Doctor, over the last month I have been struck by a terrible bout of nausea which does not seem to go away. I have had no associated symptoms whether they are abdominal pain, diarrhea, or anything else for that matter. I’ve been taking my vital signs regularly and they are stable. I haven’t had any weight loss or night sweats or fever. Previous to this bout of nausea I have been completely well – a 22 year old healthy male who happens to be a medical student.

 

If you ask me about the timing of my sickness I can clue you in to one thing. The onset of my nausea happens to follow recent events in the Occupied Territories of Palestine which have been deeply concerning to me. It’s as if the more I read and learn about the conflict, the more I become sick to my stomach.  I know you’re busy, but hear me out for a second.

 

Crimes against humanity are occurring on a day to day basis in the Occupied Territories. As a student of medicine, I have taken on the task of focusing on health specific issues. The universal right to health is guaranteed in a number of international conventions, the most detailed being Article 12 in the International Covenant on Economic, Social and Cultural Rights. In addition, the Fourth Geneva Convention highlights the duty of an occupying power in relation to health which includes the obligation to protect freedom of movement for both medical personnel and patients in need, to protect hospitals, and to supply medical services at the same level as to one’s own citizens.

 

It doesn’t take much time to see that these norms of international law are being violated on a day to day basis by current Israeli policies. Israeli military occupation of the West Bank and Gaza includes the perpetuation of an illegal system of military checkpoints which destroy the Palestinians’ right to freedom of movement and thereby disrupt the ability of medical personnel to attend to patients in need. Internal borders set up by the Israeli Defense Forces within the territories have split towns and villages into virtual ghettos where the only consistency is hardship. Checkpoint closures, military raids, curfews and mass demolition of Palestinian homes are part of daily existence. This systematic destruction of Palestinian civil society is growing ever worse and ultimately is destroying the Palestinian right to health.

 

A recent publication by the WHO in April 2008 describes in full detail five despicable cases of patients who died either awaiting an Israeli permit to exit their besieged land, or died after illegal denial of such a permit (Saymah & Salha, 2008). Another 27 cases of patients unable to receive specialized care outside Gaza are also documented in the booklet freely available online. Amir al-Yazji, age nine, is just one example of a patient who died from meningoencephalitis while awaiting the clockwork of the Israeli bureaucratic permit system. Unfortunately his illness did not work under a 9-5 schedule. Another horrifying case study describes how a patient’s father, Mahmoud, is separated from his dying son, Kamal, who was suffering gastric cancer and in transport to Israel for treatment. The father is strip searched, interrogated and imprisoned for ten full days, while his son dies alone in Israel, with no notification to his family in Gaza.

 

With specific regards to Gaza we must pay heed to the increase in need for referrals abroad for treatment. Why? Because many essential medicines, aid, and equipment imports have been restricted by Israel’s siege of Gaza.  Now more and more patients who would prefer to have gone to Egypt for treatment are being forced to try their fate with Israel, as the Rafah Egyptian border crossing has been completely closed by Israel. While Israel is currently allowing in more patients through Erez (into Israel) than it did before 2007, the proportional percentage of patients denied access has risen exponentially, the WHO said (IRIN, 2008). In January 2006, only three percent were denied, while in December 2007 that number rose to 36 percent. "Tragedies that could and should have been avoided," was how Ambrogio Manenti, head of the World Health Organization (WHO) in Jerusalem, described the cases of Palestinian patients who died while awaiting medical treatment outside the Gaza Strip.

 

Given the circumstances, it is not surprising that a study by Johns Hopkins and Al Quds universities found that 20% of children under 5 years old were anaemic, 9.3% were acutely malnourished, and a further 13.2% chronically malnourished (Abdeen, Greenough, Shahin, & Tayback, 2002). The World Bank estimates that 60% of the population are subsisting at poverty level ($2 per day), a tripling in only three years. Half a million people are now completely dependent upon food aid and over half of all households are eating less than one meal a day.  Most recently the United Nations has said that almost half a million people will go hungry if the blockade conditions do not change. John Ging, director of the UN in Gaza has recently stated that food aid will be unable to be delivered to Gaza due to Israel’s fuel blockade. "Irresponsible acts of one side do not lift the clear legal responsibilities from the other side," he said. "Under international humanitarian law Israel has a responsibility to provide supplies for the civilian population of Gaza." (Butcher, 2008)

