Attacks on Medical Installations in the Gaza Strip During the Israeli attack on Gaza damage was caused to clinics

, hospitals, and other medical installations. In some cases the installations came under direct fire, while in others they were damaged by attacks on adjacent areas. The World Health Organization reported that 34 medical installations were attacked during the course of the war, including eight hospitals and 26 primary health clinics57. Medical

installations are supposed to enjoy neutrality and special protection in view of their status. During combat, all sides are required to make every effort to avoid injury to medical crews and damage to medical installations. The deliberate bombardment of medical installations is an offence under international law.

Israel claimed several times that Hamas operatives were hiding in hospitals in the Gaza Strip58. These claims were never proved, however, and were denied forcefully and publicly by the directors of the hospitals during the course of the fighting59. In just one case it was alleged that shots were fired at army forces from the Al-Quds Medical Center (see details below). The information gathered by PHR-Israel from crews in the field, physicians, patients, and so forth does not provide any evidence supporting Israel’s official claim that hospitals were used to conceal political or military personnel.

International humanitarian law addresses the subject of attacks on medical centers:

Article 18 of the Fourth Geneva Convention expressly states that “Civilian hospitals organized to give care to the wounded and sick, the infirm and maternity cases, may in no circumstances be the object of attack, but shall at all times be respected and protected by the Parties to the conflict.”60

Article 19 of the same convention states that “The protection to which civilian hospitals are entitled shall not cease unless they are used to commit, outside their humanitarian duties, acts harmful to the enemy. Protection may, however, cease only
"Health Situation in the Gaza Strip", World Health Organization, 19-20 February 2009 http://www.ynet.co.il/articles/0,7340,L-3647934,00.html 59 Mr. Hassan Khalaf, deputy Minister of Health in Gaza, denied the accusations in a report on Channel 10 Israeli television, 4.1.2009. He also addressed these accusations in an interview to www.ynet.co.il. see: http://www.ynet.co.il/articles/0,7340,L-3648269'00.html 60 See http;//www.btselem.org/English/International_Law/Fourth_Geneva_Convention.asp
58 57

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after due warning has been given, naming, in all appropriate cases, a reasonable time limit, and after such warning has remained unheeded.” The convention adds: “The fact that sick or wounded members of the armed forces are nursed in these hospitals, or the presence of small arms and ammunition taken from such combatants who have not yet been handed to the proper service, shall not be considered to be acts harmful to the enemy.” 61

The following are examples of attacks on medical installations as reported to PHRIsrael: 27 December – damage caused to a Palestinian Red Crescent building and the administrative building for rescue vehicles. In the afternoon two medical installations were damaged by an Israeli air force bombardment directed at the former central base of the Preventative Security service in the Tal al-Hawa neighborhood of Gaza City. 28 December – damage caused to the Al-Sarani Clinic. The Al-Sarani clinic in the Shaja’iya neighborhood was badly damaged by an Israeli Air Force bombardment aimed at the police station in the neighborhood. As a result of the attack, Rawiya Ud, a pharmacist who was working in the clinic at the time, sustained critical injuries. 30 December – damage caused to the main building of the Gaza Mental Health Center. The bombardment of a traffic police station on Al-Rashi Street in Gaza City seriously damaged the adjacent main building of the Gaza Mental Health Center. Information provided to PHR-Israel by representatives of the center stated that windows and doors were shattered, walls were cracked and perforated, and most of the computers in the center were rendered inoperable. The reports also stated that the attack led to the complete cessation of operations at the center, including the provision of psychological and psychiatric services for the civilian population. 4 January – attack on Al-Raeiya Medical Center and mobile clinics. On the night of 4-5 January, Al-Raeiya Medical Center was bombed. The center is adjacent to Shifa Hospital in the center of a residential

61

Ibid,

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neighborhood. There are no government buildings or military positions in the area. According to initial estimates, the damage caused to the center and the mobile clinics totalled approximately $ 800,000. The center provided various outpatient services – specialist clinics in internal diseases, a pediatric clinic, a gynaecology and prenatal clinic, an urology clinic, neurosurgery, and emergency services. All the services were halted, including the use of the center’s three mobile clinics, which were completely destroyed. On the night of 9 January the medical centers Sabha al-Harazin and Hala al-Shawa, which are operated by the Palestinian Ministry of Health, were damaged by Israeli artillery fire. On 10 January artillery fire destroyed the northern wall of the European Hospital in Khan Yunis. The main water pipes were damaged, as was the hospital generator, leading to a power cut. One of the maintenance workers suffered a traumatic response. On 13 January a clinic in the Shaja’iya neighborhood used as a mental health and child health center was destroyed by Israeli missiles. On 13 January the Mohammed al-Dura Children’s Hospital sustained a direct hit. There were eight patients and medical staff on the premises at the time. 15 January – direct attack on Al-Quds Hospital. In the afternoon the Israeli army hit the hospital, operated by the Palestinian Red Crescent in the Tel al-Hawa neighborhood. The attack destroyed the administration floor completely. A fire erupted in another section of the hospital. Some 300 people were present in the hospital at the time, including 40 medical personnel and several dozen patients, including 15 connected to medical machinery. Fighting continued for hours around the hospital compound, which was surrounded by army forces. Most of the patients and the hospital staff were taken down to the basement to hide during the attack. Patients in the intensive care ward were left in their beds since they could not be disconnected from the machinery. Three people were slightly injured during the attack. The army claimed that shots were fired at its soldiers from the hospital.

