A number of leading medical professionals and a US lawyer have written an open letter pointing out that the Israeli occupation authorities continue to block the passage of vital medical supplies to the besieged Gaza Strip. It is, they say, “collective punishment” of the Palestinians in the coastal enclave. The letter was sent originally to a medical journal, which had published similar letters and did not respond to the signatories. This, they say, is a “worrying sign of neglect” of the issue.

The Gaza Strip has been under a blockade imposed by Israel and its allies for seventeen years. The territory was described by the then British Prime Minister David Cameron as a “prison camp”. That was in 2010, and the situation has deteriorated for the 2.4 million Palestinians in Gaza ever since.

The full text of the letter is as follows:

The Ministry of Health (MoH) in the Gaza Strip wrestles with the cumulatively deleterious effects of Israel’s siege of Gaza imposed since 2006. In 2022, delivery of essential medical supplies to hard-pressed public and private hospitals was denied or delayed. This has affected, for example, the import of x-ray machines, calibration tools for mammograms, interventional catheters, digital video monitors, and mobile imaging units for general surgery and orthopaedics. All of these require Israeli permission to be released from suppliers in the West Bank and delivery to the Gaza Strip through the Israeli-controlled border. The MoH estimates that about 50 per cent of patients in the Gaza Strip have been affected by the lack of medical equipment.

Gaza Health Access

Historically, Israel has maintained a “controlled below needs” scarcity of medicines and laboratory supplies in Gaza, even when these have been donated charitably. The MoH’s recent press release noted that the tightening of the Israeli blockade compounds the ongoing problems of chronic scarcity and uncertainty facing the MoH and jeopardises service planning and provision.

This situation leads to patients seeking diagnosis and special care outside the Gaza Strip. According to the 2022 UN report, 2,067 patients applied for treatment outside Gaza in specialist hospitals in the West Bank and Jerusalem, and 868 applications (42 per cent) were delayed or rejected. Patients with cancer, heart disease, stroke and complex fractures face a harsh fate as a result of delays in obtaining diagnostic tests and starting treatment, including surgery. Ten patients, including a baby, were denied urgent exit for potentially lifesaving care and have died since the start of 2022.

As an occupying power controlling Palestinian life, Israel continues to flout its obligations in international humanitarian law to ensure the basic rights to health care of Gazan society.

This has occurred “normally and is a political practice also in time of peace” for almost 17 years. The continuity of afflictive collective measures, the length and the intentionality of the “system”, in point of law enshrines the crime of collective punishment — a war crime¹ — and implies States’ responsibilities in its prevention.

The criminal system of the blockade of Gaza must be lifted in all fields.

Recently and noticeably, some political parties and individual Parliamentarians in the new Israeli Knesset are, indeed, ready to go further, even spelling out genocidal intentions, including threatening to raze Gaza soon.

Meanwhile, collective punishment measures have been escalated in all other Palestinian territories, including evictions, demolition of housing, displacements, arbitrary detention, punishment of prisoners, destruction of crops and agricultural lands, and impediments to medics and ambulances to assist the wounded. All of these based on ethnicity and all fitting the definition of collective punishment.

Israeli impunity continues to be bolstered by the shameful inaction of the international community in this situation. This pattern has not and will not be changed by condemnatory words, but requires concrete action to remove the blockade of Gaza and to protect Palestinian lives. In cases of collective punishment, there is indeed a mandate for all States to act by all means available.

Meanwhile, as professionals in health and law, our duty is to present the facts we witness and the paradigm in which the suffering of Gaza’s people is inscribed.

The content of this article was presented to a Medical Journal, but not accepted for publication, a worrying sign of neglect.

Table I- Original of the 2 pages for public diffusion by the MoH of Gaza, press conference 4 January 2022

References

1- Collective punishment is a punishment or sanction imposed on a group for acts allegedly perpetrated by a member of that group, which could be an ethnic or political group, or just the family, friends and neighbours of the perpetrator. Collective punishment is prohibited by treaty in both international and non-international armed conflicts, more specifically Common Article 3 of the Geneva Conventions and Additional Protocol II. .The current blockade of Gaza has been criticised by the International Committee of the Red Cross, in a United Nations report, and by various other organisations as collective punishment aimed at the Palestinians. UN condemns ‘war crimes’ in Gaza” BBC News. 16 September, 2009.