 

In Gaza, the Ministry of Health announced that most ambulances have stopped due to lack of fuel (PCHR, 2008). In addition, the ministry announced that it has started using its limited fuel reserve to operate health centers and important equipment. The Ministry warned that the expiry of this small reserve will paralyze the health sector and the remaining operational ambulances, thus depriving civilians of minimum healthcare services. In addition, hospitals and medical centers in the Gaza Strip are suffering from the absence of staff due to their inability to reach their workplaces. As a result, the operation of these institutions is threatened at a time of escalated Israeli military activity inside the Gaza Strip. This is not even mentioning the consistent reports of ambulances carrying the acutely ill being hit by gunfire, or detained for long periods of time while drivers and even patients are interrogated, searched, threatened and ultimately humiliated.

 

These violations of international law are clearly documented by Physicians for Human Rights – Israel, Human Rights Watch, B’Selem, Amnesty International and many other reputable human rights organizations. It is not with much surprise that Israel denies many of these allegations and blames this humanitarian catastrophe on the democratically elected leadership of the Palestinians: Hamas. Israel often denies responsibility to provide adequate access to health care for Palestinians on the basis that health care in the West Bank and Gaza are obligations of the Palestinian Authority since the Oslo Accords. However this is sidelining the major point that Israel has effectively reoccupied the majority of Palestinian territory. As one Human Rights Watch representative said Israel maintains "effective control over the Gaza Strip" and therefore it "must provide for the well being and welfare of the population." (IRIN, 2008)

 

Children dying for senseless reasons like the bureaucratic delay of a slip of paper – a permit – which grants or denies life so nonchalantly. Women dying while giving birth as they wait at Israeli border closures.  Ambulance drivers, physicians, clinics, fired on routinely. Is it that surprising that I am brought to you stick to my stomach? Are we ready to talk about treatment?

 

 I’ve talked to you about all the worsening factors with regards to my nausea. I keep reading more and more of these atrocities, and my sickness seems to worsen proportionally. But I do have to tell you about one alleviating factor. I have recently decided to refuse to be silent on this most dire crisis. I am actively working on a strong campaign in support of the Palestinian Right to Health. With every additional member to this campaign, I seem to start feeling a little bit better. And as I read more and more about groups, organizations and individuals who are working towards changing the situation on the ground I gain a little more strength. No Gravol needed here, Doc.  And that’s precisely why I have come to see you. I’d like you to treat me. I’d like you to join the growing number of health professionals and concerned citizens informing themselves and mobilizing themselves towards a world where such violations of the human right to health will not go unopposed. If we as health care providers do not protect the human right to health then who will?  

 

Damon Ramsey, Class of 2009

 

McMaster  School of Medicine

 

National Officer of Human Rights & Peace, Canadian Federation of Medical Students

 

http: //www.healthforall.ca 

 

Works Cited:

 

Abdeen, Z., Greenough, G., Shahin, M., & Tayback, M. (2002). Nutritional Assessment of the West Bank and Gaza Strip. CARE International.

 

Butcher, T. (2008, April 25). UN forced to halt Gaza food aid to a million. Retrieved from Telegraph.co.uk.

 

(2003). Harm to Medical Personnel: The Delay, Abuse, and Humiliation of Medical Personnel by Israeli Security Forces. Jerusalem: B’Tselem & Physicians for Human Rights – Israel.

 

IRIN. (2008). ISRAEL-OPT: WHO concerned about Gaza patients dying while awaiting treatment.

 

PCHR. (2008). Gaza fuel cuts paralyze education, health and transport sectors. Gaza: The Palestinian Center for Human Rights.

 

Saymah, D., & Salha, D. (2008). Access to health services for Palestinian people – Case studies of five patients in critical conditions who died while waiting to exit the Gaza Strip. West Bank & Gaza: World Health Organization (WHO).

---