her to walk by herself. Guerino held the other end of the rope and pulled on it when Layan stumbled, catching her before she hit the ground. 

Shawn Malik, the prosthetist, watched Layan carefully as she moved. Sometimes he adjusted her test prosthetics; he kept track of her body’s specifications so he could design custom legs for her. These would be ready for her in a few weeks.

At one point, Malik wheeled a full-length mirror into Layan’s path. “She loves looking in the mirror,” he told me. Layan perked up at the sight of her reflection. She swayed her hips with each step and mumbled a song to herself in Arabic that I couldn’t quite hear. 

Layan allowed Eman to take photos of her when she was strapped to her prosthetics, but she shooed the camera away when Guerino was stretching her body without them. I remembered the wrenching video in which she said she wanted real legs, not prosthetics. It now seemed that what Layan wanted was for the world to see her standing on two legs, even if they were fake. She wanted to appear upright, undaunted, ready for whatever came next.

HEAL and organizations that do similar work are able to get U.S. visas for kids like Layan on certain conditions. Medical evacuees can’t apply for asylum, and they must leave the country once their treatment is concluded. From the U.S. government’s perspective, such stipulations prevent programs like HEAL from becoming immigration work-arounds. 

For years, Sosebee was satisfied enough with this arrangement. Kids who received specialized treatment in the U.S. were for the most part able to get the follow-up care they needed back home—Gaza’s medical system had been robust enough for that. But Israel’s siege has changed that calculus. According to data from May, there have been around 450 attacks on health facilities, and 31 of Gaza’s 36 hospitals are now damaged or destroyed. Those that are still functioning must focus on immediate and lifesaving care, when they have the resources to do so. “Our medical supplies are critically low due to the limited flow of aid that is being allowed into Gaza by Israeli authorities. If we don’t manage to get medical supplies into Gaza very soon, we may have to stop our medical activities,” Guillemette Thomas, the medical coordinator for Doctors Without Borders in Palestine, said in a statement in June. “We have patients with severe burns and open fractures, and we don’t even have enough painkillers to alleviate their suffering.”

The situation in Gaza presented a horrible question: What if Layan came all the way to the U.S. and learned to walk again, only to return home and find that the long-term care she needed was unavailable? Emily Mayhew, a military medical historian who works with the Center for Pediatric Blast Injury Studies, told me that “life beyond survival as an amputee is immensely complicated.” She described a colleague, a double amputee like Layan, who checked the weather forecast every morning; if the temperature would be above 77 degrees, he knew to stay home the following day, because the heat would make it too uncomfortable to use his prosthetics two days in a row. Mayhew also told me about a Paralympic athlete who developed an ingrown hair on the bottom of his amputation that became so badly infected, he couldn’t train for a year. 

Those people were adults. Younger amputees face unique difficulties; they often require additional medical procedures and new prosthetics as their bodies grow and change. Meeting the needs of thousands of pediatric amputees in Gaza will be an overwhelming task. Dr. Abu-Sittah, the surgeon in London, said that prosthetists around the globe need to be training now, rather than waiting until the war is over, to care for these children. A steady rotation of specialists from abroad will need to visit Gaza to provide treatment, because it will be all but impossible to bring the kids to them. “These children will need to be treated by the Palestinian health system, whatever it looks like,” he said.

Additionally, Abu-Sittah noted that Gaza itself will have to be reimagined to accommodate a generation of young amputees. “It needs to be a different place in terms of access, in terms of disability. The schools that need to be rebuilt need to be completely different looking. Everything needs to be informed by this,” he said. “Every little thing.”

For now the bombs are still falling, with no end in sight. The idea that Gaza will be rebuilt anytime soon, let alone with the needs of someone like Layan in mind, is a pipe dream. Dina knows this, and at an appointment with Layan’s orthopedic surgeon, Dr. Ackman, she expressed concern about how Layan would use her prosthetics in a place where more than 70 percent of civilian infrastructure has been destroyed. 

“She can use them on flat surfaces,” Ackman said. 

