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Denying access to health is a silent tool of occupation

The Palestinian health system is fragmented into three segregated territories — East Jerusalem, Gaza and the West Bank — and Israel controls access to and from each of them.

By Dana Moss

A disabled Palestinian man approaches a ‘humanitarian lane’ at the Israeli army’s Qalandiya checkpoint separating Ramallah from Jerusalem during Ramadan, June 10, 2016. (Oren Ziv/Activestills.org)

A disabled Palestinian man approaches a ‘humanitarian lane’ at the Israeli army’s Qalandiya checkpoint separating Ramallah from Jerusalem during Ramadan, June 10, 2016. (Oren Ziv/Activestills.org)

While discussions over health in Israel often focus on the healthcare provided to Israeli citizens, Palestinians in the occupied territories struggle to secure even the most basic components of their right to health. On World Health Day, it is important to remember that the obstacles to healthcare faced by Palestinians are a more silent side of the occupation, less visible than the construction of settlements or the razing of homes, but with a deep, lasting impact for those touched by the machinery of the occupation.

The Palestinian health system is fragmented into three segregated territories — East Jerusalem, Gaza and the West Bank — and Israel controls access to and from each of them. This system requires Palestinian patients to obtain a permit whenever they need to travel for medical treatment outside of their local area.

Such travel is particularly crucial for Palestinians in Gaza and the West Bank. Certain medical equipment, physician specializations and treatments are only available in hospitals in East Jerusalem. In Gaza the situation is largely a result of the blockade and Israel’s restrictions on the import of dual use items, which prohibit certain medical materials from entering the Strip. In the West Bank, one of the major factors is Israel’s historical lack of investment in medical infrastructure.

It has been increasingly difficult for Palestinian patients in Gaza to secure exit permits in order to access treatment in recent years. The World Health Organization (WHO) reported a drop in the rate of approved applications from 92.5 percent in 2012 to 77.5 percent in 2015. According to the WHO’s latest report in January 2017, more than half of applicants were denied permits or had their permits delayed.

This reality takes what should be ordinary stories of medical access and turns them into absurd tragedies with painful consequences for the Palestinian patients. Here are three of those stories from the Gaza Strip:

Asraa is two and a half years old. At age one, Asraa developed a high fever that didn’t subside, and was taken to the European Hospital in Gaza. A large, pus-filled wound was discovered on her leg, which prevented her from moving around, and doctors decided to conduct a surgery that required full anesthesia. A short while later, the wound became infected once again; her leg swelled and she developed the same high fever. Asraa had to undergo the same routine: surgery, anesthesia, discharge, home. This happened another 10 times. “Asraa is no longer quiet,” says her mother. “She is always crying and nervous and crying, she does not sleep at night, and I’m sure it’s the anesthetic she gets when she undergoes surgery each time.”

Doctors recommended transferring Asraa to Al-Makassed Hospital in East Jerusalem for a better diagnosis and treatment. An appointment was booked for January 2 and her parents submitted a permit request to exit Gaza. The Israeli army sent a reply simply stating that the request was “under consideration.”

Asraa missed her appointment and remains in Gaza. She still suffers from the same condition and has now undergone another three operations, once again under full anesthesia.

Hazar, 35, was diagnosed with thyroid cancer, which requires treatment that is unavailable in the Strip. She initially received treatment in Egypt, but when crossing through Rafah became impossible, she was referred to Al-Ahli hospital in Hebron in 2014. Her permit request was initially refused by the Israeli authorities, but she was later brought for an interrogation, after which her request was approved.

Al-Ahli hospital referred Hazar to Ichilov Hospital in Tel Aviv, saying they didn’t have the necessary means to treat her and that there was a risk that the disease had spread. Hazar then applied for an exit permit to receive treatment in Ichilov, but was denied. She applied three more times, and was refused each time.

The permit regime also impacts patients indirectly by placing travel restrictions on doctors and other medical service providers. Dr. Suheil Aeish has worked at Al-Makassed Hospital in East Jerusalem since 1997, and today heads the Molecular Clinic which provides genetic testing for patients, including pregnant women. However, in August 2016, Professor Aeish was denied an exit permit and has since been unable to leave Gaza to attend to his patients.

As a department head, there is no one in place who can replace him at Al-Makassed. Less urgent cases are being delayed. Dr. Aeish is trying to help some of his patients via Skype but regular technical problems are compounded by Gaza’s electricity shortages, and Dr. Aeish can only see test results and communicate verbally intermittently, as opposed to accompanying patients through the entire medical process. According to Dr. Aeish, several babies were born with birth defects due to his inability to fully attend to his patients.

