This article contains references to suicide.
Like many babies, Karam's first word was "mama".
But when he stares into the eyes of his caretaker, it's not his mother looking back at him but a kind woman who works for an orphanage in Gaza.
The one-year-old, who was found beside a university wall, will never know his biological mother, says Bertil Videt, global communications head at the non-profit organisation SOS Children's Villages International.
"Because of the chaos and continuous bombardment, it seems his mother was injured and gave birth while wounded, and passed away shortly afterwards," he says. "These are the initial details our team has received, but they cannot confirm them."
Karam has been under the care of the staff at SOS since a rescue worker took him there last year. In April, he celebrated his first birthday at the makeshift shelters he now calls home. He received a haircut and a custom-made outfit.
"The whole camp celebrated his first birthday," Videt says.
"His caregiver, Mama Basma ... made every effort to make it a celebration fit for a prince."
Karam is one of nearly 2,000 children estimated to have been left without parents amid a war that has destroyed their homes and torn their families apart.
Their futures are uncertain, in part because of continuing airstrikes from the Israeli military but also due to the lack of food, water, and other essential supplies. Most aid has been blocked since 2 March, leaving the population at risk of starvation.
"Gaza is an extremely dangerous environment for a child to be in because of the bombardments, because of the risk of disease, the lack of access to medical services, the very dangerous living environment — many people live in the middle of the rubble in makeshift tents — it's a very unsafe place for children in general," UNICEF Gaza spokesperson Rosalia Bollen says.
"Children who are unaccompanied ... we try to place them immediately [in a] shelter to avoid risks of abuse, of exploitation that these kids are particularly vulnerable to."
Even if there is a ceasefire, orphaned children could face a tough life.
Islamic law does not permit adoption, and children who have lost their parents may face legal disadvantages, such as a lack of inheritance rights, on top of the mental health impacts of losing family and growing up in a war zone.
The 'lonely refugees'
This week, an American surgeon told the United Nations Security Council about the terrible conditions facing children in Gaza, pointing to research from the War Child Alliance that shows nearly half of Gaza's children are suicidal.
"They ask, why didn't I die with my sister, my mother, my father? Not out of extremism, but out of unbearable grief," he says.
"I wonder if any member of this council has ever met a five-year-old child who no longer wants to live."
Dr Nedal J Jarada is the executive manager of Al-Amal Institute for Orphans, which is assisting thousands of families in Gaza. He says the tragic scenes in Gaza are forcing Palestinians of all ages to think about ending their lives.
He points to one recent example of a child pleading not to be given first aid, instead saying: "I want to die."
The number of children without surviving families has grown so dramatically that medical professionals have coined the term Wounded Child with No Surviving Family (WCNSF) to describe them.
A report from the International Rescue Committee published in June last year noted that some children were effectively living in hospitals because no one was able to care for them.
It notes that unaccompanied and separated children are at especially high risk of child labour, sexual and other forms of exploitation, engagement in illegal activities, neglect, starvation, recruitment, illegal adoption, discrimination, poor mental health and experiencing grief, depression and isolation, as well as disability, violence, injury and death.
Jarada estimates that Al-Amal — which means "hope" in Arabic — is currently looking after 25 minors who are what they call 'lonely refugees': children who have lost all family members.
The situation is tragic. Losing parents and extended family is a trauma that no care centre can ever replace.
'Their future is filled with uncertainty'
Unaccompanied or orphaned children are often referred to organisations such as Al-Amal, SOS Children's Villages, and UNICEF.
SOS is currently caring for 46 children in Gaza, ranging in age from a few months old to 17 years old.
The children are living in a displacement camp in Khan Younis, in the south of Gaza, after being evacuated from the not-for-profit's previous site in the southern town of Rafah, which was destroyed.
The former SOS Children's Village buildings in Rafah, before they were destroyed, likely in 2024. Source: Supplied / BO Holmberg/SOS Children's Villages International
The site of the former SOS Children's Villages buildings in Rafah in Gaza's south. Source: Supplied / SOS Children's Villages International
The conditions mean access to medical care is nearly impossible.
