The Disengagement from the Gaza Strip: Patients Pay the Price
Hundreds of patients who cannot receive treatment in the Gaza Strip are trapped in the area, waiting for the gates to open. The closure imposed on the Gaza Strip by Israel since the beginning of the disengagement plan prevents entry into Israel or passage through Israel in order to reach the West Bank and East Jerusalem. The border with Egypt is also closed until further notice. It was open for a about a day and then closed again and it is unclear when the crossing will reopen. Complaints received by Physicians for Human Rights-Israel indicate that, given these circumstances, hundreds of patients have been left without treatment.
Exit to Israel: Cancer patients who had been receiving treatment in Israel very rarely receive permits enabling them to travel to the hospitals. For example, 16 children undergoing chemotherapy treatment in Israel have been unable to reach their scheduled appointments for two weeks now. Over the past two weeks, out of 40 applications submitted by patients for entry permits for treatment in Israel, only 6-7 have been approved. Exit to Egypt: In normal times, 40-50 patients travel to Egypt to receive medical treatment unavailable in the Gaza Strip. Since the closure of the border, noone, besides a few that "fled" during the day it was open, has been able to leave
On September 12, 2005, PHR-Israel received notification from General Dan Harel, Commander of IDF Forces in the Gaza Strip Area, regarding the termination of military government. Despite earlier contacts from PHR-Israel emphasizing that
Israel must ensure arrangements enabling the passage of patients to Egypt and Israel even after the disengagement, no steps have been taken to ensure contiguity of treatment for these patients. It should be noted that many treatments are not available in the Gaza Strip (such as catheterization and heart operations, burns, pediatric cardiology, neurosurgery and so on). Other treatments exist, but not at an adequate standard. Thus, for example, the Palestinian Authority refers approximately half the cancer patients for treatment in Israel and Egypt, although Shifa Hospital has an oncology department.
In emergencies, when urgent medical evacuation is required, the only possibility is immediate evacuation to Israeli hospitals. Even if the border with Egypt opens, this route involves an extremely long drive, endangering the patient’s life. Despite this, nothing has been done to ensure that such a possibility is available.
Patients wishing to leave Gaza for treatment in Israel (or to pass through Israel in order to obtain treatment in the West Bank or East Jerusalem) must obtain a permit. The Legal Advisor for the Gaza Strip has suddenly announced sweeping restrictions on men aged 16-35 and women under the age of 30. Patients in these categories are automatically denied entry into Israel. Apart from the prevention of treatment for patients in these age groups, this restriction also prevents many parents from leaving to accompany their children who are undergoing medical treatment. Answers to applications for entry permits are received late, often after the date of treatment has passed, and in many cases only after heavy pressure from Physicians for Human Rights-Israel.
On September 20, 2005, a 10-year old boy requiring catheterization was referred to Wolfson Hospital near Tel Aviv. The father submitted an application for an entry permit to Israel so that he could accompany his son. He requested a permit six times, and six times he was rejected. The distressed father contacted Physicians for Human Rights-Israel. After the organization’s intervention, another application for a permit was submitted and approved. However, when the father and his sick son reached Erez Checkpoint, they were forced to wait for six hours before finally being permitted to enter Israel for medical treatment.
On many occasions, patients are denied entry due to alleged security reasons (sometimes this is a general provision, such as an age restriction, and sometimes an individual one). In many cases, the objection of the Israeli security forces is lifted after Physicians for Human Rights-Israel intervenes, and the patient is allowed to enter Israel. This pattern shows that the medical circumstances were not sufficiently considered when reaching the original decision.
On September 20, 2005, an 11-month old baby, M., was undergoing chemotherapy at Tel Hashomer Hospital. His 31-year old mother has been denied entry to Israel because of her age. The attending physician writes: “M. must be enabled to come to Tel Hashomer Hospital for chemotherapy treatment. Any delay in his arrival could endanger his life.” Despite this, the application for an entry permit is denied.
Physicians for Human Rights-Israel demands that the application be reconsidered. After massive pressure, a permit was issued at 5 pm on the evening of the day on which he was supposed to come to hospital. The child and mother waited at Erez Checkpoint until 8:30 pm, and only then were permitted to cross. They reached the hospital that night.