The writers:

Paola Manduca, PhD, Retired Geneticist, University of Genoa, Italy

Vittorio Agnoletto, MD, University of Milan, Italy

Swee Ang, MD, Consultant orthopaedic surgeon, former UN and WHO consultant to Gaza and the OPT(1988 and 1989)

Andrea Balduzzi, Retired Researcher, University of Genoa, Italy

Ireo Bono, MD, Retired Oncologist, Savona, Italy

Francis Boyle, Lawyer, USA

Franco Camandona, MD, Gynaecology and Obstetrics, E.O. Ospedali Galliera, Genova, Italy

Iain Chalmers, Department of Primary Care, University of Oxford, UK

Carla Ciccone, MD, Gynaecologist, retired AOSG Moscati, Avellino, Italy

Valerio Gennaro, MD, PhD, Oncologist, environmental epidemiologist, past director Liguria Mesothelioma Registry, Genoa, Italy

Colin Green, Professor of Surgical Science, University College London and Academician of the Ukraine National Academy of Science

Brigitte Herremans, PhD, research fellow at Justice Visions, Human Rights Centre, Faculty of Law and Criminology, Ghent University

Jon Jureidini, PhD MBBS FRANZCP, Child Psychiatrist, Robinson Research Institute, The University of Adelaide, Australia

Lucio Nitsch, MD, Professor Emeritus of Applied Biology, University of Napoli Federico II, Italy

Alice Rothchild, MD, retired, Harvard Medical School, USA

Derek Summerfield, MD, King’s College London, UK

Nozomi Takahashi, Department of Biomedical Molecular Biology, Ghent University, Belgium

Gianni Tognoni, MD, Milan University, Italy and Permanent People’s Tribunal

Guido Veronese PhD, Associate Professor in Clinical Psychology, Dept. of Human Sciences “R. Massa”, University of Milano-Bicocca

La delegazione dovrebbe partire per una missione nei territori occupati la prossima settimana, ma per la seconda volta Tel Aviv nega l’ingresso al suo Presidente Manu Pineda. Chiesta riunione urgente con Metsola per prendere misure contro Israele

Dall’inviato a Strasburgo – Manu Pineda, presidente della delegazione Ue per le relazioni con la Palestina (Dpal), non è il benvenuto in Israele. Per la seconda volta il Ministero degli Esteri di Tel Aviv ha notificato all’eurodeputato della Sinistra europea il divieto di ingresso nel Paese, a una settimana dalla missione che la delegazione dovrebbe condurre in Palestina.

“Una decisione unilaterale e inaccettabile”, ha commentato da Strasburgo Pineda, che dopo aver preso conoscenza della misura nei suoi confronti ha chiesto una riunione d’urgenza con la presidente dell’Eurocamera, Roberta Metsola. L’eurodeputato spagnolo le chiederà “di prendere misure di reciprocità contro Israele”, ovvero il “divieto di ingresso al Parlamento Ue a rappresentanti e diplomatici israeliani”. La situazione è delicata, perché Tel Aviv è un partner privilegiato di Bruxelles, che riceve ingenti risorse dall’Unione e partecipa a numerosi programmi europei. Nonostante questo, da 13 anni la delegazione Dpal non riesce a visitare la Striscia di Gaza e i territori occupati.

Nel maggio 2022 l’Eurocamera aveva sospeso la missione della delegazione a causa del veto imposto già allora a Pineda, ma questa volta potrebbe andare diversamente: “Dobbiamo assolutamente mantenere la missione, frutto di un anno di lavoro con l’ambasciata dell’Ue a Gerusalemme”, ha dichiarato ancora il presidente della delegazione, sottolineando che “la presenza in Palestina, in un momento che vede in Israele il governo più estremista degli ultimi anni, è indispensabile”.

