Israel restricting medical permits for Palestinians is a mechanism of oppression

Around the world, 15 February is recognised as International Childhood Cancer Day. The campaign seeks to raise awareness of the more than 400,000 people under the age of 20 who are diagnosed with cancer every year, as well as the fact that while survival rates for childhood cancer are around 80% in high income countries, low- and middle-income countries (LMIC) report rates as low as 20%.

While a country’s economy and ability to provide quality healthcare accessible to all is certainly a reason for such disparity, in environments of political violence, oppression, and discrimination, there are multiple additional factors that make receiving desperately needed care even more difficult.

For Palestinians, this includes the movement restrictions imposed on them by Israel—and the complex medical permit system required to overcome them.

''Denial of movement and onerous restrictions are nothing new to Palestinians who have lived with them for decades. But health issues are time-sensitive and a delay in care could, for some, mean the difference between life and death.''

This year, on International Childhood Cancer Day, the Palestinian Centre for Human Rights (PCHR) released a heartbreaking report, finding that there are 350 children living in the Gaza Strip with cancer, in desperate need of constant and timely care. Yet on top of their illness, and the struggles endured by their families, these children must also face the bureaucratic hardship of applying for and attaining permits to leave the besieged Gaza Strip to go to Israel, East Jerusalem, or the West Bank, to receive the care unavailable to them locally.

In 2022, 28% of such permits were delayed or denied. Three children who had been referred for care abroad died while awaiting their permits.

Even for children able to secure the permit, their escorting family member may not be so lucky. For 43% of children, their difficult trip out of Gaza and into a hospital setting where they may be receiving physically and emotionally draining treatments, is one that they have had to endure without their parents whose permits were either denied or delayed. These children often have to travel with a distant relative they may not know well, or an elderly grandparent for whom the journey itself is challenging.

There are around 9,000 people diagnosed with cancer in the Gaza Strip, all of whom face the same lack of pharmaceutical treatments and advanced equipment that would more quickly and easily diagnose and treat cancer.

The problem imposed by Israel doesn’t just impact cancer patients, however. People with a variety of ailments and critical health needs must apply for permits to receive the care they need, including heart surgery, neurosurgery, and ophthalmology services.

While Palestinians from the West Bank have access to more advanced services, they still may need to apply for permits to receive certain types of care in Israel or East Jerusalem.

In 2017, Israel only approved 54% of permits, the lowest approval rate since data on permit applications has been collected by the World Health Organization. An estimated 54 Palestinians died that year, awaiting their permits.

“At best, each denial or delay heaps unnecessary stress and worry on the patient and their family. At worst, obstruction can have deadly consequences,” explained Rohan Talbot, the Director of Advocacy and Campaigns at Medical Aid for Palestinians. “This situation is inherently discriminatory. Israel has created a situation of permanent insecurity for Palestinians in Gaza, over whose lives and basic needs it maintains control, while justifying its collective punishment as necessary for the security of its own citizens,” he added.

Thus, while Palestinians often experience the limitations typically associated to poorer countries, their suffering is exacerbated by Israeli restrictions that render their health care system even more unable to meet their needs. Such restrictions include limitations on what can be imported into the countries, especially due to the blockade of the Gaza Strip, like PET CT medical imaging devices, radiotherapy equipment, and even the raw materials needed to build and maintain health facilities like cement and pipes.

Palestinians also face barriers to attending trainings and workshops outside of the territories, and external personnel hoping to enter the territories to support the health workers.

In November 2022, Physicians for Human Rights-Israel (PHR-I) published a position paper on what they term the ‘mechanisms of oppression’ regarding the medical permit system which involves “procuring documents, filling out forms, submitting them to the Palestinian Civil Affairs Committee, allowing them to be reviewed and handed over to Israeli authorities, and finally waiting for the permit to be issued – all while hoping an answer arrives before the scheduled treatment.”

PHR-I is one of the organisations patients often turn to when their permits are denied or delayed, and in many cases their intervention is successful in having a denial overturned. This demonstrates the arbitrary and overtly harsh process Israel imposes on people who, with copious medical documentation and often in a state of visually obvious physical deterioration, are still deemed to be security risks—even, seemingly, children.

Israel often justifies its onerous and harsh movement restrictions on the basis of security. They claim that Palestinian abuse the medical permit system, citing a handful of cases where individuals “planned” or had “the intention” to commit a terrorist attack in Israel, despite the lack of evidence provided for such incidents. Regardless, Israel remains the occupying power of the Gaza Strip and the West Bank and has a responsibility towards Palestinian health as a result.

The collective punishment imposed on Palestinians through the medical permit system and multiple other avenues, is not justifiable by any measure, legally or ethically. Evidence suggests instead, that Israel uses the permit system as a mechanism of control, and to apply pressure on groups like Hamas. It is also used as a means to force individual Palestinians to inform on others.

West Bank Access 2022 - @WHO's summary
❌12,905 Patient permits denied
🧑‍🤝‍🧑 20,094 Companion permits denied
🏥330K+ People's health access affected by closures of Nablus and Shu'fat
🚑93% Ambulance transfers delayed at checkpoints into East Jerusalem

👉https://t.co/LBrnt3FKcG pic.twitter.com/22wWxn1xku

— WHO in occupied Palestinian territory (@WHOoPt) February 23, 2023

A woman who applied for a permit to visit her ill mother in the West Bank from Gaza was told: “We’ll let you visit your family on one condition: you and your children have to give up your West Bank registered address and register it in Gaza.”

Denial of movement and onerous restrictions are nothing new to Palestinians who have lived with them for decades. But health issues are time-sensitive and a delay in care could, for some, mean the difference between life and death.

The medical permit system is part of a broader structure of oppression that, because it is bureaucratic rather than overtly violent, often goes ignored by the international bodies that might otherwise moderately criticise or at least question bombing campaigns or raids. This “mechanism of oppression,” however, causes untold harm, including premature mortality, in ways that are harder to measure than those that come from military violence, but are just as destructive.

Yara M. Asi, PhD, is an Assistant Professor of Global Health Management and Informatics at the University of Central Florida, a Visiting Scholar at the FXB Center for Health and Human Rights at Harvard University, and a US Fulbright Scholar to the West Bank.

Follow her on Twitter: @Yara_M_Asi

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Opinions expressed in this article remain those of the author and do not necessarily represent those of The New Arab, its editorial board or staff.