Access-related deaths of patients referred to medical care outside Gaza are hard to determine with statistical certainty. Since several factors are involved, it is very difficult to define how far the delay or denial of a permit has influenced the final outcome in each case. However, there is no doubt that every delay lessens the patient’s chances of recovery, and denies them the right to the best available medical care. The fact that in Gaza the delay has nothing to do with medical constraints of any kind, but with external reasons, makes the violation all the more serious and raises questions regarding the definition of the term “security” in the Israeli Secret Police (GSS) lexicon. For the individual patient, the difference between receiving a permit and receiving a rejection, or no answer at all, may be the difference between life and death.
An additional constraint is the fact that many patients in Gaza, knowing the current situation at the border crossings, prefer to forego the hopeless process, and die at home, their stories untold and their voices unheard.
Physicians for Human Rights-Israel has therefore chosen to tell the stories of the deaths of three women and one baby girl, as told by their families. The stories give a small glimpse of the Kafkaesque process, in which the suffering of sickness and the cruelty of a hostile bureaucracy combine to embitter the last days of these people’s lives.
Khadija Al-Aqed, 65 years old, suffered from heart disease, and had a pacemaker implanted in her body in the 1990s at Beilinson hospital in Israel. In December 2007 the pacemaker stopped working and she was referred urgently to Al-Urdun Hospital in Amman, Jordan for surgery. On 21 January the family submitted a request for an exit permit to Jordan, via Israeli-controlled Erez Crossing. The Palestinian medical referrals department relayed the request to the Israeli authorities at Erez. Despite the urgency, a response was only received on 30 January when Mrs. Al-Aqed was denied an exit permit for “security reasons.” On the 10 February, she died of cardiac arrest.
Fatmeh Mahdi, 77 years old, was diagnosed with a cancer in her neck in June 2007 at Shifa Hospital in Gaza. In early July she exited Gaza and underwent a series of tests at Ichilov Hospital in Tel Aviv, Israel, after which she was told she must return for surgery and commence chemotherapy and radiotherapy in August 2007. From August she repeatedly tried to re-enter Israel for medical care without success. Despite five consecutive requests submitted to the Erez Crossing, no response was received. Mrs. Mahdi’s condition deteriorated. All that her doctors could do was administer painkillers. On 11 February 2008, Mrs. Mahdi died due to the spreading of the cancer throughout her body.
Bayyan Abu Hilu, one year old, was born in Al-Bureij refugee camp in Gaza. Her parents had previously lost two other children due to a genetic liver disease at an early age. Two months after she was born, Bayyan was diagnosed with a similar genetic condition. In November 2007 she entered Israel with her parents for treatment in the hematology department in Hadassah Ein Karem Hospital in West Jerusalem, and started lifesaving care. After the first stage of treatment, the doctors asked that she return as soon as possible for continuation of care. However, when the family applied a second time for exit permits, the Palestinian medical referrals department told them that the request of the parents had been rejected by the GSS for “security reasons,” and that an alternative companion for the child must be found. Since they had missed their appointment, the family applied to PHR-Israel in January to ask for help with renewal of an appointment at the Israeli hospital. The new appointment was set for 3 March 2008 and Bayyan’s father applied again to the Palestinian medical referrals department to relay the request for a permit for the Erez Crossing. However, before a response was received, Bayyan died in Gaza on 2 March 2008.
Fatmeh Al-Ladawi, 45 years old, was a mother of ten children. In September 2007 she was diagnosed at the European Hospital in Khan Younis, Gaza, as suffering from injury to her spleen, with internal bleeding and infection, following trauma. Fatmeh was referred by the Palestinian Ministry of Health to Al-Takhassusi Hospital in Nablus, West Bank, for surgery. In late September 2007, Fatmeh was permitted by the Israeli authorities at Erez Crossing to enter Nablus. However, the necessary care was not available there and she was sent home for re-referral. Fatmeh’s condition deteriorated while she waited for a correct referral to a medical center, which was delayed for two and half months.
Fatmeh finally received a referral to Maqassed Hospital in East Jerusalem in late 2007, but she was not permitted to exit Gaza due to the closing of the Erez Crossing on the scheduled day of her exit. When the Crossing re-opened, Fatmeh submitted a new request for a permit to go to East Jerusalem. However, this time, the GSS refused to allow her husband to accompany her. She was required to submit a new request with a different companion. She was allowed to travel from Gaza to East Jerusalem five days later with another companion. However, in Maqassed Hospital she was told again that the necessary treatment was lacking and Fatmeh was returned to Gaza two days later. Upon her return, she was led to an interrogation chamber in a basement beneath Erez Crossing, where she was interrogated by the GSS for five hours. Fatmeh was next referred to Ma’hed Nasser hospital in Cairo, but once again encountered obstacles, when the GSS refused to allow her brother-in-law to accompany her to her medical care. Her condition continued to deteriorate.
In January 2008, Fatmeh was finally referred to Ichilov Hospital in Tel Aviv. However, this time the visit of US President George Bush to the region stopped her from leaving since Erez Crossing was closed for three days during the visit. Only on 20 January was she informed that she had been issued a permit, and she arrived at Erez Crossing on a wheelchair suffering from difficulties in breathing. Fatmeh was once again led to a GSS interrogation, which lasted several hours. Her interrogators asked her to prove that the purpose of her exit was medical and not other. At the end of the interrogation, and after a total delay of 10 hours, she was allowed to go to the hospital. She was admitted to the hospital in the evening, but it was too late. Fatmeh died the next day, 21 January, in Tel Aviv’s Ichilov Hospital.
Security — personal security — is a universal right, and may not be used as a slogan to justify human rights violations. Universal security for all the people living in Israel and the Occupied Palestinian Territories can only be achieved through political means, by ending occupation and all other forms of oppression in our region.