Lo scopo della missione, ha spiegato a Eunews Rosa D’Amato, eurodeputata dei Verdi/Ale e membro della delegazione Dpal, “è perfettamente in linea con le prerogative di questa istituzione e con quanto già avviene negli altri paesi”: appurare il trattamento della popolazione palestinese da parte delle autorità israeliane, incontrare attori della società civile e monitorare la situazione umanitaria nei territori occupati. Dopotutto anche la Relatrice speciale delle Nazioni Unite, Francesca Albanese, ha definito come “ostinata e continua” la violazione da parte di Israele del diritto all’autodeterminazione del popolo palestinese. E l’Unione europea stessa ha più volte richiamato le autorità israeliane sulle politiche di colonizzazione del territorio palestinese, come ribadito poco meno di un mese fa dall’Alto rappresentante Ue per gli Affari esteri, Josep Borrell, nell’ultimo incontro con il primo ministro palestinese, Mohammad Shtayyeh.

Dopo le svariate denunce della delegazione per le relazioni con la Palestina sull’ostruzionismo israeliano, secondo D’Amato è arrivato il momento di “una presa di posizione forte”, se Metsola “ha a cuore l’immagine del Parlamento europeo”. Per il momento Manu Pineda dovrà accontentarsi di una riunione con il capo di gabinetto della Presidente, ma si è detto “fiducioso che Metsola trovi spazio nella sua agenda per riunirsi con la delegazione”.

The Gaza-based Palestinian Ministry of Health (MOH) urged Sunday, February 5, 2023 the international community and human rights organizations to step up efforts to improve diagnostic and treatment options for the hundreds of Palestinian cancer patients suffering due to Gaza siege.

According to the Health Ministry official, Abdul Latif Al-Hajj, there are around 9,000 cancer patients in Gaza waiting for urgent and immediate medical treatment.

According to Al-Hajj, Gaza’s health system suffers from significant inadequacies in the provision of health care for Palestinian cancer patients, including early diagnosis, diagnostic services, radiotherapy, and chemotherapy treatment as well.

He urged the international community and human rights organizations to take responsibility and encourage Israel to allow the mobility of Palestinian patients to hospitals in Jerusalem and the West Bank for medical treatment.

It’s noteworthy that many Palestinian patients in Gaza mainly depend on hospitals in occupied territories to receive the proper treatment and perform operations that are not available in the Strip.

For the first time, doctors from the Palestinian territories occupied in 1948 performed kidney transplant operations in the Gaza Strip. Dr Abed Khalayleh, Director of the Organ Transplantation Unit at Hadassah Ein Kerem Hospital, and Dr Samer Diab, a Vascular Surgeon from Rambam Hospital, both members of the Physicians for Human Rights Association, performed two kidney transplants over the weekend on Palestinian patients from the Gaza Strip.

Dr Khalayleh and Dr Diab both arrived in the Gaza Strip as part of the Physicians for Human Rights delegation which visited the Gaza Strip during the weekend to carry out medical activities. The number of delegation members totalled 25 doctors and medical staff, who performed surgeries, brought in medications and medical equipment, provided medical care to patients and held mental health rehabilitation courses.

The two kidney transplants were performed at Al-Shifa Hospital in Gaza City. The first operation was performed on a 27-year-old girl from Gaza City, whose father donated his kidney.

The second operation was performed on a 25-year-old girl from Nuseirat refugee camp, who received a kidney from her sister. The operations were carried out after several weeks of preparatory work, led by Physicians for Human Rights and in coordination with Al-Shifa Hospital in Gaza. The preparations included meetings via Zoom between the surgeons and the medical staff at Al-Shifa Hospital, in addition to taking blood samples from the patients and sending them to Hadassah Hospital, which cost tens of thousands of shekels in order to ensure the organs being transplanted were a match, and buying injections and special medicines for them.

READ: UNRWA Gaza employees strike in protest at recruitment issues

Only a few kidney transplants have been performed, from time to time, in Gaza by two doctors, one from the UK and the other from Jordan. However, Israel has stopped allowing the Jordanian doctor to enter Gaza, which has caused a reduction in the number of such operations in Gaza.

