NEW YORK (AP) — Omar Abu Kuwaik is far from his home in Gaza. The 4-year-old’s parents and sister were killed by an Israeli airstrike, when he lost part of his arm.

He’s one of the lucky ones.

Through the efforts of family and strangers, Omar was brought out of Gaza and to the United States, where he received treatment, including a prosthetic arm. He spent his days in a house run by a medical charity in New York City, accompanied by his aunt.

It was a small measure of grace in a sea of turmoil for him and his aunt, Maha Abu Kuwaik, as they looked to an uncertain future. The grief and despair for those still trapped in Gaza is never far away.

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Abu Kuwaik is glad she could do this for her beloved brother’s son, whom she now considers her fourth child.

But it was a terrible choice. Going with Omar meant leaving her husband and three teenage children behind in a sprawling tent camp in Gaza’s southernmost city of Rafah. With Israel carrying out strikes in areas where it told civilians to take shelter, including Rafah, Abu Kuwaik knows she might never see her family again.

“My kids love Omar so much,” she said. “They told me, ‘We’re not children anymore. Go, let Omar get treated. It’s what’s best for him. It’s his only chance.’”

Omar used to be an outgoing boy, she said, and he’s clever like his late father, who was an engineer. Now he’s often withdrawn and breaks into tears easily. He wonders why they don’t have a home like the kids he sees on YouTube.

Ask Omar a question, and he covers his ears with his right hand and the stump of his left arm, declaring, “I don’t want to talk.”

“Kindergarten was nice,” he eventually admits, “and I was happy on the first day.” He started school just weeks before the war broke out. But he says he doesn’t want to go to kindergarten anymore because he’s afraid to leave his aunt’s side.

His flight to New York may have given him a new dream, though.

“When I grow up, I want to be pilot,” Omar said, “so I can bring people places.”

Omar was the first Palestinian child from Gaza taken in by the Global Medical Relief Fund. The Staten Island charity’s founder, Elissa Montanti, has spent a quarter-century getting hundreds of kids free medical care after they lost limbs to wars or disasters, including in Iraq and Afghanistan.

Each child started out as a stranger. Each one joined what she calls her “global family,” and will come back to the U.S. for new prosthetic limbs as their bodies grow. Her charity sponsors everything except the medical treatment, which is donated, primarily by Shriners Children’s Hospital of Philadelphia.

When the war in Gaza erupted in October, Montanti knew she had to help. “But quite frankly, I said, ‘How? How will I ever get these kids out when they can’t even get out of Gaza?’”

Montanti had never laid eyes on Omar, but she understood that children like him were being severely wounded every day.

The deadliest round of the Israeli-Palestinian conflict in decades was sparked Oct. 7 when Hamas-led militants broke through Israel’s security barrier around Gaza and stormed into Israeli communities. Around 1,200 people were killed and some 250 taken hostage.

Israel has laid waste to much of Gaza in response. In less than five months of war, Israel’s military has created a staggering humanitarian crisis and 80% of Gaza’s 2.3 million people have fled their homes. One assessment suggests half of the coastal enclave’s buildings have been damaged or destroyed.

The number of people killed in Gaza rose above 30,000 Thursday, with more than 70,000 wounded, the Health Ministry said. The ministry does not differentiate between civilians and combatants in its figures but says women and children make up around two-thirds of those killed. Israel blames civilian deaths on Hamas, saying militants operate among the population.

Two weeks into the war, Omar’s family narrowly escaped death. Minutes before it was flattened by an Israeli airstrike, they evacuated the Gaza City apartment they’d bought just months earlier. His aunt’s family rushed out of the building next door. It too was bombed.

Homeless, with only the clothes on their backs, the families split up to stay with different relatives. But in wartime, seemingly trivial decisions — like where to seek shelter — have outsized consequences.

