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Physicians for Human Rights-Israel April 2008
Since Hamas took political control over Gaza, several decisions taken by both Israel and the international community have caused a severe deterioration of the civilian infrastructure – including medical systems – in the Gaza Strip. At the same time, Israeli government policies are making access out of the Gaza Strip increasingly difficult for those patients for whom treatment is not available in the Gaza Strip and who need to access more advanced medical centers in Israel, the West Bank & East Jerusalem, Jordan or Egypt.
Closure of the crossings
Prior to June 2007, about 400-500 patients left Gaza for Egypt via Rafah each month, and an additional monthly average of 652 patients requested permits for exit via Erez Crossing to medical centers in Israel, the West Bank and East Jerusalem, Jordan or elsewhere.
On 9.6.07 Rafah crossing into Egypt was closed and, as a consequence, the number of applications to exit Gaza via Israeli-controlled Erez Crossing doubled. Although the absolute number of people exiting Erez increased in the second half of 2007, the proportion of people granted permits in relation to the number of requests decreased drastically towards the end of the year, from 89% in January 2007 to 64% in December 2007. Requests were usually denied due to “security prohibitions” issued by the Israeli General Security Service (GSS, Shabac). Whereas in the past patients could go to Egypt if refused access via Erez, from June 2007, “prohibited” persons have no alternative at all and must remain in Gaza.
Tightening policies at Erez Crossing
Patients from Gaza apply to PHR-Israel either after they receive a “security prohibition” to a request they have already forwarded to the Israeli authorities at Erez Crossing, via the Palestinian MoH medical referrals department, or after the answer is so far delayed that they have missed appointments and are still stuck in Gaza with no reply.
An analysis of applications received by PHR-Israel from patients in Gaza each month clearly shows the steep rise in the number of people denied access to care during 2007.
The most dramatic increases occurred in June-July and in October. The first peak corresponds to the closing of Erez and Rafah Crossings and the decision by Israel to allow exit via Erez only to lifesaving cases; the second peak corresponds to the Israeli declaration in late September of its intentions to impose collective measures against the civilian population, due to its definition of Gaza as a “hostile entity”.
· Security prohibitions increased: the monthly average of applications to PHR-Israel increased from 32 per month in Jan-May, to 72.5 per month in Jun-Sep, to 146 per month in Oct-Dec.
· PHR-Israel success rates decreased: Jan-May 67%; Jun-Sep: 47%; Oct-Dec: 7%
· From June 2007: “life / limb” distinction: In June, the State refused to recognize the right of patients not in life-threatening condition to exit Gaza. The result on the ground was amputation of limbs and loss of eyesight.
· From September 2007: even life-threatening cases are denied: Increasing numbers of access-related deaths are recorded.
· January to April 2008: More than 407 applications for assistance from patients encountering problems of access were handled by PHR-Israel.
The tightening permits regime at Erez Crossing corresponds closely to a drastic deterioration in the policy of two other Israeli organs: the Israeli High Court of Justice (HCJ) and the General Security Services (GSS, shabac):
The High Court of Justice: from non-intervention on policy to rejection of patients
June 2007: Discussion limited to humanitarian aspects HCJ 5429/07 (PHR-Israel and Gisha on behalf of 26 patients)
• Refusal to discuss the legal status of Gaza and Israel’s responsibility or lack thereof
• Decision to limit the court to the “operative common denominator, i.e., to humanitarian aspects” (HCJ ruling, 28.6.07)
• Current system of coordination adequate.
• Questioning of life/limb distinction but decision not to intervene, since intervention could “by the stroke of a pen, expose IDF soldiers and civilians at the Crossing…”
• Refusal to intervene in the security prohibition of two patients to whom denial of care caused the loss of a limb (a leg and an eye, respectively).
à result on the ground: patients lose legs (amputations) and eyesight because refused exit from Gaza.
November 2007: “Even ‘evil people’ should not be denied life-saving care” HCJ 9522/07 (PHR-Israel and 11 patients).
• Court decision on day of first hearing (12.11.07) led to delay of 16 days in the course of which one patient, Nael ElKurdi died.
• Ruling (28.11.07) repeats decision not to relate to principle issues connected to Israeli legal status vis a vis Gaza, but states that there are grounds for addressing the reasonableness of the implementation of Israeli policy.
• Ruling states that the life/limb distinction is not justified when dealing with severe conditions.
• For life-threatening cases, the ruling recommends finding solutions that enable medical care while minimizing the possibility of damage to security. Comparison is made to prisoners who receive appropriate medical care. Court adds that “even if these are evil persons…access to life-saving care should not be denied them.”
• Court requests that a way be found to allow access of individual rejected patients to Jordan at their own expense and with escorts acceptable to the State.
à result on the ground: steep rise in access-related deaths as even life-threatening cases denied exit from Gaza. By April 2008 WHO had registered 32 deaths related to denial of access to care.