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Al-Quds Hospital following the army bombardment

Photo: World Health Organization

On 1 January PHR-Israel wrote to the minister of defence and demanded an end to attacks on medical installations.62 A written reply was received 17 days later from the Ministry of Defence, just two days before the end of the war. The reply stated that “since the subject is pending before the Supreme Court, the position of the defence system will be presented to the Supreme Court in accordance with usual practice.”63

*** The large number of incidents reflects the trigger-happy behaviour that characterized the army’s actions during the attack on Gaza. The large number of medical crews and centers attacked during the course of the fighting suggests that the army forces failed to take sufficient steps to prevent injury to personnel and damage to installations. This behaviour further impaired the functioning of the health system, which was already forced to cope with impossible conditions.

See http://www.phr.org.il/phr/article.asp?articleid=1027&catid=26&pcat=1&lang=HEB From the letter of Ms. Ruth Bar from 18.1.2009, see appendix. Details of the petition and the State's reply see below.
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62

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Injury to Chronic and Acute Patients After the hospitals in the Gaza Strip began to operate in an emergency format, chronic and acute patients did not receive proper medical care during the fighting (even if they were not actually injured by the army attacks). Moreover, the coordination mechanism for the exit of patients via Erez Crossing for treatment outside the Gaza Strip ceased to function during the attack. The roads leading to Erez Crossing were blocked, as was the crossing itself for protracted periods during the attack. As a result, patients who had routinely left the area for treatment were now unable to do so.

From the beginning of the Israeli attack against the Gaza Strip, the hospitals were forced to send many patients home without treatment due to the shortage of hospital beds and medical crews. The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) published a report on 5 January stating that “patients in stable condition are being released as soon as their condition permits in order to make room in the hospitals.” Moreover “there is an urgent need for surgeons from the fields of neurology, vascular medicine, orthopaedics, and open heart surgery.”64 As of 11 January, Shifa’ Hospital was attempting to keep the bed occupancy rate to no more than 75 percent in order to enable the intake of additional injured persons.65 Of primary health clinics, 34 out of a total of 58 were functioning on a partial basis by the end of the war.66 As a result, the World Health Organization reported that the medical treatment of approximately 40 percent of chronic patients was impaired.67

Dr. Hassan Khalaf, Palestinian deputy health minister in the serving government in Gaza, alerted representatives of PHR-Israel as early as 28 December to the serious problems facing the hospitals, noting that many patients had been sent home due to the state of emergency. “The heavy patient load and grave shortage of operating theaters has led to a situation in which four delivery rooms in the maternity ward have been converted into general operating theaters, and maternity patients are not currently being admitted to Shifa’ Hospital.” The outpatient departments in the

64 65

Gaza Situation Report by the Humanitarian Coordinator,, OCHA, January 5, 2009 Health Situation in the Gaza Strip, World Health Organization, (WHO), January 11 66 Health Situation in the Gaza Strip, World Health Organization, (WHO), January 8 67 Health Situation in the Gaza Strip, World Health Organization, (WHO), January 14

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hospital, as well as four intensive care stations in the burns ward, have been turned into hospitalization wards for those injured by the Israeli attacks.”68

An injured patient in hospital

According to figures from the Palestinian Ministry of Health, as of 15 January there were 321 patients in the Gaza Strip who had been registered as requiring medical treatment outside the area and who had been prevented from departing following the collapse of the Palestinian-Israeli coordination mechanism69. Half the above-

mentioned patients were women and children, of whom over 90 percent were cancer patients. Following the invasion of the Gaza Strip, and through 15 January, the departure of patients was coordinated in just 20 cases and just seven patients were authorized to depart. In practice, however, not a single patient was able to leave due to the failure of attempts to coordinate departure through Erez Crossing. This information was forwarded to PHR-Israel by the Palestinian Ministry of Health. Throughout the Israeli invasion of the Gaza Strip, of 90 requests submitted for passage through Erez Crossing, departure was coordinated for just 30 patients.70

The collapse of the Palestinian coordination mechanism

68 69

See: http://www.phr.org.il/phr/article.asp?articleid=1017&catid=26&pcat=6&lang=ENG PHR-Israel received the data on January 15 from the Palestinian Ministry of Health 70 Gaza: initial health needs assessment, WHO, January 29, 2009, p. 14

