Two recent reports discuss it, a July Physicians for Human Rights - Israel (PHR-IL) one titled, "A Situation Report on Obstacles Facing Gaza Residents in Need of Medical Treatment," and a June one titled, "Who Gets to Go," jointly prepared by PHR-IL, the Al Mezan Center for Human Rights, and the Adalah Legal Center for Arab Minority Rights in Israel. All cite Israeli medical ethics and international law violations by discriminating on the basis of need, denying adequate treatment to seriously ill Gazans by:
- preventing the restoration and development of the Strip's healthcare system; and
- restricting travel to the West Bank, East Jerusalem, Israel, or neighboring countries for treatment.
In its July report, PHR-IL said Gaza's healthcare system is getting progressively worse "due to a lack of medical expertise, medicine(s) and medical equipment," the ICRC recently saying it's "at an all time low."
In June, the World Health Organization (WHO) reported that Israel blocked delivery of essential equipment, including a CT scanner, defibrillators and monitors. In addition, the Palestinian Health Ministry said Israel confiscated seven oxygen machines, donated by a Norwegian development agency, and blocked x-ray machine deliveries, claiming they were dual-use, meaning possibly for military purposes.
As a result, critical shortages of most everything exist, including vital medicines, essential equipment, and other supplies expected to run out this summer, harming chronic disease sufferers the most, hampered by draconian impediments for permission to leave Gaza for treatment - what PHR-IL calls "an inexcusable breach of medical ethics" based on political, not medical considerations, most non-life threatening cases denied, including ones PHR-IL calls urgent, such as for:
"Paraplegia; retinal detachement; SLE (Lupus); foreign body in vitreous; subluxated lens; chronic severe febrile anemia; fever(s) of unknown origin (FUO); traumatic macular hole; psychomotor retardation; anemia; suspected abdominal abnormal vascular pressure; suspected chronic intestinal disease; psedoarthrosis (non-union of fractured bones) - arms, hand; infected plate - hip; deformation of cornea; recurrent dislocation of shoulder; lumbar discopathy; opacity of vitreous; (and) malformation of urinary tract."
Numerous other non-urgent/non-life-threatening ones are also denied, some chronic, severe, painful and/or disabling, badly in need of treatment, including a 24 year old Gaza resident shot in the arm in October 2007, unable to use his hand because of atrophied muscle tissue around the wound area.
As a result, he suffers severe pain, orthopedic surgeon, Dr. Yosef Leitner, saying a tendon transfer is the only hope to restore proper hand functioning, Gaza's Al Shifaa Hospital (the Strip's largest and most advanced) with neither the means or staff to perform it.
In August 2009, an exit request was submitted to receive treatment in East Jerusalem's Al Makassed Hospital. Initially denied, it was appealed and again denied - unprincipled, unethical, illegal, and common practice against Gazans under siege, PHR-IL saying:
"....all patients are entitled to the best available medical treatment, regardless of the urgency....or the severity of their clinical state," legitimate distinctions only permissible in cases of limited resources (such as after a natural disaster), even then for the shortest time possible to restore proper care to everyone in need.
Under international law, denying medical care is illegal, Fourth Geneva's Article 3 saying all non-combatants and those having laid down their arms "shall in all circumstances be treated humanely" with no distinctions for any reasons.
Article 16 states:
"The wounded and sick, as well as the infirm, and expectant mothers, shall be the object of particular protection and respect."
The UN's Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment prohibits mistreatment in any form (including denying medical treatment), as do the International Covenant on Civil and Political Rights, the Constitution of the International Criminal Court (the Rome Statute), and civilized countries globally, Israel and America not among them.
An Israeli Supreme Court decision provides an example, approving restrictions to exit Gaza for treatment, with narrow exceptions, ignored by government officials because the ruling left final authority in their hands, an easy cop-out to permit cruel and unusual punishment to continue, what PHR-IL calls "routine, permanent policy," unethical, immoral, illegal, and deplorable.
Medical training outside Gaza is also denied, Fatah in charge of Ramallah's Health Ministry, collaborating with Israel against its own people, blocking training and treatment of many, persecuting and abusing many more, acting as Israel's enforcer, its duplicitous, self-serving agenda.
In addition, Israel prohibits its own or foreign doctors entering Gaza to provide treatment or professional training. Its authorities rejected two recent requests for a Ramallah Musallam Center team to come, to perform eye surgery and cornea transplants, most patients in need rejected or subjected to long delays.
For the past year, PHR-IL medical delegations were denied entry to Gaza, ones operating in 2008 as part of its Mobile Clinic, providing treatment, surgeries, medications, training, counseling, and referring patients for follow-up treatment in Israeli hospitals.
Repressive Security Services
In 2009, Shin Bet, Israel's internal security service, interrogated over 600 of the thousands of Gazans applying for treatment exit permission. Usually, patients are summoned "after their hospital appointment date(s) passed," causing them to lose out and have to reschedule. In addition, many face "threats and extortion....health (for) ransom," collaborate or be denied, a choice most won't accept.
In other cases, Shin Bet summons patients to Erez Crossing (on the pretext of permission to leave), arresting and detaining them instead - a Palestinian Red Crescent Society (PRCS) worker as well, part of a paramedic/ambulance driver team en route to a Ramallah training course, arrested and imprisoned in Israel.
In January 2010, Adalah complained officially to Israel's Attorney General, the Prime Minister's office saying:
"The State of Israel reserves the right to detain elements who seek medical treatments in Israel following information that they are terror activists or that their entry to Israel might pose a security risk," common Israeli boilerplate - disingenuous, duplicitous, and dishonest justification for repressive state policy, including against seriously ill patients and medical workers providing care.
Israeli also denies quality care outside Gaza and the West Bank, even in East Jerusalem where treatment is better. In some cases, follow-up permission is denied (including for rehabilitation) for those initially allowed in, leaving them in limbo, unable to get what they need.
Dr. Danny Rozin, an internal medicine expert at Israel's Sheba Medical Center, said the following:
"It is important to understand that in many cases providing a complete, effective treatment requires more than a one-time appointment and many patients need follow-up, post-surgery checks, or an additional medical or rehabilitative treatment....The lack of continuity might bring about a failure of treatment in part or in full and resources allocated to treat patients might go down the drain. Sometimes there is also a real danger that the patient will suffer functional damage or even lose his life....Preventing the continuity of treatment harms patients and is inconsistent with the many efforts made by medical staff to provide full and optimal care."
It also violates international law and medical ethics, what Israeli authorities disdain and spurn. PHR-IL says it's illogical and inconsistent that a patient given permission "suddenly becomes a security threat" and is denied. It reinforces the notion that politics and repressive policy are at issue, not security, a duplicitous red herring.
Israel further denies permission for West Bank treatment, saying patients might stay with their families - their legal right, unrelated to security, entirely state-sanctioned repression, part of enforcing Gaza's siege.
Another part involves confiscating patients' belongings on returning home after treatment, forced on reentry to leave behind whatever they bought or were given, including medical equipment, clothing, toys and other non-threatening items - another way to harass and intimidate.
A Final Comment
As a result of Israel's post-January 2006 embargo, its siege since June 2007, Cast Lead, regular incursions, and its longstanding collective punishment policy, Gaza's healthcare system is "at an all time low." Many of the Strip's sick and injured lack proper care, or enough, in violation of medical ethics and international law explicitly prohibiting these practices.
"As an occupying power, (Israel bears full) responsibility for the health of Gaza's residents," including to treatment outside the Strip, unconditionally without constraints, authorities denying it as collective punishment - prohibited under international law, what, throughout its history, Israel disdainfully spurned.
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