Since pandemic, has Israel allowed almost no Palestinians out of Gaza for medical treatment

3 May 2021

איבראהים אל-אח'רס עם בנו יאמן ושתי בנותיו. התמונה באדיבות המשפחה

In March 2020, Israel announced that as part of its fight against the coronavirus, it would further reduce the already miniscule number of Palestinians permitted to leave the Gaza Strip for medical purposes. In doing so, Israel shirked its duty to allow ill residents access to essential treatment unavailable within the Gaza Strip, and left them to their fate.

Gaza’s healthcare system has been in a state of collapse for years due to Israeli policy. Already, it cannot meet the population’s needs due to a shortage of medicine, equipment, doctors and professional training. Before the pandemic, thousands of Palestinians a year applied to leave Gaza to receive medical treatment unavailable at home, either in hospitals in the West Bank (including East Jerusalem) or in Israel. The Israeli authorities hampered the approval of these requests, including by restricting permits to treatment they define “lifesaving” and only if they are unavailable in Gaza.

This reality, which barely met the minimum requirement for the medical care residents of the Gaza Strip need, ceased to exist with the outbreak of the pandemic. Three main factors contributed to this situation:

Further stringent restrictions imposed by Israel: Since the pandemic broke out, residents who need vital treatment outside Gaza have faced insurmountable obstacles due to the new movement restrictions Israel imposed in March 2020. Israel, like many other countries, has lifted some of the restrictions it imposed on the area under its control during the pandemic – including allowing Palestinians from the West Bank who have work permits to enter its sovereign territory. Yet the restrictions on Gaza remain in place.

Patient concerns due to the pandemic: The uncertainty of the past year, and especially its first few months, led some residents who need medical care not to apply for permits to leave Gaza. They preferred to postpone the appointment if their medical condition allowed it, rather than risk a long ride on public transportation to unfamiliar hospitals and enter lengthy quarantine upon their return.

The Palestinian Authority’s cessation of security coordination with Israel: In May 2020, the Palestinian Authority (PA) announced it would halt its security coordination with Israel, in response to Israel’s intentions to annex parts of the West Bank. Accordingly, the PA’s Ministry of Civil Affairs stopped forwarding applications to leave Gaza for medical treatment. Many patients who were scheduled for treatment found themselves unable to obtain a permit. In November 2020, the PA resumed its coordination with Israel.

Throughout the coordination hiatus, Israel did not acknowledge its obligation to provide an alternative solution for these patients. International organizations, human rights organizations and Palestinian hospitals in the West Bank and in East Jerusalem intervened in critical cases to help patients obtain permits from Israel, but this fell far short of meeting their needs.

Due to these changes, the number of applications to enter Israel or the West Bank from Gaza for essential medical care dropped sharply, from a monthly average of some 2,000 to only several hundred a month. In March 2021, traffic at Erez Crossing was at some 6% of its volume in prior months.

In comparison, from March 2019 to February 2020 (just before the pandemic), according to World Health Organization figures, almost 24,000 Gazans applied for permits to enter Israel for vital medical treatment. Some 65% of the requests related to treatment at hospitals in East Jerusalem, about 22% to hospitals in the rest of the West Bank, and some 13% to hospitals in Israel. Of all these applications, more than a third (about 8,500) were rejected or not answered before the scheduled appointment, including at least 2,274 minors and about 996 persons over 60. Among the persons who were rejected or went unanswered, at least 1,996 had cancer, 597 had a heart condition, and 210 required neurosurgical treatment.

Allowing Palestinians from Gaza to enter the West Bank or Israel for medical care is not an act of charity on Israel’s part. Israel created this reality and is therefore responsible for it. It is the authority that controls all passage into and out of the Gaza Strip (except for Rafah Crossing), that determines the level of medical care available within Gaza, that has chosen to imprison more than two million people and keep them cut off from the world, and that prevents residents from receiving crucial treatment they cannot receive within Gaza due to Israeli policy.

B’Tselem’s field researchers in the Gaza Strip collected testimonies from Palestinians who were denied permits to leave Gaza for essential medical care.

איבראהים אל-אח'רס עם בנו יאמן ושתי בנותיו — Ibrahim al-Akhras with his son Yamen and his two daughters. Photo courtesy of the family

Two-year-old Yamen al-Akhras has cancer and has been waiting since January for a permit to travel to Nablus for medical treatment. B’Tselem field researcher Muhammad Sabah collected a testimony with his father, Ibrahim (29), a father of three from Yabna Refugee Camp in Rafah, on 28 February 2021:

My son Yamen started showing signs of pain when he was six months old. He cried all the time and we were always busy trying to calm him down. At first, we thought he had dislocated his hip at birth. Then we thought it might be something to do with teething. We took him to doctors who tested him, and they all said everything was fine and that the test results were good.

