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Medical care for children in Gaza headed for the dark ages

What ails the Gaza Strip is not an incurable disease. We know the antidote that could immediately begin rebuilding the structural determinants of children’s right to life and health.

By Priscilla Wathington

An injured Palestinian child awaits treatment at Al Shifa Hospital in Gaza City following Israeli attacks, July 30, 2014. So far, Israeli attacks have killed at least 1,300 Palestinians and injured more than 6,900. At the same time, 56 Israeli soldiers have been killed, as well as three civilians in Israel. (Basel Yazouri/Activestills.org)

An injured Palestinian child awaits treatment at Al Shifa Hospital in Gaza City following Israeli attacks, July 30, 2014. (Basel Yazouri/Activestills.org)

Children in the Gaza Strip today are more likely to develop health problems than ever before but less likely to access medical care. And as the need surges, Israel is granting a diminishing percentage of Palestinians permission to exit Gaza for medical treatment.

Imagine you are a parent in the Gaza Strip and your child falls ill, seriously and unexpectedly. That is, assuming your child makes it through her first year of life, which is no longer a given considering the rising infant mortality rate.

If the case is atypical, her condition may be undiagnosable in the Gaza Strip. Successive wars combined with a decade of Israel’s land, sea, and air blockade have kicked medical care in Gaza back into the dark ages. Israeli air strikes destroyed medical infrastructure, and the blockade has made it tough to keep up with restocking basic supplies. Access to cutting edge technologies and the expertise to go with them are a pipe dream.

Just to get a diagnosis, you would have to find a way to get your kid out of the Strip. It is about 50 miles to East Jerusalem, to the Palestinian-run Al-Maqassid hospital. But as Google Maps will tell you, that is an impossible trip.

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The problem is, exiting the Gaza Strip through Erez crossing for any reason — including for medical care — requires a permit from the Israeli Ministry of Defense. You would need to prove your child’s need cannot be met inside Gaza, request that the Palestinian Ministry of Health approve the expenditure, book an appointment at the receiving hospital, then secure permission for you and your child to cross the Israeli-controlled Erez border.

All this before the journey has even begun.

It doesn’t require any expertise to see that these are the ingredients of an unwieldy, inefficient system that denies children the right to adequate medical care. And while there are faster tracks for urgent cases, medical delays should be measured in seconds, not weeks.

If this were not enough, last year Israel approved the lowest percentage of medical exit permits to Gazans since the World Health Organization began tracking the figure in 2008 — 54 percent. In 2012 Israel approved 92.5 percent of medical travel permits.

Palestinians cross into Gaza at the Erez Crossing between Israel and Gaza on September 3, 2015. (Yonatan Sindel/Flash90)

Palestinians cross into Gaza at the Erez Crossing between Israel and Gaza on September 3, 2015. (Yonatan Sindel/Flash90)

In many cases, there is no outright denial. Just a non-response, which means you have to return to the start of the bureaucratic maze, if you can find it. In other cases, Israeli authorities might clear your child for travel, but not you: just your child, seriously ill, unable travel alone.

Born with cerebral palsy and a cluster of other complications, Aya Abu Metleq was a victim of this torturous system. When Defense for Children International – Palestine (DCIP) visited the family last spring, her father, Ghaleb, said that after a recent surgery, Aya stopped gaining weight.

“My wife and I struggled a lot and had to watch her all the time because she would spasm and we had to resuscitate her continuously,” Ghaleb said.

Between February and March 2017, the family attempted to take Aya to Al-Makassed hospital in East Jerusalem. Each time they received notice that either Aya or her father’s application was still under evaluation. Just 10 days before her third appointment, Aya died at age five.

As this man-made crisis continues to punish every Gaza resident, more and more Palestinians, including children, need to exit the Strip for any hope of adequate care. Nabhan al-Masri, 10, previously received permits to exit Gaza for his metabolic disorder appointments. In January, he found his path blocked for no known reason, his family said.

Shada Ardaa, 9, was wounded by an Israeli air strike in Rafah, Gaza strip, An-Najah hospital, Nablus, West Bank, August 5, 2014. (Ahmad Al-Bazz/Activestills.org)

Shada Ardaa, 9, was wounded by an Israeli air strike in Rafah, Gaza strip, An-Najah hospital, Nablus, West Bank, August 5, 2014. (Ahmad Al-Bazz/Activestills.org)

To be sure, Palestinian authorities are not blameless here. Last year’s political strife between the Ramallah-based Palestinian Authority and the Gaza-based Hamas government cost children dearly. Electricity shortages caused severe dips in medical services; hospitals went dark and sanitation standards plummeted. DCIP also documented six cases in 2017 where children died after Palestinian authorities delayed or denied their requests for treatment coverage in the West Bank or East Jerusalem.

Now the U.S. has dramatically cut funding to the United Nations Relief and Works Agency (UNRWA), a move that will no doubt further imperil Palestinian children in Gaza.

“At stake is the access of refugees to primary health care, including prenatal care and other life-saving services,” said UNRWA Commissioner-General Pierre Krähenbühl, in a January statement about the aid decrease. “At stake are the rights and dignity of an entire community.”

Gazans who evacuated their houses to find emergency shelter go on with the activities of daily life, Al-Shifa Hospital, August 9, 2014. According to UN figures, at least 425,000 people have fled their homes in search of safe shelter including UNRWA schools, government buildings, and host families.

Gazans who evacuated their houses to find emergency shelter in UNRWA facilities go on with the activities of daily life, Al-Shifa Hospital, August 9, 2014. (Activestills.org)

Approximately 70 percent of the Gaza Strip’s population registered as refugees, and UNRWA clinics are a frontline provider for basic services like school screenings and vaccines. According to a recent World Bank report, such a financial blow to UNRWA will have a “severe impact on its ability to provide education, health services and food parcels to more than one million Gazans.”

What ails the Gaza Strip is not an incurable disease. We know the antidote that could immediately begin rebuilding the structural determinants of children’s right to life and health: end the blockade.

Priscilla Wathington is a managing editor with Defense for Children International – Palestine, an independent child-rights organization dedicated to defending and promoting the rights of children living in the Occupied Palestinian Territory. Follow DCIP on Twitter and Facebook.

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