May 2022 - Ahlam is a 5-year-old girl born in Beit-Lahia in the north of the Gaza Strip.

Since she was six months old, Ahlam’s family noticed she was not as responsive as other children her age and suspected that a problem with her hearing. They took her to two charitable organizations in the Gaza Strip, Atfaluna and Hamad Hospital in Gaza City, who examined her hearing and diagnosed Ahlam with partial hearing loss.

A year ago, Ahlam started to face further problems with her ears. Her grand-mother explained.

"Ahlam had discharge from both her ears, which had a foul smell. We took her to Beit Hanoun Hospital, where they diagnosed her as having an infection in her ear and treated her with antibiotics. Initially it helped and she improved, but then she kept getting the infection again and again."

Ahlam was seen by ear, nose and throat (ENT) specialists at Beit Hanoun Hospital, who advised her family that she should have surgery (removal of a part of bone near the ear called the mastoid process) to prevent complications of repeated middle ear infections. Because of lack of appropriate equipment in the Gaza Strip, she was referred to St Joseph Hospital in East Jerusalem. Although the hospital is within the occupied Palestinian territory, Ahlam would need a permit to exit Gaza and reach her appointment.

In December 2021, the family received financial coverage from the Palestinian Ministry of Health for surgery in Egypt. However, they could not afford to travel for the treatment.

"We did not travel to Egypt because we do not have money for that," Ahlam’s grandmother explained." Ahlam’s father works as a labourer in the fields. He earns 20 shekels a day [just under $6 a day]. We get some support from a Qatari programme for poor families [in the Gaza Strip]. It is expensive to travel to Egypt and the Ministry of Health referral doesn’t cover all associated costs. We requested to change the destination to Jerusalem.” Ahlam lives with her father, mother and 3-year-old brother in a room in the house of her extended family.

From January to May, Ahlam received three hospital appointment for St. Joseph Hospital in East Jerusalem. For the first appointment, the family was advised there was not sufficient time for processing of a permit request by Israeli authorities and so did not apply for a permit. For appointments in April and May, the family received no response from Israeli authorities to their permit application by the date of Ahlam’s hospital appointment – meaning she was unable to travel for care.

Appointment Date	Permit application date	Destination	Israeli response
23/01/2022	Nil	St. Joseph Hospital- Jerusalem	No application
06/04/2022	22/03/2022	St. Joseph Hospital- Jerusalem	Under study (delayed)
18/05/2022	13/04/2022	St. Joseph Hospital- Jerusalem	Under study (delayed)
27/07/2022	07/07/2022	St. Joseph Hospital- Jerusalem	Awaiting response