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A Request for Intervention: 4 Palestinian Patients and a System that Denies Medical Care

Dear Colleagues,

Kamil, Abed Al-karim and Muhammed are residents of the Gaza Strip. They are also all in need for critical medical care. Their requests to exit Gaza to receive medical care in Palestinian medical centers in the West Bank or East Jerusalem were rejected by the Israeli authorities, disregarding the harsh consequences on their lives and health.

Mohammed is from the West Bank. He too is trying to access vital medical care, and is faced with the Kafkaesque bureaucracy of occupation. He too is left without medical care.

All four patients had to go through interrogation with the Israeli Security Agency (ISA) as a prior condition to handling their applications for permits. Their stories and PHR Israel’s attempts to obtain the permits needed for them to reach medical treatments are detailed below.

PHR Israel requests that to the best of your ability you will:
1. Discuss the individual cases with your Israeli counterparts, so these patients are allowed to reach the medical centers where their treatment is scheduled.
2. Raise you concern on the arbitrary and opaque nature of the decisions of the Israeli authorities in regards to access of patients to medical care.
3. Convey your objection to using one’s medical need to drag him/her into a “honey trap” – coming to Erez on the pretext of receiving a permit and being arrested.

For more details: Kifah Abdul Halim 054-7577696 kifah@phr.org.il or hadas@phr.org.il

Sincerely,
Hadas Ziv
Public Outreach
PHR Israel

Kamil Altaramsi (ID no. 801839432)

Medical Condition
24 year old. Suffers from Acromegaly, a rare disease in which the hands, feet and skull keep increasing disproportionately due to anterior pituitary microadenoma.
Application to Exit Gaza for Medical Care
Kamil was told by the Civil Affairs Committee that his application to exit Gaza for an urgent medical treatment at El Makassed Hospital in East Jerusalem was approved.
February 19th 2012: Arriving at Erez Crossing Kamil was arrested and transferred to Shikma Prison. He was held there for the day without food, water or treatment, and was released in the evening to return to Gaza because he was found to be “medically unqualified for imprisonment!” Despite his declining health situation, Kamil didn’t dare make a new appointment. Only following PHR Israel’s intervention, did he obtain a new date for treatment and handed a permit application. Now he faced a new obstacle as the Palestinian Civil Affairs Committee refused to submit a new request to the Israeli DCO for him;
March 13th, 2012: PHR- Israel submitted an urgent request in his name directly to the Israeli DCO, demanding to urgently allow his exit for medical treatment and ensure he will not be arrested or undergo any other sort of harassment.
April 7th 2012: Kamil was examined in Gaza by Dr. Mustafa Yassin, one of PHR-Israel’s volunteer doctors who participated in the PHR-Israel’s last delegation to Gaza.
April 16th 2012: Equipped with a new medical report, another request was sent to the Israeli DCO. April 30th 2012: A complaint was submitted to the Israeli Security Agency (ISA) referring to the use of the “honey trap” – the arrests of patients upon arriving at Erez Crossing to receive a permit.
June 6th 2012: A response was received from the ISA: “the Agency’s comptroller at this stage is prevented from examining the complaint, as the decision in the matter of the complainant is in the hands of the court.” Kamil’s appeal against the rejection of his request to exit Gaza for medical care, handed in by PHR's Attorney Yoni Lerman, was set for July 9, 2012 in the Administrative Affairs Court in Beersheba.
July 7th 2012: The attorney general’s office gives a preliminary response to the appeal saying it should be rejected because – among other things –the treatment was not urgent or life-saving. In addition the reply insisted that the treatment can be obtained in hospitals outside of Israel (Israel views entry to East Jerusalem as entry to Israel itself), and that kamil is an "active militant terrorist". This last claim is particularly hard to understand in light of the fact that Kamil was released from detention because of his medical condition; he has been confined to his house for a long time and is incapable of managing normal life or hold a steady job.
July 15th 2012: A court hearing was held on his case, and the judge decided to reject the appeal based on the information which was presented to her by the state!
The Implications on Kamil’s Life
Dr. Ruth Stalnikowicz-Darvasi wrote in her review: "If the disease is not treated there is increased morbidity in cardiovascular, cerebrovascular, and the pulmonary system, with 30% reduction in life expectancy. Given that therapeutic measures do not exist in Gaza, the patient should be allowed to reach the center where it can be treated urgently"

Abed Alkarim Alastal (ID no. 926656539)