“But what if there are no roads anymore? What about rubble?” Dina asked. 

“They will break down a lot faster,” Ackman said. Once that happened, he continued, “they basically won’t work.”  

Sometimes when she thought about returning to Gaza, Layan’s mind went to the darkest of places. “I’ve heard her crying and saying things like, ‘If they didn’t kill me the first time, they’re going to kill me the second time,’” Dina said. 

When Eman and I visited Chicago a second time, in June, Layan greeted us with a slight smile while walking down the stairs of the Assafs’ home on her new prosthetics. These were the legs Malik had designed, and Layan would use them for the next year or two at least, until her growing body required new ones. They had been customized to match her skin tone, with a material meant to resemble the texture of human flesh. 

When her medical team gave them to her two weeks before our visit, Layan wasn’t thrilled. “Their appearance was acceptable,” she told us with a shrug, but she didn’t like walking in them. They required adjustment and effort, and unlike the test prosthetics, she was supposed to use them all the time, which was exhausting. When she came home from the hospital she put the legs in her room, where they stayed, unused, for the next several days. To encourage her to practice walking with them, Dina hid Layan’s wheelchair. If Layan wanted to get around the house, she’d have to use her new legs. 

During her sessions with Guerino, Layan worked her way from one side of the room to the other. “It’s really the left leg that bothers me,” she explained. That was the one with the mechanical knee; to unlock the motion of the joint, she had to put pressure on the prosthetic’s toes. The problem for Layan was the repetition—doing this with every single step, especially when the other prosthetic didn’t require it.

For the time being, she had settled on dragging her left leg without bending the knee. She had also decided that she was ready to don footwear other than orthopedic sneakers. A pair of silver flats were on the way in the mail, arriving just in time for Eid celebrations.

Layan’s final medical appointment in Chicago was scheduled for July 3, and as the date approached, there was a swell of anxiety in the Assaf household. Sometimes when she thought about returning to Gaza, Layan’s mind went to the darkest of places. “I’ve heard her crying and saying things like, ‘If they didn’t kill me the first time, they’re going to kill me the second time,’ ” Dina said. 

In my conversations with him, Sosebee insisted more than once that HEAL would not return evacuees to Gaza amid continuing hostilities. But the Assafs and Layan weren’t convinced. What if the U.S. government gave Sosebee no choice?

There are scenarios in which Layan could wind up in a third country—perhaps Egypt, where the aunt who traveled with her to get a visa remains; or in Europe, where her sister Areej lives. Layan said that she misses Gaza, her family, and her friends. She wants to go back, but not if it means risking her life. She never wants to feel trapped again. 

Since the rocky meeting at O’Hare, Layan had become a fixture in the Assafs’ lives. She’d attended family gatherings and gotten to know Baha’s many sisters, their husbands, and their kids by name. She went on vacation with the Assafs to Miami. She could still be defiant, but her biting comments had given way to witty ones. That she had come to trust her hosts enough to be vulnerable in front of them was something Dina especially took to heart. “She has all her faith in us,” Dina said. “She believes in us.”

Dina was insistent that she would do everything in her power to keep Layan from going back to a place that is scarcely a shadow of the home she once knew. “That’s not an option,” Dina said. “We will put up lawyers. We will pay as much money as we have to.”

On our last night in Chicago, Baha and Dina lit up the backyard firepit, and the girls made s’mores before their attention flitted away. Sereen zipped around on a hoverboard with LED-illuminated wheels as Sara attempted to wrangle her sisters and Layan into doing a TikTok dance tutorial together. At one point, Layan dropped the crutches she used to steady herself on her prosthetics and bounded toward the firepit. She then propped one of her new legs on Sereen’s hoverboard and glanced over at Dina and Baha with a smirk. 

“Get away from that right now Layan!” Dina yelled across the yard. 

Layan laughed and galloped back to the other girls, joining them as they swiveled and shook their hips in front of a phone screen. In that moment she was just a kid, dancing. 

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