Amira Hass : For some Gazans who need treatment outside the Strip, wait for an exit permit ends in death
Israel delays half of Gazans seeking to leave Strip for medical care, WHO says
Gaza kids
live in hell: A psychologist tells of rampant sexual abuse, drugs and despair
Opinion
Palestinians in Gaza suffer enough without being defamed as sexual deviants and
mentally ill
In January,
4-year-old Yara Bakheet fell ill. She vomited frequently over an entire week
and became dehydrated, and after a series of examinations at the European
Hospital in Khan Yunis, Gaza, the doctors told her mother, 28-year-old Aisha
Hassouna, that her daughter was suffering from heart failure.
An
appointment was made for her at Al-Makassed Hospital in East Jerusalem where,
the mother was told, there were suitable resources for treating her child.
The medical
records, the appointment slip and the commitment to pay, together with an
application for a permit for Yara and her father to exit Gaza, were submitted
to the Israeli Coordination and Liaison Administration, which grants exit
permits subject to the opinion of the Shin Bet security service.
The mother
told a field researcher for the B’Tselem human rights group that the first
application was denied. Yara missed her appointment. A new appointment was made
for February 16. The family went through the whole bureaucratic rigmarole
again: documents, copies, appointment, commitment to pay, application form and
a trip to the Palestinian liaison office, which sent the documents to the
Israeli officials and officers.
This time,
to ensure that the application for the permit would not be denied because of
the identity of the accompanying adult, the mother’s grandmother was selected
as the accompanying adult: 72 years old. The application was granted and the
two set out for Jerusalem.
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The
great-grandmother herself suffers from high blood pressure and diabetes. Worse,
little Yara didn’t know her well and refused to accept help from her at the
hospital. The little girl thought her parents had abandoned her, and during the
whole time she was at Al-Makassed, where she underwent catheterization, she
refused to speak to her parents on the telephone. “I felt like my heart was
crushed with longing for her voice,” said Hassouna, Yara’s mother.
Yara
returned home gaunt and remained angry at her mother who had not been at her
side. Her condition became even more obvious when Lara, her twin sister, was
nearby. After treatments and hospitalizations in the Gaza Strip, it was
decided to send Yara to Al-Makassed again. An appointment was made for June 2
and the documents and stamps made their way again to the Israeli liaison
office.
A week
before the appointment the family’s mobile phone received an instant message
saying the request was still under consideration. The appointment was missed.
The days passed, Yara’s condition worsened and when she experienced shortage of
breath and choking she was again taken to the European Hospital. Another
appointment was made at Al-Makassed, for July 20, to implant a pacemaker that
is not available in Gaza. But Yara died at the European Hospital on July 13.
Yara is one
of 20 severely ill patients who died this year in Gaza after their application
for an Israeli exit permit to receive medical treatment was not granted in
time. A new B’Tselem report to be published this week discusses this growing
phenomenon of unexplained delays in the issuing of exit permits for medical
treatment.
The
patients did not receive official refusals, but only the message “Your
application is under consideration.” The Israeli liaison officers send this
message to the members of the Palestinian liaison office, who send an instant
message to the family, sometimes on the evening before the appointment.
It’s hard
to determine if and when a death is caused directly by a delay in issuing an
exit permit for treatment. But it’s clear that the waffling, the expectations
and disappointment, the constant uncertainty, the tension and the need to go
through the whole exhausting bureaucratic procedure all over again each time
aren’t salubrious.
Worse over
the past four years
In June,
when Yara was supposed to go to Jerusalem to have a pacemaker implanted, 1,920
requests from patients for exit permits from Gaza were submitted. The World
Health Organization notes that 951 of those applications were approved, 20 were
refused (less than 1 percent) and 949 (49.4 percent) went unanswered by the
date of the hospitalization or treatment. Of the latter, 222 of the
applications were for children under 18 and 113 for people over 60.
In
September, 42 percent of the 1,858 applications for permits for medical
treatment remained in limbo. Of them, 140 were for children under 18 and 99 for
people 60 or over.
The Erez
crossing Eliyahu Hershkovitz
This has
been a clear trend during this past year, about which Haaretz reported on
November 9: Applications for exit permits for any purpose are delayed with no
reply for weeks and months. By September this year their number had reached
about 16,000.
The
percentage of unanswered applications for exit permits for medical treatment
has nearly tripled over the past four years. According to the World Health
Organization, which the B’Tselem report cites, in 2014, 15.4 percent of
applications went unanswered; in 2015, this number was 17.6 percent. By
September 2017, there were 8,555 that remained unanswered, accounting for 43.7
percent of nearly 20,000 applications.
“Security
reasons” was the explanation for the refusal of 2.9 percent of the
applications, while about 53 percent were granted. About three quarters of the
applications were for treatments at Palestinian hospitals in the West Bank and
East Jerusalem.
The Shin
Bet said in response, “Over the past year, we have seen an increase in the
practice whereby terrorist organizations, headed by Hamas, exploit the
departure of Gaza residents (including for medical treatment) to promote
terrorist activity, including by transferring explosives, money for terrorism
and other means of promoting terrorist activity.
