Fatma was a 19-month-old girl from Khan Younis in the Gaza Strip. She died on 25 March 2022 after she was delayed access to lifesaving cardiac surgery for nearly three months. Fatma was born with a congenital heart condition known as an atrial septal defect. She needed curative surgery at Makassed Hospital in East Jerusalem and was required by Israel to obtain a permit to reach her hospital appointment. Her family applied three times for permits to reach hospital appointments on 28 December 2021, 13 February 2022, and 5 April 2022. She also received hospital appointments for 6 and 27 March, though at this stage no permit application was submitted by the Palestinian Health Liaison Office. Fatma’s father was told this was because there would not enough time for processing of the permit application.

Since December 2021 and her first hospital appointment for heart surgery, Fatma’s health had been gradually deteriorating as her heart began to fail despite medical treatment and follow up by doctors in the Gaza Strip. “I was out the day Fatma died. My brother called and asked me to come home because Fatma was tired. They called an ambulance, which arrived before I got home. She died before she reached the hospital. We were in shock. I felt like I had died,” Fatma’s father said. “Everyone in the family loved Fatma dearly, she was so precious to all of us. Especially to my wife and me. She came to us after five years of fertility treatment. Our hearts are broken.” On 4 April, ten days after Fatma’s death, her family received a text message telling them that Fatma’s application for a patient permit remained under study.

Jalal, the father of Fatima added, “When I lost my daughter, I felt that there is no life anymore. I am sure my daughter is not the only one killed by this blockade. Of course, there are so many patients who have died. But why should my little girl have been denied medical treatment? Can anyone tell me why she deserved this? This killing must be stopped. This could happen to anyone who needs medical care.”

Musaab, 21 years old, was in the third year of his university studies in Nablus, in the north of the West Bank.

In the summer of 2022, he was diagnosed with a cancer called a synovial sarcoma in his left ankle. To confirm the diagnosis and to guide the best approach to his treatment, Musaab was referred to Makassed Hospital in East Jerusalem for bone biopsy in June 2022, for an appointment on 6 July. Because of his West Bank ID, Israeli authorities required Musaab to obtain a permit to access East Jerusalem. He applied three times for a permit for his initial hospital appointment and was denied each time. The family were told that Musaab and his companions (different family members for each application) had been denied on security grounds. He eventually received a bone biopsy at Istishari Hospital in Ramallah, where he didn’t require a permit to reach his appointment.

Musaab was in Israeli prison from July 2020 to January 2021. It was during his detention that he started to feel pain in his left ankle. “He was given paracetamol, which didn’t help,” his father said. “He has been suffering a lot. He told me sometimes he felt as if his bone was being crushed.”

After his diagnosis, doctors considered to refer Musaab to Augusta Victoria Hospital, the major Palestinian cancer centre, in East Jerusalem. However, because he had been denied a permit to East Jerusalem previously, the doctors instead referred him to An-Najah University Hospital in Nablus, which meant he didn’t require an Israeli permit to reach care. Musaab received the chemotherapy he needed before he would undergo an operation. By November 2022, he was ready for surgery and his family applied for permits for him to reach Assuta Hospital in Tel Aviv. They wanted a private surgical consultation, to see the extent to which it would be possible to salvage Musaab’s leg. His three applications for a permit to reach two different appointments at the hospital were again denied.

Musaab’s father spoke with a doctor at Makassed Hospital to get advice on how to proceed. “He told me that repeatedly delaying surgery might cause bone erosion requiring leg amputation, God forbid.” The family had lost hope of obtaining a permit to access East Jerusalem, so Musaab’s father went to the Services Purchase Unit (SPU) of the Ministry of Health in Ramallah to request a change of destination to Jordan.

“Musaab and I travelled [to the Jordan border, the King Hussein Bridge] on 12 December. At the Bridge, we were asked to sit and wait. We waited about an hour, then an Israeli officer came out and asked us to go back to the West Bank. He said that we were both denied for security reasons. We refused to leave, and I requested to see the Mukhabarat [intelligence] officer. I insisted, telling them that my son has cancer and that he has the right to access health care. I asked them to let him go. After waiting another four hours, they decided to allow Musaab to cross to Jordan, but they made me return.” Although he crossed, Musaab missed his appointment at King Hussein Cancer Center in Amman, which had been for 12:30pm that day. The next available appointment was a week later.

“My son needs me beside him during these difficult times. We should see the doctor together so we can discuss the different options to help Musaab decide about the surgery.” Musaab’s father appealed through nongovernmental organizations Physicians for Human Rights Israel and Hamoked, as well as through a private lawyer, to get approval to travel to Jordan. He said, “This is so inhumane. How can this happen in any place in the world? Why are they blocking me from accompanying my son? I just want to hold his hand when he goes for surgery.”

Moaayd is the driver of a mobile clinic for the Palestine Red Crescent Society (PRCS) operating in the Jordan Valley of the West Bank. He has been part of the team for 10 years, working with communities in remote areas that depend on mobile clinics for access to primary health care. The communities face obstacles to planning and development, demolition orders that make their lives and livelihoods precarious and uncertain, and the under-provision of basic services.

“These communities face a lot of violations. The Red Crescent  tried four times to assist with building six houses to provide emergency shelter, but each time the houses were demolished… We should be providing health services at least three times a week, but we cover communities in three districts of the Jordan Valley and there is only so much we cando. To reach all communities, the mobile clinic needs to serve two or three communities at a time. Here in Khirbet Al-Meiteh, some people need to walk half an hour from nearby communities to reach us,” Moaayd comments.

Khirbet Al-Meiteh is a community served by Moaayd’s team, located in Wadi Al-Maleh in the northern Jordan Valley, in the governorate of Tubas. The community of 300 people is situated in Area C, where Israel maintains civil and military control. It lies in an area designated as a firing zone, meaning severe restrictions on planning and development, including for roads, schools, and health facilities. Residents rely on agriculture and pasture for their livelihoods, which are threatened by land confiscations and expanding settlements in the surroundings. There is lack of adequate protection for the communities, who experience settler- and occupation-related violence and who face loss of livelihoods due to destruction of crops and attacks against livestock.

The nearest permanent primary care facility is in Tubas, which would be around 30 minutes away by car without unpredictable checkpoint delays. Many in Khirbet Al-Meiteh do not have a vehicle, so the mobile clinic serves as a vital lifeline for the community. However, the community remains underserved, with expansion of service provision and establishment of permanent facilities needed.

“The mobile clinic covers part of the needs for our community in Wadi Al-Maleh,” says Mahdi, a member of the community council. “However, we desperately need a permanent facility. We tried to build two rooms last year to use them as clinics, but Israeli forces demolished the rooms. We’ve been unable to build them again due to lack of funding.”

The PRCS clinic Moaayd works for covers Tubas, Nablus, and Jericho. Each community or cluster of communities served by the mobile clinic receives one or two visits a month. The clinic itself operates five days a week, providing primary health care on three days and services for women’s health on two days. The team consists of a driver, nurse and doctor, with a social worker joining the team on occasion. Recently, the PRCS community service programme was able to offer additional support to the communities in Wadi Al-Maleh, training youth in the provision of first aid to offer immediate support to injured persons and responding to the high numbers of casualties during demonstrations against settlement expansion.

“As a resident of Tubas, Wadi Al-Maleh is very close to my heart,” Moaayd says. “I feel connected to the people here, and I understand their suffering because I live their experience too. When the community faced demolitions, I was there to help. Despite all our efforts, we need to do a lot more. I’m happy we can provide at least basic health services, but our communities deserve comprehensive health care like all people.”