Dana Moss is the international advocacy coordinator at Physicians for Human Rights-Israel, which works to guarantee the right to health of all those under Israel’s control.

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    1. carmen

      This is genocide, slow, slow genocide.

      Reply to Comment
    2. carmen

      Bring on the ICC. This is a war crime.

      [PDF]Right to health: Barriers to health access in the occupied Palestinian

      Health Under Occupation: Constraints on access to healthcare in the …

      Health care in the Palestinian territories – Wikipedia
      Barriers to access[edit]

      A 2012 study commissioned by the World Health Organization identifies the Israeli Military’s blockades of the West Bank and Gaza Strip as a major health challenge.[29] In both Gaza and the West Bank, restriction of movement is such that individuals cannot exit these respective regions without the permission of Israeli authorities.[30] Hospitals in the West Bank and in Gaza are sometimes not equipped to deal with more advanced medical problems and procedures. In such cases, doctors will refer their patients to more sophisticated treatment centers in Israel. Such treatment is often delayed by the Israeli bureaucratic process which has to approve requests. Even in true emergency cases, ambulances traveling from the Palestinian territories to hospitals in east Jerusalem are often delayed or denied at security checkpoints in a manner that places patients at risk.[31] Moreover, within the West Bank, mobility is limited as residents must pass through Israeli checkpoints in order to travel in between various West Bank cities. This means that West Bank residents have trouble accessing health care providers located in other nearby West Bank towns. The limited mobility has even more serious ramifications in emergency situations wherein ambulances traveling in between West Bank towns experience delays.[32]

      According to the WHO, the residents of Gaza are in a particularly precarious position given Israeli tensions with the de facto Hamas government. Hamas claims that Israel has severely obstructed the flow of goods to that region since 2007, preventing the importation of essential medical equipment and prescription drugs. In recent years, periodic battles between Hamas militants and the Israeli Military have resulted in much damage to the medical infrastructure in Gaza which cannot be readily repaired due to limitations on the amounts of construction material being imported to the region. According to the Israeli government, it has imposed no restrictions whatever on medical supplies and equipment since 2010. In any case, supplies could be imported through Gaza’s border with Egypt.[33] Additionally, Palestinian officials maintain that the quality of health care professionals in Gaza has been hampered as they are often not permitted to travel abroad to conventions and training sessions where they can advance their skills and knowledge.[34]

      Reply to Comment
    3. Pepper Wingate

      Strange, I am hearing a different theme. It seems that Gaza officials are collecting bribes from those who wish to access Israeli medical services. Who actually is controlling Gaza access to Israeli medical services? Where does the holdup actually occur?
      Isn’t it strange that despite Gazan rhetoric to destroy the “Zionist entity” they still rely on Israeli medicine and claim hardship if they are prevented from accessing Israeli medical services. Where else in the world is there a border so porous that despite a state of war, an enemy combatant can access the medical services of the opponent state?

      Reply to Comment
    4. Miran

      Sorry but i see that as a silent tool of slow genocide ethnic cleansing of the Palestinians,,, “the so called occupation”

      Reply to Comment
    5. Bruce Gould

      The Israeli human rights group Gisha has good information on healthcare in Gaza – here’s a report on dental care in the strip and how Israel is constantly messing with medical supplies, supposedly because some of them are “dual use” – read the report to see how nonsensical this justification is:


      Reply to Comment
    6. Ben

      This is the cold denial or deliberate stalling of medical care based on ethnicity. It is apartheid. It is also the denial of medical care to protected persons under occupation, while at the same time moving heaven and earth for any settler in the same occupied territory needing medical care. Based on ethnicity. This is an unambiguous violation of the Fourth Geneva Convention and hence a war crime.

      Reply to Comment
      • i_like_ike52

        Not true, Israeli Arabs are entitled to exactly the same medical care in the same facilities as Israeli Jews.
        Regarding relatively poor medical care in Gaza, I suggest everyone ask why the HAMAS terrorist regime why they invest in rockets, attack tunnels and other assorted weapons instead of in their human infrastructure. If there is a “slow genocide”, it is the terrorist regime that is inflicting this on its own people, viewing them as nothing more than cannon fodder to fulfill the Salah ed-Din dreams of glory of their heartless rulers, who couldn’t care less about their people’s welfare.

        Reply to Comment
        • Ben

          I’m not talking about “Israeli Arabs.” I’m talking about all the Arabs under Israel’s occupation within the space comprising Israel (where are the borders?) and the territories it occupies. That system, in total, is an intricately arranged and meticulously maintained apartheid system.

          Reply to Comment