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[Editor’s Note: This is the third post in a series of case studies describing the bureaucratic and political barriers to medical access outside of Gaza and the stories of three individual Gazan patients. The first post can be found here, and the second can be found here.]

Below is one PHR-Israel case study representing a current trend in the provision of exit permits to Gazans for medical reasons. Case studies such as this one have been provided by PHR-Israel to raise awareness about border restrictions in Gaza that prevent Gazan patients from receiving critical health care. Full names are withheld for reasons of medical confidentiality and can only be released for purposes of access to medical care.

Case Study 3

(Provided by PHR-Israel)

August: Diplomatic pressure fails to reverse a prohibition on medical access from Gaza
Yousef I.A.L, male, 41, is a father to six children from the Jabalia refugee camp in the Gaza Strip. In 2005, Yousef underwent surgery replacing a mitral valve and also removing a cancerous tumor from his heart. He currently suffers from chronic renal failure and is awaiting a kidney transplant. He also suffers from recurrent venous and arterial thrombosis, including pulmonary embolism and critical ischemia in the legs and hip, from diabetes, high blood pressure, and nerve atrophy which began in childhood. Over the past three months, Yousef has lost over 30kg of his body weight and together with the overall deterioration in his physical condition there is a concern for the recurrence of cancer in his body. Read more

[Editor’s Note: This is the first of three posts covering a series of case studies describing the bureaucratic and political barriers to medical access outside of Gaza, focusing on the stories of three individual Gazan patients. Look for the next case study on Monday, October 26.]

The Israeli-imposed border restrictions in Gaza continue to choke off needed medical assistance for Gazan patients. Humanitarian and medical aid can barely squeeze into the blighted region, and sick Gazans with referrals for medical treatment outside of Gaza may not be granted permission to exit.

Additionally, the Gaza War earlier this year triggered major setbacks in health sector operations, according to data published by the World Health Organization in July 2009. Bureaucratic complications and political disputes led to delays in processing applications, culminating with the closure the Referral Abroad Department from March 22 to April 27. The report indicates that in the six months following the war, only half of the applications to exit Gaza via Erez Crossing for medical reasons were approved. The only other way out — the Rafah Crossing leading into Egypt — is open infrequently and only for short periods of time.

Physicians for Human Rights-Israel, a Jaffa-based Israeli organization, has been documenting these permit constraints in order to advocate for patients in tremendous need of care outside of Gaza. According to PHR-Israel, more than 100 Gazan patients apply to PHR-Israel for assistance in medical access from Gaza every month.

Below is one PHR-Israel case study representing a current trend in the provision of permits. Case studies such as this one have been provided by PHR-Israel to raise awareness about border restrictions in Gaza that prevent Gazan patients from receiving critical health care. Full names are withheld for reasons of medical confidentiality and can only be released for purposes of access to medical care.

Case Study 1

(Provided by PHR-Israel)

May and June: Bureaucratic hurdles decreased medical access at Erez Crossing. These months were characterized by severe delays in the handling of Palestinian patients’ requests for permission to exit Gaza for medical care.

Issam Z, male, 44, a resident of Gaza, suffered from severe ischemic heart disease. He was referred for open heart surgery – unavailable in Gaza – in Al Takhasussi hospital in Nablus, West Bank. However, although he had all necessary documents by February 2009 (referral letters from both hospitals and a financial undertaking from the PA to cover the costs of the procedure), he did not succeed in coordinating his exit from Gaza.  Since the Palestinian coordinating mechanism for medical permits was not functioning throughout March and April, his request was not forwarded to the Israeli side, while at the same time, the Israelis were refusing to process applications direct from the patients.

In late April Issam applied to PHR-Israel for assistance, who appealed to the Israeli coordinating authority at Erez Crossing, on April 27, 2009, asking for a speedy processing of the patient’s request to exit Gaza, in the light of his condition and the lack of a Palestinian go-between. On May 5 the Israeli authorities informed PHR-Israel that the Palestinian coordinating mechanism had returned to functioning and therefore they were stopping their handling of his application. They demanded that Issam re-apply via the Palestinian side. On May 14 the Israeli army informed PHR-Israel that the application for exit from Gaza had been approved, only to reverse this decision without explanation several days later. On June 3, after several vain attempts by the patient to re-apply for exit, PHR-Israel demanded of the Israeli army that they expedite the process of dozens of cases that had been delayed in this way since May, including that of Issam. On June 7 the patient’s family informed PHR-Israel that Issam had died of his illness at his home in Gaza.

A new report from Breaking the Silence describes the testimonies of 30 Israeli soldiers, many of whom stated they were encouraged by military leaders to “shoot first and worry about civilians later” during the Israeli military offensive into the Gaza Strip earlier this year. The soldiers, all of whom remained anonymous, also reported using Palestinians as human shields and bombing buildings indiscriminately. One soldier said of white phosphorous, a lethal incendiary agent found to have been used against civilians: “[I]n training you learn that white phosphorus is not used, and you’re taught that it’s not humane. You watch films and see what it does to people who are hit, and you say, ‘There, we’re doing it too.’ That’s not what I expected to see. Until that moment I had thought I belonged to the most humane army in the world.”

Groups conducting investigations on the Gaza Strip include Amnesty International, Human Rights Watch, the International Committee of the Red Cross, the UN Human Rights Council, and the Palestinian Center for Human Rights. The results of these investigations have generally indicated that “Israeli forces inflicted civilian death and destruction on an unjustifiable scale” during the assault. Amnesty International estimated that 1400 Palestinians (including 300 children) were killed during the attack, although Israeli officials put the number at closer to 1100 and stated that most of those deaths were Hamas terrorist operatives. The Israeli government has not cooperated with any investigations and vehemently denies these claims; a spokeswoman for the Israeli military stated recently that their forces went to “extraordinary lengths” to avoid civilian deaths during the offensive. Read more