Physicians for Human Rights-Israel Gaza Update 11.3.08
Access-related deaths of patients referred to medical care outside Gaza are hard to estimate statistically. Since several factors are involved, it is very difficult to define how far the delay or denial of a permit has influenced the final outcome in each case. However, there is no doubt that every delay lessens the patient’s chances of recovery, and denies her or him the right to the best available medical care. The fact that, in Gaza, the delay has nothing to do with medical constraints of any kind, but with external reasons, makes the violation all the more serious and raises questions regarding the definition of the term “security†in the Israeli GSS lexicon. For the individual patient, the difference between receiving a permit and receiving a rejection, or no answer at all, may be the difference between life and death.
An additional constraint is the fact that many patients in Gaza, knowing the current situation at the crossings, prefer to forego the hopeless process, and die at home, their stories untold and their voices unheard.
Physicians for Human Rights-Israel has therefore chosen to tell the stories of the deaths of three women and one baby girl, as told by their families. The stories give a small glimpse of the Kafkaesque process, in which the suffering of sickness and the cruelty of a hostile bureaucracy combine to embitter the last days of these people’s lives.
Khadija Al-Aqed, 65 years old, suffered from heart disease, and had a pacemaker implanted in her body in the 1990’s at Beilinson hospital in Israel. In December 2007 the pacemaker stopped working and she was referred urgently to Al Urdun Hospital in Amman, Jordan for surgery. On the 21st of January the family submitted a request for an exit permit to Jordan, via Israeli-controlled Erez Crossing. The Palestinian medical referrals department relayed the request to the Israeli authorities at Erez. Despite the urgency, a response was only received on the 30th of January: Mrs. Al Aqed was denied an exit permit for “security reasonsâ€. On the 10th of February, Mrs. Al Aqed died of cardiac arrest.
Fatmeh Mahdi, 77 years old, was diagnosed with a cancer in her neck in June 2007 at Shifaa’ Hospital in Gaza. In early July she exited Gaza and underwent a series of tests at Ichilov hospital in Tel Aviv, Israel, after which she was told she must return for surgery and commence chemotherapy and radiotherapy in August 2007. From August she repeatedly tried to re-enter Israel for medical care without success. Despite five consecutive requests submitted to the Erez Crossing, no response was received. Mrs. Mahdi’s condition deteriorated. All that her doctors could do was administer painkillers. On the 11th of February 2008, Mrs. Mahdi died due to the spreading of the cancer throughout her body.
Bayyan Abu Hilu, one year old, was born in Al Bureij refugee camp in Gaza. Her parents had previously lost two other children due to a genetic liver disease at an early age. Two months after she was born, Bayyan was diagnosed with a similar genetic condition. In November 2007 she entered Israel with her parents for treatment in the hematology department in Hadassah Ein Karem Hospital in Jerusalem (west), and started lifesaving care. After the first stage of treatment, the doctors asked that she return as soon as possible for continuation of care. However, when the family applied a second time for exit permits, the Palestinian medical referrals department told them that the request of the parents had been rejected by the GSS for “security reasonsâ€, and that an alternative companion for the child must be found. Since they had missed their appointment, the family applied to PHR-Israel in January to ask for help with renewal of an appointment at the Israeli hospital. The new appointment was set for 5.3.08 and Bayyan’s father applied again to the Palestinian medical referrals department to relay the request for the permit to Erez Crossing. However, before a response was received, Bayyan died in Gaza, on the 2nd of March 2008.
Fatmeh Al-Ladawi, 45 years old, was a mother of ten children. In September 2007 she was diagnosed at the European Hospital in Khan Younis, Gaza, as suffering from injury to her spleen, with internal bleeding and infection, following trauma. Fatmeh was referred by the Palestinian Ministry of Health to Al Takhassusi hospital in Nablus, West Bank, for surgery.
