Geneva, Switzerland - A Doctors Without Borders official has pleaded for countries to open their doors to tens of thousands of Gazans in dire need of medical evacuation, warning that hundreds have already died waiting.

"The need is really huge," said Hani Isleem, who coordinates medical evacuations from Gaza for the charity, known by its French acronym MSF.

The numbers taken in by countries so far remains "just a drop in the ocean," Isleem told AFP in an interview on Tuesday.

The World Health Organization estimates that more than 8,000 patients have been evacuated out of Gaza since Israel began its all-out assault on October 7, 2023.

It says more than 16,500 patients still need treatment outside of the Palestinian territory.

Speaking at the MSF headquarters in Geneva after accompanying seriously ill and injured Gaza children to Switzerland for treatment, Isleem said that number was based only on patients registered for medical evacuation and the true figure was higher.

"Our estimate is that it is three to four times that number," he said.

To date, over 30 countries have taken patients, but only a handful, including Egypt and the United Arab Emirates, have accepted large numbers.

In Europe, Italy has taken over 200 patients, while large countries like France and Germany have taken none so far.

Switzerland in November took in 20 Gaza children who arrived in two batches.

The 13 children aged two months to 16 years whom Isleem accompanied last week included four babies with severe congenital heart disease, as well as cancer patients and children requiring complex orthopaedic surgery.

Without the evacuation, some of those children would not have made it, he said, pointing out that the babies basically went straight to surgery after their arrival in Switzerland to avoid "irreversible damage."

Isleem lamented that as conditions in Gaza become more desperate, the pace of medical evacuations has slowed.

Initially, some 1,500 patients left each month on average, but after Israel in May 2024 closed the Rafah crossing into Egypt, the monthly average has dropped to around 70.

A US-brokered ceasefire that came into effect on October 10 has not seemed to speed up the process.

Nor, surprisingly, has a dramatic drop in Israeli evacuation refusals.

Isleem pointed out that the Israeli authorities' denial rate had plunged from an average of around 90% to just 5% in recent months, adding that this was still too high.

They should not "block any patients from leaving Gaza to access treatment," he said.

Despite these shifts, there has been no big uptick in evacuations, with 148 carried out in October and 71 last month, with only around 30 expected to take place in December, Isleem said.

The problem, he said, was the long and often "politicized" process for nations to accept Gaza's medical evacuees.

"Countries are taking a long time to decide or allocate the budget for these patients, but (they cannot) wait for this discussion to happen."

More than 900 people have died while waiting for evacuations from Gaza since October 2023 – a figure Isleem said was an underestimate.

Another problem, Isleem warned, was that "99.9% of countries are asking for children."

"They are ignoring completely the adults (who also) need support and lifesaving aid," he said, pointing out that three quarters of those waiting for medical evacuations were over 18.

Governments also impose other criteria, including refusing patients with accompanying family members, and especially with any male siblings over 18.

Isleem urged countries to "stop this selection shopping list," and to "focus only on the needs and saving people's lives."