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Contrary to the situation regarding Palestinians injured by army attacks, the mechanism for the passage of chronic and acute patients should ostensibly have continued to function during the attack on the Gaza Strip, since no decision was taken to stop the referral of patients to Israel. However, although the patients held medical referrals from the Palestinian Ministry of Health ( including an appointment, financial undertaking, and medical opinion), they were unable to submit applications for passage to the head of the Palestinian Civilian Committee, Mr. Rif’at Muheisin, for the following reasons: 1. The Office of the Palestinian Civilian Committee and the Ministry of Health in Gaza were closed. Following the army bombardments, the offices closed at the beginning of fighting on 27 December and could not be used to forward requests to the Israeli side for departure from the Gaza Strip. In these circumstances, patients had no address to which they could submit requests. 2. Inability to access the Palestinian coordinator. Due to the closure of the Palestinian Civilian Committee, the head of the committee in Gaza remained in his home in the Shaja’iya neighborhood of Gaza throughout the war. There was no electricity in his home for most of this period and he could not be reached by telephone. His home address or fax number were not known to patients and their families, and in any case most residents could not have reached his home due to the fighting. During the course of the fighting, the authorities at Erez Crossing informed PHR-Israel on several occasions that the coordination of departure of sick residents would be possible only through Mr. MuheisMn, whom they defined as the only person in the entire Gaza Strip with whom they were willing to cooperate. In the situation that emerged, however, Mr. Muheisen was unable to perform his function. Moreover, he was also responsible for coordinating the passage of ambulances and the evacuation of injured persons within the Gaza Strip, and for the passage of patients to Egypt. This is a heavy burden for one individual in the absence of any other alternatives.

After PHR-Israel contacted the Minister of defenCe on 15 January, the Gaza DCO stated on the following day that it would receive requests to leave the area directly from PHR-Israel. Again, however, this step was inadequate to solve the problem. The submission of requests to the Gaza DCO was not sufficient – patients were in any

47

case unable to reach Erez Crossing due to the blockage of the access roads, and since the crossing was closed for part of the time.

Blockage of the access roads to Erez Crossing and closure of the crossing After the coordination mechanism for the departure of patients ceased to function, a very small number of applications from patients to leave the Gaza Strip via Erez Crossing were approved during the course of the fighting. However, various obstacles prevented even those few patients who secured a permit from leaving the area: 1. The access roads to Erez Crossing were blocked by Israeli Military forces and by large earth piles. 2. A closure was imposed on the crossing without prior warning. On 13 and 14 January, for example, Erez Crossing was closed after a closure was imposed on the north of the Gaza Strip. 3. The passage of civilians – including sick persons – through combat areas was possible only in ambulances or international vehicles belonging to UNRWA and the ICRC, and only with prior coordination. Due to the state of emergency in the Gaza Strip, there was a shortage of rescue vehicles available to evacuate patients who had not been injured by the army attacks.71

According to the WHO data of January 13, fifteen ambulances of the Palestinian Health Ministry were hit and were out of service. In its report summarizing the fighting in Gaza it wrote that at least 29 of the 148 ambulances in the Gaza Strip were destroyed or damaged.

71

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A.A.R, a ten year-old boy, has been suffering from neuroblastoma cancer for the past five years. He has been undergoing experimental treatment at the Hematology Department in Rambam Hospital for several years. Since this is an experimental treatment, the hospital itself has been financing the treatment; the applications for the passage of the patient have been submitted by PHR-Israel. On 24 December PHR-Israel submitted an application on behalf of A.A.R and his grandfather, who accompanies him to the treatments, in order that they could attend further treatment in Israel on 5 January. After the request was approved, on the morning of 5 January – the intended day of treatment – the PHR-Israel representatives were informed that the departure of the boy and his grandfather had been approved and that they could leave for Israel. However, the boy’s father, Khalid, was afraid to leave his home in their car since any car not identified as belonging to the international organizations was liable to be shot at by the army. During the day PHR-Israel representatives attempted to coordinate the departure of the patient and his grandfather in an ICRC vehicle. As the coordination efforts continued, however, notification was received from the Gaza DCO that “their departure would not be possible” due to “problems on the road” – i.e., the road to Erez Crossing had been blocked by the army. In a telephone conversation on 6 January, A.A.R’s father described to PHR-Israel representatives the difficulties they were facing. His son A.A.R could not undergo treatment in Israel since the road to Erez Crossing was blocked by army tanks. The father attempted to reach the European Hospital in Khan Yunis on foot – a distance of some eight kilometers – in order to secure treatment for his son and receive additional medication. After carrying his son to the hospital on his back (since the roads leading to the hospital were also blocked), the father learned that not only was the required treatment unavailable, but that the medication had also run out. Thus his son was left without treatment or medication.

***

Thus it can be seen that access to medical care was impaired in the Gaza Strip not only for those injured by the attack, but also for sick persons. The hospitals were unable to admit the sick due to the continuous intake of those injured in the attacks.