When Yamen turned one, he still couldn’t stand or walk, so we took him for tests at the European Hospital in Gaza and at a-Najar Hospital in Rafah. Again, the results were good and the doctors didn’t find anything. We didn’t give up and went to the UNWRA clinic in Rafah. The pediatrician there diagnosed a dislocated hip. We went to another doctor, and he also said that Yamen had a dislocated hip and installed a pelvic fixator for six months. When the six months, were up, we went for a checkup and he said there was no improvement. He set a date for hip dislocation surgery at the cost of USD 1,000, which is a lot of money for us.

We wanted a second opinion, so we went to another pediatrician who gave us an MRI referral. We did the MRI, and it turned out that Yamen has spinal cancer. When my wife Hala and I heard that, we were shocked. The pain and sadness were immense. It hadn’t occurred to us that our son had cancer. He was probably born with it. After all the suffering he went through, and we went through with him, we felt we might lose him. We were terrified of the suffering that awaited him and the thought that we might lose him.

The doctor asked to do more tests, and Yamen was referred to a-Rantisi Children’s Hospital in Gaza, where he received a round of chemotherapy. Then he was referred to a-Najah Hospital in Nablus, because the treatment he needs isn’t available in Gaza, and they scheduled an appointment for 26 January 2021. I applied for a permit for him and for Hala. We waited for the permit, but it didn’t arrive. On 25 January, the Ministry of Civilian Affairs notified us that our application was still under review. We missed Yamen’s appointment.

We were stressed and very worried that he’d never make it to the hospital for treatment. We filed a new application through the Ministry of Civil Affairs, this time for Yamen, for my wife Hala and for Yamen’s grandmother, because we hoped we could get a permit for one of them. We waited anxiously. We were stressed the whole time. Yamen was suffering and crying constantly, and could only sleep on his stomach because of the pain. We kept trying to ease his pain.

The evening before the appointment, the Ministry of Civil Affairs notified us that our application was still under review. We were shocked. There’s no justification for that. It’s a baby with cancer who needs urgent treatment, and any delay causes the disease to spread and increases his suffering. We waited patiently and asked the hospital for another appointment. Now we’re waiting again for an answer from the hospital.

Manatallah al-Hanafi with her mother Amal al-Hanafi. Photo courtesy of the family

Manatallah al-Hanafi (15) from Rafah has a cancerous tumor in her thigh. Israel is barring her from getting treatment at in Ramallah. B’Tselem field researcher Olfat al-Kurd spoke with her mother, Amal al-Hanafi (43), on 7 March 2021:

In early 2018, we discovered that Manatallah has a cancerous tumor in her right thigh, right by the artery. She was in seventh grade, and I remember waking up at night because she was crying in pain. At first they gave her painkillers for a month, but that didn’t help. I took her to an orthopedist who said she didn’t have anything. She kept getting worse and cried from the pain all day long.

We went to another orthopedist, and he sent her for an MRI at al-Quds Hospital in Gaza, which we paid for privately. The scan revealed that Manatallah had a 7-centimeter-wide cancerous tumor in her thigh. We were shocked. I broke down when I heard that. Manatallah tried to calm me down and said she’d be strong and would cope with the disease and the treatments, and that we’ll all pass away one day.

My husband applied for treatment abroad, and the Palestinian Authority authorized coverage for treatment at Palestine Hospital in Egypt. Manatallah went there with my husband Khaled, and on 23 December 2019 had surgery to remove the tumor. She stayed in Egypt and received treatment for 45 days, and came back confined to a wheelchair. I was shocked when I saw that.

Two weeks later, the pain came back just like before the operation. We went back to al-Quds Hospital in Gaza, and the doctor referred her to al-Istishari Hospital in Ramallah.

We filed an application through the Ministry of Civil Affairs and set an appointment for 26 April 2020. My husband was supposed to go with her. But the day before the appointment, we received a message that my husband was denied entry. He asked human rights activists for help, and meanwhile we set a new appointment for 10 May 2020. This time, we asked for a permit for me as the escort.

We got the permits and traveled to al-Istishari Hospital. By then, Manatallah’s condition was very bad and she’d developed chronic pneumonia. At the hospital, they put her straight in the ICU, where she spent about 17 days. The doctors said her immune system was very weak and gave her all kinds of treatment to strengthen it. During her time in the ICU, her condition improved.