The two operations that took place in Al-Shifa Hospital are in addition to 16 other surgeries that were performed by the doctors of the Physicians for Human Rights delegation, including 9 orthopaedic surgeries in Nasser Hospital in Khan Yunis, under the supervision of D .Mustafa Yassin and Dr Mahmoud Khatib, two specialist orthopaedic doctors from Hasharon Hospital, 7 eye surgeries under the supervision of Dr Ahed Mtairat, an ophthalmologist from Soroka Hospital, and a vascular operations under the supervision of Dr Jamal Hijazi, a vascular surgeon at Shaare Zedekk Medical Centre, at the European Hospital in Jerusalem.

The members of the medical delegation also held medical days, along with the operations, in the fields of family medicine and gynaecology, both of which were held in the Nuseirat refugee camp, where more than 330 patients were examined. As for the psychologists, who are members of the delegation, they held vocational rehabilitation courses in the field of mental health for Palestinian mental health teams from the Gaza Centre for Mental Health, the Palestinian Ministry of Health and the Medical Centre for Trauma Victims in Gaza City. The visit also included the delivery of medical equipment and medicine worth more than 300,000 shekels (about $87,000).

Salah Haj Yahya, Director of the Physicians for Human Rights delegation, said, “The Gaza Strip has been suffering for a long time, 365 days a year, for more than 15 years, as a result of the Israeli blockade that suffocates the civilian population and prevents them from the possibility of establishing liveable conditions; it violates the Palestinians’ political, civil, economic and social rights. The delegation’s visit, along with its medical purposes, is a form of solidarity with the suffering and hardship of the residents of Gaza. It is a clear message that there is a need to stop the illegal Israeli policy of blockade.”

treatment

Aseel Mousa The Electronic Intifada 31 January 2023

Mahmoud al-Kurd, 45, from Deir al-Balah in the central Gaza Strip, died on 16 December, two days after he was granted an exit permit by the Israeli military to leave Gaza for treatment in the West Bank.

A father of six – one girl and five boys – Mahmoud underwent months of fear and pain.

“We submitted five applications to the Israeli authorities to transfer Mahmoud to a hospital in Jerusalem. For six months, we kept receiving ‘request under review’ replies,” his wife Amatulrahman al-Kurd, 40, said.

In November 2020, al-Kurd had been diagnosed with lung cancer. He underwent seven chemotherapy sessions in Gaza but his health continued to deteriorate.

In 2021, he was transferred to Egypt for treatment, where he stayed three months but showed no improvement.

In September 2021, he was referred by the ministry of health to Augusta Victoria Hospital in Jerusalem for urgent medical treatment.

But he needed a permit from Israel’s Gaza Coordination and Liaison Administration (CLA) – a branch of the Israeli military – to allow him to exit Gaza through the Erez checkpoint.

He had already been assured of financial coverage from the Palestinian Authority.

“My husband lost 60 kilos. I was totally helpless, just waiting for their approval [for travel permit]. Seeing him like this will forever be the hardest thing I went through,” Amatulrahman told The Electronic Intifada.

On 25 November, Mahmoud’s health deteriorated dramatically. He lost consciousness and suffered convulsions and was hospitalized for three days.

Doctors said the cancer had spread to the rest of his body.

At the same time, his family was repeatedly completing procedures to secure his travel permit.

“From July to December, we submitted five applications,” Amatulrahman said. “All were delayed or we didn’t get any replies.”

Too late

Frustrated, the family turned to the Gaza-based rights group Al Mezan and Physicians for Human Rights in Haifa to try to expedite the process.

The two organizations tried to persuade the Israeli military authorities to grant him a permit to receive treatment in the King Hussein Medical Center in Amman, Jordan, which meant more delays.

“We had no choice but to start new procedures to transfer him for treatment in Amman, even though we realized that we were clinging to the tiniest shards of hope,” his wife said.

The permit never came and at this point, she said, Mahmoud was getting progressively worse. With the cancer spreading to his brain, he had first lost the ability to walk, then to move, then to talk and eat.