Medical Condition
28-year old, married with 3 children. Abed Alkarim complains of bilateral purulent ear discharge for many years, which has caused partial hearing loss in one ear. A mastoidectomy he underwent in Egypt on May 25, 2010 has failed, and the infectious condition returned and worsened. Thus, Abed Alkarim requested to undergo another operation in the Augusta Victoria Hospital in East Jerusalem. On February 14th 2011 he entered for an initial examination at Augusta Victoria Hospital, where the doctor recommended drug treatment for three months at least, to be followed by surgery to save his auditory system. The surgery was scheduled for June 19th 2011.
Application to Exit Gaza for Medical Care
June 12th 2012: To have the operation in Augusta Victoria Hospital, Abed Alkarim submitted an application for an exit permit to the Palestinian Civil Affairs Committee (CAC) who handed it in to the Israeli DCO.
June 20th 2012: Abed Alkarim checked the status of his application with the CAC on and was told that his application had been denied. He makes a new appointment for surgery, for September 11th 2011 and asks for the assistance of the Palestinian Center for Human Rights (PCHR).
June 30th 2011: PCHR submitted a second application to the CAC;
July 7th 2011: Abed Alkarim received another refusal.
August 2nd 2011:Attorney Walid Dahnoun from Al Mezan Center for Human Rights in Gaza, approached PHR Israel requesting to assist in submitting a new application to the DCO. Abed Alkarim sets his surgery for November 10th 2011.
September 11th 2011: Abed Alkarim was invited for an interrogation at Erez. He was asked several questions and promised by the investigator that he could exit Gaza for his treatment.
October 25th 2011: PHR-Israel sent a request to the Israeli DCO.
November 23rd 2011: The request was refused.
June 4th 2012: An appeal submitted by PHR Israel on behalf of Abed Alkarim was in the Administrative Affairs Court in Beersheba. In the hearing it was decided to reject the appeal based on confidential material the court received from the State.
The Implications on Abed’s Life
Dr. Michael Prsico, a specialist ENT physician, wrote (October 2011): “Generally, a condition such as this gradually destroys the middle ear, and greatly damages hearing, with the danger of damaging deep blood vessels in the cranial cavity, and the vestibular system […] I recommend allowing the patient to be examined and undergo repeated surgical treatment as soon as possible, in order to save the ear.” ]

Muhammed Nasir (ID no. 954626669)
Medical Condition

49 years old, from Gaza. Diagnosed as prostatic adenocarcinoma gleason score 3, and is receiving follow-up hormonal treatment at Al-Shifa Hospital in Gaza. Muhammed has been complaining of strong lower back pain and hemotoma. He had a CT scan for his chest area, stomach and pelvis, and needs to undergo an isotope bone scan immediately in the Palestinian Medical Center in Ramallah in order to examine whether the cancer has metastasized in the bone. An appointment was scheduled for November 23rd 2011.
Application to Exit Gaza for Medical Care
Muhammed submitted an application for an exit permit but was told by the CAC that his request was refused.
March 27th 2012: PHR Israel submitted an urgent request to the Israeli DCO.
April 10th 2012: The request is rejected on “security grounds”. PHR-Israel has handed Muhammed’s case to Attorney Lerman to consider an appeal to the court on his behalf.
The Implications on Muhammed’s Life
Professor Dina Ben Yehuda, director of Hematology at Hadassah Hospital in Ein Kerem, wrote in her medical opinion: “Concerning a 49 year old man, married with seven children, diagnosed with prostate cancer at an advanced stage, with suspected bone metastases. The request of the treating doctor is to implement a bone scan, and to consider radiation of the prostate. Because there is no possibility of a bone scan in Gaza (which is the examination of choice in this situation), and there is no possibility for radiation there, I recommend his transfer to a tertiary care center in Israel where he can receive both these things. Since we are talking about a fatal disease, the urgency is extremely high.”

Mohammed Awawdeh (ID no. 920633435)
Medical Condition
52 years old from Hebron. On January 6, 1992, he was injured while working in Ashkelon on construction, an injury from which he still has not recovered. He was diagnosed with PTSD and his physical condition does not allow his return to work. Mohammed was was recognized as the victim of a work accident by the Israeli National Insurance Institute (NII), with 77% disability. Since then, for twenty years, he has regularly been coming to Israel for medical and psychological treatments which are needed for his injury.
Application to Enter Israel for Medical Care
Beginning of June 2011:
Mohammed turned to the CAC requesting an exit permit in order to receive the treatments in Israel; however his request was denied. Only after he re-appeal was he was told that the denial is based on “security grounds". He was told that if he arranges to be accompanied by a private security company, at his expense, each time he enters Israel, a permit will be given. The sum needed is high for anyone living on Palestinian wages, let alone for someone who is unemployed.
December 11th 2012: PHR-Israel approached the DCO and were given the same response.
December 19th 2011: An appeal was made to the Jerusalem District Court, to instruct the State to explain why the petitioner would not be given an entry permit to Israeli territory for medical and psychological treatment which he needs and which he had received for many years in Israel.
April 15th 2012: The demand for an escort by a private security company was dropped. The Attorney General’s office relayed that: “The position of the security forces is that at this moment the petitioner’s entry into Israel for medical treatment is not conditional upon being escorted by a security company.” In spite of this reply, the patient’s entry to Israel was only made possible three times. Once following PHR Israel’s submitting a request, and twice following Hadassa Hospital submitting a request. All other appointments were “missed” due to various bureaucratic excuses.
June 18th 2012: After Mohammed received another refusal, PHR Israel requested for an explanation. The Health Coordinator (at the Israeli civil administration), Ms. Dalia Bassa, explained that he had been forbidden entry by the Israel Security Agency. It seems that after backing off from the demand of a private escort, and trying all other bureaucratic excuses, nothing was left for the DCO to do, but to claim that he was “forbidden by the Israel Security Agency.” The true reason for why a person who was regularly receiving treatments in Israel is suddenly deemed as a security threat is left unknown.


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