Update: End of Gaza Patients Referral Crisis

30 Apr 2009

• 122 Requests were submitted to the army authorities by PHR-Israel
• 42 patients were granted exit permits to receive medical treatment
• The army refuses to process the remaining 78 requests thus hindering medical treatment for dozens of patients: 31 in need of surgery, 17 cancer patients, and 15 cardiac patients.

Background: On April 27 Hamas and Fatah reached an agreement to establish a committee, whose members are accepted by both, and whose role will be to refer patients from Gaza for treatment abroad. This committee will be under external Palestinian supervision. This brought to an end the crisis that had begun almost 5 weeks ago, after the Hamas took over the referral and coordination mechanism for patients that needed medical treatment abroad.

As reported by PHR-Israel, the former mechanism was not operating, and the new one, run by Hamas, was not recognized by the Israeli authorities. The absence of an acceptable coordination mechanism meant that patients were left with no address to accept their appeals. This led, in some cases, to deterioration in their medical conditions, and in other –at least 10 cases - to premature death.
It was in these circumstances that civil society organizations in Gaza and PHR-Israel stepped in and took upon themselves to send requests on behalf of patients.

PHR-Israel's role during the crisis: PHR-Israel, with its two case workers, became the only body to bear the burden of mediating between the patients in Gaza and the Israeli authorities throughout the crisis period. PHR-Israel received more than 150 requests of which it submitted 122 written appeals on behalf of patients for medical referrals. The work was carried out in close coordination with Palestinian civil society organizations: The Palestinian Center for Human Rights (PCHR) and Almezan.

The army's conduct: The army tried throughout the crisis, by way of the Gaza DCO, to renounce its responsibility. Time and again it tried to avoid dealing with requests submitted to it by PHR-Israel, using different excuses that were easily refuted, sometimes by the army itself. For a week it claimed that the Civil Committee was working as usual, and then had to admit this was not so; it argued that the Palestinian representatives in Ramallah were accepting patients' requests, and then admitted this too was not so; it agreed to accept requests on behalf of patients from PHR-Israel, and then refused to do so; it informed PHR-Israel a number of times it will not process its requests but eventually it did.

The army's changes of policies were a result of the pressure exerted on it by PHR-Israel and the intervention of local and international bodies on behalf of the patients, from the Israeli MPs Dov Hanin and Hayim Oron to diplomats of the EU embassies. Thanks to these interventions 40 patients were granted exit permits. Their requests would have probably not been processed otherwise.

On April 28 the DCO informed PHR-Israel that it will not continue and process the remaining 78 requests he had been holding for more than a week, and that these patients need to submit them to the reinstated Palestinian Civil Committee. Some of these 78 patients have initially submitted their requests at the beginning of the crisis, approximately 4 weeks ago. They will now have to begin the whole process anew. Among these are 17 cancer patients, 15 cardiac patients, and 7 patients suffering from life threatening diseases or are at risk of loosing an organ.

PHR-Israel's position:The inconsistencies in the army's conduct have severe repercussions for patients that have been waiting throughout the period for medical treatment, some of them extremely urgent. Transferring the requests from one organization to another has cost these patients dearly and might have influenced their chance for recovery.

The functioning of the coordination mechanism for referring patients abroad depends on Israel's consent. It can sometimes decide whether a patient will live or die. In the absence of any alternative, PHR-Israel took upon itself the task of coordination, though it is well beyond its usual practices and roles. From the moment these requests reached the offices of the DCO, it is the responsibility of the army to process them, a responsibility it cannot denounce. PHR-Israel demands the army complete the processing of the applications it holds and prevent further bureaucratic delays and obstacles on the patients' path to medical treatment.