On Dec. 6, two Israeli airstrikes slammed into Omar’s grandparents’ home in the Nuseirat refugee camp, in central Gaza. The explosion peeled the skin from his face, exposing raw pink layers peppered with deep lacerations. His left arm could not be saved below the elbow. His parents, 6-year-old sister, grandparents, two aunts and a cousin were killed.

Omar was pinned beneath the rubble as rescuers dug with their hands through soot-blackened concrete. Finally they reached his little body, still warm, bleeding but somehow alive, and lifted him to safety. He was the only survivor.

As the weeks passed, Omar lay on a bed in a hospital corridor with his arm wrapped in bandages — even as his child’s mind somehow imagined it might grow back. The collapsing heath care system in Gaza could provide only rudimentary care for the burns on his leg and torso.

“Our view was, anywhere is better for him than being in Gaza,” said Adib Chouiki, vice president of Rahma Worldwide, a U.S.-based charity, who heard about Omar from the group’s humanitarian team in Gaza.

Israel and Egypt have tightly restricted the movement of people out of Gaza, allowing just a few hundred to exit each day, mostly those with foreign citizenship. Some Palestinians have been able to get out by using private brokers. The World Health Organization says 2,293 patients – 1,498 wounded and 795 ill – have left Gaza for medical treatment alongside 1,625 companions. Yet roughly 8,000 patients remain on a waiting list to go abroad, according to the U.N. refugee agency.

Chouiki began reaching out to contacts in the Palestinian, Israeli and Egyptian governments. He got new passports issued for Omar and Abu Kuwaik, and Israeli security clearance for the aunt to accompany her nephew from Gaza to Egypt.

Abu Kuwaik was taking a leap of faith. Permission to leave Gaza came while Montanti was still working to get U.S. government approval for Omar to fly to New York.

“He cried and cried and begged me to take him back to my kids,” Abu Kuwaik said. “Eventually we got him into the ambulance and drove toward the border.”

After waiting nervously while their paperwork was examined, they were loaded into an Egyptian ambulance and whisked across the Sinai desert.

Once safely in an Egyptian military hospital, Omar and his aunt waited for weeks until U.S. Customs and Border Protection gave them the green light to fly to New York on Jan. 17.

Omar’s wounds are healing, but he remains deeply traumatized. At Shriners Children’s Hospital in Philadelphia, he had skin graft surgery for the severe burn on his leg. A constellation of gray shrapnel scars remain scattered across his face, looking almost like freckles.

He was eager to be fitted with his new prosthetic arm, and approached it as it lay on a table Wednesday, smiling mischievously as he reached out to touch it. “My arm is nice.”

“The kids, they feel whole,” Montanti said. “Psychologically it means so much.”

Shriners is currently treating two other kids from Gaza, including an American citizen who was trapped there when the war began. There are plans to bring another child from Gaza, a 2-year-old boy whose leg was amputated above the knee. He’ll be accompanied by his mother, leaving behind family for the sake of her child.

Omar and his aunt boarded a plane back to Cairo a day after the boy got his arm. They were accompanied by a member of her extended family who has a home in Egypt, where they’ll stay while trying to secure more permanent housing.

“I almost don’t sleep,” Abu Kuwaik said. “I think about Omar and I think about my kids, and the conditions they’re living in back there in the tents.”

Food is scarce. Israel’s near-total blockade of Gaza has pushed more than half a million Palestinians toward starvation and raised fears of imminent famine. And the flimsy tent they share with 40 other people offers little protection from rain and wind, she said. When one person gets sick, illness spreads like wildfire.

The war has repeatedly knocked out cellphone and internet service in Gaza, but Abu Kuwaik keeps in touch “when there’s network.” Her family often has to walk to the Kuwaiti Hospital, a hub for journalists, to get a signal.

After coming back to Egypt, Omar and his aunt’s futures are unclear; they might be stuck in exile.

For Abu Kuwaik, though, there’s no home for Omar to return to.

“I cannot imagine ... that I go back back to Gaza,” she said. “What would his life be? Where is his future?

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