“This past
April, two Palestinians who had been allowed entry into Israel so that one of
them could receive medical treatment for cancer were caught at the Erez
crossing. Their baggage was found to contain medical tubes, inside of which
explosives were hidden that apparently were meant for a Hamas attack in Israel.
“Given the
great danger this activity presents, strict security checks are performed on
everyone applying to leave Gaza. Naturally, these checks take time, and efforts
are constantly being made to reduce that time and prioritize the handling of
all entry applications, with an emphasis on humanitarian applications whose
subject is entering Israel to receive life-saving medical treatment.”
Nearly 20
percent of the applications that have gone unanswered in 2017 were for children
and adolescents under 18, and about 8 percent (725) were for people 60 and
over.
One of the
latter is Fatma Biyoumi, 67, who suffers from a serious blood disease.
Following tests and treatments in Gaza, appointments were made for her for
October 24 and November 4 at An-Najah Hospital in Nablus. In the absence of a
reply, she missed the appointments. A new appointment was made, this time for a
date in August at Augusta Victoria Hospital in Jerusalem, and the reply
remained “under consideration,” even though Israeli nonprofit group Physicians
for Human Rights accompanies her in her requests for an exit permit.
A new
appointment has been made for December 17, and Biyoumi and her family are
living in a state of constant suspense: Will the application be approved, or
will it be approved at the last minute in order to increase the suspense, and
will there be enough time to plan?
In its
statement to Haaretz on Thursday, the Shin Bet said Biyoumi “has been summoned
for questioning, after which it will be possible to complete the process of her
security evaluation.” Biyoumi, it turns out, was questioned by the Shin Bet at
the Erez crossing on Wednesday.
Huwaida,
48, who suffers from blood cancer, has an appointment for December 6, after
having received the “under consideration” reply to all her previous
applications: for treatment on August 13, September 11, September 24, October
9, October 29, November 8 and November 22. She too has sought help from
Physicians for Human Rights, and she too is living tensely in the fear of yet
another disappointment.
The Shin
Bet told Haaretz that “after she was questioned and her case was examined, an
answer was sent to the liaison office saying there is no security obstacle to
approving her request.”
Disappointment
the day before
Aya Abu
Mutlaq was 5 when she died. She suffered from cerebral palsy from birth and was
treated in Gaza. In October 2016 it was decided to send her for treatment at
Al-Makassed. An application was submitted for a permit for her and her father,
because her mother had given birth only two months earlier. The appointment was
for February 4, and on February 3 the family received an instant message
stating that the application was still under consideration. The appointment was
postponed to March 16. Again, just one day before the appointment, a message
was received saying the Israeli side was still considering the application.
The little
girl’s condition deteriorated. A new appointment was made for April 27, but she
died on April 17. Her father had exited Gaza three times in the past to
Ramallah and Jerusalem – for treatment for a knee problem. He couldn’t
understand why, out of the blue, when his daughter needed him to accompany her,
the application was delayed until she died.
According
to the World Health Organization, about half the people applying to accompany
patients do not obtain exit permits – something that often postpones the
patient’s treatment. Under new procedures at the Coordinator of Government
Activities in the Territories, the amount of time the liaison office takes to
deal with applications for exit permits has increased significantly – up to 70
days not counting weekends and Jewish holidays. For medical conditions (but not
in life-or-death situations), the maximum amount of time that has been set is
23 days.
Close
tracking by Physicians for Human Rights of the cases of nine female cancer
patients shows that the Liaison Office does not keep to the time limit that it
set for itself. Eight of the nine women did not make it to their appointments
for medical treatment in recent months because their requests for permits were
“under consideration.”
But
according to the Shin Bet, “an examination of the cases mentioned in Haaretz’s
query” – which dealt with 11 patients who died and several others who have been
awaiting approval for several months – “revealed that most of their requests
for entry into Israel have been approved, and some have already used their
permits to enter Israel and receive medical treatment.”
On November
29, Ghada Majadala and Mor Efrat of the Israeli physicians’ organization sent
an urgent letter to Maj. Gen. Yoav Mordechai, the head of the Coordinator of
Government Activities in the Territories, and to Moshe Bar Siman Tov, the
director general of the Health Ministry. In the document, which focuses on the
nine women suffering from cancer, Majadala and Efrat noted that the cancer
treatment available in Gaza is inadequate.
In recent
months there has been a drop in the stock of medications used in conjunction
with chemotherapy, they wrote, and it is difficult to perform surgery to remove
tumors because of the shortage of fuel and electricity. Moreover, in Gaza there
are no radiation or radioactive iodine treatments, nor is there equipment for
following the progress of the disease. In addition, both the Majadala-Efrat
letter and the B’Tselem report note that the Palestinian Authority is now
pursuing a policy of reducing the number of patients sent for treatment outside
Gaza.
In their
letter, copies of which were sent to the Israel Medical Association and to the
nurses’ ethics committee, Majadala and Efrat wrote that the waiting causes not
only suffering but also exhaustion in the battle with the bureaucracy. “A
non-reply does not enable patients to use their right to appeal a refusal if
one is given,” they wrote. “Not replying for many months attests to a policy of
contempt for the patients’ suffering.”
Amira Hass
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