Patients stranded in Gaza under Israel’s permit regime

Five nurses in protective gear and masks walk down a street

Curfews were imposed in Gaza to control the spread of coronavirus. But despite the efforts of local healthcare professionals, some treatment is simply not available in Gaza.

Ashraf Amra APA images

After nearly two months of curfew, authorities in Gaza are beginning to relax the lockdown here.

Roadblocks have been removed and we can again move between governorates. During the day, with schools and universities reopening, and restaurants and hotels allowed to operate, it’s almost normal, at least until 8 pm when the curfew kicks back into force.

Before then, Gaza had been ghostly. My neighborhood, for instance, was almost void of life and people after a neighbor living in the building opposite was diagnosed with Covid.

In March, I wrote an article reflecting on my experience with my children after the COVID-19 outbreak forced us to stay quarantined at home.

When I started interviews for this article, I quickly understood that my suffering is nothing compared to the suffering of those who have children needing medical treatment outside Gaza.

Not only are they caught up in the anxiety of the COVID-19 pandemic and resulting restrictions, but they also face the Kafkaesque maze that is Israel’s military permit regime.

And relaxing the lockdown has done little for them.

Nihad al-Dabba, 58, from the Shujayia neighborhood of eastern Gaza City has little to do but wait for her children to die.

Both her children suffer a neuromuscular disease for which a combination of medicine and surgery is used as treatment, most of which is unavailable in Gaza.

For three months, Nihad has been trying to find a way for her son Emad, 31, and her daughter Miasar, 38, to return to the Hadassah hospital in Ein Kerem, outside Jerusalem, for treatment.

They receive dialysis in Gaza, which mitigates some symptoms, but too much could be fatal for the siblings whose veins and nerves have grown weak.

The two were supposed to have traveled to Jerusalem at the end of May to have a tube implanted that would make dialysis treatment possible again.

Trying all avenues

The May surgeries had to be canceled as a result of the suspension of civil and security coordination between the Palestinian Authority and Israel on 19 May that came in protest at Israel’s plans to annex large swaths of the occupied West Bank.

Palestinians in Gaza normally apply for medical referrals through the local office of the civil affairs committee, which is run by the PA in Ramallah. That office coordinates with the Israeli military which decides whether or not a permit will be granted.

Nihad, who has three more healthy children, has already lost one son, Elian, who died in April while suffering complications from dialysis treatment given him at Gaza’s al-Shifa hospital for the same condition.

“In April I wasn’t able to travel because of COVID in Israel,” Nihad told The Electronic Intifada. “Now I’m trapped because of COVID here and because of the suspension of security coordination. I fear I will lose my children at any moment.”

Nihad has tried to reach out to various human rights organizations in Gaza, including Al Mezan, the Palestinian Center for Human Rights, and the Independent Commission for Human Rights.

Human rights organizations in Gaza have started an alternative coordination method with the Israeli side, by speaking directly with the Israeli military coordinator at the Erez checkpoint.

Samir Zaqout, Al Mezan’s deputy director, told local media that this way, his and other organizations in Gaza manage to secure approval for an average of five cases per day for medical referrals.

Since the signing of the Oslo Accords in 1993, this is the first time there has been direct coordination with the Israeli side outside the Palestinian Authority. However, Zaqout said it cannot adequately cover for the official mechanism.

“Our capacities as human rights organizations cannot compare with an official government body,” Zaqout told The Electronic Intifada. “Communication is clearer between official bodies.”

Nihad has so far failed to secure any result and reached out instead to Physicians for Human Rights-Israel.

But according to Ghada Majadle of Physicians for Human Rights-Israel, the organization never knows if and when permits are granted.

“Al-Dabba submitted a request for her children a while back,” Majadle told The Electronic Intifada. “We transferred her request, along with tens of others, to the Israeli authorities. But we never know if we can get permits. All we can do is wait.”

Majadle said before the coronavirus crisis, between 2,200 and 2,500 people would leave Gaza every month for treatment in Israel or the West Bank.

In April, this dropped to 159 people because of the COVID-19 restrictions.

Obstacles everywhere

Nihad and her husband Taysir, 60, do what they can for their children. Mostly, this involves taking them three times a week to al-Shifa hospital to receive dialysis treatment.

