Baby Siwar back in hospital in Gaza after returning from treatment in Jordan

A one-year-old Palestinian girl evacuated from Gaza with severe nutritional problems is back in hospital in the territory after being returned there from Jordan. Siwar Ashour, whose story the BBC has followed for several months, was repatriated to Gaza on 3 December after completing her medical treatment in Amman.

She'd spent six months in hospital there under a medical evacuation programme run by the Kingdom of Jordan. Her grandmother, Sahar Ashour, said she became ill three days after coming back.

"She started having diarrhoea and vomiting and her situation keeps getting worse. The diarrhoea won't go away," she told a freelance journalist working for the BBC in Gaza. International journalists have been banned by Israel from entering Gaza independently since the start of the war nearly two years ago.

Siwar is being treated at al-Aqsa Martyrs Hospital in the central Gaza Strip where Dr Khalil al-Daqran told the BBC she is "receiving the necessary treatment, but the situation is still bad for her". The doctor said Siwar was suffering from a gastro-intestinal infection. She has an immune system deficiency which makes it hard for her to fight bacteria. She also struggles to absorb nutrition, meaning she requires specialised baby formula.

Dr Daqran said that hospitals in Gaza - many of which were badly damaged by Israeli bombing and fighting nearby with Hamas before a ceasefire took effect in October - were seeing an increase in child admissions. Poor hygiene conditions caused by the destruction of vital infrastructure have led to the spread of infections and disease.

"Since the ceasefire was announced, the number of child patients arriving at Gaza Strip hospitals is three times the capacity… The situation at al-Aqsa Martyrs Hospital is no different from other hospitals in the Gaza Strip.

"It suffers from a severe shortage of medicines and medical supplies, and a major shortage regarding electric generators, which are the main artery to keep a hospital going."

The World Health Organization (WHO) described humanitarian needs in Gaza as "staggering, with current assistance addressing only the most basic survival requirements".

Siwar was evacuated to Jordan in June after the BBC reported on her case and raised it directly with the Jordanian authorities.

Jordan's Minister of Communications, Dr Mohammed al-Momani, told us that Siwar was among 45 children returned to Gaza after completing their treatment. Under the evacuation scheme all patients are sent back after medical attention.

I put it to Dr al-Momani that people might find it hard to accept that a child in such a vulnerable condition could be sent back to Gaza in the current conditions.

"No patient is sent back before they finish their medical treatment… the first reason [why they are returned] is that this will allow us to bring more patients from Gaza. We cannot take all of them at once. We have to take them in batches. So far we have taken 18 batches.

"The second reason is that we don't want to contribute in any shape or form to the displacement of Palestinians from their land and all patients are told… after treatment you are sent back so other patients and other children can be brought in for treatment."

Jordan also treats war wounded at its field hospital in Gaza and has supplied aid via air drops and road convoys. The kingdom hosts more than 2 million Palestinian refugees, who fled conflicts with Israel since 1948, and 500,000 refugees from other countries, mostly Syrians.

Since last March some 300 sick and wounded children and 730 parents and guardians have been brought to Jordan out of 2000 scheduled for treatment. Other countries in the region like the United Arab Emirates and Turkey have treated thousands of sick civilians from Gaza.

The specialised formula milk Siwar needs was either not available or in very short supply during the ongoing conflict. In March, Israel imposed a total blockade on aid into Gaza that was lifted partially after 11 weeks. Since the ceasefire there has been a surge in aid deliveries, although the UN and aid agencies say not enough humanitarian supplies are flowing.

The Jordanian authorities gave Siwar's family a supply of 12 cans of the hypoallergenic Neocate formula on their departure for Gaza. However her mother Najwa told us that Israeli officials confiscated much of what they'd been given - nine of their 12 cans were taken.

"They told us, 'It is forbidden to take more than these cans,'" said Siwar's mother, Najwa Ashour. "Even though it is therapeutic milk and they said that treatment is allowed, yet they took them."

She also said that extra clothing the family had been given in Jordan was taken. "They searched us from top to bottom. When they saw us wearing clothes over each other [layered] they refused to let us out, and told us, 'You must take off all the clothes, down to one outfit.'"

I asked the Israeli government why the milk formula and clothing were confiscated? They replied that limits were placed on what could be taken back for "security considerations."

They said only minimal luggage was allowed and this had been conveyed to the Jordanian authorities and the returning families. "In cases where the luggage exceeded the approved scope, its entry was denied."

The WHO has appealed for more countries to offer medical evacuation to patients who cannot get the necessary treatment in Gaza.

It has also called on the Israeli government to allow patients to be treated in occupied East Jerusalem and the West Bank "which is the most time and cost effective route." Israel stopped allowing such evacuations after the Hamas-led 7 October attacks on Israel in which about 1,200 people were killed and 251 abducted into Gaza.

Siwar's family has been given Neocate milk formula since returning to Gaza. There have also been donations of money, including funds raised from online appeals. Jordanian representatives in Gaza have also visited the family to provide assistance.

The Ashours are trying to have Siwar evacuated once more - a process that has begun with the issuing of a permit by Palestinian health officials. It will be managed by the WHO which deals with all evacuation requests from a place the UN calls "a wasteland".

With additional reporting by Malak Hassouneh, Suha Kawar and Alice Doyard.