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Moreover, passage to the neighboring countries – including Israel – was blocked for protracted periods. Although a handful of patients left the area during the course of the fighting, they constitute no more than a drop in the ocean.

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Conclusion Through the 22 days of the Israeli attack against the Gaza Strip, the State of Israel made a considerable effort to conceal the actions of its army in the area and the humanitarian crisis that prevailed. The sweeping prohibition on the entry of international media into the area and the vague responses given to the High Court of Justice were just two of the mechanisms used to secure this objective. With regard to the issues examined by this report, the events constituted a humanitarian crisis that was exacerbated due to the attack, causing extensive damage and injury.

The Palestinian health system in the Gaza Strip was already facing a shortage of medical knowledge and equipment after eighteen months of siege. In its debilitated condition, the system was unable to provide proper medical care for thousands of residents injured by the army attacks. The volume of injured persons was one that even an advanced health system such as that in Israel would have found it difficult to cope with.

During the early days of the fighting, many injured persons, particularly those with head injuries who were unconscious and required ventilation could not be treated by the health system in the Gaza Strip and required transfer to advanced medical centers outside the area. The imposition of bureaucratic obstacles by Israel and Egypt in the initial phase, and the refusal of the Hamas authorities to cooperate with Israel at the expense of injured civilians in the latter phase, led to defective medical care, impairing the health of many of those involved. The rapid evacuation of the injured relatives of Dr. Az-Addin Abu AlAish proved that in certain cases Israel was able to remove patients rapidly from the Gaza Strip when this served its own interests. The opening of the clinic alongside Erez Crossing during the last few days of the fighting was “too little too late” and was also undertaken for considerations of image.

Medical crews came under attack during the entire period of fighting, and appear to have been regarded as legitimate targets by the army 51

forces. According to the report of the World Health Organization, 16 medical personnel were killed and 25 injured while performing their duties. The state’s response to the petition submitted to the Supreme Court by PHR-Israel, Adalah, and other organizations was considered satisfactory by the judges, who refused to intervene in the matter despite ruling that it was within the court’s sphere of jurisdiction. Perhaps the clearest evidence of the inadequacy of the coordination mechanisms that were supposed to reduce, at least, injuries to medical personnel, was that even after the Supreme Court’s decision, medical personnel continued to be injured as they traveled to rescue the injured. At least five cases of injury to medical personnel occurred after the first hearing in the petition. On the basis of earlier reports published by PHR-Israel, a dangerous and retrograde trend can be identified of an increasing disregard for the obligation to protect medical personnel during Israeli military operations. It seems that army soldiers no longer regard medical personnel as entitled to the special protection they are granted during the performance of their duties.

As a result of the growing fear of attack by army forces against medical crews, many injured persons remained trapped in their homes without any possibility of evacuation. According to the ICRC, the average time required for the evacuation of the injured after the beginning of the ground offensive was between two and ten hours. More seriously still, in some cases Israeli military forces were only a few meters from injured Palestinian civilians yet failed to provide medical assistance (see the cases of the Shurab family and the AlA’ida family), contrary to international law and to basic human values.

Medical installations were damaged both by direct attacks and indirectly. During the course of the fighting, Israel reported that Hamas leaders were hiding in the basements of the hospitals. These charges were vigorously denied by the directors of the hospitals with 52

whom PHR-Israel was in contact in the Israeli and foreign media. At least six medical installations – hospitals, clinics, and medical equipment storerooms – were damaged during the fighting despite the protection such sites enjoys under international law. Even if the damage to these installations was not caused deliberately, the impression is that the army forces did not take special care when firing in areas adjacent to medical installations.

As a result of the enormous pressure facing the hospitals and the closure imposed on the Gaza Strip, patients who were not injured by the army attacks did not receive proper medical treatment. Particular damage was caused to the health of chronic patients requiring treatment outside the Gaza Strip. Although a handful of patients managed to leave the area during the course of the fighting, such instances were extremely rare and did not meet the real needs of patients in the area at the time.

It is not the purpose of this report to establish whether the army forces committed war crimes. This is a question that must be examined by legal experts in this field after exhaustive investigation. It can be stated with certainty, however, that violations of international humanitarian law occurred during the course of the attack. These violations included attacks on medical personnel; damage to medical installations; indiscriminate attacks on civilians not involved in the fighting; and the delaying of medical treatment of the injured.

In moral terms Israel’s image has been stained by the manner in which it pursued the attack; by its disproportionate use of force; and by its gross disregard for requests from local and international human rights organizations in the face of the humanitarian crisis in the Gaza Strip. The process of demonization of Palestinians bears a heavy price for Israeli society. This process reached its nadir when soldiers in an army that flaunts its morality declined to help evacuate injured civilians and trapped families; when soldiers acted in trigger-happy manner as they opened fire on ambulances, medical installations, and medical personnel; and when Israel’s leaders

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employed doublespeak in order to deny the existence of a humanitarian crisis in the Gaza Strip.

