TEL AVIV: If Operation Cast Lead proved to be the breaking point for Gaza's healthcare system, it also illuminated where the responsibility for its collapse lies. The pressures that left it unable to cope with a sudden influx of patients were both internal and external. In the days and months leading up to Operation Cast Lead, the Gaza Strip's healthcare system was stretched to the breaking point. An ongoing Israeli blockade and a health workers' strike in Gaza - due in part to the political tug-of-war between Fatah and Hamas - had placed immense strain on an already fragile institution. Hospitals and clinics in Gaza found themselves lacking almost a quarter of the drug items that comprise the World Health Organization's essential drug list. Various other drug items stood at critical levels. A shortage of medical supplies endangered the long-term function of some equipment, such as dialysis machines, while other vital medical equipment was unavailable, had fallen into disrepair, or remained unused because health care workers lacked the training to operate it. On the second day of the Israeli incursion, Dr. Zaki Zakzuk of the European Hospital in Khan Younis spoke with Physicians for Human Rights (PHR)-Israel, an organization that promotes the right to health for Palestinians and Israelis alike. He described the impact that the lack of supplies had made upon patient care: "As of today, we have 30 wounded individuals in very grave condition. All of them are in need of ICU [intensive care unit] beds for ventilation machines, but because of the lack of such equipment only half of them are able to receive the ventilation treatment while others are resuscitated manually. [T]here is an extreme need for additional blood units. [but] the lack of refrigeration equipment and emergency vehicles are making it impossible for us to transfer blood units from Shifa Hospital. Health care workers in Gaza were forced to turn some patients away. Dr. Halil Nahlah, an ICU physician at Shifa Hospital reported to PHR-Israel: "[W]e cannot accept patients with basic injuries. We accept the urgent cases for life-saving efforts, operations, etc., and if possible we transfer them to other hospitals. But often it was not possible. Some of the injured found they were unable to reach hospitals, both within Gaza and beyond its borders. Although Operation Cast Lead cast light on a health care system in crisis, this problem over lack of access to medical facilities is not particular to times of war. The chronically ill in Gaza routinely face obstacles that prevent them from accessing necessary medical care. Throughout the Israeli blockade, over half of those who have applied for exit permits to leave Gaza through Israel for external health care facilities have been denied permission. Many of these patients then turn their hopes to the Rafah crossing with Egypt, only to find a political dam that allows no more than an irregular trickle of patients through the border. Appeals for Jordanian visas are often denied, as well. PHR offers the case of Karima Abu Dalal, a 33-year-old Gazan woman who suffered from Hodgkin's lymphoma. She received a variety of treatments in Egypt before this was stopped due to the Israeli closure of the Rafah crossing. In 2007 she began treatment in the West Bank, but later that same year it came to a sudden halt when Israeli authorities barred her from leaving Gaza. PHR-Israel applied for an exit permit on her behalf. Israeli authorities were silent in response. PHR-Israel sought help in the Israeli High Court. They included in their petition a testimony from Professor Dina Ben Yehuda, an Israeli physician familiar with Karima's case, who stated that Karima's life was endangered by the disruption of medical treatment. But the court abstained from intervening on Karima's behalf. Karima again appealed to the Israeli authorities who control the Erez crossing, between Gaza and Israel. Her request for an exit permit was once more denied. Her condition deteriorating, Karima next turned to a nearby Arab country, Jordan. Her subsequent visa application was denied not once but twice. After almost a year had lapsed since her last treatment, Karima finally managed to enter Egypt via the Rafah crossing in June of 2008. But the hospital in Cairo turned her away because she lacked the means to pay for medical care. After a long struggle against Hodgkin's lymphoma and the political bodies that surrounded her, Karima died in Gaza in November of 2008. Where a patient does or does not receive health care - whether it be for a chronic illness or injuries sustained as a result of military confrontation - depends on decisions made by political entities. But Israel and the governments of Gaza, the West Bank, and the surrounding Arab countries, who are most immediately responsible for the people of Gaza, must put human rights before political struggle. We mustn't treat individuals merely as symbols or representatives of their governments. Punishing the people of Gaza - whether by means of an external blockade or an internal strike - so they, in turn, will exert pressure on their government, polarizes opinions and is certain to prolong the conflict. To move the peace process forward we mustn't lose sight of the humans in the political landscape. We cannot afford to stand by while the injured and sick suffer in a snare of politics; ensuring access to medical care is a move towards health for the whole region. Mya Guarnieriis a freelance writer and journalist based in Tel Aviv. This article is part of a special series on cross-border medical practices written for the Common Ground News Service (CGNews).