Finally, he had to be put on a ventilator.

During this time, the two rights organizations eventually prevailed upon the Israeli authorities to issue an exit permit for treatment in Jerusalem.

On 14 December, an ambulance transported Mahmoud from the Gaza Strip to Jerusalem.

It was too late.

“At 10 pm on Friday, Mahmoud died before my eyes. I don’t know what sin he committed to deserve all this torment. I hope that no one else will suffer the same fate as Mahmoud, although I know there are dozens of similar cases.”

According to the World Health Organization, since 2007 and the tightening of Israel’s blockade of Gaza, about a third of Gaza’s patients’ exit permit applications have been either denied or delayed.

According to Al Mezan, nine patients, including three children, died in Gaza after being denied exit permits in 2022.

“The lives of dozens of patients with critical conditions in Gaza are at risk because they need urgent medical treatment in West Bank hospitals,” said Ashraf al-Qedra, a health ministry spokesperson.

“But they are still waiting for exit permits. A number of them have applied several times.”

A wedding with no relatives

A wedding with no family, a bride without bridesmaids and a special day that caused only painful memories.

This is how Oruba Othman, 32, described her September wedding in the West Bank.

Othman is from Gaza but is teaching at Bethlehem University’s department of social sciences. She is also a PhD student at Birzeit University.

She married a lawyer from Bethlehem, but her wedding turned into a somber occassion without family and friends, who were denied exit permits from Gaza to attend.

“Two months before the wedding, I submitted an application for my father to attend, but I kept receiving ‘request under review’ replies. Not one of my family or friends was able to attend my wedding and this will be one of my saddest moments.”

They supported her as best they could, she told The Electronic Intifada. Her friends and relatives attended via video conference.

It was scant consolation.

Indeed, Othman has not seen her family since 2015, because of Israeli travel restrictions that were always onerous but became almost impossible to navigate after the siege was tightened in 2007.

“I moved to live in the West Bank because I got a scholarship from Birzeit University [in the West Bank] seven years ago,” Othman said, describing her obtaining an exit permit as “miraculous” for a young person.

She had to wait a year.

“Fortunately, I was invited to an event organized by a German Palestinian Academy to collect stories about the suffering of Palestinian journalists, so I took advantage of this opportunity and presented my problem to this academy. They helped me secure the exit permit.”

The Gaza Strip should be less than an hour’s drive from the West Bank. Yet with travel restrictions and checkpoints, the journey can take months or years.

It also confronted Othman with her first direct meeting with an Israeli soldier.

“When the Israeli soldiers searched me at the checkpoint, my emotions were disturbed. I felt so offended: this is my land, yet this soldier controls my freedom.”

She persevered, however, in her excitement to see the West Bank for the first time in her life.

“I was enthusiastic to enter the West Bank, which the Israeli occupation tries to split from the Gaza Strip.”

Palestinians in Gaza who succeed in entering the West Bank then encounter further obstacles. They are not allowed to move between the cities of the West Bank.

The Israeli military checks IDs at the some 100 military checkpoints dotted around the West Bank, and a Gaza ID holder risks imprisonment or forced return to Gaza if stopped in the “wrong” area.

“In brief, being a Palestinian means that you do not have the luxury to enjoy your simplest rights,” Othman said, recalling her student days in the West Bank city of Ramallah, when she was not allowed to go anywhere else.

“Being Gazan and living in the West Bank means that I can barely see my family and friends in Gaza. In other words, I will spend my happy and sad moments alone.”

Not only that, even though she has a permit to work, she lives in constant fear that her marriage, her job, and West Bank life could be ruined at any moment.

“I am always terrified that I may lose my husband, my job and my studies. All it takes is a colonial soldier in a bad mood who discovers that I am from Gaza.”

Her precarious situation has also affected her professionally.

“I am not just prevented from moving through the West Bank, I am also deprived from traveling abroad. Unfortunately, I missed a lot of opportunities to attend international conferences and research fellowships abroad.”

Aseel Mousa is a journalist based in Gaza.