Recommendations 1. Israel must enable injured Palestinians to reach advanced medical centers outside the Gaza Strip and must loosen security criteria in light of grave injuries. 2. Israel must enable advanced medical equipment to be brought into the Gaza Strip and must enable Palestinian physicians to leave the area in order to acquire advanced medical knowledge elsewhere so that they may facilitate the development of an independent health system. 3. The army must reiterate to its soldiers the protection granted to medical personnel performing their duties, under international law, and must prosecute those who violate these provisions. 4. The Supreme Court must not confine itself to accepting the state’s position that guidelines were issued not to harm medical personnel. It must ensure that such cases do not reoccur. It must also ensure that the state enforces the judges’ decision regarding the need to investigate the circumstances surrounding attacks on medical personnel and installations. 5. In any future armed conflict, the army must refrain from damaging medical installations. 6. Soldiers, and in particular medical personnel serving in the army, must provide medical attention for any injured person in their vicinity, provided this is possible under the given circumstances. 7. In the absence of a proper Israeli investigation, PHR-Israel demands that a neutral, independent international body carry out a thorough investigation. Should this investigation find Israel had violated the International Law, the Customary Law and the Israeli Law, those responsible for these violations should be brought to justice and Israel should be held responsible for the rehabilitation of the victims of these violations.

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Appendices

Ministry of Defense Office of the Minister of Defense Kiriya 8 Tevet 5769 Date: 4 Jan. 2009 Ran Yaron Physicians for Human Rights 9 Dror St. Jaffa – Tel Aviv 68135 Re: Application to Transfer Rawiya Ud to Hospital in Israel I hereby confirm receipt of your letter dated 31 December 2008 to Minister of Defense Mr. Ehud Barak.

Sincerely, Attorney Ruth Bar Assistant to the Minister of Defense

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Israel Medical Association 5 January 2009

Mr. Yaron Ran Physicians for Human Rights - Israel Dear Sir, I received a copy of your letter to the minister of defense regarding damage to medical installations during Operation Cast Lead in Gaza. I shall send a letter in similar spirit to the minister of defense and the chief of staff. Separately from my response as above, it is jarring, irritating, and annoying that you do not take the trouble to mention in your letter to the minister of defense that the damage to medial installations is the result of attacks on other installations that were proper targets for attack, and whose proximity to medical installations forms the real and intolerable problem in terms of the behavior of Hamas. To the best of my knowledge, there has not been and will not be any decision to attack medical institutions by the IDF as a target in their own right; I hope you too believe this. Furthermore – the proportion of your response to the ongoing firing of missiles at the communities around the Gaza Strip is very very disturbing and bothersome, to put it mildly. As an Israel, albeit from Physicians for Human Rights, your approach and that of your organization to the exposure of a civilian population and civilian installations in Israel, such as kindergartens and schools, medical and other installations, should be in a proportion and degree of severity that at least approaches the subject of your clarion call. Israelis – Jews, Arabs, and Bedouin – also have rights that are supposed to be on the agenda of your organization during the conflict with the terror / organization – Hamas.

Sincerely,

Dr. Yoram Blachar Chairperson, Israel Medical Association

CC:

Minister of Defense – Mr. Ehud Barak Chief of Staff – General Gabi Ashkenazi

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Unclassified Office of the Chief of Staff Israel Defense Force Office of the Chief of Staff Secretariat of the Supreme Command 10 Tevet 5769 6 January 2009

Ms. Miri Weingarten 9 Dror St. Jaffa – Tel Aviv 68135

Dear Ms. Weingarten, I would like to confirm receipt of your communication dated 6 January 2009 addressed to the Office of the Chief of Staff. Your communication has been forwarded to the relevant bodies for examination and we shall reply once their examination is completed.

Sincerely,

Neta Shmariyahu, Major Assistant Secretary to the Supreme Command

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Ministry of Defense
Office of the Minister of Defense Kiriya 15 Tevet 5769 Date: 11 Jan. 2009 Reut Katz Physicians for Human Rights 9 Dror St. Jaffa – Tel Aviv 68135 Re: Evacuation of the Al-A’idi Family from an Area of Firing in Gaza Your letter dated 6 January 2009 Further to your letter as above, the Office of the Coordinator of Operations in the Territories has informed us that the members of the family have been evacuated from their home to the nearby hospital in Gaza in order to receive medical treatment.

