Israel's cruel punishment of the very ill in Gaza

March 17, 2011
Richard Kuper

haaretz.comSore eyes

Ilana Hammerman, 11 March 2011

After many delays, a diabetes patient from the Gaza Strip was finally allowed to travel to a Ramallah hospital for surgery. A fraught journey through the land of the checkpoints.

Driving south past the Ashkelon intersection on Highway 4 that Thursday morning, I began to notice a few of the signs along the side of the road. They announced several local points of interest at which I might have otherwise considered stopping – particularly at the Yad Mordechai intersection, where I could have taken a left turn and enjoyed coffee and a fresh pastry at the gas-station convenience store. Or I could have taken a right into the kibbutz, where I might have honored the memory of Mordechai Anielewicz, the commander of the Warsaw Ghetto uprising, who is commemorated thanks to a large statue of him next to the old water tower that was shelled in 1948.

I could have visited the site there where the attack of the Egyptian army is reenacted, walked through the trenches and climbed on the tanks. Afterward, I might have visited the museum, which is dedicated to the Holocaust and the revival of the Jewish people. I could have tried to rediscover the connection between Holocaust and revival to which I so devotedly clung when I was a child and which I have since lost. Maybe I would have ended the visit with a tour of the kibbutz’s honey-making facility, observed a model beehive and then tasted the sweetness without considering the sting. But I did not turn left or right. I continued south, past signs to Moshav Netiv Ha’asara, and then beyond, heading straight. The road is a good asphalt road, a smooth black strip lying between the gleaming orange-painted shoulders; on one side are trees and on the other, a verdant strip of grazing land. I am alone in the car, and the car is alone on the road. Above is a sloping sky, pale blue with whitish feathery clouds that lead to the end of the road, which comes into view in the form of a jumble of tall poles and a cluster of buildings with an unknown purpose.

The last sign on the road reads “Erez Checkpoint” in Hebrew, Arabic and English. The sign is large, but the wording and the arrow pointing left take up only the top one-third of it; the rest is empty, as if to say: After this, there is nothing. From up close, one can discern on the dark-green surface of the sign the vestiges of white Arabic letters. Something else was apparently once written here but then expunged, along with the various options it may have pointed out to motorists.

For me, at any rate, there was no other objective than to reach the Erez checkpoint, so I turned, directed by the arrow, in my heart a fear of the unknown. I was then greeted on the right by a white metal sign held up by three steel poles. “Welcome to the Erez Crossing,” was the bright message on the clean panel, in light-blue letters in all three languages. I stopped alongside it and spied a low barbed-wire fence stretched nearby. My eyes then lit on the corrugated tin roof of a long structure behind several fences. Most of it was hidden from view, with only one whitewashed wall with several dark rectangles of windows visible. I drove a little further and came to a halt in front of concrete barriers, whereupon I turned to the right, into the spacious, free parking lot that awaited me.

I parked the car and got out. Given the silence and the wide expanse of space around me, my initial urge was to stretch my limbs, withered from the car trip, and take a deep breath of the soft air of this sunny winter day. Another moment or two of relaxation passed until I reminded myself where I was and why I was there, and the transitory pleasure of the tranquil respite faded as if it had never happened.

It had been many years since I was here, and the place had completely changed. The big surprise was the absolute quiet and order, and the clean geometry of straight lines, squares and rectangles that had supplanted the old chaos and confusion, the hustle-bustle of people and possessions, the makeshift stands selling drinks and food and a plethora of merchandise, the dusty army jeeps and pickup trucks, the luxurious limousines and the rattletraps, the horses and donkeys tethered to carts, and the armed soldiers carefully scrutinizing the ID cards and permission slips of passersby.

Now two dozen or so taxis and private vehicles were parked in the lot, their engines turned off and their drivers quietly smoking alongside them or speaking in hushed tones with one another. Sitting on benches under a tin shed were several older people, with bags and bundles at their feet. They watched me as I walked past, but no one spoke.