For further information please call or write Reut at: reut@phr.org.il 0547320029

Collapse of Israeli-Palestinian Coordination Mechanism for Referrals of Patients for Medical Treatment outside Gaza

23 Apr 2009
Physicians for Human Rights-Israel: The army must accept patients' referral applications and facilitate their exit from Gaza to receive medical treatment- 10 patients from the Gaza Strip have died since the collapse of the Israeli-Palestinian coordination mechanism- Israel refuses to deal with dozens of referrals of Gaza patients it has received from organizations that form a temporary alternative arrangement to the collapsed coordination mechanism.
The Israeli army, by way of the Gaza DCO, refuses to deal with dozens of referrals to medical treatment outside of Gaza that Physicians for Human Rights-Israel had submitted even though the Palestinian coordination mechanism has stopped functioning. In so doing, the DCO prevents many patients from receiving adequate, at times, life-saving, medical treatment. The Palestinian Centre for Human Rights in Gaza has documented ten cases in which the circumstances that brought about a patient's death were directly related to the collapse of the coordinating mechanism. The World Health Organization, (WHO) confirmed eight of the ten cases.
The coordination mechanism that worked to refer patients to external medical treatment from Gaza, and worked in coordination with Israel and the Palestinian Authority, effectively stopped operating on March 22 when the Hamas Government dissolved the referral office, and replaced its workers, among them the Palestinian coordinator Mr. Rif'at Muhesen with new officials. As a result, Israel immediately stopped its cooperation with the new coordination office.
International organizations like the World Health Organization and the PCRS announced they would not serve as an alternative to either committee – the previous or the new one - and will not submit individual requests on behalf of patients to the Israeli authorities. They therefore do not offer a temporary alternative address to the patients of Gaza.

PHR-Israel that usually operates as an appeal instance in cases of prevention of medical treatment is obliged, under these circumstances, to function as the only body that receives applications for referrals from patients. In the last four weeks more than 120 written requests were delivered by PHR-Israel to the Israeli DCO on behalf of patients in need of medical treatment outside of Gaza. These patients already held all the required documents and the only obstacle preventing them from reaching the medical treatment they needed was an exit permit from the Israeli authorities. The army refuses to deal with most of the appeals submitted by PHR-Israel.
The army is actively preventing medical treatment from patients:- By refusing to acknowledge the existence of a new coordinating mechanism in Gaza, and by refusing to deal with it. - By refusing to process the dozens of applications referred to it by PHR-Israel, arguing the former coordination committee will soon be reinstated, though it is evident this is not happening.- By referring patients to Mr Husein al-Sheikh the person appointed by the Palestinian Authority in Ramallah to chair the former Civil Committee. The army claims this committee is referring patients from Gaza while in practice, the representatives of this very committee, in Gaza and Ramallah have repeatedly stated they were not referring patients' applications.
Physicians for Human Rights-Israel addressed the army in a letter on April 8 demanding it to process the applications on behalf of patients that are referred to it by PHR- Israel and other organizations. To date, we did not receive any reply and the army's policies persist.
In its conduct, Israel is making the patients of Gaza into hostages in political power struggles that have no relevance to their medical situation. Israel is using these patients and their vulnerable condition to advance political interests.
Until the inter-Palestinian political struggles are resolved, and until the reinstatement of a functioning Civil Committee accepted by all parties, PHR-Israel calls on the State of Israel to establish an alternative mechanism for referrals of patients until the inter-Palestinian dispute is resolved and to accept and process patients' referral applications already submitted to it and enable these patients to exit Gaza for medical treatment.
For further information please contact Ran Yaron, Director of OPT Department Tel: 0547577696 email: ranyaron@phr.org.il

UNIFEM: Voicing the needs of Men and Women in Gaza

The United Nations Gender Task Force has launched the results of a household survey on the impacts, needs and perceptions of men and women in the Gaza Strip following the Israeli military offensive in 27 December 2008 - 18 January 2009. The survey conducted in March 2009 through face-to-face interviews screens more than 1,100 adult men and women across the Gaza Strip.



Respondents, regardless of gender, region, or social sector consistently rate psychological trauma and stress as a main concern – and express a critical need for psycho-social services including food and water. The overwhelming obstacles to getting access to psycho-social support are material and informational than social reservations or taboos. With increased trauma and stress and limited access to professional psycho-social services, there is a rising problem of self-medication with unsupervised pharmaceutical therapies among the Gaza population. Respondents express the same high level of concern over domestic violence as they do towards Israeli military violence. 37% of women cite domestic violence as the primary safety problem facing women and girls in their communities, while more than 50% of men cite public and political violence as the main safety and security problem facing men and boys. The highest perceived rise in domestic violence against women is among households displaced by the war and in the southern Gaza Strip where there is also the strongest perception ( 57%) of an increase in domestic violence against children.