After 17 days in the ICU, Manatallah had surgery to remove the tumor that had developed again in the same spot. The operation was very complicated and took eight hours. I waited anxiously by the operating room. I felt terrible. I was alone, scared and worried about Manatallah.

After she recovered, Manatallah and I stayed for three months at the hospital’s patient hotel for follow-up. Her physical and mental state improved, and she could walk again.

While we were there, the Israel Security Agency summoned my husband to Erez Crossing. They told him they wanted to ask him general questions, but he refused to go.

On 7 August 2020, we came back to Gaza. We waited at Erez Crossing from 9:00 A.M. to 4:00 P.M., when we were allowed to cross. Then we went into quarantine for 21 days at the Blue Beach Hotel in Gaza. The quarantine was tough for both of us, and Manatallah’s mental state deteriorated.

On 11 January 2021, Manatallah was supposed to go back to al-Istishari Hospital for tests. We submitted an application, but the day before the appointment, we both got a negative answer from the Israelis. We checked with an attorney from the Al-Mezan Center, and he suggested we do another MRI scan. The scan showed that the tumor was back, in the same spot.

We set another appointment for 22 February 2021 and submitted an application. The same day, we received a message that the application was still under review. We were in touch with a human rights organization, and they asked us to set another date and reapply for a permit. We haven’t received a new date to this day. We’re eagerly waiting for an appointment to take care of Manatallah. She desperately needs treatment. I worry about complications for her health, and want her to get back to a normal life.

Manatallah stopped going to school because of the illness, and now because of the coronavirus, she doesn’t leave the house at all.

Manatallah al-Hanafi has been scheduled another appointment for 15 May 2021. She has applied for a permit and is currently awaiting a reply.

Maram Darwish. Photo courtesy of the witness

Maram Darwish (22) from Beit Lahiya in the northern Gaza Strip has cancer, but since the pandemic began, has not received a permit to leave Gaza for radiation therapy in the West Bank. She gave her testimony to field researcher Olfat al-Kurd on 1 March 2021.

In January 2019, when I was in my fourth year of medical studies at al-Azhar University in Gaza, my pulse quickened and I started suffering from phlegm, a severe cough and chest pain. I took medication for the phlegm and the coughing, but didn’t feel any improvement. My mother insisted that I undergo an examination and an X-ray at the UNWRA clinic in Jabalya Refugee Camp. I got examined and did a chest X-ray, and it turned out that I had a 35-centimeter-wide lump in my lung. I was immediately transferred to the Indonesian Hospital in the northern Gaza Strip, where I had a CT and an echocardiogram, and it turned out that I had a tumor in my lung. I had a very severe cough and was kept at the Indonesian Hospital for three days.

I applied for a permit to leave Gaza for treatment at a-Najah Hospital in Nablus. I got the permit easily and went there with my father, Nafez, on 6 October 2019. I was treated there for a month and then went back to Gaza in relatively good condition. On 22 November 2019, I was supposed to go to a-Najah for treatment again, this time with my mother Maha (54), but the Israeli DCO informed me that my mother was denied entry. We submitted an application for my father and it was approved, and we went for treatment at a-Najah on 26 November 2019. We stayed there for about three months. By that time, all the muscles in my body were aching but I tried to stay positive in order to overcome the disease.

On 1 March 2020, I went to Nablus again with my father to do a culture test. I stayed there until 22 March 2020, and the doctors decided that I should come back in June 2020 for radiation therapy. Then the coronavirus broke out and I couldn’t get a permit. In November 2020, I was scheduled another appointment, this time at al-Mutala’ Hospital (Augusta Victoria) in East Jerusalem, but both my father and I were refused. This happened twice. In January 2021, I had another appointment, and again my application was denied.

The Ministry of Civil Affairs informed me that I had to come for a meeting at Erez Crossing. When I got there, no one was waiting for me. One of the officers simply told me, “Go to Jerusalem.” I said, “Alone? Without my father? I didn’t bring any documents or money for the trip.” I got really frightened and stressed and told the officer that I wanted to go back to Gaza.

I went home. Two weeks later, an officer from the Israeli DCO called my father and set up a meeting with him. In the meeting, they asked my father about my brothers, about our home and about all sorts of people from our area. They asked, “If we send Maram alone for treatment, will you agree?” My father refused and said it would be difficult to send me for treatment without an escort. At the end of the meeting, they told him to go home and that God willing, he’d be able to go with me next time. Now I have another appointment for 15 March 2021. I urgently need radiation therapy and to have the catheter inserted into my chest a year and a half ago removed. Now we’re waiting to see if we’ll get the permits.