"Water for washing comes from a well inside the camp ... for drinking water, we depend on tanks that are filled weekly," she says.
"The scarcity of nutritious food is alarming, especially for younger children."
SOS Children's Villages International is helping to take care of children without parental care in Gaza. Source: Supplied / Mohammed Abed/SOS Children's Villages International
"They've lost homes, families, and their sense of safety," she says.
She worries deeply about what will happen to children like Karam, who don't have extended family to look after them.
"This is one of the most painful realities we face," she says.
"Some of these children were born outside of wedlock, and others have lost all known relatives during the war."
There are no immediate family members to turn to, and their future is filled with uncertainty.
Around 22 of the children SOS is supporting have no clear prospect of family reunification.
These include 10 whose entire families were killed during the war, for whom no extended family could be found, and 12 children born out of wedlock and abandoned at birth.
Thousands of children orphaned
The Palestinian Central Bureau of Statistics estimates 39,384 children have lost one or both parents since 7 October 2023.
UNICEF, a United Nations agency that provides aid to children worldwide, estimated that in February 17,000 children in the Gaza Strip were unaccompanied or separated from their families.
The agency's Gaza spokesperson Rosalia Bollen says Palestinian authorities report that almost 2,000 children have lost both parents.
While every child in Gaza has been scarred and traumatised by what they've witnessed during the conflict since 7 October 2023, Bollen says those who have lost parents are particularly vulnerable because they don't have the safety and care of their mother and father to rely on.
She's also concerned that some children are falling through the cracks and not receiving help, partly due to the continued and unpredictable nature of airstrikes, which forces people to continually relocate in search of safety.
At times, Jarada says Al-Amal has had to turn away unaccompanied children because it has no room or capacity to look after them, especially during evacuations.
It's devastating — it undermines the institution's mission and goals. I feel powerless and defeated.
The institute was established in 1949 and currently cares for and houses around 100 unaccompanied children within its compound of several buildings. But the facility has become overcrowded with more than 4,000 displaced people, who are not orphans, living there also.
There are thousands more living in tents outside, which the institute also assists.
The overcrowding has disrupted services for the orphans, including their education, because classrooms are now being used as shelters. Families are surviving on one meal a day, typically consisting of rice, pasta, and lentils.
Damaged buildings at al-Amal Institute for Orphans where thousands of families are seeking shelter. Source: Supplied / Al-Amal Institute for Orphans
"We've heard stories of kids that have lost their parents that basically, they're in a shelter with a whole bunch of other people and they're effectively adopted by the village," he says.
The practice of 'kafala'
While legal adoption is not permitted under Islamic law, an alternative system of care known as 'kafala' allows for orphaned children to be looked after by extended family members, reflecting strong family bonds in the culture.
It's a form of guardianship that ensures the child's well-being while preserving their identity and lineage where possible. However, the child's name remains unchanged, and they are not guaranteed inheritance rights.
Bollen says it's also a system commonly used when widowed women remarry.
"There's lots of solidarity and there's a very strong sense of community," she says.
UNICEF supports this arrangement by providing support to extended families who take on the care of unaccompanied or separated children.
Orphans at the al-Amal Institute for Orphans are living with thousands of other displaced families. Source: Supplied / Al-Amal Institute for Orphans
There is also hope that some unaccompanied children may eventually be reunited with family members.
"When people are pulled from underneath the rubble, there's actually a good chance of children becoming separated from their parents," Bollen says.
Parents will sometimes receive treatment at a different hospital or may be arrested and taken away.
Alreqeb says the war has made tracing families extremely difficult because relatives are also displaced or live in areas that are not accessible.
When extended family members can be found, SOS will work with the social development ministry to ensure a safe environment and that caregivers are capable of providing proper care.
This can include providing basic resources and psychosocial support.
"Even after reunification, we continue to follow up with these children to monitor their well-being and intervene when needed," Alreqeb says.
Children left behind
Kafala isn't an option for all children left parentless in Gaza.
Some children don't have extended family to rely on, while, according to SOS, others have been abandoned due to being born out of wedlock.
These children are often placed in orphanages and will likely grow up in institutionalised care.
