Common Ground News Service, April 16, 2009
Daily News Egypt, May 7, 2009
In the days and months leading up to Operation Cast Lead, Gaza Strip’s healthcare system was stretched to the point of tearing. Hospitals and clinics in Gaza found themselves without almost a quarter of drug items that comprise the WHO essential drug list. Various other drug items stood at critical levels. A shortage of medical supplies endangered the long-term function of some equipment, such as dialysis machines. Vital medical equipment was unavailable, and others had fallen into disrepair, while some sat in disuse as health care workers lacked the training needed to employ them.
If Operation Cast Lead proved to be the breaking point, it also illuminated where the responsibility lies. An ongoing Israeli blockade and, within Gaza, a health workers’ strike—due, in part, to the political tug-of-war between Fatah and Hamas—had placed immense strain on an already fragile institution. The pressures that left Gaza’s medical system unable to cope with a sudden influx of patients were both internal and external.
On the second day of the Israeli incursion, Dr. Zaki Zakzuk of European Hospital in Khan Younis spoke with Physicians for Human Rights-Israel—an organization that promotes the right to health for Palestinians and Israelis alike—regarding the impact a lack of supplies made upon patient care, “As of today, we have thirty wounded individuals in very grave condition… All of them are in need of ICU beds for ventilations machines, but because of the lack of such equipment only half of them are able to receive the ventilation treatment while others are resuscitated manually. [T]here is an extreme need for additional blood units… [but] the lack of refrigeration equipment and emergency vehicles are making it impossible for us to transfer blood units from Shifa Hospital.”
Health care workers in Gaza were forced to turn some patients away. Dr. Halil Nahlah, an ICU physician at Shifa Hospital reported to PHR-Israel, “[W]e cannot accept patients with basic injuries. We accept the urgent cases for life-saving efforts, operations, etc, and if possible we transfer them to other hospitals.”
That is, if possible. Some of the injured found themselves unable to reach hospitals, both within Gaza and beyond its borders, in the first place. This problem is not particular to times of war—though Operation Cast Lead cast light on a health care system in crisis, the chronically ill face constant obstacles that prevent them from accessing necessary medical care.
Throughout the Israeli blockade, over half of those who have applied for exit permits to leave Gaza for external health care facilities have been denied permission. Many of these patients then turn their hopes to the Rafah crossing only to find a political dam that allows only an irregular trickle of patients out. Appeals for Jordanian visas are often denied, as well.
PHR offers the case of Karima Abu Dalal, a 33-year-old Gazan woman who suffered from Hodgkin’s lymphoma. She received a variety of treatments in Egypt before beginning treatment in the West Bank upon the 2007 closure of the Rafah crossing. In late 2007, however, the life-saving medical care Karima was receiving came to a sudden halt when Israeli authorities barred her from leaving Gaza. She tried again, and PHR-Israel also applied for an exit permit on her behalf. Israeli authorities were silent in response.
PHR-Israel sought help in the Israeli High Court, including in their petition testimony from Professor Dina Ben Yehuda, an Israeli physician familiar with Karima’s case. Ben Yehuda stated that Karima’s life was endangered by the disruption of medical treatment. However, the court abstained from intervening on Karima’s behalf—leaving her to appeal, yet again, to the Israeli authorities who hold control of Erez Crossing. Her request for an exit permit was denied.
Her condition deteriorating, Karima then turned to a nearby Arab country—Jordan. Her subsequent visa application was denied not once but twice. In June of 2008, Karima at last managed to enter Egypt via the Rafah crossing. Almost a year had lapsed since her last treatment. But the hospital in Cairo turned her away as she lacked the means to pay for medical care.
After a long struggle against Hodgkin’s lymphoma and the political bodies that surrounded her, Karima died in Gaza in November of 2008.
Where a patient receives health care—whether it be for a chronic illness or injuries sustained as a result of military confrontation—has implications for the larger question of what political entity assumes responsibility for Gaza as a whole. But we mustn’t treat individuals merely as symbols or representatives of their governments. Punishing the people of Gaza—whether by means of an external blockade or an internal strike—so they, in turn, will exert pressure on their government polarizes opinions and is certain to prolong the conflict. To move the peace process forward we mustn’t lose sight of the humans in the political landscape.
This is the approach of Physicians for Human Rights- Israel. PHR-Israel works closely with Palestinian and Israeli organizations, institutions, and individuals to coordinate the exit of patients who have been denied permits. This task has only become more difficult in the wake of Operation Cast Lead. The Palestinian Ministry of Health is refusing to provide financial coverage for patients seeking care in Israel. Further, there is currently no representative from the Ramallah-based MoH in Gaza—Hamas has taken over the office—so the chronically ill turn to PHR-Israel for help.
PHR-Israel has been able to coordinate the exit of patients via the Erez Crossing and, in some cases, has been able to provide or facilitate financial assistance. “All of the individual assistance we provide for the patients is done with an eye at the broader issues. We are interested in responsible policy changes,” Norich says. PHR-Israel pursues advocacy with representatives of the EU, the US, members of Knesset, and other stakeholders. Via these lines of communication, PHR-Israel rallies for the opening of the borders to the free-flow of patients, medical practitioners and medical supplies in to and out of the Gaza Strip.
Israel and the Arab world, who are both most immediately responsible for the people of Gaza, must follow PHR-Israel’s example of putting human rights before political struggle. None of us can stand by while the injured and sick suffer in a snare of politics—ensuring access to medical care is a move towards health for the whole region.