During the time of crisis, women are usually less able to cope than men because they have less access to and control over resources , limited decision making authority and extensive demands on their time and income.



The survey also revealed that women have limited access and control over access to health services, mainly because of distance.

Approximately 20% of households said that boys’ needs are considered as a priority when there is a food shortage. The most vulnerable household members, at risk of not getting adequate food quantities in a situation of food shortage and forced prioritizing, are elderly men and women. While 60% of respondents claim to have received food aid since the end of the war, about half of the recipients express dissatisfaction with the assistance (50% regarding quantity and 15% regarding the appropriateness of the aid received

Independent fact-finding mission of medical experts

Independent fact-finding mission of medical experts commissioned by Physicians for Human Rights-Israel and the Palestinian Medical Relief Society (PMRS) published today its special report on the Israel

6 Apr 2009

In their report, the experts detail 44 testimonies by civilians who came under attack and by medical staff who were prevented from evacuating the wounded. The report provides first-hand evidence regarding the broader effects of the attacks on a civilian population that was already vulnerable on the eve of the offensive.

The experts collected samples of human tissue earth, water, grass and mud suspected to be contaminated by unidentified chemicals. These were sent by the team to laboratories in the UK and South Africa for analysis.

During the military operation in January, Physicians for Human Rights-Israel called for an external independent investigation into the events, for the rehabilitation of the Gaza Strip and for the opening of the Crossings.

Five independent experts in the fields of forensic medicine, burns, medical response to crises and public health, from Germany, Denmark, South Africa and Spain, immediately answered the call and traveled to Gaza between 29 January and 5 February 2009 for their first fact-finding investigation, and then to hospitals in Egypt, where some of the most seriously wounded were being treated.

The medical experts are: Professor Jorgen Thomsen from Denmark, expert in Forensic pathology; Dr. Ralf Syring from Germany, an expert in Public Health in crisis regions; Professor Shabbir Ahmed Wadee from South Africa, an expert in Forensic pathology; Professor Sebastian Van As from South Africa, an expert in Trauma surgery and Ms. Alicia Vacas Moro from Spain, an expert in International health.

From the conclusion of the report:

"...Besides the large-scale, largely impersonal destruction that the team witnessed and heard of, it was especially distressing to hear of individual cases in which soldiers had been within seeing, hearing and speaking distance of their victims for significant stretches of time, but despite the opportunity for 'humanisation', had denied wounded people access to lifesaving medical care, or even shot at civilians at short range..."


One of the testimonies in the report describes the aftermath of an attack. Muhammad Saad Abu Halima had lost two brothers and a young sister; his wife and daughter were wounded. He told the delegation his experience of evacuation:

"…We were going down the street Kamal Adwan, and we had almost reached the school when the soldiers halted us. A tank appeared on the street and stopped close to the school. The soldiers were occupying the second floor of a building which was only 20 meters away from the street. They could see that we were all wounded and dirty from the explosions, because the tractor was open at the back. They shot at us, killing my cousins Matar Saad Abu Halima and Muhammad Hikma Abu Halima, who were driving us to the hospital. The soldiers ordered us to get out of the tractor, and they asked me to take off my clothes. I did it and they checked all my body. I think they were looking for explosives, but we were all injured and in pitiful conditions. How could we think of carrying explosives when my younger siblings and my own children were dying? Then, when I was almost expecting death, they shouted at me: “you can get dressed and go”. They did not allow us to use the tractor.
I held my sister Shahed in my arms … but the soldiers said that the baby was already dead, so they forced me to leave her in the car. I tried to help my wife Ghada, who was completely burned, and they forced us to walk to the hospital. For about 300 meters the soldiers were shooting at our feet as we walked, raising so much dust that the wounds of my wife became full of dirt. After a while we saw a lorry on the road. It was overcrowded with people going to the hospital after the heavy attacks, but they made us room and we arrived at Shifa’ Hospital….“

