From: PHR@netvision.net.il Subject: Mideast: PHR Activity Bulletin
*****A Special PHR Activity Bulletin:***** ****Closure and Medical Rights****
Introduction. I am posting this report in June 1996 even though it is dated April because last week I was informed that the situation has not changed. Indeed it has got worse with the arrest of some of the medical personnel involved.
Israel's most recent closure of the West Bank and Gazaimposed after a wave of suicide bombings against Israeli civilianshas been the most unyielding to date. Its implementation has fully disregarded medical rights, while simultaneously bringing operation of the Palestinian health network to a virtual standstill.
By using the closure as a political tool rather than a genuine defensive bulwark, the Israeli government is forcing Palestinians with legitimate and oftentimes life-threatening medical concerns to endure an unwarranted form of collective punishment. Physicians for Human Rights Israel (PHR) believes that, in accordance with international standards, Israel must guarantee doctors, patients and medical supplies free passage regardless of the political situation in Israel, the West Bank or Gaza.
The following report is divided into two parts: the first briefly outlines the major medical services affected by the closure and includes several cases illustrating its harmful impact; the second provides an overview of PHR endeavors to lessen the damage caused to Palestinian health care in the wake of the closure.
**PART I: Medical Services**
__Shortages of Medical Personnel__
The IDF restricted movement of medical personnel within the West Bank and between the West Bank and Gaza Strip for the first three weeks of the closure. Hospital activity was dangerously interrupted as medical staff continued to be denied entry into East Jerusalem and Israel where they work. As an outcome of a PHR-initiated High Court petition, a partial settlement has been reached which should begin to ease the situation at East Jerusalem hospitals.
__Arbitrary Case Processing and Lack of Appeal Mechanisms__
The Israeli Central Coordinating Office (CCO) and its regional Coordinating and Liaison Administrations (CLA) lack clear definitions for what constitutes an "emergency humanitarian case" entitled to special consideration under the closure's entry restrictions. Typically, the two bodies can provide conflicting answers that accentuate the arbitrary nature of the IDF's decision-making. Furthermore, the process for overturning negative decisions is complicated by the fact that CLA personnel examining original requests are not required to sign their names to decisions.
__Shortages of Medicine and Medical Equipment__
During the first days of the closure, Israel prohibited the entry of medicine and medical equipment into the Gaza Strip, both from Israel and the West Bank. While the restrictions have been relaxed somewhat over the past two weeks, the transfer of medical supplies into Gaza continues to be plagued by bureaucratic delays and obstacles.
__Denial of Access to Treatment and Patient Visitation__
In a three week period, approximately 100 permit requests were filed at the Gaza CLA concerning medical treatment in Jordan and Israel; only 10 received positive answers, and three of those required PHR intervention. Additionally, family members from the West Bank and Gaza are unable to visit patients hospitalized in East Jerusalem.
__Cases__
Hadija Adwan, a Gazan woman suffering from cancer, received an entry permit 48 hours after the request was first handed to the Israelis via PHR. Her ambulance was detained at the Erez checkpoint, and only after five hours of waiting did the IDF order a second ambulance to take her into Israel. After these delays, she arrived at Assaf Harofeh Hospital, dying later the same night.
The parents of Shaker Bassam Yusef Shwana attempted to transfer their newborn by ambulance from a hospital in Kalkilya to a hospital in Tulkarem. The ambulance was delayed twice: once after leaving Kalkilya and again when entering Tulkarem. In both cases, passage was only approved due to the parents' beseeching and the infant's rapidly deteriorating condition. Shaker passed away within five hours of arriving in Tulkarem. An IDF officer was taken to disciplinary court as a result of the incident.
**PART II: PHR Intervention**
__Permits for Medical Personnel__
Dr. Abed El-Shafi, a prominent resident of East Jerusalem, turned to PHR for assistance in renewing his permit to continue working as a surgeon in Gaza. Israeli authorities conveyed to PHR that due to the terror attacks, Dr. El-Shafi should leave Gaza immediately, no matter how vital his work was. PHR then turned to the CCO in Tel Aviv, explaining that during such a harsh closure it would be unreasonable to demand that a specialist desert his post and patients. The CCO subsequently issued a permit allowing the doctor to stay in Gaza.
__Entry Permits for Medical Supplies__
PHR intervention coordinated with MK Yael Dayan helped obtain entry permits for oxygen and sterile water bound for operating rooms in Gaza.