Bureaucratic hassles

I shifted my attention to the border crossing itself. Behind the concrete barrier, the asphalt split into “exit” and “entrance” lanes, blocked off by thick poles. All of this was housed in a large metal structure that was open at both ends, with a blue roof. To its right stood a modest white shed. A young female clerk was sitting inside, in front of a computer, with a glass window between her and those wishing to enter the Gaza Strip; no one was there at that moment. Beyond was a fenced-off, paved lot, with a yellow sign that warned of vehicles crossing and a painted pedestrian crosswalk, but this area was also empty; the building behind it looked unoccupied.

With nowhere else to go, I stood next to the shed, alternately watching the clerk and the building. I was waiting for two women from Jabalya, the refugee camp in the northern part of the Strip. I hadn’t met them yet, but knew their names, Hibah and Zainab Abu Khamer. I knew a few details about Hibah and the reasons I’d come to take her and her mother.

Hibah, 24, has diabetes, is nearly blind, suffers from intraocular pressure, and was in urgent need of an operation meant to save what remains of her eyesight. An appointment had been made for her at an ophthalmological hospital in Ramallah. It was the second one she had made: She had not been able to get there for the first appointment, about a month earlier. Why? Despite the urgency, there were a few critical bureaucratic matters that had not been taken care of with the various authorities. Prior to Hibah’s first scheduled operation date, the family had submitted all requisite documents to an authority known as the Palestinian Civil Committee. The committee is authorized by the State of Israel to coordinate the movement of patients through Israeli territory, and essentially consists of a single Palestinian civilian: the “health coordinator.” He had submitted the request, as per regulations, to the District Coordination and Liaison Office (DCL ), the Israeli body authorized to issue entry and exit permits to the besieged residents of Gaza. But it had failed to respond to the request, and the date for the scheduled operation passed.

The hospital in Ramallah scheduled a new one. Again, the family submitted documents to the committee which again sent its request to the DCL; again the DCL was silent. The family then sought the assistance of the Israeli non-governmental organization Physicians for Human Rights-Israel, which helps patients whose rights have been violated. The association approached a specific department within the DCL, known as the Humanitarian Center. Yet in spite of its name, this authority did not respond either. So it was that the second date was about to pass, and the eyesight of the young woman continued to deteriorate.

At this stage, I of all people – a citizen who has suffered for a long time from an ophthalmological condition, and whose eyesight has been saved (so far ) by medical intervention – tried my luck and turned to MK Haim Oron of the Meretz party, for whom human rights are paramount, personally and party-wise. Oron responded wholeheartedly, but his efforts also proved fruitless.

Several more days passed and there was still no response, and here we were, with only two days until the operation. I decided to try my luck again, and contacted Haaretz journalist Chaim Levinson. At this point, almost instantaneously, Abu Khamer’s luck changed: Levinson approached various army authorities and demanded that they explain their silence; they promised to give him an answer within one day – and made good on that promise: The following morning, the day before the scheduled surgery, they informed Levinson that they had authorized the trip by Hibah and her mother through the sealed gates of the Strip and through Israeli territory to Ramallah.

Levinson informed me of this, I told the physicians’ organization of the permit and they informed the Abu Khamer family. But it was not a done deal at that moment: Apparently, it is a rule, and perhaps a military-security directive, that patients who receive an exit permit from the Strip for treatment do not receive the absolute final permit until close to 7 P.M. on the eve of their departure. In any event, at 8 P.M., Hibah’s father called to say he had received the final document and that I could pick up his wife and daughter early the following day on the Israeli side of the Erez crossing.

Absurd reality

That is how events transpired until that wintry Thursday morning when I stood edgy and perplexed at the current “incarnation” of the Erez checkpoint – a poor and preposterous excuse for a border-crossing terminal between two countries, next to a shed with a single clerk inside. My eyes were fixed on the building near the parking lot, from which the two women were supposed to emerge. For a long time, no one came out. Then the trickle began – by ones or twos, people who were mostly elderly, some of them parents with children in baby carriages, and here and there, looking conspicuous, men in suits who looked like businessmen.