Another testimony in the report tells the story of the Abed Rabbo family. Souad Abed Rabbo, 54, told the team that the soldiers called to the family to exit their house. She, her daughter-in-law and her three granddaughters exited the house holding white flags:

“Outside the house there was an Israeli tank. It had come from the west towards the house that was facing north. It was 11.30 – 12.00. The tank was in the garden about ten meters from her, when she stopped to receive permission to leave unharmed. On her right side were the three girls; behind her was the daughter in law close to the door of the house. The soldier on the tank never replied. They were looking into each others´ eyes for 7-10 minutes, when suddenly a soldier opened fire and shot the granddaughter of the witness, Souad, in the neck and chest. She died immediately. They also shot Amal. She was hit in the chest and abdomen, and the interviewee saw her intestines come out. Amal died a little later. The daughter in law ran immediately into the house and was not hurt. The witness Souad Abed Rabbo was hit twice, as she turned around in a clockwise movement. She was hit in the left arm and in the left buttock. She did not see who shot. She assumed that the shots were fired from gun(s) not from the tank, but she was not certain. She saw three soldiers on top of the tanks holding weapons…Samar was hit in the chest with the bullet coming out of the back…at the time of the interview she was in a hospital in Belgium suffering paralysis."

In their concluding remarks, the experts say:

“The underlying meaning of the attack on the Gaza Strip, or at least its final consequence, appears to be one of creating terror without mercy to anyone. Nearly all the people we spoke to slept cuddled together with the other members of their family in a central room of the house during the three weeks of attack. No one knew where or when the next bomb or explosion would occur. It appears that the wide range of attacks with sophisticated weaponry was predominantly focussed on terrorising the population. ...”


Hadas Ziv, Executive Director of Physicians for Human Rights-Israel:

The military was well aware that such an attack on a densely populated area would exert a terrible toll on the civilian population. It was the Israeli Army’s responsibility to secure a way for the civilian population to flee the zone of combat.
At the moment, three things need to be done:
- A rigorous, transparent, and independent investigation should be conducted, one in which the victims' voices will be heard. The newly appointed investigative committee of the Human Rights Council is an important step in this direction. We hope Israel will fully cooperate with it.
- There is also an urgent need to open the Crossings and to allow the rehabilitation of Gaza.
- Israeli society needs to understand and assert its responsibility to end the culture of impunity so that such severe violations of international law and medical ethics will not occur in the future.


For further information please contact:
Tami Sarfatti 0546995199 email: tami@phr.or.il

Launch of the fact finding mission report in Brussels and Jerusalem on 6th April

Media Advisory: Press Briefing

simulatenous in Jerusalem and Brussels

Independent medical fact-finding mission commissioned by Physicians for Human Rights – Israel (PHR) and the Palestinian Medical Relief Society (PMRS) confirms violations of health-related human rights and severe violations of International Humanitarian Law during the Israeli offensive in the Gaza Strip, 27.12.2008 – 18.01.2009

What Release and briefing on a report which follows the only independent medical fact-finding mission, conducted by five independent experts in the fields of forensic medicine, burns, medical response to crises and public health, from Germany, Denmark, South Africa and Spain. The experts conducted the investigation in Gaza between 29 January and 5 February 2009, along with a second mission to hospitals in Egypt, where some of the most seriously wounded were being treated, between 2 March and 7 March 2009.

The report:

· details 44 deeply distressing testimonies by civilians and medical personnel who came under attack;

· provides first-hand evidence regarding the broader effects of the attacks on a civilian population;

· confirms suspicions with regard to serious violations; and

· underlines the need for an impartial international investigation into violations of human rights committed in during the offensive.

Click to read report summary under strict embargo until Monday, April 6 at 11:00

Who Physicians for Human Rights-Israel (PHR-Israel) and the Palestinian Medical Relief Society (PMRS) launch the report in Jerusalem, as its authors simultaneously launch the report in Brussels.

Where Mishkenot She’ananim, Jerusalem (Djanogly Hall)

When Monday, April 6, 10:30 am

Media Press conference given in English

RSVP -- Libby Friedlander, 054-245-7682 (sms welcome) | libby@benor.co.il