Tuesday, December 06, 2022

Child dies while waiting for permit for treatment in Gaza

JERUSALEM – Jalal al-Masri and his wife spent eight years and their life savings on fertility treatments to give birth to their daughter, Fatma. When she was diagnosed with a congenital heart defect in December, they waited three more months for Israel’s permission to take her for treatment outside the Gaza Strip.

The permit never came. The 19-month-old child died on March 25.

“When I lost my daughter, I felt there was no life in Gaza anymore,” said al-Masri, her voice trembling. “My daughter’s story will happen again and again.”

Israel grants what it defines as life-saving treatment to Palestinians from the Gaza Strip, which have been under a severe Israeli-Egyptian blockade since the Islamic terrorist group Hamas seized power in 2007 .

But families must negotiate an opaque and uncertain bureaucratic process. Applications are submitted through the Palestinian Authority, reports must be stamped, paperwork must be processed. In the end, all al-Masris received a text message from the Israeli military saying the application was “under investigation.”

COGAT, the Israeli military body that oversees the permit system, did not respond to multiple requests for comment.

According to data from the World Health Organization, 37% of more than 15,000 patient permit applications from Gaza were delayed or denied in 2021.

Al-Mezan, a Gaza-based rights group that has helped al-Masris and other families, says that at least 71 Palestinians, including 25 women and nine children, have rejected their applications since 2011. have been killed since being committed or delayed.

That doesn’t mean Israel’s decisions were responsible for the deaths – even the best hospitals can’t save everyone. But the families of the sick faced the added stress of negotiating a complicated bureaucracy – and the uncertainty of whether things might have turned out differently.

In December, doctors in the city of Khan Younis diagnosed Fatma with an atrial septal defect, a hole in her small heart. Gaza’s health care system has been hit by a 15-year blockade and four wars between Israel and Hamas. So they referred him for treatment at a Palestinian-run hospital in East Jerusalem, linked to Israel, which offers pediatric cardiac surgery.

Her father took the medical report and ran to a small office in Gaza City run by the internationally recognized Palestinian Authority. Hamas ousted the PA from Gaza in 2007, limiting its authority to parts of the Israeli-occupied West Bank, but it continues to serve as a liaison between Gazans and Israeli officials.

A few days later, al-Masri was informed that the application had been approved. The PA booked an appointment at Macassed Hospital in East Jerusalem on December 28 and agreed to pay for the treatment. The girl’s grandmother will accompany her.

All they needed was a security permit from Israel.

Israel occupied Gaza along with the West Bank and East Jerusalem in the 1967 Middle East war. Palestinians want all three regions to build their future state. Israel withdrew troops and settlers from Gaza in 2005, but it still imposes heavy restrictions on the movement of people and goods in and out of the narrow coastal strip.

Israel says the blockade is needed to stop Hamas, which Western countries see as a terrorist group because of its long history of carrying out deadly attacks against Israel. Critics see the blockade as a collective punishment for Gaza’s 2 million Palestinian residents.

Israel has refused permits to the Palestinians, whom it considers a security threat. But in the case of 19-month-old Fatma and her grandmother, it was only said that the application was being considered.

The hospital kept appointments open till January 6. Jalal then applied again. Same story.

He made a third appointment for February 14. Still no permit.

He made a fourth for March 6.

This time, he was told that Israel needed 14 more days to process the application, so he postponed the appointment until March 27. The PA’s financial coverage ran out, so he reapplied. The Israelis said they needed a new medical report because the one from December had expired.

“I spent the last three months running back and forth,” he said. “I told everyone I saw: Do the impossible, just take him out. Take him alone with no escort, and leave him in the hospital.”

He made the sixth appointment for April 5.

On Friday, March 25, Fatma got up early. He played with his father and kissed his newborn baby brother. She wanted chicken wings for lunch, so her father went out to get some.

Anything for your little girl.

While he was out, his brother called and said that Fatma looked tired. When he reached home, his family members were waiting outside for an ambulance. He was declared brought dead on arrival at the hospital.

The medical report stated the cause of death as cardiac arrest, which is due to enlargement of the heart due to atrial septal defect.

Jalal would have added Israel to the chain of events.

“It is a deliberate murder. My daughter was a victim of blockade and bandh,” he said. “What did he do to deserve it? He had all the papers.”

Dr. Murphek Al-Farra, a pediatrician who saw Fatma several times in his clinic, said that he had pulmonary hypertension due to a hole in his heart, putting him at risk of stroke.

“If the hole is 4 millimeters, we can treat it in Gaza, but the hole in his heart was 20 millimeters bigger, and it requires special child open-heart surgery that isn’t available in Gaza,” he said. . “That’s why the hospital issued him at least four urgent referrals.”

Abraham Lorber, former chief of pediatric cardiology at Israel’s Rambam Health Care Campus, said ASD alone is rarely fatal. Doctors often recommend elective surgery later in life to prevent symptoms from emerging. Sometimes they discover congenital defects in adults.

The Israeli authorities may have concluded that her life was not in danger, having lost weight during Fatma’s treatment.

But Lorber, who did not treat Fatma, said ASD can exacerbate other heart and lung conditions. In such a situation, it should be treated quickly, especially if the patient has trouble breathing.

“It wouldn’t be just a matter of correcting the ASD. The patient would need other interventions, not just surgery,” he said. “This patient probably had underlying conditions.”

Despite the diagnosis, he said, his chances of survival would have been much better at a hospital in Jerusalem.

Jalal would have tried anything that day in Gaza’s emergency room.

“I told the doctor, take my heart and put it in it,” he said. “I thought it was me who died, not him.”

Ten days after her daughter’s death, she received another text message from Israel. The application was still pending.


Akram reported from Hamilton, Canada.

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