Sincerely, Attorney Ruth Bar Assistant to the Minister of Defense

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Ministry of Defense
Office of the Minister of Defense Kiriya 18 Tevet 5769 Date: 14 Jan. 2009 Physicians for Human Rights 9 Dror St. Jaffa – Tel Aviv 68135 Re: Passage of Patients for Life-Saving Treatment in Israel Your letter dated 30 December 2008 Further to your letter as above, the following is the response of the Coordinator of Operations in the Territories: Ahmad Abu Hawaij – entered for medical treatment at Rabin Hospital on 31 December 2008. Sari Sama’ana – entered for medical treatment in Israel at Tel Hashomer Hospital on 31 December 2008. Mohammed Sawafiri – entered for medical treatment in Israel at Tel Hashomer Hospital on 31 December 2008. Rawiya Ud – Gaza DCO contacted the organization and requested medical documents, the request has not yet been met. Fatima Salam – according to the organization she has been transferred to Egypt for medical treatment. Akram al-Khatib – according to the organization he does not require medical treatment in Israel and the request is therefore immaterial. Sincerely, Attorney Ruth Bar Assistant to the Minister of Defense

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Unclassified Office of the Chief of Staff Israel Defense Force Office of the Chief of Staff Secretariat of the Supreme Command 19 Tevet 5769 15 January 2009 Ms. Miri Weingarten 9 Dror St. Jaffa – Tel Aviv 68135

Dear Ms. Weingarten, Further to your communication dated 6 January 2009 and addressed to the Office of the Chief of Staff, I should like to respond. In your communication, you requested that the evacuation of Palestinians injured during the fighting currently taking place in the Gaza Strip be facilitated so that they may obtain medical treatment in Israel and in Judea and Samaria, given the inability of the Palestinian health system to cope with caring for the large number of injured. In opening we wish to note that our position (contrary to that stated in your letter) is that Israel is not responsible for treating injured residents of the Gaza Strip. At the most, this was the situation during the period in which the Gaza Strip was subject to the military administration that operated in the framework of the laws of belligerent occupation in international law. As is well known, in September 2005 the military administration in the Gaza Strip ended, and since then these laws no longer apply to the IDF operations (as established in the ruling of the Supreme Court – HCJ 913207 Al-Basiuni et al. v Prime Minister et al.). The IDF operations in the Gaza Strip are now regulated solely by the laws of combat, which do not require a party to an armed conflict to enable subjects of the opposing side to enter its territory in order to obtain medical treatment. Alongside the above, it should be clarified that despite the absence of a legal obligation to attend to the well-being and welfare of the civilian population in the Gaza Strip, the State of Israel is making every effort to alleviate the humanitarian situation prevailing in the area. This despite the fact that the sole responsibility for the situation of the population rests with Hamas, due to its cynical use of civilians for despicable purposes. In this context it should be noted that of the applications forwarded to the coordination and liaison functions over the past three weeks relating to the entry of residents of the Gaza Strip into Israel for the purpose of obtaining medical treatment for injuries caused during the operation, not a single application has been refused (some have been approved and others are still being processed).

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Moreover: since the beginning of Operation Cast Lead, the coordination and liaison functions have contacted the Palestinian health bodies on their own initiative and have specifically offered to coordinate the transfer of injured persons from the Gaza Strip to medical treatment in Israel and in Judea and Samaria. Despite this, the Palestinian bodies have unequivocally rejected the said offers, and have replied that they are not interested in transferring patients to Israel or to Judea and Samaria, but prefer to transfer them to Egypt and Jordan via Rafah Crossing (and, indeed, figures in our possession show that over 200 persons have already been transferred to Egypt for medical treatment). In light of the above, we do not feel that there are any additional steps that can be taken at the present time. As may be seen, and even in the absence of formal responsibility, the State of Israel does not ignore the situation of the civilian population in the Gaza Strip. In this framework, and although the IDF is in the midst of fierce and intensive fighting against a terror organization that attacks the residents of the State of Israel, and exploits the residents of the Gaza Strip to this end, we are making every effort to minimize the injury to the latter and to offer them assistance insofar as possible.

Sincerely,

Neta Shmariyahu, Major Assistant Secretary to the Supreme Command

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Ministry of Defense
Office of the Minister of Defense Kiriya 22 Tevet 5769 Date: 18 Jan. 2009 Ran Yaron Physicians for Human Rights 9 Dror St. Jaffa – Tel Aviv 68135

Re: Your request to the Minister of Defense regarding damage to medical installations Your letter dated 1 Jan. 2009 Since the subject is pending before the Supreme Court, the position of the defense system will be presented to the Supreme Court in accordance with usual practice. For your information.