In late September 2007 Fatmeh was permitted by the Israeli authorities at Erez Crossing to enter Nablus. However, the necessary care was not available there, and she was sent back home for re-referral. Fatmeh’s condition deteriorated while she waited for a correct referral to a medical center, which was delayed for two and half months. In late 2007 Fatmeh finally received a referral to Maqassed hospital in East Jerusalem, but she was not permitted to exit Gaza due to the closing of the Crossing on the scheduled day of her exit. When the Crossing re-opened, Fatmeh submitted a new request for a permit to go to East Jerusalem. However, this time, the GSS (Israeli secret police) refused to allow her husband to accompany her. She was asked to submit a new request, with a different companion. Only after five days was she allowed to exit Gaza to East Jerusalem with another companion. However, in Maqassed hospital she was told again that the necessary treatment was lacking, and Fatmeh was returned to Gaza after two days. Upon her return, she was led to an interrogation chamber in a basement beneath Erez Crossing, where she was interrogated by the GSS for five hours. Fatmeh was next referred to Ma’hed Nasser hospital in Cairo, but once again encountered obstacles, when the GSS refused to allow her brother-in-law to accompany her to her medical care. Her condition continued to deteriorate. In January 2008 Fatmeh was finally referred to Ichilov hospital in Tel Aviv. However, this time the visit of US President George Bush to the region stopped her from leaving, since Erez Crossing was closed throughout the visit, from the 9th to the 12th of January 2008. Only on the 20th of January was she informed that a permit had been issued her, and she arrived at Erez Crossing on a wheelchair, suffering from difficulties in breathing. She was once again led to a GSS interrogation, which lasted several hours. Her interrogators asked her to prove that the purpose of her exit was medical and not other. At the end of the interrogation, and after a total delay of 10 hours, she was allowed to go to the hospital. She was admitted to the hospital in the evening, but it was too late: On the next day, 21st of January, Fatmeh died in Ichilov hospital, Tel Aviv.
Security – personal security – is a universal right, and may not be used as a slogan to justify human rights violations. Universal security for all the people living in Israel and the occupied Palestinian territory can only be achieved through political means, by ending occupation and all other forms of oppression in our region.
For further details, please contact Ran Yaron ranyaron@phr.org.il Tel: +972 547577696 or Miri Weingarten, miri@phr.org.il , or +972 546 995199
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Physicians for Human Rights-Israel is a non-party-affiliated, non-profit foundation, whose goal is the advancement and defense of health-related human rights for all the residents of Israel and the occupied territories. This includes residents who are undocumented or who are not recognized by the state.
End the Siege on Gaza
International Day of Action
Saturday 26th January
The Cape Town Anti-War Coalition will hold a protest at 10am in Adderley Street, Cape Town, on 26th January 2008.
This has been declared as an International Day of Action to End the Siege on Gaza.
Action Palestine is organising a coach from Manchester to go to London
for the protest outside the Parliament
Leaving from outside the Students’ union at 9am
The coach will be returning on the same day.
Tickets: £5
Tickets available from the Campaigns office in UMSU.
Join us in protesting against Israel blocking desperately ill Palestinians from accessing medical treatment and its escalating military attacks on Gaza.
Saturday 26 January, 4-6pm Parliament
We are particularly appealing to medical staff to join us in uniform to visibly express their opposition to Israel preventing Gazans from travelling for lifesaving medical treatment.
‘The human catastrophe deliberately inflicted on Gaza by western policies over the past two years is one of the great crimes of the century so far’. Jonathan Steele, Guardian 11 January.
Israel’s illegal, brutal siege of Gaza is tightening, restricting fuel and electricity, and preventing even medical supplies, food, essential construction materials and paper for UN schoolbooks from entering Gaza . With lethal military strikes being launched on Gaza , and Ehud Barak has warned that an Israeli invasion of Gaza is nearing.
Even those who desperately need medical treatment are prevented from leaving. Over 65 Palestinians have died as a direct result of Israel ’s prevention of access to medical treatment. Miri Weingarten from the Physicians for Human Rights-Israel said ‘ Israel intends and wishes to punish the general population in Gaza , and they’re not hiding it — in fact, they’ve stated it clearly.’
Dr Ahmed Abu Tawahineh, deputy director of the Gaza Community Mental Health Programme, has pointed out that since last June, only a hundred patients have been allowed out of Gaza to seek treatment – less than 10 per cent of the more than 1,000 applicants.
How long can this inhuman treatment continue unchallenged by international leaders?
Collective punishment is being inflicted upon the Palestinians for voting for a government against the wishes of Israel , the US and the EU.
Call on the British government to end its collusion with these policies, which are imprisoning Gazans and attempting to destroy their lives by limiting access to food, electricity, clean water supplies and medical treatment.
Action Palestine
Gaza – Ma’an – A Palestinian man suffering from a heart attack died Tuesday after Israeli forces twice refused to allow his ambulance to enter Israel where he was to be treated.
A Palestinian human rights group is saying Israeli soldiers fired on the ambulance.
According to the Palestinian Center for Human Rights (PCHR), Seventy-seven-year-old Nemer Mohammed Salim Shuhaiber from Gaza City was admitted to the intensive care unit at Shifa Hospital in Gaza City on Sunday suffering an acute heart attack. The Palestinian Ministry of Health ordered Shuhaiber to be transferred to an Israeli hospital for further treatment.
