Following suspension of permit processing and coordination, Palestinian patients face additional difficulties to accessing healthcare. Before March, there were more than 1,750 permit applications each month for Gaza patients and more than 7,000 permit applications each month for West Bank patients, though this number reduced drastically during the COVID-19 outbreak. Patients need permits to reach health services in different parts of the occupied Palestinian territory, with the majority needing access to East Jerusalem. Almost a third of applications are for cancer patients; others require specialized surgeries, diagnostic imaging, cardiology, or other services otherwise unavailable. Overall, this group of patients is very sick, with their probability of survival at six months from first permit application less than 90%.
Waseem is 25 years old and has a congenital heart problem. He is from Beit Lahia in the north of Gaza Strip.
21 June 2020
Waseem was born with a congenital heart problem that involved the narrowing of one of his heart valves. When he was a child, he underwent treatments including a procedure to dilate the valve and open-heart surgery. The surgery was effective at that time, and Waseem finished school and went onto graduate from Al-Azhar University in business administration in 2018.
In March 2018, however, Waseem noticed general tiredness and had difficulty breathing. Investigations at Shifa Hospital revealed that the same heart valve was not working properly. He was referred to Makassed Hospital in East Jerusalem and had further surgery there in April 2018. After he returned to Gaza, he suffered complications of his surgery with an infection in the heart. He was treated in the intensive care unit at Shifa Hospital in Gaza City where he stayed for approximately six weeks, until his condition stabilized. Waseem attended several follow up assessments at Makassed Hospital after his health had improved, the last of which was on 3 February 2020.
On 14 April 2020, Waseem was admitted again to Shifa Hospital with infection in his heart and stayed as an inpatient again for almost two months.
Now he has been referred urgently to Makassed Hospital for further surgery that is unavailable in Gaza. He had an appointment on 15 June 2020, but since the suspension of permit processing and coordination between Palestinian and Israeli authorities he has been unable to obtain a permit to exit.
Frustrated, Waseem discharged himself from Shifa Hospital. He said, “I’m tired of hospitals. I need to be in a calm environment and the doctors have agreed that I can receive antibiotics at home for now.”
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Azmi is a 52-year-old man from Deir Al-Balah in the Gaza Strip, who was recently diagnosed with a cancer called a cholangiocarcinoma.
21 June 2020
He was admitted to hospital on 18 May with pain and jaundice. Subsequent investigations showed that the cause of his symptoms was a cancer in his bile duct, and he had an initial intervention to remove obstruction of the duct by the tumour.
Doctors at Shifa Hospital needed to understand the extent of spread of the tumour, in order to plan for the most effective treatment course. Azmi was referred for a PET scan and surgery in East Jerusalem. He had an appointment on 15 June at Makassed Hospital in Jerusalem.
In the context of Israel’s closure of the Gaza Strip, Palestinian patients must apply for Israeli permits to access healthcare in other parts of the occupied Palestinian territory. However, following the suspension of permit processing and coordination between Palestinian and Israeli authorities, Azmi was unable to find any means to apply for a permit to exit.
After missing his first appointment at Makassed Hospital, his family request another referral and he received an appointment for 22 June.
Azmi’s son Alaa commented, “We went to the Coordination Office to apply for my father, but I was told they stopped contact with Israeli authorities. Then we went to the Palestinian Centre for Human Rights, but they told me that they cannot help as well. We have an appointment for the 22nd, but we are trapped and there is no way for us to exit.”
Azmi is a father and used to work as a laborer. He is currently waiting at home with no means to access the healthcare he needs.
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Osama is a one-year-old child from Gaza City, who was diagnosed with leukaemia on 8 June 2020.
21 June 2020
He was referred urgently to Augusta Victoria Hospital in East Jerusalem for specialized investigations unavailable in Gaza and to initiate treatment. In the context of Israel’s closure of the Gaza Strip, Osama needed an Israeli-issued permit to exit. However, following the suspension of permit processing and coordination between Palestinian and Israeli authorities, Osama’s family had no means to apply for a permit to exit.
Osama’s father commented, “My wife and I couldn’t believe that our child has leukaemia. But on top of that the treatment he needs isn’t available here in Gaza and we were told there was no way to coordinate a permit for him.”
On 11 June 2020, after the family faced several difficulties, Augusta Victoria Hospital was able to coordinate a permit for his exit, and he reached the hospital the same day.