"Sadly, they're up for a really tough life," Othman says.
There's so many challenges for them. [Many] have seen a lot of violence, they've lost their parents, they've seen their entire world crumble around them. It's very likely they're going to have really serious PTSD.
Eva Alisic, professor of child trauma and recovery at the University of Melbourne, says people with lived experience of trauma push back against the idea of leaving it behind.
"We hear from people that it goes in waves," she says. "There may be relatively stable times, and there may be times, when you partner [up], when you [have] children, that things come up again."
SOS takes care of children until they achieve economic independence and the support does not necessarily stop when they turn 18 years old.
"We see that people without parental care often have a very hard time when they turn 18," Videt says.
"You need to have some adults you can trust."
Although these children do not have inheritance rights under kafala, Videt says they receive social and financial support from the organisation throughout their development.
"This enables them to build a stable future, even in the absence of inheritance," he says.
It's also possible for these children to be fostered by a family.
There's hope that children like Karam, who, despite growing up in a war zone, is healthy and even has four baby teeth, will one day be fostered.
"If the fostering process works well and conditions improve, there is hope that we can identify a suitable family," Videt says.
Children who have lost their entire families during the war in Gaza face a future filled with uncertainty. Source: Supplied / SOS Children's Villages International
"This can take the form of legal disadvantages, such as lack of inheritance rights or limited access to alternative care pathways, as well as deep-rooted social stigma, particularly for children born out of wedlock or those separated by conflict," he says.
In contexts like Gaza, where formal adoption is not permitted and family tracing is often impossible due to war, these children can face further marginalisation as they grow up.
"The report notes that such discrimination is rarely isolated, but often intersects with other factors such as poverty, displacement, and disability, placing these children at heightened risk of exclusion throughout their lives," Videt says.
Jarada doesn't believe orphans in Gaza will face formal discrimination, but they will carry the burden of being labelled and defined by their loss.
"This stigma of deprivation is lifelong. It's hard to describe, but it is perhaps the most painful kind of societal exclusion," he says.
What about international adoption?
Bollen says UNICEF is not aware of any formal international adoption scheme and it's not something it would support at this stage.
"There have to be certain safeguards in place for international adoption to take place in a dignified and safe manner, and there has to be procedure [to examine] whether it's in the best interest of the child," she says.
"With the ongoing war in Gaza, those safeguards can't be met."
She says once there is a ceasefire, there will likely be discussions on institutionalising care for children.
Alisic says it's clear from the history of groups such as Australia's Stolen Generations — where Aboriginal and Torres Strait Islander children were forcibly removed from their families — that disconnecting children from their culture can have consequences.
"If children are sent to a neighbouring country because there's family there, and the children want to go, and they are safe, physically and emotionally, then that can be a fantastic outcome ... but there are so many factors and considerations," she says.
Othman says that while adoption is not favoured under Islamic guidance, the unprecedented scale of human loss may lead to exceptions.
"Perhaps things that didn't happen too much before start happening because of the gravity of the situation," he says.
Many families have lost everything
Regardless of whether children are being cared for by families or orphanages, they are facing enormous challenges in their everyday lives just to survive.
Bollen says children have been robbed of their childhoods.
I've seen children fighting with each other over a bag of bread. I've seen [older] children fighting with adults.
"It's unimaginable the situation that the children in Gaza are in," Bollen says.
UNICEF, SOS, and the Al-Amal Institute are among the numerous organisations that have repeatedly called for a ceasefire.
This week, Israel agreed to a revised deal brokered by the United States, which is being reviewed by Hamas.
"What we are doing on the ground is really just a drop in the ocean," Videt says.
"This war has to stop.
"The price that children are paying is way too high."
Readers seeking crisis support can ring Lifeline on 13 11 14 or text 0477 13 11 14, the Suicide Call Back Service on 1300 659 467 and Kids Helpline on 1800 55 1800 (for young people aged up to 25). More information and support with mental health is available at beyondblue.org.au and on 1300 22 4636.
Embrace Multicultural Mental Health supports people from culturally and linguistically diverse backgrounds.
