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.

On May 13, 2009, Yousef was referred by the Palestinian Health Ministry for treatment at Al Makassed Hospital in East Jerusalem after the hospitals in Gaza could not provide him with the required care. The patient was since invited five times by Al Makassed Hospital, three times by the Department of Cardiology (June 21, July 1, and July 19) and the other two by the Department of General & Vascular Surgery (June 3 and June 18). Yet Yousef was not able to attend any of these appointments. The Israeli secret police (ISA/GSS/Shin Bet) rejected three applications that Yousef had submitted to the Israeli authorities at Erez, based on a “security prohibition” against him. In addition, an application to exit Gaza submitted by the Palestinian coordinating mechanism in May 2009 did not receive any response from the Israeli army. Only after PHR-Israel contacted the army in July 2009 it was told that the application had been denied by the secret police. Applications submitted by PHR-Israel on behalf of the patient on July 21 and August 12 were also denied on the same grounds.

To assess the patient’s medical condition, PHR-Israel consulted with two of its volunteer Israeli medical doctors who are experts in the fields of Yousef’s condition. These physicians were provided with his medical files. Professor Raphael Walden, an expert on vascular medicine and Deputy Director at Sheba Medical Center in Tel Hashomer, wrote that “treating the patient in Gaza is impossible and his life is in danger….” Prof. Dina Ben Yehuda, Head of the Hematological Department at the Hadassah Medical Center in Jerusalem, wrote that “the patient requires evaluation in a tertiary hospital to find the reason for his thrombosis as well as for the possibility of performing surgery on his ischemia.” Despite the fact that this information was brought to the attention of the Israeli military authorities and secret police, Yousef’s applications were denied. It is worth mentioning that Yousef entered Israel and East Jerusalem at least seven times in the past to receive treatment. On August 19 PHR-Israel applied to the embassy of the EU presidency (Sweden) in Tel Aviv as well as the Norwegian embassy, to members of Knesset and to well known public personages in Israel to apply pressure on the Israeli authorities to enable access to lifesaving care to this patient. One week later, the Israeli coordinator of operations in the OPT (COGAT), Mr. Uri Singer, informed the embassy representatives by telephone that their response to this request was negative. The patient remains in Gaza in imminent danger of his life.

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.

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.

Many of these reports have also concluded that in the six months since the Israeli military attack known as Operation Cast Lead, inhabitants are still unable to recover from the devastating attacks. The lack of construction materials, medical supplies, and other humanitarian aid allowed into the area are prolonging reconstruction and recovery. Insufficient supplies, an overloaded water and sanitation infrastructure, and unavailable health care continue to thwart recovery efforts and attempts to improve public health. Unemployment in Gaza was at 44% in April of this year, partly because 96% of all industrial businesses have shut down due to restrictions on import and export of goods. Injured or ill patients who require medical attention outside of Gaza (medications and equipment are often scarce in hospitals, as little is allowed in) have to wait for months to receive permits to leave, and many are never allowed to leave at all.

For more information:

Hamas rocket attacks on civilians unlawful

Seven Palestinians die in Gaza tunnel accident

Impunity for war crimes in Gaza and southern Israel a recipe for further civilian suffering

IDF soldiers give testimonies to counter Gaza war crimes claims

Hamas bends to pressure in Gaza and abroad

Hamas’ deadly campaign in the shadow of the war in Gaza

Gazan doctor and peace advocate loses 3 daughters to Israeli fire and wonders why