2008: No Hope for Patients
On January 30th 2008 the Court clearly declared that the occupation of Gaza Strip had ended and that Israel has very little responsibility toward its residents (HCJ ruling 9132/07, 30.01.08). Through this ruling the Court has, in effect, granted legitimacy to Israeli governmental decisions to impose collective measures on the civilian population of the Gaza Strip, leaving its residents little hope for legal redress. The ruling has moreover sown confusion among legal experts and human rights actors both locally and internationally, with regard to the current legal responsibilities of Israel toward residents of the Gaza Strip. Surprisingly enough this passed with little international attention or criticism. The affect of this policy shift on patients is clearly to be seen in HCJ rulings since January 2008:
January 2008: Patients in life-threatening condition denied redress
HCJ 11105/07 (PHR-Israel and 15 patients);
HCJ 559/08 (PHR-Israel and one patient)
• Court refused to address any policy issue and claimed that each patient should submit a separate petition. Hearing of cases was delayed by one week.
• Court overturned previous HCJ ruling and found “no grounds for intervention” in the decision of the State to deny access to 7 patients on security grounds (ruling 8.1.08).
• In a second petition, Court refused to intervene on behalf of a leukemia patient denied exit from Gaza and rejected the petition.
• In March, in a separate petition for cancer patient Mustafa Hilu, not only was the patient rejected, but the Judge, Justice Melzer, wondered why he had submitted no letter of thanks to the Israelis following care that had been given him previously…
Rajab Almughrabi, 28, was diagnosed in October 2007 as suffering from Chondrosarcoma, a rare cancer. On 25.11.07 he was referred by the Palestinian MoH for medical care at Maqassed hostpital in East Jerusalem. The GSS opposed his exit. PHR-Israel submitted a request on his behalf on 25.11.07, which was rejected. A High Court petition submitted on his behalf on 27.12.07 resulted in an undertaking (out of court) by GSS to enable his exit to Jordan. The Jordanian embassy, however, rejected his request for a visa a month later. Rajab’s condition deteriorated and a second request was submitted on his behalf for passage to East Jerusalem on 14.1.08. Before an answer was received, the Rafah Crossing was breached on 25.1.08, and Rajab reached Al Arish hospital on 28.1.08, where, however, the necessary treatment was unavailable. His access to Egypt was blocked by the Egyptians. He returned to Gaza in late February and died at home on the 9th of March, untreated, seven months after his disease had been diagnosed
GSS policies at Erez Crossing: manipulation and coercion
According to data collected by PHR-Israel from patients, in at least 30 cases since July 2007, the Israeli secret service has called patients – many of them with exit permits – to interrogation at Erez Crossing. In the course of the interrogation they were asked to provide information about relatives and acquaintances, and/or required to collaborate and provide information on a regular basis, as a condition for being allowed to exit Gaza. If they refused or could not provide the information, they were turned back into Gaza. These cases include several patients in life-threatening condition. A petition submitted by PHR-Israel to the Court on this issue was rejected after the judges refused to discuss the topic.
Ashraf Qdeih was diagnosed approximately one year ago as suffering from lymphoid cancer. In January 2007, after undergoing primary treatment in the Gaza Strip, his condition worsened and he was transferred to Ichilov Hospital in Tel Aviv for advanced treatment. He then returned to the Gaza Strip with a chemotherapy program. In September he was told to come to Sheba Hospital in Tel Hashomer for an advanced isotope test that is unavailable in the Gaza Strip, but his application for an exit permit was rejected. Two further applications were also rejected without any reason being given. Ashraf contacted PHR-Israel and asked for assistance. After an application submitted by PHR-Israel was also rejected, a petition was filed at the Supreme Court on Ashraf’s behalf. Following the petition, Ashraf received a permit for entry on December 2, 2007 at 2:00 pm.
Ashraf arrived at the Erez Crossing at 11:00 am in order to leave the area. After waiting for almost an hour, however, he was summonsed for interrogation by the GSS. He was asked to give his own telephone numbers, as well as those of his family and friends, and was told that he must collaborate with the GSS in order to enter Israel. The interrogator scolded him for filing a petition against the State of Israel and told him “You have cancer and soon it will spread to your brain if you do not help us.” After Ashraf refused to collaborate with the GSS, he was forced to wait until 3:00 pm. He was then permitted to leave the checkpoint and head for Israel, but by this time he had missed his appointment at the hospital and the radioactive isotope materials had been destroyed. He returned to the Gaza Strip and was obliged to reschedule his appointment. He continued to submit repeated requests that went unanswered, until concerted media pressure initiated by PHR-Israel finally led to the issuing of a permit for exit to Israel in March 2008.
PHR-Israel demands:
• That the Government of Israel ensure access of all patients needing medical care unavailable in Gaza to medical centers outside Gaza, as a matter of policy.
• That the GSS (Israeli secret services, Shabac) desist immediately from conditioning the exit of patients from Gaza on acting as informers on others.
• That Israel recognize its responsibility as Occupying Power for the welfare of the population of Gaza.
• That international players use political means as well as leverage connected to their own provision of aid to Gaza to pressure Israel to recognize its responsibilities for the oPt as a whole, and to end its siege on Gaza.
For further details and case studies please contact Ms. Miri Weingarten at miri@phr.org.il, 00 972 546 995199, or Mr. Ran Yaron at ranyaron@phr.org.il , 00 972 547 577696