Sincerely, Attorney Ruth Bar Assistant to the Minister of Defense

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Written testimony by Muhammad Shurrab In the name of allah, the merciful, the compassionate Friday ,as we all know, is God's day for the Moslems. We began, my sons and I, Qassab , graduate of the faculty of engineering, department of construction engineering ,at the Islamic university, and Ibrahim, first year at the faculty of accountancy, at "AlAzhar" university. It was a beautiful warm day. I awoke in the morning as usual, did the things that I needed, and then the boys awoke, and I asked them to do some chores for me. I decided that, with the help of allah ,we would set out for the city together, before the end of the humanitarian ceasefire/truce that the Israeli army declared while it was entering the AlFukhary neighborhood, which is on the border of my private farming land . And so it was, after the Friday noon prayers, we took the things we needed for home and set out in the car, and after 200 meters, we passed a route that was blocked because of tanks and heavy mechanical equipment which had been used to surround the area in the night before, and we managed despite the digging works to pass another 700 meters, and then we found a route that was being used by heavy mechanical equipment, it was a harder way than the one before, but because our car was a land rover jeep I managed to go through it, and I said to my children, "I am going to cross this road-hump, which looks like a sand roadblock" and I continued and said "I am not driving a Subaru" and I called for the help of allah. All the way I took care to go according to the instructions, as they were written for me, from the AlUmur Mosque "AlReda" route we passed through the" Electricity" square ['Muhawal alQahraba'], I proceeded straight on, intending to pass through a side alley that I know well. I was surprised to discover an empty area, and when I looked to my left, I was surprised to see two soil roadblocks, with a tank in one of them. This was an unexpected surprise. I raised my hand as in greeting, no one stopped me. I continued driving for another 50 meters and then bursts of gunfire were shot at me. I immediately told my sons "bend down". The shooting continued in our direction. I thought it was warning shots, until I was amazed to hear a voice of someone ,shouting "get down, son of a bitch", I said to my sons, get down, bend down, get down from the car, and lie down on the ground. I bent down, and I could not see me son Qassab who had been sitting next to me and I did not know how he got down or how he behaved, but Ibrahim who was sitting behind, and was unhurt, opened the door of the car and got out, and then suddenly he started shouting "I'm hit". I looked at him and saw that he had been injured in the leg, below the knee. I said to him, "never mind, it is a light injury, not lethal ." The soldiers shouted at me "get out of the car" and shot at the car where it was standing, so that I could not get out of the car because of all the bullets that were being fired being shot at me. Then I started to feel hot blood dripping from my left arm. I looked in my clothes to see where I had been hit and I saw that my left arm was injured, above the elbow, and then I leaped over the passenger seat and out of the car and lay down flat on the ground, all while the shooting was continuing. At the same time, Ibrahim was screaming, "I'm hit, ambulance, I'm hit", and then I heard the soldier say to him "shut up or I will shoot you ." I asked Ibrahim to be quiet and to crawl toward the fence, and then he answered me, "father, call an ambulance". I answered that I did not know the number, and he said it was 101. I said, can you call them, I'm hit the arm. While he was trying to call, the soldier shouted at him,

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"don't talk, I'll shoot you, throw away the phone." Ibrahim threw away the phone and sat there bleeding . I shouted, I called the soldiers, "I have an injured person here, I am also hurt ,get us a paramedic, wound dressings, an ambulance". They answered, "shut up or call an ambulance". I called an ambulance and they answered me that they cannot come, and that only the Red Cross could do it, by coordinating with the] Israeli] army commanders, who had refused to authorize their passage. Time passes and my son is bleeding. Qassab lies on his stomach, I don't know if he is alive or dead. I tried to crawl toward him and then one of the soldiers told me not to move and fired a warning shot . Ibrahim bled, and no ambulance or medic could be seen. The soldiers took over a house just 40 meters away from us, no more. I see them and they see me. I hear them and they hear me, and so I called them, "the boy is bleeding, send a paramedic to do something," and at the same time I was phoning for an ambulance more than 20 times, until they told me there is not much they can do, and that they would pass on my issue to the media. Time passes, and sunset is near, and I and my two sons, bleeding, started to feel the cold of January, I felt that I was in a race against time. And my younger son is calling to me every 5 minutes, begging "father call 101", and I would call, because of his shouting and begging, to no avail, the evacuation authorities told me they were aware of the situation I was in, and asked me to keep my phone available, so that local press and radio could contact me, so I could explain the situation to them, and call for our rescue ,so that perhaps everyone would hear and could help . It was already dark, and there was no one to help, only the sounds of the cellphone ringing all the time, whether from a local radio station, or a satellite station, or a human rights organization, and other bodies . I gathered courage and crawled toward my eldest son, when I saw some cats wandering around him. One of the soldiers shouted at me, and said in Arabic "go back to your place or I shoot you". So I answered him, "you can shoot me if you want". I reached Qassab, who lay on his stomach, I looked for the place where he was injured, and then I discovered with certainty that he was dead. His body had become hard. I turned him on his back and covered his face with his coat. He was lying one meter away from the jeep, and I thought "Qassab is dead, Ibrahim remains" – or Abbas as we used to call him. I went back to Ibrahim, and then he asked me, "how is my brother Qassab, is he still alive?" I answered, Qassab is dead [was martyred], and we are next ." "Bless him father", that's what my younger son said to me. I answered "how can I not bless my martyred son, who was murdered by the enemies of God with no justification?" And then again he asked me to call 101, I said "I will call, and you talk to them, maybe they will take more account then". But he answered me that he could not talk. I phoned and phoned countless times, and each time they told me this was the last time, and I said to them "I beg you for help, you respect neither Man nor humanity". And they answered me weakly and helplessly ,and swore… Believing or not believing [them], it was all the same to me. And here, my younger son, asking me "are you satisfied with me father," and again" are you satisfied with me father", and I repeated my answer over and over .

