Israel’s control over Gaza’s border crossings has shifted from temporary security measures to a harsh, daily reality that punishes Palestinians. The Rafah crossing with Egypt, once Gaza’s main exit, is now tightly controlled by Israel since May 7, 2024. This shutdown has blocked vital humanitarian aid and medical evacuations, leaving food shipments to rot and aid trucks stranded. The system controls who enters and exits Gaza, when, and what goods enter. After Rafah’s closure, Israel allowed only limited aid and patient movement through other crossings like Karem Abu Salem and Kissufim, creating a volatile and unpredictable flow of aid. Inside Gaza, road closures and checkpoints limit movement even more, isolating communities from food, health care, and other services. Humanitarian missions face frequent delays or denial, obstructing efforts to help. Maha al-Hussaini of the Euro-Med Human Rights Monitor described Israel’s policies as "a systematic policy through which Israel used control over movement to and from Gaza as a central tool of siege, collective punishment, and coercive management of the civilian population." Medical evacuations suffer the most. Since May 2024, only a fraction of patients needing treatment abroad have been allowed to leave. Over 18,500 patients still need urgent care outside Gaza, but only 2,513 were evacuated between May 2024 and July 2025 through limited crossings. More than 1,600 Palestinians died waiting for treatment. Al-Hussaini said, "Thousands of wounded and ill Palestinians were denied travel or forced to wait for weeks under complex rules," calling these "cruel and inhuman treatment." Even when Rafah was partly reopened in early 2025, only a few patients and family members crossed due to strict security checks. Israel’s blockade of Gaza has lasted since 2007. Originally presented as security concerns following Hamas’s rise, it now controls Gaza’s economy and daily life. The blockade has blocked goods, destroyed Gaza’s economy, and caused widespread poverty. UN and Red Cross reports call the blockade collective punishment and a violation of international law. Restrictions on aid have worsened during the war, with aid convoys often stopped or looted. Food shortages have escalated, and famine risk remains high. Al-Hussaini said Israel’s control "strips Gaza of the means of life," damaging social and economic rights, education, and family unity. These policies have created a trapped population. Al-Hussaini warned these "serious violations may amount to war crimes."