No Appeal against Security Restrictions – No Possibility to Receive Vital Medical Treatment In this reality, and given that the problem relates to the actions of the Israeli authorities, it is vital that an Israeli NGO inspect and monitor the actions of the various security services. However, the security establishment attempts to restrict such activities, for obvious reasons. On September 15, 2004, First Lieutenant Zrihan, assistant to the Legal Advisor for the Gaza Strip Area, informed Physicians for Human Rights-Israel that appeals regarding denial of entry to Israel are to be submitted through the Appeals Committee in the Coordination and Liaison Administration at Erez: “This committee was established with the agreement of the Palestinian Authority, and its purpose is to enable a resident of the Gaza Strip whose application to enter Israel for various needs has been denied for security reasons and/or because of police refusal to appeal against this denial. Reservations are to be brought before the committee by the representatives of the Palestinian Authority.” In a conversation with the Office of the Legal Advisor for the Gaza Strip, Physicians for Human Rights-Israel was informed that an Israeli organization would no longer be permitted to represent patients from Gaza whose entry for treatment is denied, since the only avenue of appeal is through the Appeals Committee via the Palestinian Civilian Committee.
Our attempt to contact the Palestinian Committee revealed that no one answers the telephones in their offices. Two residents of Gaza who went to the committee to
examine the possibility of appealing against the prevention of their entry to Israel were sent away. The members of the committee did not even know that they were supposed to forward appeals to the Appeals Committee. In effect, it emerges that the committee does not exist, so that it is impossible to appeal against a security refusal and to receive life-saving medical treatment. The Israeli District Coordination Office at Erez Checkpoint was also unaware of the new procedure, and advised us to appeal against security refusal as in the past, through the Office of the Legal Advisor.
Given this lack of clarity, Physicians for Human Rights-Israel contacted the State Attorney’s Office in the matter of M., a female cancer patient. The addressees listed in the State Attorney’s letter seem to offer further indication that the Israeli establishment itself is in some confusion as to responsibility for developments in the Gaza Strip: The Legal Advisor for the Gaza Strip, via the IDF International Law Division; the General Security Service; and the Legal Advisor of the Ministry of the Interior.
M., a 26-year old patient suffering from thyroid cancer, was referred for an operation to remove the thyroid gland at Tel Hashomer Hospital. Her application for a permit to enter Israel in order to receive treatment was denied on security grounds. In
accordance with the new procedure as described above (the Appeals Committee), and since the appeals process as established is in any case fictitious, Physicians for Human Rights-Israel addressed an urgent letter of exhaustion of proceedings to the State Attorney’s Office, threatening to petition the Israeli High Court. In response, the director of the HCJ Department instructed the Legal Advisor for the Gaza Strip and the legal advisor of the Ministry of the Interior to process the appeal immediately. The same night, a reply was received from the State Attorney’s Office removing the refusal: “I forwarded your request to the security sources, who informed me that, given the grave medical condition of your client, she will be permitted to enter Israel for the purpose of receiving urgent medical treatment.”
Conclusion The State of Israel proudly announced the end of its rule in the Gaza Strip, adding a sigh of relief that the end of its rule effectively implied the end of Israel’s
responsibility for the residents of the Gaza Strip. Although the withdrawal was planned long in advance, and although Physicians for Human Rights-Israel repeatedly warned that attention must be given to the passage of patients and the improvement of the medical infrastructure, no preparations were made in this field. As a result, seriously ill patients whose lives are in danger cannot receive the medical treatment they require, and patients who have been treated in Israel for extended periods are suddenly left without treatment.
Recommendations: 1) Even if it is decided that the procedure of the Appeals Committee is the agreed procedure, Physicians for Human Rights-Israel believes that the attempt to prevent us, as an Israeli human rights organization, from monitoring the function of Israeli authorities is contrary to Israeli administrative law. This argument is reinforced by the fact that the procedure relates to the right to medical treatment and to life. Our experience shows that the balance of power between Israel and the Palestinian Authority renders the appeals procedure meaningless. Only the threat of High Court petitions or media attention have motivated the system to reevaluate security needs in view of medical condition of the patient.
2) Regarding entry to Israel and passage through Israel to the West Bank and East Jerusalem, the authority is due to be transferred from the Civil Administration to the Ministry of the Interior. It is important to
reiterate that the occupied Palestinian territory constitute a single entity. Accordingly, passage through Israel cannot be conditioned on the same requirements as govern entry to Israel. In addition, Israel cannot claim that its departure from Gaza marks the end of the state of occupation as long as it remains in the remainder of the occupied Palestinian territory.
As long as Israel influences policy regarding entry to and from Gaza, it bears overall responsibility for developments in the area and for patients suffering in the Gaza Strip. If Gaza becomes a prison with Israel as its warden, that warden bears full responsible for those under its custody.
Israel should publish the text of the agreement with Egypt regarding passage from the Gaza Strip to Egypt and from Egypt to the Gaza Strip, and should disclose the extent to which it will influence free passage via this border. Israel should discontinue its involvement in entry to and exit from the Gaza Strip – continued intervention means continued occupation, albeit by different means.
In the current situation, Israel must enable passage in general, and the passage of patients and medical staff in particular, via Erez Checkpoint.