I followed this meager procession as the individuals slowly made their way through the lot to the fence and the narrow turnstile leading out, not far from the shed. A heavy feeling of discomfort descended on me. I felt as if only I were now waking up to the reality of this place. An absurd and nightmarish reality. The people on the other side of the fence seemed in my eyes to be emerging from a void, from the depths of a black hole. As if there never were or could be a million and a half people behind this sterile structure that had arisen here in the middle of nowhere, in place of the lively checkpoint of the past; it had had a defective, distorted life, but a life nevertheless. As if during the years in which I have no longer been able to enter Gaza – which I often visited before – this crowded strip of land had been transformed into a sort of ghost kingdom. Its residents, who have disappeared from view, have disappeared from our consciousness as well, and lost their image as human beings.

In their place came mortars and Qassams, missiles and targeted assassinations – not to mention the image of Gilad Shalit, who has himself been swallowed up, to our utter terror, by the black void, although his delicate boyish face has not been expunged and continues to look out at us from countless photos and illustrations that tug at the heartstrings. These are the things that can still be detected within the immense, dark gloom that has swallowed up the people. And then came Cast Lead, and photos of bombings and heaps of ruins and the nameless figures that wandered around and picked through them. And then came the statistics: 61 percent of Gaza residents suffer from food insecurity; 40 percent have been added to the ranks of the unemployed; and 90-95 percent of the well water is unsuitable for drinking, leading to “blue baby syndrome” and anemia.

There was a time when I knew people there, submerged in the unemployment and the poverty and the lack of adequate water, young people and old, men and women and children. I walked together with them along the beach, I ran with them in the alleys of the cities and the camps, I found shelter in their homes, and with complete strangers who rescued me, tugging at my arm to flee when the stones began to fly, amid the black smoke of burning tires and white smoke of tear gas, and the rubber bullets and the live gunfire. I drank and ate with the residents and heard stories of their lives – sad tales, yes, but also juicy and spiced with a great deal of humor. I discovered an entire world there, a foreign and distant world, which over time became less frightening, more familiar and close, and even comprehensible despite the conflicting views.

In the Gaza Strip I learned for the first time how to cross borders, not ideological ones but human borders, both real and imagined. I learned to break and ultimately bring down partitions – whether external or within me; to show contempt for anxiety and prejudice; to become addicted to curiosity and not fear. And in this way to taste the flavor of a unique individual freedom, one of many other types of freedom, which a person can experience even in bad times, times of conflict and war, attack and brainwashing. Indeed, in spite of my own humanistic worldview, I also have been subjected to such manipulations.

Then the fences were erected and the breaches were sealed, and I did not return anymore to the Erez checkpoint or to the Palestinian people behind it. The telephone calls with them ceased as well; the voices were silenced, the sights were blurred and the aromas paled into insignificance. The checkpoint won, and for me, the people disappeared. I knew that Palestinian leader Dr. Haidar Abdel-Shafi had in the meantime died, that my friend Razi had fled with his wife and children to Egypt, that another friend, Hilmi, had somehow made it to Syria and Ala to the United States, and that others had evidently remained imprisoned here, between the fences and the sea.

Now I was back again, seeing people from Gaza. In different circumstances. There were only a few that day, very quiet, with careful movements; a few limped and leaned on walking sticks; a few were pushed in wheelchairs. Nevertheless, these were living people, with clothes that are neat, belongings packed in suitcases and bags. And their nutritional deficiency and the salinity of the tainted well water was not noticeable.

I wanted to walk up to them, extend my hand, smile, but I felt there was no interest in such gestures. The people exiting Gaza pushed their belongings through the turnstile, while those seated in the wheelchairs or who had large possessions were sent though another, ordinary gate. Then each person immediately headed for the cars and taxis.

Shy smile

After a long wait, Hibah and Zainab emerged. I recognized them quickly: The young woman wore dark glasses and the older woman held her by the arm; in her other hand, with noticeable effort, she carried a bulging black bag. The mother led her daughter toward the revolving steel turnstile, walked behind and got stuck because of the overstuffed case. Someone came from behind and extracted the bag by pulling firmly at it. The mother and daughter went through, and the rescuer carried the case through the gate nearby, and gave it to them.

Now I could extend my hand and smile. But this pair was not into smiles and welcomes. The daughter’s face was extinguished, the mother’s tired and tense; they pressed my hand weakly and walked with me to the car. Hibah sat in the back and Zainab was next to me in front.

