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Medical care under siege: Israel’s Systematic Violation of Gaza’s Patient Rights - February 2018

Al Mezan
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The protracted humanitarian crisis in the Gaza Strip is principally the combined result of the Israeli-imposed closure and blockade, and its systematic destruction of public and private infrastructure. The deterioration of Gaza’s health sector is rooted in these practices and is maintained through the severe restriction on movement of people and goods. By consequence, the closure has also strained the ability of Palestinian authorities to respond to the increasing health needs of Gaza’s residents. Included in this report are the profiles of the 20 medical patients from Gaza, including 11 women and three children, who died after their permit requests to exit Gaza for medical care were delayed or rejected by Israeli authorities. This figure, which covers the cases Al Mezan was able to document and is not to be taken as inclusive of all deaths in 2017, is up from two patient deaths in 2016 and speaks to the stringency of Israel’s current closure restrictions.

The process of reconciliation between Palestinian political powers, which is based on the reconciliation agreement formed in Cairo and pursued from October 2017, may lead to improved engagement with the Gaza Strip and its residents. The situation would produce genuine change if new developments lead to the complete lifting of Israel’s closure and blockade. However, at the time of drafting, the closure remains at its most stringent—and notably so on the grave and increasing movement restrictions for patients that form the basis of this urgent report.

This report presents information documented by Al Mezan and collected from victims and witnesses. It also present documentation from specialized entities that interact with Gaza patients’ movement and access cases. Together they frame how Israel’s closure restrictions hinder the civilian population’s right to access adequate medical care and in an increasing number of grave cases impact their fundamental right to life. This should be viewed and acted upon as an urgent and grave human rights issue that requires immediate remediation.

With total control over Gaza’s border crossings with Israel, the Israeli authorities use Erez crossing to regulate movement in and out of Gaza, with individuals—particularly patients—often detained, and sometimes ill-treated and coerced by Israeli security agents to give information in exchange for crossing permits. Patients who secure referrals and financial coverage from the Palestinian Authority and appointments at hospitals are allowed to submit requests for permits that, if issued, would allow them access to hospitals. Increasingly, permit requests are delayed or rejected by Israeli authorities, leaving patients to face a serious deterioration in their health condition, or death.

The movement restrictions also prohibit Gaza’s doctors and nurses from leaving the territory in order to receive training, while the flow of critical medicines and medical equipment is severely hindered. The tight restrictions imposed by the Israeli authorities on movement make Palestinian patients one of the most vulnerable groups in Gaza as patients rely on exit from Gaza for specialist and often-times lifesaving medical care.

Israel’s attacks on medical infrastructure have played a severe, detrimental role in adequate access to hospitals and medical care in Gaza. Between Israel’s 2008/09 assault on Gaza “Cast Lead” and its 2014 campaign “Operation Protective Edge”, Israeli forces damaged and destroyed 32 hospitals and 99 primary care clinics. In the three assaults from 2008, 80 ambulances in Gaza were damaged and destroyed by Israeli forces. Critically, 511 of the 2,219 Palestinians who were killed in the 2014 assault never received medical assistance due to the Israeli military obstructing ambulance access to victims.

By imposing a system that severely restricts access to healthcare within a framework of collective punishment, Israel is in serious violation of its obligations, as an occupying power and a duty bearer, under international human rights law and international humanitarian law. This significantly includes the fundamental human rights obligations of the right to life and the absolute prohibition on the use of torture and other cruel, inhuman or degrading treatment or punishment. While restrictions on movement can be applied in certain conditions that respond to justified military necessity and/or for the benefit of the civilian population, a blanket ban on the movement of the entire civilian population with limited exceptions stands out as a form of unlawful collective punishment.