__Entry Permits for Patients and Family Members__
Shuruk Sabihat, a one-and-a-half year old from Jenin, was receiving treatment at the oncology department at Hadassah Hospital in Jerusalem. Due to the closure, she was denied an entry permit for her regular check-ups and follow-up appointments. PHR, intervening on the family's behalf, was able to secure permits for Shuruk and her father.
The CCO similarly denied Fida Tapesh, age 16, and Mahmud Mana'ame, age 3, exit permits for cardiac surgery in Jordan until PHR advocated on their behalf.
Georgette Terazi, a resident of Eastern Jerusalem, married to a Gaza resident, gave birth by emergency cesarean section to a premature baby (birth weight of 1600 gm). Her newborn was in critical condition at Makassed Hospital in East Jerusalem when PHR contacted both the CCO in Tel Aviv and the General of the Southern Command in an attempt to obtain an entry permit for her husband. After being shuttled between the two offices, PHR received notification that the request was denied even though Mr. Terazi cleared all security checks. As a result, PHR launched a successful Internet/fax urgent appeal, and Mr. Terazi was issued an entry permit within 72 hours.
__Coordination of Donated Medical Supplies__
A joint delegation of PHR and the Galilee Society for Medical Research and Services (GSMRS) distributed $4,000 worth of medicine and Materna milk formula to the Nablus health office which was subsequently handed out in the surrounding villages. Additionally, the same team distributed medicine and Materna in Tulkarem according to a list of families in need.
PHR and GSMRS, together with Rabbis for Human Rights traveled to Gaza in an effort to hand deliver medicine and Materna. The supplies were held for hours at the checkpoint until the IDF finally agreed to allow the medication and formula to go through on condition that only one representative of the delegation accompany the supplies. The delegation returned without delivering the supplies and two days later another successful attempt was made to transfer the medical supplies to the PA.
__High Level Intervention and Public Awareness__
Over the past month, PHR provided continual reports to Israeli and international media concerning the severe effects of the closure. This activity represented an attempt to create public awareness regarding the violations of human rights due to the closure and apply pressure to decision makers withholding medical treatment as a means of collective punishment.
Together with PHR and Makassed Hospital, Association for Civil Rights in Israel (ACRI) attorney Eliyahu Avram petitioned the Israeli High Court requesting that the State enable a specific number of Palestinian medical professionals to return to work at hospitals in East Jerusalem. Due to the petition, the State promised entry of 250 employees. A Court order was also issued that requested a provision from the military within 45 days that will allow entry of medical personnel in future closures.
PHR requested an urgent change in closure limitations on the entry of patients from the West Bank and Gaza to medical treatment in Israel and on the entry of medical equipment and medicine to Gaza Strip from Prime Minister and Minister of Defense Shimon Peres.
PHR requested that the IDF's chief attorney and chief medical officer publish clear procedures that will ensure orderly passage of patients in need of treatment from Gaza to Jordan, Israel or the West Bank. PHR also demanded that a doctor review patient medical reports and sign his decision in accordance with standard procedure in every other medical organization. Furthermore, PHR requested that appeals to CLA decisions be reviewed by an independent third party rather that by CLA staff, which is the current protocol.
On Wednesday, March 20, PHR physicians demonstrated in front of the office of the Ministry of Defense in Tel Aviv to bring attention to the medical human rights violations resulting from the closure.
**Conclusion**
It is difficult to summarize the events of the last month, especially since it is unlikely that the closure will be lifted in the near future. The Israeli officials' willingness to re-evaluate the requests of Palestinians when PHR or other human rights organizations intervene underlines the fact that security is not the sole consideration leading the policy of the total closure. Moreover, in PHR's negotiations with numerous Israeli authorities it has become apparent that different levels of compassion exist: even within the very strict rules of this closure, room for one's own judgment remains. In the worst of cases, this arbitrariness endangers lives. In light of the reality of the situation, PHR will continue to seek durable solutions through High Court rulings and government and military directives. Onl y these changes can provide the clarity that is needed to free medical rights from the political sphere.
*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-* Physicians for Human Rights--Israel P.O. Box 10235, Tel Aviv, 61101 Tel: +972-3-566-4526 Fax: +972-3-566-2527 E-mail:phr@netvision.net.il
Date: 04/11/96 Time: 12:52:01
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