We immediately set out. I offered chocolate I’d brought with me, at which point I remembered that the daughter has diabetes, and suggested that we stop for coffee at the gas station. Then I realized that the mother was concerned that we might be late, since they had already been delayed a long while at the checkpoint. I offered to play a CD of Fairuz or Umm Kulthum, but couldn’t figure out what they preferred. A shy smile of politeness from the back seat revealed (in the rearview mirror ) even white teeth in the melancholy face of the daughter; the embarrassed smile next to me, in the worried and pinched face of the mother, revealed missing teeth. The sounds of the opening orchestral bars of the song “Enta Omri,” at first slow and suppressed, and afterward gaining in strength, sweeping and addictive, prevented me from hearing what the mother evidently wanted to say to me.

I turned off the CD player. I said to myself: It’s not as if I don’t know what’s going on here. I am driving two sad, dispirited women from the Gaza Strip. It is not possible to make them happy or to be happy with them, as I am with the women I smuggle from the West Bank into Israel. In my heart, I thus said: Is there anything I might hear here that I can’t already guess?

Nevertheless, I made the utmost effort to understand the Gazan dialect spoken by Zainab. She talked about the blindness that began only a few months before, and which put an end to Hibah’s university studies. She told me about the decision to operate, about the first operation that had to be canceled, about the extended wait for the exit permit.

She told me about the lengthy wait at the crossing point, about the degradation of multiple body searches of Hibah; something on her was beeping persistently – evidently her belt buckle.

Then Zainab told me a little about their life in the Strip: about the damage caused by the war, which forced them to leave their ravaged home; about her husband, who had worked in Israel for many years; about the hours and days spent without electricity and water; about having to buy expensive bottled water; about the faulty medical treatment of her daughter’s illness and the scarcity of medication; and about her other children who were growing up and studying, but have no chance of finding work. Hers was a helpless lament of absolute hopelessness, rooted in a life that is only an hour and a half away from Jerusalem.

When we reached the Qalandiyah checkpoint north of Jerusalem it was already midday. Here everybody who comes from Israeli territory is met by an ugly, congested mass of vehicles and pedestrians rushing to squeeze between cars and fences; no one seemed to have any desire to get a little exercise and breathe some fresh air. The three of us trudged on foot from the improvised parking lot, not a short distance, to the vast checkpoint area. The daughter held her mother’s arm, and Zainab and I carried the large bag together.

I went through the checkpoint with them, although technically speaking I was not supposed to do so by virtue of some sort of military order. Essentially, however, unlike the Erez checkpoint, this one was full of breaches and openings. For the most part, the soldiers at Qalandiyah paid no attention to anyone heading north, and only carefully inspected those heading south, to Jerusalem, even then mainly focusing their attention on the Palestinians among them.

Thus I was able to accompany Hibah and Zainab to the hospital in Ramallah, to leave them there to their fate, and to head home in peace. To be a human being in this country, you have to violate a few orders and memorize others by heart.

Failed surgery

Hibah Abu Khamer was subsequently operated on three or four times in Ramallah, and all the operations failed. There was nothing more that doctors there could do. Three weeks later I came to pick up the two of them for the return trip, from the Qalandiyah checkpoint to the Erez checkpoint. Once again, I fixed my eyes on the exit gate of yet another facility that tries to impersonate a border crossing between two countries. Once again I waited with a heavy heart, this time dreading the sight of Hibah’s young face, which would no doubt be emotionally deadened and more melancholy than before. Over an hour passed from the time that Zainab called to say they had arrived at the other side, but they were not to be seen; now the cell phone was silent. In the end, my patience snapped and I did what I was forbidden to do at Erez: I entered the compound.

Inside, on a large paved surface, was a massive, high fence of barbed wire, some of which delineated narrow passageways called “sleeves.” I squeezed myself into one of them and looked for two women in the lines designated for entry into Israel. In vain; they were not there. The soldier inside one of the window niches remembered the blind woman and the woman with her. He told me he himself could not allow them to pass because their permit had expired. He did not know where they were now. Perhaps they’d gone to the DCL in sleeve No. 5 to arrange a new permit? He had allowed them to leave the facility. I returned to where I’d come from.

