Gaza, home to 2.3 million people and one of the most densely populated places in the world, is currently under siege. Clean water, food and fuel are running out, electricity hasn’t been reliable in days. Bombs continue to fall, and the Israeli army has told people in the north to flee south.

Israel has closed two border sites. And the Rafah crossing, on Gaza’s southern border with Egypt, is also shuttered.

There is no way out.

Up to 600 Americans remain in Gaza, according to the State Department.

Among them, Haneen Okal, a Palestinian American from New Jersey, who told NBC News Saturday that she had been at the crossing all weekend after she received notice from American officials to stay close.

The State Department previously warned that “there may be very little notice if the crossing opens and it may only open for a limited time.”

Okal said Sunday that she was “waiting for it to open so we can get out of here.” She added that she was worried that officials wouldn’t let her cross with her newborn son, Elias, because he doesn’t have a passport yet. She added that she had been applying for passport appointments in Tel Aviv before the war began.

An already ‘unstable’ border crossing

The Gaza Strip has been under a military blockade since 2007, limiting all free movement to and from the area.

There are two main crossings in and out of Gaza for civilians: Erez, shared with Israel at the northern side of Gaza, and Rafah, which sits next to the Sinai Peninsula in northeast Egypt. Both have been subjected to frequent and prolonged closures over the years.

A third crossing near Rafah into Israel, Kerem Shalom, is a commercial junction and the sole passageway for goods into Gaza.

Mai Abushaban, a Palestinian American citizen, told NBC News Friday that she had crossed the Rafah border 10 times and even under the best circumstances, the travel across isn’t as simple as one may think.

“It’s not like the border between the United States and Mexico,” she said. “It’s not efficient, it’s not reliable, it’s dangerous and unstable.”

Egypt had opened the Rafah crossing indefinitely in 2021 after negotiations with Palestinian leadership, with both Hamas which governs the Gaza Strip, and Fatah, it’s more secular and moderate rival which controls the Palestinian Authority in the West Bank. 

But it closed last week.

Egyptian officials said they never closed the crossing, a claim which Palestinian authorities have disputed. The crossing itself also sustained physical damage from Israeli airstrikes on Gaza.

The border to Egypt likely remained closed because of concerns of mass exodus from Gaza by anguished refugees, according to H.A. Hellyer, a senior associate fellow specializing security and geopolitics in at the Royal United Services Institute, a London based think tank. Historical precedent shows Palestinian refugees who flee are unlikely to be able to return, he said.

“It’s extremely understandable [which is] why the Egyptians and why a lot of the neighboring states are very reluctant to say, ‘Yeah, sure, we’ll take them in,’” Hellyer said. “Because they know that they’ll never be able to go back.”

It’s entirely appropriate to ask why Rafah is still closed, Hellyer said, noting that Israel has control over other crossings.

“I don’t hear here at the same volume of calls upon Israel to open up its own border crossings in order to receive Palestinian civilians that have nothing to do with Hamas with that attack,” Hellyer said. “And there should be.”

An elusive deal

Safe passage out of Gaza is dependent on a multinational deal and the cooperation of Hamas.

U.S. officials said they are working with partners in Egypt, Israel and Qatar to get the border reopened for a short period of time. Egyptian officials have also expressed concerns that any deal should come with a guarantee that humanitarian aid into Gaza, one U.S. source told NBC News.

But there’s no guarantee that Hamas, which urged Palestinians not to leave Gaza, will open their side of the crossing, three U.S sources with knowledge of the situation, told NBC News.

Secretary of State Antony Blinken landed in Cairo on Sunday, where he told reporters that one of his top priorities is to “address the humanitarian crisis that exists in Gaza.” He defended Israel’s “right to defend itself” but also noted that the importance of preserving innocent life.

“As I said in Tel Aviv, as President Biden has said, the way that Israel does this matters,” Blinken said. “[Israel] needs to do it in a way that affirms the shared values that we have for human life and human dignity, taking every possible precaution to avoid harming civilians.”

Desperation mounts

In Riverside, California, the Kaoud family sits yearning for any hope that their 12 relatives trapped in Gaza will be able to return home safely as Gaza is bombarded with strikes.

Hala Kaoud said her father, Nezam, called to ask for “whatever we can do to help them.”

“He said it’s really dangerous to go outside,” Hala said. “He said the bombs aren’t stopping. He told me to tell you that our family is still stuck in north Gaza will children. He’s begging for help.”

Nezam Kaoud is also there with his four brothers and nephew — Hesham, Jamal, Mohammad, Esam and Esam’s son, Ameer.

Jamal Kaoud’s daughter, Shamiss, said her father and uncles were supposed to return from a monthlong visit on Oct. 21, but the family frantically began contacting the U.S. Embassy in Jerusalem when the war broke out last week.

American citizens inside Israel will given passage out of Haifa by sea on Monday morning, according to the U.S. Embassy in Jerusalem. Haifa is located on the northwest coast of Israel, but those in Gaza have no way of getting there.

Esam Kaoud’s daughter, Helal, told NBC News that her cousin Sarah El Najjar is also stuck with her husband and their four children, the youngest of whom is only 2 years old. But there was no way for the family to leave the northern Gaza, where bombing and shelling are the most aggressive.

“The Embassy messaged her that they advise her to go to the south but also basically said you either make it down there safe or don’t, they won’t provide other assistance,” Helal Kaoud said. “It is not safe for her to make the trip so they are stuck there.”

Jamal Kaoud has a heart condition that requires a pacemaker and defibrillator. His medication is running out, his daughter said.

None of the family located in Gaza were notified of Saturday’s alert about the Rafah crossing opening, according to Shamiss Kaoud, and it was family based in the U.S. who told them about it.

The Kaoud brothers made their own way to Rafah, only to be turned away.

“So basically, the United States is refusing to help their citizens that are trapped in the Gaza Strip,” Shamiss Kaoud said, “but they are willing to help any and all U.S. citizens leaving from Israel.”