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International mechanism for coordinating patients’ travel out of Gaza still unimplemented

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Despite the United Nations announcement that an alternate mechanism for coordinating exit permits for patients requiring medical treatment outside Gaza would be put into place in July, such a mechanism has yet to become operational and hundreds of Palestinians patients in the Gaza Strip still cannot leave Gaza for treatment, as documented the newly released report by Physicians for Human Rights Israel (PHRI), which assists Gaza patients who need to obtain treatment outside the Gaza Strip.

PHRI – which has become the main body helping with Gaza patients’ permit applications since the Palestinian Authority (PA)-Israel coordination mechanism collapsed – reports a five-fold increase in the number of applications it has been handling. In its new paper, PHRI describes the increasingly restrictive policy Israel has implemented vis-à-vis issuing medical exit permits to Gaza residents.

The situation described by PHRI comes on the heels of the statement by the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) of July 21 which announced the establishment of a temporary coordination mechanism by the end of July. This mechanism was supposed to function in place of the PA-Israel coordination mechanism which has been suspended ever since the PA decided to freeze all security and civil coordination with Israel due to the unilateral annexation measures being promoted by Israeli Prime Minister Benjamin Netanyahu’s administration.

Under the new mechanism, the United Nations – through the World Health Organization (WHO) – was to mediate between the Palestinian Civilian Affairs Committee, which is responsible for filing permit applications on behalf of the PA, and the Israeli authorities at Erez Crossing. However, despite the UN’s statement and its efforts to launch the temporary coordination mechanism, due to unknown reasons the mechanism has yet to begin operations.

Against the backdrop of the delay in establishing the alternate coordination mechanism, a new paper published by PHRI provides the latest status report on the obstacles to medical treatment facing Gaza patients. PHRI’s analysis is supported with examples that demonstrate how the usual restrictions of the Israeli permit system have been compounded in the last couple of months with the addition of further obstacles placed by Israel and the difficulties that have resulted from the suspension of civil coordination.

The Main Findings:

Applications can be made only for patients classified as urgent: Since the COVID-19 crisis began, Israel has been permitting applications only for urgent, lifesaving treatment, such as in the case of cancer and cardiac patients, infants and young children, and back-to-back ambulance transport. Patients in need of non-emergency medical care are denied even the option of applying for a permit on the grounds that they do not meet the criteria for medical exit permits.

Half of the applications are not approved: Even though Israel currently permits treatment only in urgent cases, only half of the applications submitted via PHRI in June and July received approval. In most of these cases, Israeli authorities did not provide an answer in time so that patients missed their scheduled appointments and were forced to re-apply. The paper also documents the deaths of three Gaza patients – two infants and a 22-year-old man – who were referred for urgent, lifesaving treatment outside Gaza but did not obtain it due to difficulties in coordination and delays in response to medical exit permit applications.

Delays at Erez Crossing: In some cases, even though their permit request had been approved, patients who arrived at Erez Crossing were detained there for a long time before being allowed through the crossing, while others were even sent home. The paper also reports the case of a patient with leukemia who was detained at Erez Crossing for four hours and was questioned by the ISA (Israel Security Agency) as he lay in an ambulance – in contravention of medical ethics – before being allowed to leave Gaza to receive his medical treatment.

Problems communication between Erez Crossing and patients: In late June the Coordinator of Government Activities in the Territories (COGAT) launched an online form to enable organizations, hospitals and lawyers to file applications for permits on behalf of patients. After PHRI interceded, COGAT also granted Gaza residents permission to apply independently and directly to COGAT at Erez Crossing. However, to date, COGAT has not informed the public in the Gaza Strip of the option of unmediated online applications. In addition, it is unclear if and how many such applications have actually been made via this form, nor is there an automated confirmation when filing is completed or an option for tracking the application’s status.

Requiring imaging tests as a prerequisite for approval: Recently Israeli authorities have instituted the stipulation that applications would not be reviewed unless patients provide the results of medical tests they have undergone, such as MRI, X-rays and biopsies. This requirement constitutes a further burden on patients and in many cases causes delays in handling the applications.

Bogus claims that treatment is available in the Gaza Strip: In order to obtain medical treatment outside Gaza, patients must prove to the Israeli authorities that the therapy they need is unavailable in the Gaza Strip. Over the past two months, several cases have been documented of oncology patients who were refused permits to leave Gaza on the grounds that the therapy they need is available in Gaza, even though this was not the case.

Providing last-minute answers: In a substantial proportion of applications, a decision is only given at the very last minute, sometimes as late as the day that the patient has to leave for treatment. This situation does not give patients the opportunity to properly prepare either for the trip or for the duration of hospitalization or treatment, and imposes additional strain and tension to an already stressful situation.

PHRI stated: “Every day that goes by without the international mechanism in operation takes a toll in human life. Ultimately, since Israel has control over the crossings and decides all matters regarding patients’ travel for treatment, Israel must act to safeguard patients’ lives until a solution is found. In the long run, such a solution necessitates lifting the blockade imposed on Gaza and ensuring free access between the Gaza Strip, the West Bank and East Jerusalem. Until that time Israeli authorities must rescind the stringent criteria it has imposed and also allow patients in non-emergency situations to leave Gaza for treatment. In addition, Israel must revise the online form for applying for permits to leave Gaza for medical treatment so that patients can easily check on the review status of their application. Finally, Israel must ensure that responses to applications are provided in a timely manner that is compatible with the urgency of the medical condition.”