The DCL in sleeve 5 was closed. Again I pushed myself into the waiting lines and wandered about, between the sleeves, until at some point I nearly fell, literally, over Zainab’s big bag. The mother was holding two green ID cards, crying. Hibah was standing alongside her with bowed head, gripping her arm.

What had happened? The Interior Ministry of the State of Israel had issued Hibah and Zainab Abu Khamer two entry permits to Israel that had been valid for a Thursday three weeks earlier, from 5 A.M. until 7 P.M. “Exit for the purpose of hospitalization,” they read.

The hospitalization, not surprisingly, had extended more than 14 hours. Apparently, Zainab had not read the permit, and when she finally arrived with her daughter and handed it to the soldier, he simply tore up the expired forms in front of the sighted eyes of the one and the blind ones of the other, and instructed them to go back. When Zainab refused, he yelled at her. They had nowhere to go; they didn’t know a soul in Ramallah. Zainab wanted to return with her daughter to their hut in the Gaza Strip. When she wouldn’t budge, the soldier had her removed. He didn’t explain anything to her. He didn’t even speak her language. Eventually, one of the people standing in the line volunteered to take her to the DCL, where she was immediately issued a new entry permit for the same day.

Zainab told me all this later on in the car, during a trip that seemed to last forever on the crowded Thursday afternoon roads. She cried. It took her a long time to shake off the panic that had seized her, for fear that she would remain with her daughter without anywhere to sleep that night. And also over the humiliation that the young soldier at the checkpoint had put her through. She was also crying over dashed hopes, over her daughter’s unseeing eyes, for which no remedy had been found. Eventually her nerves were calmed by family members who called her, one after another, to find out exactly where, between Ramallah and Gaza, they were located. She took some candies out of her bag and offered me some. And smiled. There were people in the besieged Gaza Strip who cared about their welfare and who were waiting for them.

When we arrived at the Erez checkpoint, it was nearly 7 P.M., and the place was all but abandoned. A handful of people were waiting and milling around, two little children were running in the parking lot, there wasn’t a car in sight, and a young couple was walking hand in hand. A full moon winked at them out of the night sky. Then the head of a clerk appeared in the window and a small, but crowded line immediately formed. Zainab rushed to free her arm from her daughter’s, to grab a spot in line. Hibah remained standing there, helpless. I stroked her shoulders. She smiled sadly. Zainab returned, the signed papers in her hand. I hugged her tightly, she kissed me on two cheeks, and invited me to visit them in their home in Jabalya. Then she took Hibah and the black case, which this time was loaded onto a cart, and turned toward the fence. Some Israeli workers who were digging a ditch there under the spotlights helped her to walk around the ditch with her daughter, and pushed the cart close to the gate, which opened immediately to welcome the returnees home. To their family of 13 children and 32 grandchildren.

Zainab gave me a final wave of her hand from the lot before she was swallowed up into the long shed with Hibah. I imagined that I could hear her breathing a sigh of relief.

Gaza’s medical siege

According to figures of the World Health Organization from 2010, nearly 1,000 patients are referred each month for medical treatment outside the Gaza Strip. Most are sent to medical centers in the West Bank, East Jerusalem, Israel and Jordan. Travel to the centers requires them to exit through the Erez crossing, under Israel’s control, and must be approved by Israeli authorities.

The need to refer patients for treatment outside Gaza stems from its lack of medical services, due to a shortage of skilled personnel and equipment. The Palestinian health system in the Strip cannot, for instance, provide a full range of care in oncology (radiation, CT and PET scans, bone-marrow transplants ), cardiology (angioplasty, open heart surgery, bypasses ), ophthalmology (cornea transplants and surgery ) or organ transplants, or certain treatment in the fields of urology, orthopedics, neurology and neurosurgery. In addition, it is not possible there to carry out certain sophisticated tests and procedures that are essential for proper diagnosis.