By Monday, the Health Ministry had secured Israeli approval for the transfer. When the ambulance carrying Shuhaiber and his two sons arrived at Erez border crossing, PHCR said, Israeli soldiers fired on the vehicle, forcing it to return Gaza City.
Medical officials made a second attempt to transfer the patient on Tuesday. This time, PHCR said, the ambulance was delayed for five hours at the border while Israeli soldiers inspected the ambulance. Shuhaiber, still in serious condition, was laid on the ground in direct sunlight for over an hour. At the end of the inspection, the border guards order the ambulance back to Gaza, where Shuhaiber died.
Shuhaiber also reportedly suffered from diabetes and hypertension.
According to PHCR, this is the fifth death in six months resulting from the obstruction of ambulances at Erez crossing.
by Dr Samah Jabr
The New Internationalist
May 2007
D
r. Samah Jabr exposes the damage done to the emotional health of Palestinians by the Israeli occupation.
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Ahmad, a 46-year-old man from Ramallah was doing well, until his last detention. But this time he just could not tolerate the long incarceration in a tiny cell, with complete visual and auditory deprivation. First, he lost his orientation to time. Then he became over-attentive to the movement of his gut and started thinking that he was Œartificial¹ inside his body. Later, he developed paranoid thinking, started hearing voices and seeing people in his isolated cell. Today, Ahmad is out of his detention, but still imprisoned by the idea that everyone is spying on him.
Fatima spent several years doctor-shopping for a combination of severe headaches, stomach-aches, joint pain and various dermatological complaints. There was no evidence of any organic cause. Finally, Fatima showed up at our psychiatric clinic and spoke of how all her symptoms started after she saw the skull of her murdered son, open on the stairs of her house, during the Israeli invasion of her village of Beit Rima on 24 October 2001.
Such are the cases I see in my clinic. The traumatic events of war have always been a major source of psychological damage. In Palestine the kind of war being waged needs to be understood in order to appreciate the psychological impact on this long-occupied population. The war is chronic and continuous, over the lifetime of at least two generations. It pits an ethnically, religiously and culturally foreign state against a stateless civilian population. In addition to daily oppression and exploitation, it involves periodic military operations of usually moderate intensity. These provoke occasional Palestinian fractional and individual responses. The vast majority of people are never consulted about such actions. While their opinion does not matter, it is they who must endure pre-emptive Israeli strikes or collective punishment in retaliation.
Displacement
Demographic factors complicate the picture. Those living in the occupied territories make up just a third of Palestinians; the rest are scattered around the region in a Diaspora, many in refugee camps. Almost every Palestinian family has experiences of displacement or major painful separation. Even inside Palestine, people are refugees, expelled in 1948 to live in refugee camps. The massive displacement of 70 per cent of the people, and the destruction of over 400 of their villages, are referred to by Palestinians as the Nakba or Catastrophe. This remains a trans-generational psychological trauma, scarring Palestinian collective memory. Very often, you will encounter young Palestinians who introduce themselves as residents of towns and villages from which their grandparents were evacuated. These places are frequently no longer on the map, either razed entirely, or now inhabited by Israelis.
Palestinians perceive Israel¹s war against them as a national genocide, and to resist it they give birth to many children. The fertility rate among Palestinians is 5.8 – the highest in the region. This leads to a very young population (53 per cent under the age of 17) – a vulnerable majority, at a crucial stage of physical and mental development. The geographical enclosure of Palestinians in very small neighbourhoods, with the separation wall and a system of checkpoints, encourages consanguineous marriages, increasing a genetic predisposition to mental illness. Walling off friends and neighbours from each other also has a debilitating effect on the cohesion of Palestinian society.
But, it is the violent environment in which they live which most undermines the mental health of Palestinians. Population density, especially in Gaza – with 3,823 persons per square kilometre – is very high. Elevated levels of poverty and unemployment – 67 per cent and 40 per cent respectively – undermine hope and deform personality. The war has left us with a huge community of prisoners and ex-prisoners, estimated at 650,000, or some 20 per cent of the population. The handicapped and mutilated make up six per cent. Recent screenings found a disturbing level of anaemia and malnutrition, especially among youngsters and women. The intense emotional hostility provoked by our daily friction with the Israeli soldiers at our doorsteps is a constant stress factor. Many Palestinian kids have been living with daily violence since birth. For them, the noise of bombardment is more familiar than the singing of birds.
Sudden blindness
During my medical school training in several Palestinian hospitals and clinics, I saw men complaining of non-specific chronic pains after they lost their jobs as labourers in Israeli areas; school children brought in for secondary bed-wetting after a horrifying night of bombardment. My memory of a woman, brought to the emergency room suffering from sudden blindness that started when she saw her child murdered as a bullet entered his eye and went out from the back of his head, remains all too vivid.