Osama was separated from his mother when he traveled, even though he was still breastfeeding. Instead, he was accompanied by his grandmother, as the family was warned that his mother might not be approved a permit on time because of her age. The medical team at Augusta Victoria Hospital reported his severe distress for days after his separation.
Augusta Victoria Hospital managed to obtain a permit for Osama’s mother to travel to replace his grandmother as companion. Osama’s mother travelled to East Jerusalem on 17 June 2020.
His father commented, “We were told he is crying most of the time. Someone from the hospital has contacted me to try to coordinate a permit for Osama’s mother to travel and be close to him.”
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Mira is a 4-year-old girl from Khan Yunis.
11 June 2020
She was diagnosed with a cancer in her eye known as a retinoblastoma in February this year, and now she needs an Israeli-issued permit to reach a hospital in Jordan to have specialist eye surgery that is not available for her in the occupied Palestinian territory.
Mira has lost vision in her right eye and needs surgery urgently to prevent spread of her tumour, and to prevent any further loss of vision. She had an appointment at the Jordan Hospital in Amman for 4 June, but she missed this appointment because her family was unable to find a means of coordinating her permit after end to the functioning of the Palestinian Coordination Office.
Mira’s mother commented, “I fear losing my daughter because we have been unable to get help from anyone.”
Mohammed, 36 from Gaza City, was diagnosed with a brain tumour known as a glioblastoma in February this year.
17 June 2020
After surgery in February in Gaza, Mohammed was referred for adjuvant radiotherapy and chemotherapy at Augusta Victoria Hospital in East Jerusalem. This treatment that has been shown to lengthen the survival of patients with glioblastoma, but radiotherapy facilities are not currently available in the Gaza Strip. Mohammed’s first appointment was at Augusta Victoria Hospital on 20 April, but he needed an Israeli-issued permit in order to exit the blockaded Gaza Strip and reach the hospital. His permit application was denied.
Since that time, Mohammed made four further applications. In total, three of his applications have been denied by Israeli authorities on alleged security grounds and one has been delayed, with no definitive response by the date of his hospital appointment.
Following the coordination suspension of permit applications to Israeli authorities on 19 May, Mohammed applied through the Palestinian Centre for Human Rights (PCHR). His application was denied on 7 June. On 9 June, PCHR withdrew from coordinating permits, after which Mohammed struggled to find an alternative means to reapply. On 11 June, Augusta Victoria Hospital, where he was attempting to reach, finally obtained a permit on Mohammed’s behalf for him to travel out of Gaza. Initially, his companion was not approved a permit approved to accompany him. However, Mohammed was severely incapacitated by this stage and unable to travel alone.
The dates and outcomes of Mohammed’s permit applications
|
Date of appointment (2020) |
Outcome of permit application |
|
20 April |
Denied |
|
4 May |
Delayed: no response by appointment date |
|
19 May |
Denied |
|
7 June |
Denied |
|
11-12 June |
Approved |
Salma is 64 years old, from the Middle Area of the Gaza Strip.
11 June 2020
She has Hodgkin lymphoma and needs an Israeli-issued permit to access healthcare outside of Gaza, in the West Bank, to undergo treatment which would involve transplanting her own stem cells. The treatment could cure her disease, and it is unavailable in the Gaza Strip.
After postponing her initial appointment during the COVID-19 outbreak and having a subsequent permit application delayed by Israeli authorities, receiving no response by the date of her appointment, Salma received a further hospital appointment to undergo her transplant on 7 June. When she went to obtain a permit to access the treatment she needs, she was told that the Coordination Office in Gaza was no longer liaising with Israeli authorities to apply for permits. Luckily for Salma, at this stage she was able to apply for a permit through the Palestinian Centre for Human Rights and she obtained a permit to travel on 7 June. However, since 9 June the Palestinian Center for Human Rights discontinued its legal aid services to patients after a news report in Israeli media was released suggesting that Israel has reached an alternative coordination mechanism with Gaza through the human rights organization. At this stage, even urgent and lifesaving cases are being affected by the lack of any coordination mechanism.
Patients like Waseem, Azmi, Osama, Mira, Mohammed, and Salma have no current means to obtain Israeli-issued permits to access the healthcare they need. An urgent solution is needed to safeguard patient access and protect the fundamental rights of Palestinian patients.
Related links:
Right to Health: Patients in the Gaza Strip unable to access healthcare
