23 May 2012
Occupied Lives: Denying medical care
Mahmoud in his home in Gaza City
Mahmoud KhaderGaafar (24) lives with his wife Majd (23) and their one-year-old daughter Maryam in his parents’ house in
Gaza City. On 2 August 2008, Mahmoud was caught in an internal dispute, during which he sustained severe injuries to his
legs. Due to the severity of the injuries and the lack of appropriate facilities in Gaza, the Ministry of Health in Gaza
requested his referral for medical treatment in Israel.
The Israeli authorities rejected this petition on the basis of alleged‘security concerns,’ and Mahmoud had to undergo
emergency surgery in Al Shifa Hospital in Gaza City, which led to the amputation of his left leg. As his mother, Zeinab
(64), points out: “he could have saved his leg if they had granted him permission to go to the hospital in Tel Aviv.”
Finally, following an appeal to the Israeli courts, the Israeli authorities approved the transfer of Mahmoud to the
Ekholov Hospital in Tel Avivon 14 August 2008, mere days after receiving the emergency treatment in Gaza. He was
hospitalised there in the Intensive Care Unit for 3 months before returning to Gaza. During this time, he received
medical treatment for his amputated left leg and a severe fracture in his right leg.
On 11 August 2009, Mahmoud was granted permission to travel to a hospital in Jerusalem, where he could receive further
medical treatment for his right leg. After receiving this treatment, he travelled to the West Bank to arrange for an
orthopaedic left leg, which would make it easier for him to move around, and significantly improve the quality of his
life: “The Ministry of Health usually covers 80% of the orthopaedic leg’s cost, but after talking to them in Ramallah
they offered me 100% coverage. After solving the financial issue, I travelled to Bethlehem where a medical association
started taking the measurements needed to build my orthopaedic leg. They said they would have it ready within one week.”
On 14 December 2009, while Mahmoud was travelling between Ramallah and Bethlehem for medical treatment, Israeli soldiers
stopped and detained himovernight. The next morning they immediately transferred him to the Gaza Strip, again on the
basis of alleged security concerns, despite the fact that he had been outside of the Gaza Strip for the past 4 months.He
has since been unable to return to Bethlehem for medical care.
As he points out: “I was there to receive medical treatment, not for touristic activities. It is impossible for me to
get an orthopaedic leg in Gaza, because my amputation was performed too close to the hip and this treatment is not
available here. Although orthopaedic services are offered in Egypt, the orthopaedic legs provided there are too heavy to
allow for any movement.” As a result, he barely leaves his home, and, whenever he does, he moves with the help of a
wheel chair. As Mahmoud says: “With an orthopaedic leg my life would be totally different.Now, I just spent my time
sitting here doing nothing.”
That was the last time that Mahmoud was permitted to travel to the West Bank: “Despite the fact that the Ministry of
Health in Gaza has on different occasions requested my medical referral to Bethlehem so that the measurements needed to
build and assemble the orthopaedic leg can be finished, Israel has systematically refused to authorise the trip.”
Mahmoud was turned away at the Erez crossing, despite having the appropriate permits on 8 March and 8 April 2010. Since
then, all his applications requesting access to medical facilities in the West Bank have been denied by Israel,
including a request to the Liaison Office on 5 December 2010.
After this rejection in December 2010, Mahmoud approached PCHR for assistance. On 19 January 2011, PCHR sent a letter to
the humanitarian center at the Erez crossing requesting that he be allowed to travel for medical treatment. This request
was rejected on 17 March 2011.
A further request was submitted by PCHR to the Israeli Public Prosecution in Jerusalem on 28 March 2011. On 13 April
2011, this was also rejected, again on the basis of alleged ‘security considerations’, therebyeffectively exhausting his
legal remedies, despite the best efforts of PCHR.“Why do they [the Israelis] not allow me to go to the West Bank? What
am I doing to them? I just want to get the treatment I need to have a life. They have granted me access before, so why
are they preventing me from going back to the West Bank again?”
In April 2012, Israeli authorities denied a total of 42 patients who required medical treatment currently unavailable in
the Gaza Strip access to hospitals in the West Bank and Israel. Of these 42 patient applications, 8 were rejected
alleging security concerns, 7 were forced to delay their hospital appointments, 5 patients were requested to change
their travelling/care companions and 5 were prevented from leaving Gaza on arrival at the Erez crossing point, despite
having a valid permit to travel.There are still 17 pending applications.
The International Covenant of Economic Social and Cultural Rights recognises the “right of everyone to the enjoyment of
the highest attainable standard of health.” In addition to the obligations contained in the Covenant, Israel, as an
occupying power, also has obligations under international humanitarian law. Article 56 of the Fourth Geneva Convention
requires Israel to ensure and maintain the health of the occupied population.
By imposing a closure on the Gaza Strip, Israel is continuing to prevent adequate medical treatment for patients. The
closure constitutes a form of collective punishment against a civilian population living under occupation, in
contravention of Article 33 ofthe Fourth Geneva Convention.