In Palestine, such cases are not registered as war injuries and are not treated properly. This realization provoked me to specialize in psychiatry. It is one of the most underdeveloped medical fields in Palestine. For a population of 3.8 million, we have 15 psychiatrists and are understaffed with nurses, psychologists and social assistants. We have an estimated three per cent of the staff we need. We have two psychiatric hospitals, in Bethlehem and Gaza, but it is difficult to get to them, due to checkpoints. There are seven outpatient community mental-health clinics. In developing countries like occupied Palestine, psychiatry is the most stigmatized and the least financially rewarding medical profession. Psychiatrists work with desperately sick patients and, in the eyes of their communities, are far removed from the glory of other medical specialties. As a result, competent and talented doctors rarely specialize in psychiatry.
I find psychiatry a humanizing and dignifying profession – not least because it helps me personally to cope with all the violence and disappointments surrounding me. I move from Ramallah to Jericho to see psychiatric patients.
In one working day I see between 40 and 60 patients; 10 times the number I used to see during my training in Parisian clinics. I observe my patients¹ disorganized behaviour, listen to their overwhelming stories and answer them with the few means I have: a bit of talking, to pull together their fragmented ideas; some pills that might help them to organize their thinking, stop their delusions and hallucinations, or allow them to sleep or calm down. But talks and pills can never return a killed child to his parents, an imprisoned father to his kids, or reconstruct a demolished home.
The ultimate solution for mental health in Palestine is in the hands of politicians, not psychiatrists. So, until they do their job, we in the health professions continue to offer symptomatic treatment and palliative therapy – and sensitize the world to what is taking place in Palestine.
Resistance
Nowadays, Palestinians are pressured to surrender once and for all, when they are asked to Å’recognize¹ Israel. We are asked to accept, reconcile ourselves with and bless the Israeli violation of our life. The fact that our homeland is occupied does not, by itself, mean that we are not free. We reject the occupation in our minds, as far as we can cope with it; and learn how to live in spite of it, rather being adjusted to it. But, if we recognize Israel, we are mentally occupied – and that, I claim, is incompatible with our wellbeing as individuals and a nation. Resistance to the occupation and national solidarity are very important for our psychological health. Their practice can be a protective exercise against depression and despair.
Israel has created awful facts on the ground. What remains for us of Palestine is a thought, an idea that becomes a conviction of our right to a free life and a homeland. When Palestinians are asked to Œrecognize¹ Israel, we are asked to give up that thought, and to renounce everything we have and are. This will only sink us deeper into an eternal collective depression.
After several years in Paris, I returned to a tired, starved Palestinian people, torn apart by fractional conflicts as well as by the separation wall. Palestinians are especially demoralized by the infighting taking place on the streets of Gaza, but orchestrated elsewhere in order to abort the results of last year¹s democratic elections. Those who have stopped all money from going to Palestine are, in effect, sending us guns instead of bread. They encourage the psychologically and spiritually impoverished to kill their neighbours, cousins and ex-classmates. Even if the factions settle up, Palestinian society will be left with a serious problem of intra-family revenge.
We shall overcome
It is hard not to wonder whether Israel¹s targeting of Palestinians is deliberately designed to create a traumatized generation, passive, confused and incapable of resistance. I know enough about oppression to diagnose the non-bleeding wounds and recognize the warning signs of psychological deformity. I worry about a community forced to extract life from death and peace through war. I worry about youth who live all their lives in inhumane conditions; and about babies who open their eyes to a world of blood and guns. I am concerned about the inevitable numbness chronic exposure to violence brings. I fear also the revenge mentality – the instinctive desire to perpetuate on your oppressors the wrongs committed against yourself.
There has yet to be a comprehensive epidemiological study of the psychological disorders in Palestine. And, despite all that is published on Palestinian war-related psychopathology, my impression is that mental illness is still the exception in Palestine. Resilience and coping are still the norm among our people. In spite of all the home demolitions and extreme poverty, it is not in Palestine that you find people sleeping in the streets or eating from trash cans. This resilience is based on family foundations, social steadfastness and spiritual and ideological conviction.
Still, we do have a mental-health emergency. Services are urgently needed for people who have suffered and endured crises so that they can restore their recuperative powers and coping capacities. This is crucial if they are not to crack when peace finally comes, as so often occurs in a post-war period. It is not just at a small number of sick individuals but an entire wounded society that needs care. Our trauma has been chronic and severe, but by recognizing our suffering and treating it with faith and compassion, we shall overcome.
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Dr. Samah Jabr works as a psychiatrist in occupied Palestine