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Mahmoud al-Hawajri in his Yard. Photo by Khaled al-‘Azayzeh, B'Tselem, 27 January 2019
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Shoot and abandon: Israel barring wounded Gazan protesters' access to medical care

The Return Protests, which Palestinians in the Gaza Strip have been holding near the fence with Israel to demand realization of the right of return and an end to the blockade on Gaza, began nearly a year ago and are still taking place. According to the World Health Organization (WHO), by the end of January 2019, a total of 27,942 people had been injured in these demonstrations, 14,768 of whom were treated in hospitals in Gaza. More than 6,300 had been injured by live fire. According to B’Tselem’s figures, by the end of February 2019, 200 protesters had been killed, including 39 minors and two women. Most of the casualties – killed or injured – had posed no danger to Israeli security forces, who were deployed on the other side of the fence.

Any healthcare system would be hard put to treat such an immense number of casualties. All the more so for the healthcare system in Gaza, which is on the verge of collapsing. Israel has kept Gaza under blockade for more than a decade, imposing restrictions on bringing in drugs, advanced medical equipment and spare parts for broken equipment, and barring doctors from travelling abroad for further training. The restriction on bringing drugs into Gaza has severely depleted local stores of vital drugs and equipment. Gaza also suffers from an intermittent supply of power, largely due to Israeli policy, and routine power cuts damage medical equipment. This has forced hospitals to cut services to a minimum, postponing non-urgent operations and releasing patients home earlier than medically advised.

Given the failing healthcare system in Gaza, injured protesters cannot receive the medical attention they need and must seek vital treatment abroad.

Yet soon after the protests began, Israel declared that, as a rule, it would not allow persons injured while participating in them to leave Gaza for medical treatment in the West Bank (including East Jerusalem), Israel or Jordan. In April 2018, the NGOs Adalah and Al-Mezan Center petitioned Israel’s High Court of Justice on behalf of two wounded men, since amputation would be likely with the care available in Gaza. In response, the state told the court the applications had been rejected, “given the policy of the Minister of Defense on the issue, whereby, as a rule, entry into Israel shall not be granted to persons injured while taking part in the violent public disturbances organized by Hamas, where the concrete medical circumstances were not deemed to warrant considering a departure from said rule, as the petitioners are not in a life-threatening condition.” The state said it had “also warned Gaza residents against participating in the demonstrations,” as if this was a justification for denying them access to adequate medical treatment.

Despite the dire condition of both men, and the urgent treatment it called for, the justices refused to schedule an urgent hearing. The doctors had no choice but to amputate a leg on each patient. Only more than a week after the petition was filed, the High Court ordered the state to allow one of them, Yusef al-Kurunaz, 19, to travel to a hospital in Ramallah, where doctors were able to save his other leg. The justices did state, however, that this was an exceptional case and that they were not taking a stand on Israel’s overall policy toward injured protestors. In doing so, they effectively permitted the state to continue its policy of barring most injured protestors from receiving medical treatment.

According to figures released by WHO, from the start of the demonstrations through January 2019, 493 applications to exit Gaza via Erez Crossing for medical treatment in the West Bank (including East Jerusalem) or Israel had been submitted. Only 85 (17%) of the requests were approved, while 408 (83%) were rejected – directly or by delaying the issuance of a response. Given the extent of injuries in the protests and Gaza’s failing healthcare system, the number of requests filed is most likely much smaller than the actual number of persons in need, and primarily reflects the realization that applications stand a very low chance of approval.

The proportion of approved requests by injured demonstrators is much lower than that of approved requests to leave Gaza for medical care under other circumstances. According to WHO figures for 2018, 25,808 people applied for a permit to leave Gaza for medical care in the West Bank (including East Jerusalem) and in Israel. Almost 40% of these requests were rejected – directly or by responding only after the scheduled appointment. Sixty percent of the requests were for care in hospitals in East Jerusalem, 23% for hospitals in the rest of the West Bank, and 17% for hospitals in Israel.

 

  Requests submitted Rejected No response Total number of requests directly or indirectly rejected
Total 25,808 1,962 8,014 9,976
East Jerusalem 15,285 1,258 4,688 5,946
Rest of West Bank 4,773 523 1,812 2,335
Israel 5,750 181 1,514 1,695

 

Some of the persons whose requests were rejected or who received no response are trying to leave Gaza for medical care in Jordan or Egypt, via Rafah Crossing. Yet this solution is only relevant to some patients, as not all of them can receive proper treatment in these countries and some cannot endure the long, exhausting and perilous journey through Sinai. Since May 2018, Rafah Crossing has been regularly open five days a week, but Egyptian authorities restrict the number of persons allowed through. From May through December 2018, 1,510 persons in need of medical care crossed it – an average of 189 a month.