Al-Shifa is the main hospital in the Gaza Strip for patients to get dialysis treatment and the department now caters to 820 patients, according to the ministry of health in Gaza.

Coronavirus restrictions have made life for these patients even more onerous.

With some neighborhoods under lockdown at different times, just getting to the hospital has become arduous and painful for patients.

The Dabbas have to push both their adult children in wheelchairs some 700 meters before they can get to a main road, where an ambulance can pick them up.

With a shortage of medicine – overall, the ministry of health in Gaza estimates that the area’s hospitals have just over half the essential drugs they need – every day is a test for the Dabba family.

“It’s difficult to move or get medication,” said Taysir, who works as a night guard for a shop in the neighborhood and earns $200 a month.

Then there is the constant worry about permits.

“Away from COVID, my children are victims of a political decision that has no benefit to us,” Taysir told The Electronic Intifada, referring to the PA’s decision to suspend coordination with Israel.

Akram Atallah, a political analyst with al-Ayyam newspaper, said he didn’t expect the suspension of security coordination with Israel to last long, in part because of the situation with patients.

“When the PA took the decision of pausing coordination with Israel, they didn’t find an alternative plan to save the lives of patients, especially from Gaza.”

Atallah was scathing in his commentary on the decision, which he said had put people’s lives at risk and would “not bring any political gains.”

Fatal treatment delays

For all the criticism the PA comes in for, however, responsibility for the welfare of everyone in occupied territory ultimately lies with Israel, the occupying power. This is a point human rights and health organizations have made repeatedly in recent months, as fears that an uncontrolled outbreak of the coronavirus pandemic could bring Gaza’s healthcare sector to complete collapse.

But none of that will be any comfort to the Dabba family. They will be aware, as everyone in Gaza is, that four people have already died due to delays in receiving travel permits.

Among them were two infants, one of whom, Omar Yaghi, died in June at eight months, and just 72 hours before he was scheduled for surgery in Israel. That surgery had been delayed a month, after the collapse of coordination prevented him from traveling for his original appointment in May.

Jivara Ghunaim, 26, was married in mid-April to Azhar, 22. After just one month, Jivara fell very ill and was diagnosed with blood cancer.

The family tried to get their son a permit for treatment abroad. It was denied, then granted and then delayed. The delay was too long.

On 15 August, Israel granted a travel permit. A day after finally getting to the Augusta Victoria hospital in occupied East Jerusalem, Jivara died.

“Doctors told us that it was too late when Jivara arrived,” Azhar told The Electronic Intifada.

She was not in doubt who was to blame.

“Israel and the PA killed him.”

Israeli procrastination in allowing patients to travel from Gaza and Israel’s permit scheme in general has long been a source of criticism.

In Gaza, it is seen as another Israeli weapon trained at people’s heads.

In 2017, according to the WHO, 54 people from Gaza died as a result of being refused permission by the Israeli military to travel for treatment.

Over a 10-year period, from 2008 to 2018, Israel prevented over 51,000 people from Gaza from traveling to Israel or the West Bank for medical treatment, according to statistics compiled by the Palestinian Center for Human Rights.

A faint hope

In my last phone call with Nihad, her voice sounded different. There was hope in it.

She told me that her friend’s son Amjad Lafy, 4, a cancer patient, got a travel permit in the first week of September.

She is hoping this is a good portent for her own children. But as of mid-October, she has still not received any news.

Like her children, young Amjad’s appointment was at Hadassah hospital in May. It too was a follow-up visit – his left eye had been removed in April. The permit was four months late. But it came.

“What happened with Amjad was a miracle,” Amjad’s mother Khouloud, 32, told The Electronic Intifada. The family had given up hope that he would get a permit. Now, “I feel that he has a chance of survival.”

The cancer had spread. But doctors told the family that they might still be able to save Amjad’s right eye.

That wouldn’t have been possible without travel. After 13 years of an Israeli blockade, Gaza’s healthcare sector is so decimated that clinics and hospitals there lack basic facilities, medicine and medical staff.

The more care a patient needs, the less likely that it is available.

But hope springs eternal. It’s how we survive.

“After Amjad’s permit, I’m hopeful my children will get theirs too soon,” Nihad told me.

Sarah Algherbawi is a freelance writer and translator from Gaza.