Photo © 2008 Fred Abrahams/HRW

The recent humanitarian release of Libyan citizen Abdalbaset al-Megrahi from prison in Greenock, Scotland, because of his poor health, and his subsequent “hero’s welcome” in Libya is strikingly incongruous when compared with the tragic fate of Fathi al-Jahmi, a Libyan prisoner who also suffered from poor health, including coronary artery disease, congestive heart failure, hypertension, and diabetes.

Libyan authorities held Mr. al-Jahmi prisoner in Tripoli on two occasions for a total of six and a half years. His “crime”? The peaceful exercise of his fundamental rights of freedom of expression and association. He advocated for democratic reforms and free elections, as have many other Libyan citizens whose outspoken opinions have led to their imprisonment. Additionally, Mr. al-Jahmi had the audacity to directly criticize the Libyan government and its leader of 40 years, Colonel Mu’ammar al-Quaddafi.

Mr. al-Jahmi’s second arrest took place in March 2004. In February 2005, a medical doctor representing Physicians for Human Rights (PHR) visited him in a special detention facility and reported that he suffered from diabetes, hypertension, and heart disease. PHR “called for al-Jahmi’s unconditional release and access to medical care.”

However, following a secret trial in May 2006 that failed to meet fundamental fair-trial standards, the court ruled that Mr. al-Jahmi was mentally unfit to stand trial. Confinement in a psychiatric hospital, for an entire year, followed this ruling. He was denied both medical care and family visits. In mid-2007, after a diagnosis of congestive heart failure, the Libyan authorities granted Mr. al-Jahmi a transfer to Tripoli Medical Center and later claimed he was a free man.

PHR and Human Rights Watch representatives, including PHR advisor Dr. Scott Allen, visited Mr. al-Jahmi at the Tripoli Medical Center in mid-March 2008 — a repeat visit facilitated by the Quaddafi Foundation, which is headed by Col. Quaddafi’s son, Saif al-Islam. They found that Mr. al-Jahmi’s health had improved with better medical care and that he was not “mentally disturbed.” However, his health was still substantially worse than at the time of his arrest, and he remained very ill, so much so that the PHR doctor recommended immediate invasive testing and suggested possible angioplasty or bypass surgery. Because Mr. al-Jahmi did not trust the Libyan authorities, the PHR doctor said that it could prove necessary to perform such follow-up procedures abroad.

When the two rights organizations’ representatives asked Mr. al-Jahmi if he was free to leave the medical center, he said no. When they asked him if he wanted to go home, he said yes. They also reported that security officers controlled access to visitors and that neither Mr. al-Jahmi nor his family could “freely make decisions about his medical care, due to real or perceived pressure from the government.”

Mr. al-Jahmi’s family subsequently reported that he was denied regular nursing care and critical medical treatment. Guards flanked his door and confined him to his room, which they locked from the outside. During the family’s daily visits, limited to two hours, his wife and children brought him food and did what they could to make him comfortable. But they also watched his health steadily deteriorate, and by early 2009, they said he was no longer able to move, eat, or drink without assistance and could speak only with great difficulty. In early April 2009, Mr. al-Jahmi’s family requested his transfer to the intensive care unit, but this request was not granted until, on May 3, he lapsed into coma.

The International Human Rights Network of Academies and Scholarly Societies, of which I am executive director, and many other concerned groups, sent repeated and urgent appeals for Mr. al-Jahmi’s release on humanitarian grounds for health reasons to Col. Quaddafi and Libyan government authorities. We did not receive a single direct reply to our pleas. Only through an international organization, acting as an intermediary in a private process between our group of national academies and the Libyan government, did we learn that the Libyan authorities claimed, contrary to information we deemed reliable, that Mr. al-Jahmi was a free man, in the hospital of his own choice, and receiving appropriate medical treatment.

Subsequently, we learned from Mr. al-Jahmi’s brother that on May 5 of this year the apparently frantic Libyan authorities had Mr. al-Jahmi flown to the Arab Medical Center in Jordan, presumably to avoid the accusations and humiliation that would follow if they allowed him to die in a Libyan prison, as rights organizations and others had feared they would do. Mr. al-Jahmi was taken out of the country, still in a coma, and in the company of security guards who did not take along any of his essential medical records. Only his son was permitted to accompany him. Mr. al-Jahmi reportedly never regained consciousness. He was 68 years old and an internationally recognized democracy advocate and prisoner of conscience when he died on May 20, far away from his home and family, with Libyan security guards looking on.

The Libyan authorities callously denied Mr. al-Jahmi the medical treatment he required during much of his imprisonment and the last months of his life. Then, when clearly on his death bed, in an apparent attempt to avoid embarrassment, they took him away from his home and family to die in Jordan. Thus, it was a cruel and deeply offensive irony when, just four months later, another seriously ill internationally known Libyan prisoner was flown by Libyan authorities, in the company of Col. Quaddafi’s son, to a “hero’s welcome” in Tripoli. That man was Abdalbaset al-Megrahi, a convicted mass murderer, known to the world as the Lockerbie bomber.

The authorities in Edinburgh, Scotland, said they had released Mr. al-Megrahi because he was dying of prostate cancer and should be permitted to spend what time he had left at home, in the company of his family. Col. Quaddafi’s son reportedly said he was deeply grateful “to the Scottish government for taking this brave decision [Megrahi’s release] and for taking into account the special humanitarian circumstances.”

If the Libyan authorities had shown any semblance of courage or understanding or compassion toward Mr. al-Jahmi, their own citizen and a truly courageous and selfless human being, and had responded to the many repeated and urgent appeals from around the world for his humanitarian release, surely this brave and clearly innocent man would be alive today. Instead, the Lockerbie bomber is now at home among his family and friends, benefiting from the kind of medical care that could have saved Mr. al-Jahmi — a man who never got the hero’s welcome he so deserved.

This blog post was endorsed by the Executive Committee of the International Human Rights Network of Academies and Scholarly Societies.

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.