Receiving an exit permit for medical treatment outside Gaza requires a bureaucratic process that lasts an average of one month. The District Coordination and Liaison (DCL ) unit of the Israel Defense Forces checks each application and then passes it to the Shin Bet security service for review. The Shin Bet calls in some patients, or their escorts, for questioning at the Erez crossing (in 2010, over 300 patients were summoned ). The questioning always takes place after the patient’s appointment, which means requesting a new one – or starting the entire process from scratch. But even afterward, there is no way for the patient to know if and when they will receive the Israeli authorities’ response. Many people thus repeatedly miss appointments and their condition deteriorates.

Between January and October 2010, the requests of some 2,174 patients and escorts were rejected or postponed. The World Health Organization reports that since January 2009, 33 patients died while awaiting permits for treatment outside the Strip.

Data supplied by Physicians for Human Rights-Israel

A ‘humanitarian center’?

Hibah Abu Khamer is one of many patients requiring ophthalmological treatment outside Gaza, because such treatment is deficient in that besieged area. Therefore, in February 2010 a team from Ramallah’s ophthalmological hospital, where she had been referred, sought permission to enter Gaza to treat patients in need of treatment. The team included ophthalmological surgeon Dr. Ismail Masallam, an anesthesiologist and two operating room nurses. Among the candidates for treatment were numerous patients whose requests to go to the hospital had been rejected by the Israeli authorities, including patients requiring cornea transplants.

The team’s request was turned down. Physicians for Human Rights-Israel submitted an additional, detailed appeal to the authority known as the “Humanitarian Center.” Its response was garbled, but unequivocal: “1. We hereby confirm receipt of your application. 2. In your application, you requested that entry of residents be permitted, for the purpose of entry of a medical delegation. 3. Firstly, it should be noted that in accordance with arrangements agreed upon with the Palestinian Authority, all of your applications related to the entry of Palestinians from the Gaza Strip into Israeli territory must be referred to the Palestinian Civil Committee, the body responsible for coordinating and prioritizing the submission of applications from Palestinian residents of the Judea and Samaria region and the Gaza Strip to the Israeli side. 4. In addition, we inform you that following a review of the request, the authorized parties decided to reject it, as it does not comply with the criteria, which are periodically determined in accordance with the political-security situation. 5. For your information, [signed] Humanitarian Center, Gaza DCL.”

Reality of warfare

Response of the Shin Bet: “On September 19, 2007, the government of Israel declared the Gaza Strip to be hostile territory. As a consequence, limitations were imposed on the entry of residents of the Strip into Israel, which stem from the assumption of the presence of danger among residents of a hostile region.

“In addition … the State of Israel acts by means of a coordination unit, known as the Coordinator of Government Operations in the Territories, as well as the Shin Bet, to offer a response to the humanitarian and medical needs of residents of the Gaza Strip, and the state invests great efforts in this area. This effort continues, despite the reality of continued warfare against the armed forces of Hamas and other terror organizations in this sector.

“We note that in the year 2010 alone, approximately 18,000 residents of the Gaza Strip, representing some 80 percent of all applicants, entered Israel on a humanitarian basis. This finding is based on data of the World Health Organization. We emphasize that during this period, Egypt permitted entry of about 160,000 Gaza residents into its territory through the Rafah crossing, including individuals who exited due to medical and other treatment.

“In order to guarantee the security of the residents of Israel, a process was established to allow security analysis, which the resident of the Strip undergoes prior to his entry to Israel. The need for this process stems from solid intelligence information that points to intentions of the terror organizations to exploit humanitarian requests for the purpose of promoting terror activity, as has occurred in the past. The security analysis also involves, from time to time, a need for frontal questioning. We emphasize that such a means is used in approximately 2.5 percent of all entry requests. Furthermore, the order of priorities for analysis is determined first and foremost by the level of urgency indicated by the Palestinian health ministry in Gaza on application forms to the Israeli DCL.

“Clearly, with such a high number of requests there is no choice but to rely on the level of urgency noted in the Palestinian application, which is the decisive factor in determining the order of priority of treatment. The Shin Bet and the Coordinator of Government Operations in the Territories will continue to handle requests on a humanitarian basis from the Gaza Strip by employing security considerations, on the one hand, and meticulously upholding human dignity, on the other.”

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