This is a reality created by Israel. It is Israel that instituted an open-fire policy that allows live gunfire at protestors posing no danger, resulting in thousands of injuries – a policy it still refuses to change, a year in, although the horrific outcome has been commonly known for some time. It is Israel’s decade-long blockade on Gaza that has made it the major culprit in the collapse of the healthcare system there. It is Israel that is now denying the wounded passage, for just several dozen kilometers, through its territory to reach the treatment they desperately need. It follows that it is Israel’s duty to change this reality – to prohibit the use of live fire against persons posing no danger, to end the blockade on Gaza and to permit access to proper medical care.

The following testimonies were given to B’Tselem field researchers in Gaza by individuals wounded in the demonstrations, who were then refused requests to leave Gaza via Erez Crossing to seek medical treatment:

 

Hassan al-‘Issawi, 42, a husband and father of four from Khan Yunis

Al-‘Issawi volunteered with the Red Crescent’s medical teams at the protests. He was hit in the leg by a live bullet in a demonstration held on 19 October 2018 east of Khan Yunis. The bullet shattered a bone and he underwent several operations in different Gaza hospitals. Nevertheless, he needs more surgery that cannot be performed within Gaza, and the doctors have referred him to al-Makassed Hospital in East Jerusalem. Al-‘Issawi made an appointment there, but Israel rejected his requests to leave Gaza three times, and his doctors fear they will have to amputate his leg unless he receives the necessary treatment. Al-‘Issawi used to run projects for NGOs, but is currently unemployed as he cannot move around.

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Hassan al-‘Issawi at his home. Photo by Olfat al-Kurd, B'Tselem, 20 February 2019

In a testimony he gave B’Tselem field researcher Olfat al-Kurd on 20 February 2019, al-‘Issawi said:

Since the protests began east of Khan Yunis, I volunteered with the Red Crescent to give first aid. On Friday, 19 October 2018, I went as usual to the demonstration east of Khan Yunis with other volunteers. I was wearing a first-aid volunteer uniform and a Health Ministry name tag.

During the demonstration I was hit by a live bullet in the right leg, even though I was far from the fence. I was taken to the European Hospital and stayed there three days. The bone in my leg was shattered and the main nerve and tendon torn. They put a platinum implant in the leg. Then I was transferred to Nasser Hospital, where I stayed for 25 days. From there, I was transferred to other hospitals – Dar a-Salam and the state hospital in Khan Yunis – where I had three operations.

While I was still in hospital, the doctors referred me for further treatment to al-Makassed Hospital in East Jerusalem. I have to undergo another complicated procedure that can’t be performed in Gaza. I filled out the Palestinian Health Ministry’s form and scheduled an appointment at al-Mkassed for 12 November 2018. The day before, I got a text message saying my request was still under review. I couldn’t make the appointment and scheduled another one for 10 December 2018. Then my request was rejected. The third time, I set an appointment for 7 January 2019 and was rejected again. I have another appointment scheduled for 5 March and have filed a fourth request. I am now waiting for a reply, again.

Meanwhile, I’ve also filed a request for treatment in Egypt, in case I can’t get to East Jerusalem, because my leg is in bad shape. There are complications from infections in the bone. It’s a dangerous condition and if I don’t get proper treatment, they may have to amputate. In the meantime, I’m having physiotherapy sessions with Doctors Without Borders. I go to their clinic every two days. They also provide transport to and from the clinic, because I can’t drive my car. I use crutches and only leave home to go for treatment.

Since the injury, my life has been on hold. I used to do weightlifting at a sports club. We live on the fourth floor, with no elevator, so I had to move out of the house, leaving my wife and kids, and go to my mother, who lives on the first floor. It’s easier to go to hospital and treatments from there. Sometimes I spend one day a week at home, with my wife and kids. I’m stressed all the time and it’s had a bad effect on my relationships with my family. Since the injury, I also haven’t worked. I used to run projects for NGOs, but my career is over. I spend most of my time on social media and undergoing treatments.

* Update: Al-‘Issawi’s fourth request to leave Gaza via Erez Crossing for medical treatment was also denied.

