Gazans Are Now Stuck in a Medical Limbo

A.N., 65, of Gaza, has an inoperable cancerous growth on her spine and is confined to a wheelchair. Every movement causes severe pain, which her doctor in Gaza was unable to alleviate. He therefore decided to send her for pain therapy at Sheba Medical Center in Tel Hashomer.

A.N. never arrived for her first treatment on August 10. After a six-hour wait at the checkpoint, she discovered that her entry permit did not cover her wheelchair, and she is physically incapable of switching wheelchairs several times. Palestinian ambulances are not allowed to enter Israel; patients must transfer at the checkpoint, via either stretcher or wheelchair, to another ambulance waiting on the other side, a few hundred meters away.

A.N. made another appointment on August 30, and this time, thanks to assistance from Physicians for Human Rights (PHR), her permit covered her wheelchair. But the soldiers at the checkpoint did not know this, and refused to allow her wheelchair to cross.

Her next appointment was for September 13. But on September 8, a full closure was imposed on the territories, and only life-and-death cases were allowed to enter Israel. A.N. did not qualify. So she made yet another appointment, for September 28. No one in Gaza is prepared to bet that, this time, she will finally arrive.

A spokesman for Israel's Liaison Office said A.N. was allowed to enter under the procedure "whereby she must transfer from a Palestinian ambulance to a `sterile' ambulance waiting at the crossing - a procedure established to eliminate the delays entailed in checking the ambulances."

The Palestinian Health Ministry's Liaison Committee recently instructed Palestinians not to request entry permits to Israel for medical treatment unless the case is urgent, since the chances of actually being allowed in are small. The full closure imposed on September 8 only makes matters worse: According to the committee, 24 cancer patients have thus far missed regular radiation treatments in Israel because of this closure.

Even once a permit is obtained, any visit to Israel entails long hours of waiting at the checkpoint. On September 19, for instance, a 19-year-old cancer patient waited 10 hours to enter Israel for a scheduled operation, finally succeeding only thanks to intervention from his surgeon and PHR.

Between 1967 and 2004, Gaza became increasingly medically dependent on Israel, which did not allocate resources for the development of an independent Palestinian health system. The gap between the two systems has not been eliminated in the 10 years since the Palestinian Authority was established. Today, the PA prefers not to send patients to Israel, because of the expense, but many patients are reluctant to make the longer trip to Egypt or Jordan, where health care is cheaper. Thus Palestinians are still sent to Israel, but generally only if their case is serious or complicated.

Since 1994, the procedure has been that the Palestinian Health Ministry sends treatment requests to Israel's Liaison Office, which gives the ministry an oral response, by telephone. Thus the patient shows up at the Erez Checkpoint with no written proof of his entry permit. Often, the checkpoint guards also have no record of the permit, and with no written evidence, it is hard for the PA Health Ministry to prove its contention that Israel approved the visit.

Moreover, each permit is for one visit only, even if the patient needs a series of treatments.

Another problem is that the Shin Bet security service sometimes refuses to approve a patient's entry into Israel for "security reasons" - though such refusals have occasionally been overturned by the courts or reversed in response to appeals from Physicians for Human Rights. A typical example of such a Shin Bet veto was the case of Z.D., 41, a member of Yasser Arafat's presidential guard, Force 17. He was seriously injured in a traffic accident in August and was supposed to undergo a series of operations in Israel, but the Shin Bet refused him a permit. Asked for a response, the agency told Haaretz: "The subject has a security history in Fatah that includes, among other things, vicious beatings of local residents. Before the intifada, we approved his entry into Israel, but today, because of the security situation and in light of his alleged past, we will not allow his entry into Israel." Instead, it said, he received permission to go abroad for treatment.

The Liaison Office, asked for a response to this article, noted that thousands of Palestinians are treated in Israeli hospitals each year. According to Liaison Office statistics given to PHR, 6,335 permits for medical treatment in Israel were issued in 2003, and another 3,168 were issued in the first half of this year. However, it is not clear how many of these approved patients actually succeeded in entering Israel.

In addition to the patients approved for treatment in Israel, 215 Gaza residents were permitted to go abroad for treatment in 2003, and another 99 in the first half of 2004.