Even after prior coordination with Israeli authorities, soldiers can hold up ambulances at checkpoints for extended periods of time When doctors in Hebron could not find the cause of 74-year-old Abu Abed’s* acute pain they urgently referred him to a hospital in East Jerusalem. However, the ambulance he was travelling in was held up at the checkpoint entering the city. His frail wife is the only family member allowed to be with him.

“I went to the hospital in Hebron because I had terrible pains in my back and stomach. They did what they could but after nine days, when they weren’t able to find out what was wrong, they sent me home. However, the pain didn’t go away and I went back to the hospital. That’s when they decided to send me immediately to Al Maqassad Hospital in East Jerusalem.

Despite the fact that I was really sick, it took a whole day to get the papers from the Israeli authorities for my transfer. At nine o’clock the next morning, we arrived in a Palestine Red Crescent Society ambulance at one of the checkpoints outside Jerusalem. The soldiers stopped us. I heard the driver talking to them, but I didn’t understand what the problem was. I was lying in the ambulance, feeling totally helpless. I, an old man, was seeking medical treatment and it seemed no one was helping me. One and a half hours later, I was finally transferred to the ambulance that had come from Jerusalem to take me to the hospital.

Here at Al Maqassad Hospital I’m being looked after very well. They’ve run a number of tests, including two endoscopies, and they’ve sent some tissue to the laboratory. I should know the results shortly. I finally feel that someone can help me.

Only my wife, as sick and as old as I am, was allowed to accompany me. She stays at my bedside all the time. She even sleeps in a chair in my room. The Israeli authorities denied the requests from each one of my five sons to come to Jerusalem to visit me. Since we don’t have relatives here, nobody can take turns with my wife in looking after me. So, as soon as I can, I want to return to Hebron to be with my family.

I’m 74 years old, sick and weak. How could I harm Israel? I don’t understand why I’m being treated this way, why I’m not allowed to have my family with me when I need them the most.” (November 2010).

* Abu Abed’s name has been changed and some of the details of his story have been omitted in order to protect his identity.

Restricted emergency access to Jerusalem

Palestinians from the West Bank requiring emergency treatment available only in East Jerusalem are especially affected by the delay in accessing the city through Barrier checkpoints. Permission for emergency cases can be obtained the same day through the Palestine Red Crescent Society (PRCS). This involves coordination with the Israeli District Coordination Office, the authorizing of a specific checkpoint for the patient to cross, and back-to-back ambulance procedures since West Bank ambulances are prevented from entering Jerusalem.

Even if permission is granted, emergency cases are frequently delayed. In 2009, PRCS recorded 440 delays and denials of ambulances throughout oPt, two thirds of which occurred at checkpoints accessing East Jerusalem.

The right to the highest attainable standards of health as enshrined in the WHO constitution and numerous human rights instruments. Four criteria make up the right to health: availability, accessibility, acceptability and quality.

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Health access: Portraits

The entrance of Al Quds medical school in Abu Dis with the Barrier in the background cutting the school off from East JerusalemAhmed* is a medical student. He cannot continue his training at an East Jerusalem hospital because his permit was confiscated. He recounts how the Israeli secret service asked him to work for them if he wanted his permit back.

“As part of my studies at Al Quds medical school in Abu Dis, for the last two years I’ve been doing on-the-job training at an East Jerusalem hospital. Being a Palestinian from the West Bank, I need a permit from the Israeli authorities to enter Jerusalem. I’ve never had any problems getting one before. This spring, however, a soldier at the checkpoint confiscated my permit. I was told that I had to see the Israeli secret service, Shin Bet, if I wanted to get it back.

When I finally got an appointment a few weeks later, the Shin Bet officer told me: “If you help us, we will help you.” They asked me to inform them about my fellow students’ activities, in particular any travel abroad. In other words, I was asked to spy if I wanted to study. I refused and, as a result, I didn’t get my permit back.

Although I can do my training in Hebron, for example, there are huge repercussions on the quality of my studies. The East Jerusalem hospital where I’ve been training has half a dozen professors specialized in my field. In Hebron, there is only one. There is also much less interaction between students in the West Bank because there are far fewer students per hospital.

When I finish my undergraduate studies at Al Quds medical school in a bit over a year, I want to go to the United States (US) for my specialization. My diploma is recognized in the US, United Kingdom, the Arab world and many other countries. Israel, however, refuses to recognize it.” (September 2010)

*Ahmed’s name has been changed and some of the details of his story omitted in order to protect his identity.

Medical students face difficulties accessing East Jerusalem for training

150–160 students in the fourth, fifth and sixth year of studies at Al Quds medical school in Abu Dis are eligible for training at East Jerusalem hospitals.

90% come from the West Bank and need permits to attend specialized, medical training in pediatrics, neonatology, surgical interventions, internal medicine, cardiology, etc. On the whole, the same high-quality, specialized training is not available in the hospitals elsewhere in the occupied Palestinian territory.

Therefore, access to East Jerusalem for medical students is critically important, especially if the quality of medical care in the oPt is to be ensured in the long term.

In June 2010, Al Quds medical school reported that 11 students could not continue their training in East Jerusalem because the Israeli authorities had refused to renew their permits. Physicians for Human Rights Israel is helping these students to bring their case to court in order to create a precedent with regard to permits for medical students from the West Bank.

The right to the highest attainable standard of health is enshrined in the WHO Constitution and numerous human rights instruments. Four criteria make up the right to health: availability, accessibility, acceptability and quality.