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"I'm cold, you and I are wounded, we are close to our end", he said to me, and I answered "no, you were injured in the leg, below the knee, this is an injury that does not cause death", and then he asked me about my injury, and I answered that I was fine, See, I'm with you now . I asked him often if he was cold, and he answered that he was, so I put my bloodstained jacket on him, I leaned against the wall, stretched by legs forward, and placed his head on my lap, so he would be close to me, and feel some warmth. But, while shivering, he said "father, you are more sensitive to cold than I, take me to the jeep, maybe I will feel warmer there. We sat in front of the car that had crashed into the concrete fence/wall, I said to him" stand on your good leg, and I will help you". The moment we moved from our place, one of the soldiers shouted "get away, I'll shoot you". I took no notice of him, and I shouted "Bring me a paramedic, a blanket, something to tie the place of the wound with, bring me some kind of help, you who call yourselves modern people." One answer was all I got: "call an ambulance". I felt that this answer could be considered permission to use my mobile phone, it was already dark, and colder, I suffered from a terrible cold, and all the body of my sone shivered from the cold and the bleeding. I listened to sounds, hoping to hear a car, but there were only the sounds of tanks or bulldozers destroying people's homes and trees. I threw the bag of dirty washing to my son and told him to use it as a pillow, and I took out some of the clothes to cover his body and his leg. We were in the car. I sat in the back seat and he sat in front. I put his head on the headrest of the seat, and started to rub his back and his trembling body with my fingers. I asked him every five minutes "are you cold? Does it hurt?" and he would answer with only one sentence: "call the rescue teams or."101 I was in a bad condition, and despite my own injury I did not worry about myself for a moment, although I could feel that I was bleeding, and that the blood had wet all my clothes, until it was dripping from the palm of my hand. Through all this, whether the blood was flowing or drying up, I was not afraid for myself. I was afraid only for my son .I kept stroking him and talking to him, and I didn't know the seriousness of his condition, all I knew was that an injury to the leg could not cause death. Around ,20:00 I received calls from local radio stations and from bodies claiming to be human rights organizations, and I asked them all "save us, we are behind a base of tanks, before a group of snipers, who are able to help us, but they have not given us anything but killing and fear." I asked everyone I talked to on the phone, "help transfer the bleeding wounded person, because perhaps in an hour or less you will not be able to talk to me because I will not be alive". My left arm began to tremble. I felt a numbness in my arm, in my hand and in my fingertips. I kept receiving calls, "I'm from the radio… I'm from a foundation …we will talk live now, you can call for help directly…" I was tired, I wanted ,before our time was out , paramedics, nothing more . It was already ten o'clock. Night and cold. The dead one was lying in the street ,and the wounded and the bleeding one, and me and the persecuting Jew, who was ready with his weapon to finish living people at any moment, so when he wants to reach satisfaction through killing, I know it, and I shouted at them, "death at this moment is a great peace/rest". I called in a clear, sad and trembling voice, "IDF, if you were modern, or human, or grandchildren of Abraham, my son Ibrahim is dying, you murdered my son Qassab, and my life is in your hands .Either you do something, or you let me rest/die." I heard only one answer: "let the ambulance come and take you".

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I was certain the end had come, my mobile phone with which I received or made calls, its battery was finished, and I had no way of calling others. Before this I had told the human rights organizations that were dealing with the issue after being told about it by the rescue teams, that between me and the biggest hospital in the Gaza Strip there were less than 1,000 meters, that is one kilometer, but the power of the soldiers and the power of Israel persisted in their intention of deliberate murder . At midnight, AlJazeera called me, and asked me to talk. At that moment Ibrahim was breathing. When I finished the interview, I could not feel his breath. I thought he had fallen asleep. I called him and I asked him the same question, if he was cold, but he didn't answer. I put my hand on his forehead, it was warm. Then I moved my hand to his mouth, but I could not feel his breath. So I knew he was dead. Ibrahim was dead. Abbas was dead. My son. Both were gone. The first was lying in the street, the second was lying in the front seat of the care. Many people called, radio stations, bodies, organizations, I said to them all: "I am not OK, both my sons were martyred. Our rights as human beings do not exist here. I am going to die of the cold, and I don't care if I die, because I am no better than my sons, who died in front of me. My pain is harder than death, I wish for a speedy death, so I can have some rest". I shouted at the soldiers, who were coming out of the house they had taken over .There were about 30 soldiers, with full kits. They went away for about an hour and came back. Then I shouted, "why are you leaving me behind? Finish me off ,let me rest, just one bullet, it will cost you no more than pressing the trigger. Do it, cowards". None of them paid attention to my words. They don't care what I say. They did what they did, the bodies of my two sons are in front of them, they understood they had fulfilled their aim, murdered my sons, the young ones, the homeland…

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