Muhammad Saleh, 12, from Jabalya Refugee Camp

Muhammad Saleh was wounded in his right leg by a live bullet on 5 October 2018, at a protest held east of Jabalya Refugee Camp. He was taken to the Indonesian Hospital, where he underwent surgery twice and stayed until 18 October 2018. During his time in hospital and after he was sent home, his parents submitted three requests for a permit to leave Gaza via Erez Crossing, so he could undergo surgery at al-Makassed Hospital in East Jerusalem. Two of the requests were denied. The third time, they were asked to find someone other than his mother to go with him. The family is now waiting for al-Makassed to schedule a new appointment so they can file a new request. Saleh can currently walk only with the help of crutches.

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Muhammad Saleh at his home. Photo by Olfat al-Kurd, B'Tselem, 21 February 2019

In a testimony he gave B’Tselem field researcher Olfat al-Kurd on 21 February 2019, Saleh described the injury and his life since that day:

On Friday, 5 October 2018, I took part in a protest east of Jabalya R.C. I got very close to the fence and was hit in the right leg by a live bullet. At first, I felt nothing, but then I looked down and saw that my leg was bleeding badly. I blacked out. The paramedics carried me to an ambulance that took me to the Indonesian Hospital. My leg kept bleeding in the ambulance and I felt like there were electric shocks going through it. I was taken into an operating room immediately and kept in intensive care for a few days. I stayed in hospital until 18 October 2018. I had two surgeries. After I was released, I went back to the hospital every few days because my temperature rose. After about a month, I started physiotherapy with Doctors Without Borders.

Before the injury I loved playing soccer and riding my bike. I can’t do that now. When I see my friends playing soccer, my heart aches and I feel sorry for myself. I feel like crying but I hold the tears back. I spend most of my time at home, in bed. I can only walk with crutches.

I missed school during the first half of grade 7. The principal gave me permission to attend only twice a week, because it’s hard for me to get there every day. My brother Jihad, 30, carries me on his back a kilometer or more to school, because we don’t have a car or money for a taxi. The principal said he’d switch classrooms so that my class studies on the second floor and not on the third, to make it easier for me to reach. My friends help me with homework and carry my bag. My grades used to be excellent but now I’m down to C’s and D’s, because I miss a lot of lessons.

Since the injury I’ve been sad. I cry a lot and yell sometimes. I’ve become very short-tempered and I’ve lost my appetite. Sometimes, I go along with my mom to visit relatives, but I don’t enjoy it. I want to play like the other kids, to run and play soccer. I really hope I can have the surgery that will make it possible for me to walk again without pain.

Muhammad’s mother, Nuha Saleh, 45, a wife and mother of seven, told al-Kurd on 21 February what it is like living with her son’s injury:

After Muhammad was wounded and had two operations, the doctors told us he had to have another operation that can’t be performed in Gaza, because it’s very difficult and complicated. They said the chances of such surgery succeeding were very slim.

The Palestinian Health Ministry referred us to al-Makassed Hospital in East Jerusalem, where they set Muhammad an appointment for 12 November 2018. A day before the appointment, I received a text saying that Muhammad’s request had been denied. We made a new appointment, for 18 December 2018, and were denied again. The third appointment was set for 18 February 2019, but the day before, we were told that my request to accompany him was still under review, so Muhammad had to file a new request. We’re now waiting for the hospital to schedule a new appointment so we can file another request for a permit to leave Gaza.

Since the injury, Muhammad has been suffering a lot. He and I are both stressed, all the time. He shouts in pain all night and can’t sleep. I sit by his bedside all night and don’t sleep, either.

For a while, he lost feeling in his leg altogether – so much so that he was severely burned by the stove because he didn’t feel he was right up against it. His brother Iyad noticed and yelled that his leg was on fire. We took him to a-Shifaa Hospital and he had to go there every day for 40 days to change bandages, in addition to suffering from the original injury.

Mahmoud al-Hawajri, 19, single, from a-Nuseirat Refugee Camp

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Mahmoud al-Hawajri at his home. Photo by Khaled al-‘Azayzeh, B'Tselem, 27 January 2019

Al-Hawajri was injured in both legs by live fire on 31 March 2018, the first day of the Return Protests, at a demonstration held east of al-Bureij R.C. He was treated at the ICU in Shuhadaa al-Aqsa Hospital in Deir al-Balah. After three days, he was transferred to a-Shifaa Hospital in Gaza City, were a platinum implant was surgically fitted in one of his legs. Since then, al-Hawajri has submitted six requests to leave Gaza through Erez Crossing for surgery in al-Makassed Hospital, East Jerusalem. All the requests were denied. His leg deteriorated and in April, the doctors were forced to amputate it. He filed yet again for a permit to leave to have a prosthetic fitted at al-Makassed, but was refused.