Related link

Health access: Portraits

PRCS maternity hospital in East Jerusalem is an important provider of neonatal careSalam Kana’an used to drive to the Palestine Red Crescent Society (PRCS) maternity hospital in East Jerusalem in just over 15 minutes. Nowadays, in order to arrive on time, she sets out two hours before her shift starts. As Director of Nursing, she struggles to maintain her staff’s operational schedule in the face of the Israeli permit regime and checkpoint delays.

“We had difficulties before the construction of the Barrier because the permit regime was already in place. For the last 3–4 years, though, since the Barrier was built around Jerusalem, the situation has got worse. Now, depending on where you live you are only allowed to use a certain checkpoint. If the checkpoint is closed, or the queues are long, you have a real problem.

Before the construction of the Barrier, you could try an alternative route. Not anymore.

There’s a special bus service for medical staff, but the buses only run for the morning shift. And then, each bus has to be accompanied by a so-called ‘security officer’, someone who holds a Jerusalem ID card. We have only one such person. Whenever he’s sick, or on leave, the bus is held up at the checkpoint. Most of the time when that happens, the medical staff have to get off the bus and queue with everyone else – not knowing how long it will take to cross.

About 70% of the 57 nurses at the PRCS maternity hospital come from the West Bank, and almost every day someone’s delayed at the checkpoint, or even turned back. A common problem is that the machine at the checkpoint doesn’t recognize your fingerprint. This has happened to every one of us. Just last month, two doctors and a nurse couldn’t come to work because their fingerprints weren’t recognized.

Doctors have a special stamp in their permit, which facilitates their passage through any checkpoint, but a hospital can’t function with doctors alone. For any surgical operation – in our case, the 250–290 births per month – a doctor needs to be assisted by nurses. In emergencies we‘re unable to bring in additional nurses quickly, therefore to be prepared for emergency cases, we oblige the staff member who is on stand-by to remain at the hospital. This leads to additional costs and impacts the staff member’s private life.” (September 2010).

Restricted access to East Jerusalem for medical staff

East Jerusalem, with its six hospitals, is the main provider of specialized care to the population in the occupied Palestinian territory. Together the hospitals have 624 beds – 12.4% of all hospital beds in the oPt – and provide a range of specialized treatments that are unavailable in the West Bank and Gaza Strip.

Most staff working in East Jerusalem hospitals come from the West Bank. In November 2008, the Israeli authorities implemented new restrictions obliging these staff to enter Jerusalem through three designated checkpoints only. Previously, they were allowed to use any checkpoint. This concession is now limited to doctors. Currently, hospital employees coming from the West Bank must cross checkpoints on foot. The long delays and periodic refusals at checkpoints have led to severe disruptions in the efficient functioning of East Jerusalem hospitals. The use of special buses for medical staff has improved the situation; however, problems remain.

The right to the highest attainable standard of health is enshrined in the WHO Constitution and numerous human rights instruments. Four criteria make up the right to health: availability, accessibility, acceptability and quality.

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Health access: Portraits

Ala Zahwahri in her mother's armsEight-and-a-half-year-old Ala’ Zahwahri has mental and physical disabilities. Living in a house trapped between Har Homa settlement and the Barrier, her parents are obliged to take her on an arduous journey to Bethlehem, or Beit Sahur, each time they need to access medical services.

“Just last week, we needed to take Ala’ to the doctor. She can’t speak, but when she cries, we know something’s wrong because usually she’s very quiet. When she was little, we could drive her to Bethlehem or Beit Sahur ourselves in less than 15 minutes. That was before the Barrier was built a few metres away from our house. Nowadays, we first have to find a taxi driver who actually agrees to come here and drive us to Gilo checkpoint. Then, when we get there, we have to cross the terminal on foot carrying Ala’ in our arms. On the other side, we need to take another taxi to the clinic or hospital. Altogether we pay about 45 shekels one way. Most of the time, the journey takes one to one and a half hours.

Ala’ can’t eat by herself, she can’t even sit up. Mostly she just lies quietly on her couch. She needs constant care and the doctor says that she’ll need that all her life. Here, where we live, there’s no care for Ala’ at all: no doctor, no mobile clinic. Nobody helps us to take care of her. About 100 metres from here, in the Israeli settlement, there’s everything, but we’re not allowed to go there. We have West Bank ID cards, although we live on the Jerusalem side of the Barrier.

We’ve repeatedly tried to register Ala’ for health insurance with the Palestinian Authority, but we’ve had no success even though the officials are aware of her case. Fifty three members of our family live here in Um Al Asafir – nobody has health insurance. A friendly doctor in Bethlehem used to treat Ala’ for free, but he died. Now, we not only have to pay for transport and medicine, but for doctors’ visits too. All in all, we’ve spent over 500 shekels since last year.

Har Homa settlement growing closer to Ala's houseWe have six other children. They’re older and live with relatives in Beit Sahur so that they can go to school and university easily. From the hill outside our house we can see where they’re staying, but to visit their sister Ala’ they need to make the long journey through the Gilo checkpoint.” (September 2010)

Dislocated communities: trapped by the Barrier

In addition to separating large parts of East Jerusalem and its population from the rest of the West Bank, the Barrier leaves approximately 1500 West Bank ID card holders on the “Jerusalem” side of the Barrier. They are cut off from centres that provide public sevices such as health and education in the West Bank.

To access hospitals, schools or even to go shopping the inhabitants of the dislocated communities have to take long detours and mostly have to cross checkpoints. They cannot drive to and from their homes because they are unable to receive yellow license plates, which would allow them to take their cars into Jerusalem.

The right to the highest attainable standard of health is enshrined in the WHO Constitution and numerous human rights instruments. Four criteria make up the right to health: availability, accessibility, acceptability and quality.

Related link

Health access: Portraits