Gaza’s health care system is riddled with deficiencies and is unable to fully meet the needs of the population. Israel allows most patients with life-threatening conditions to receive treatment in the West Bank or inside Israel. Yet this is not the case for many others who have conditions that are not life-threatening but cannot receive adequate care in Gaza. Over the past few months – ever since Egypt began severely restricting travel through Rafah Crossing – these patients have been left with no way of obtaining the medical care they need.
The poor state of Gaza’s health care system is the result of neglect over the course of 40-odd years of direct Israeli control combined with the siege Israel laid on Gaza, with Egyptian cooperation, after Hamas rose to power in June 2007. When the siege was in effect, Israel imposed restrictions both on bringing medical equipment into the Gaza Strip as well as on doctors’ travel out of Gaza to courses and programs that would lend them greater proficiency and skills.
In certain medical fields, including oncology and hematology, Gaza’s health care system is very limited, and patients must travel to Egypt, Jordan or Israel to receive appropriate treatment. However, ever since the siege was imposed, Israel and Egypt have severely restricted travel by Gaza residents, leaving many patients with non-life-threatening conditions out in the cold.
Israel currently allows most patients with life-threatening conditions who cannot receive treatment in the Gaza Strip to enter its own territory or the West Bank for medical treatment, provided they apply for a permit and subject to security clearance. In contrast, patients with non-life-threatening conditions who require care unavailable in the Gaza Strip, such as various orthopedic conditions or certain eye diseases, are hard-put to obtain similar permits to enter Israel or the West Bank.
A document prepared by the Israeli Ministry of Defense does not spell out the criteria for receiving such permits, merely providing the unspecific explanation that permits will be issued for “the purpose of receiving life-saving medical treatment or medical treatment without which quality of life is entirely altered, all subject to unavailability of the sought medical treatment in the Gaza Strip”.
The approval process for an entry permit to Israel may include the requirement of coming in person to Erez Crossing for security questioning by the Israel Security Agency (ISA). Therefore, men between the ages of 16 and 38 sometimes choose not to apply in the first place, fearing a summons for questioning and possibly a subsequent arrest. According to the World Health Organization (WHO), in 2013, Israeli security forces apprehended four patients en route to receiving medical treatment in Israel or in the West Bank as well as three individuals escorting patients. WHO’s data for 2014 states one patient and one escort were apprehended.
In late May of 2011, after four years of restricting the use of Rafah Crossing, Egypt began allowing almost free passage to medical patients either into its territory or through it, to Jordan. However, since the government of Egypt was replaced in July 2013, Rafah Crossing has been open only intermittently with only a few types of travelers allowed through - foreign passport holders, pilgrims and individuals suffering from serious medical conditions – mostly cancer patients. Since the beginning of 2014, the crossing has been closed on an almost permanent basis. It opens only for several days each month. According to the WHO, in January 2014, only 88 medical patients were allowed to travel to Egypt for medical treatment, 36 in February and 40 in March. In comparison, prior to July 2013, an average of 300 medical patients were permitted to cross the checkpoint every month.
In light of the new Egyptian restrictions, Israel has begun issuing more entry permits to Israel or the West Bank to patients from Gaza.
In recent months, B’Tselem has collected testimonies from dozens of patients from the Gaza Strip who have been left without any medical care as a result of Egypt’s closure of Rafah Crossing and Israel’s continued restrictions on entry into its own territory and the West Bank for medical treatment. Israel prevents Gaza residents from operating seaports and airports and refuses to allow them to travel abroad via Allenby Bridge – the border crossing between the West Bank and Jordan, or through Israeli airports, leaving Rafah as their only gateway abroad. But, since the beginning of this year (2014), not only has the crossing been opened only on a very few days, many patients were not allowed passage, leaving them with no avenue to essential medical attention.
Israel cites security concerns as justification for some of the restrictions it imposes on Gaza residents. It can resolve these concerns by imposing certain travel restrictions and individual security screenings. Security considerations cannot justify indiscriminate restrictions on all Gaza residents. So long as Israel does not allow sea and air travel out of Gaza and controls one of its two land border crossings, it has an obligation to allow Gaza residents, particularly those in need of medical care, to leave Gaza and travel through Israeli territory in order to reach the West Bank and Jordan, subject to individual security clearance.