In a testimony he gave B’Tselem field researcher Khaled al-‘Azayzeh on 27 January 2019, al-Hawajri described the injury and his life today:

On the first day of the Return Protests, I took part in activities east of al-Bureij R.C .after noon prayers. When I got there, I saw thousands of people near the border.

At about 5:00 P.M., I was about fifty meters from the fence. I was just about to draw back when a sniper fired at me. The bullet went through my right calf to my left calf. I fell and blacked out from the pain. I woke up at ICU in Shuhadaa al-Aqsa Hospital, Deir al-Balah. Three days later, I was transferred to a-Shifaa Hospital in Gaza City.

At a-Shifaa, the doctors wanted to amputate my right leg but I refused. They fitted me with a platinum implant. I stayed in intensive care for a week, and then I was transferred to the surgical ward, where I stayed for another month. During that month, I submitted several requests to receive further treatment at al-Makassed Hospital in East Jerusalem, because the treatment I need isn’t available in Gaza. Israel denied all my requests. I suffered a lot from increasing pain. I started getting black gangrene spots on my right leg.

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Mahmoud al-Hawajri in his Yard. Photo by Khaled al-‘Azayzeh, B'Tselem, 27 January 2019

Every day that passed brought the amputation of my right leg closer, because the veins were ruptured. After my last request was rejected, in April, the doctors at a-Shifaa decided to amputate. They were afraid the gangrene would spread to other parts of my body and kill me.

When I woke up after surgery without my leg, I went into extreme shock. How did I lose my leg? What sort of life can I lead now? I haven’t been able to lead a normal life since then. I get around on crutches. I can’t play soccer or ride a motorbike any more. My only hobby now is pets: dogs, birds and bees. Most of the day, I keep myself busy in the yard with my pets.

I prefer to hole up at home and try to forget about my injury, but can’t really do it. I very much hope to get to hospital in East Jerusalem to have a prosthetic leg fitted that will help me walk, even a bit. The last appointment I had scheduled at al-Makassed was for 7 June 2018, but my request for a permit was denied. In the meantime, I hobble around on one leg with crutches. It makes my left leg hurt a lot, because it carries the entire weight of my body. When it’s cold it especially hurts, and then I get really blue and very short-tempered and lose patience with everyone in my family.

Muhammad Mas’ud, 18, from Jabalya Refugee Camp:

Mas’ud was wounded in the chest by live fire at a demonstration held east of Jabalya R.C. on 13 April 2018. He was taken to a-Shifaa Hospital, where doctors found that the bullet, which had penetrated his chest and exited through the lungs, had caused hemorrhaging in the chest. Mas’ud underwent surgery and was referred to East Jerusalem for further treatment, but the two first requests he filed went unanswered and the third was denied.

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Muhammad Mas’ud at his home. Photo by Olfat al-Kurd, B'Tselem, 21 February 2019

In a testimony he gave B’Tselem field researcher Olfat al-Kurd on 18 February 2019, Mas’ud related:

When I was injured, the paramedics drove me in an ambulance to the Indonesian Hospital near Jabalya R.C. and gave me first aid on the way. When I got to the hospital, I blacked out. I was so badly injured that they transferred me to a-Shifaa Hospital in Gaza City, were I stayed in intensive care for a week. I was unconscious the whole time. I had an operation in which the doctors suctioned the blood clots from my chest, but there is still shrapnel in my lungs that the doctors said they can’t get out because its too dangerous. Since then, it’s felt as though something is moving around in my chest.

The condition led to complications such as choking and bad pain in my chest. I can’t exert myself at all and can’t walk more than a few meters. I can’t lift anything with my left hand. When I feel like I’m choking, I use an inhaler. It’s especially hard to climb stairs, but we live on the second floor. In the shower, the water on my head makes me suffocate.

I’m in grade 12 but have hardly attended school since the injury. I tried to go for almost a month, but stopped because the school is far away and it was hard to walk there with the bad pain.

The doctors told me I have to learn to live with my condition and adjust. I tried to, for a long time, but it’s unbearable. I submitted a request for treatment in East Jerusalem and got an appointment for 10 November 2018. We wrote my father down as my escort. A day before the appointment, my mother got a text saying my request was still under review. I asked for a new referral and was scheduled a new appointment for 10 December 2018. My mother got the same message again. I asked for a third referral and was given an appointment for 21 January 2019. My mother got a text saying the request for my dad and me was denied.