Maram Darwish was not granted an entry permit to attend her appointment on 15 March 2021. She scheduled a new appointment for 4 May 2021.

Musa a-Rashidi. Photo courtesy of the witness

Musa a-Rashidi (52), a father of seven from Gaza City, needs surgery to remove cysts on his vocal cords that suffocate him in his sleep, but Israel has denied him a permit to reach hospital in Ramallah. He gave his testimony to B’Tselem field researcher Khaled al-‘Azayzeh on 1 March 2021:

In 2018, I started suffering from mucous cysts on my vocal cords, which make me hoarse and suffocate me in my sleep. I paid NIS 2,000 (~615 USD) to have them removed at a private hospital in Gaza. About a year later, the cysts returned and the suffering became worse. I went back for treatment and follow-up with specialists at a-Shifaa Hospital in Gaza.

I choke in my sleep, wake up and vomit. I keep a trash can by my bed just for that. When I wake up, I can’t even talk because of the phlegm that builds up on my vocal cords. I feel like I’m choking all the time and take medicine regularly to dissolve the phlegm and help with the hoarseness.

I need to have laser surgery at a hospital in the West Bank, because the equipment isn’t available in Gaza. I got a referral for al-Istishari Hospital in Ramallah, and they scheduled an appointment for 24 November 2020. I applied for an entry permit through the Ministry of Civil Affairs in Gaza, but the days went by and I received no answer. The date of the appointment passed and I asked the hospital to set a new one. They scheduled a new one on 8 December 2020. Again, I applied to the Ministry of Civil Affairs and again, got no response. On the day of the appointment, the ministry notified me that the Israelis had denied my request.

I was very frustrated. I’ve never had security issues with the Israelis and I don’t belong to any faction. I gave up and didn’t schedule another appointment, because every time you have to go to the Ministry of Civil Affairs and it takes a whole day to process the documents. In my condition, it’s tough.

I’m afraid that if I have another operation in Gaza, they’ll accidentally cut my vocal cords. But if I don’t have surgery, the cysts will grow and I won’t be able to talk at all and could choke to death in my sleep.

Because I can’t talk properly, I prefer to stay home and am cut off from the world. I don’t talk a lot with relatives or anyone else. When my phone rings, I ask my wife to answer it for me. My mental state is awful. I’m afraid to sleep and worry a lot before I fall asleep – because I’m afraid of suffocating and don’t know whether I’ll even wake up in the morning.

Riham al-Ghalban, a 21-year-old student from Gaza, has ulcerative colitis. Israel refuses to allow her to receive medical treatment in Nablus. B’Tselem field researcher Olfat al-Kurd collected her statement on 2 March 2021:

I’ve had this disease for five years. It started when I was in high school. I suffered from abdominal pain and acute diarrhea and had blood in my stool. I went for tests at Nasser Hospital and at the European Hospital in Khan Yunis, and every time, the doctors told me everything was fine and only gave me painkillers, but my condition didn’t improve.

I went to a-Salem Hospital in Khan Yunis, where I was examined but they didn’t find anything. A week later, I also underwent a colonoscopy, and it turned out that there were acute ulcers in my colon. I was hospitalized for a week at Nasser Hospital. Then I was monitored by the doctors, but nothing helped and I kept suffering. At some point, they started giving me rectal injections to stop the bleeding. I got them for a whole year, and there was a slight improvement in my condition, but then it deteriorated again. The doctors tried to give me a different type of rectal injection. I got them for a month, but they didn’t help. Then I got abdominal injections for six months.

When all that didn’t help, the doctors decided to refer me to a-Najah Hospital in Nablus. I received a referral and an entry permit through the Ministry of Civil Affairs, and on 12 January 2020 went there and had two rounds of biological treatment. I stayed for about three weeks. After that, my condition improved. Then I got another permit, and on 26 February 2020 I went to a-Najah and received one round of the biological treatment. I stayed there for three days.

On 8 March 2021, I had another appointment for treatment. But then the coronavirus broke out and I couldn’t go to a-Najah, because the checkpoint was closed. Al-Hayat Hospital in Gaza also started giving that treatment, so I got it there twice.

Then I received a referral to al-Mutala’ Hospital (Augusta Victoria) in Jerusalem and I was scheduled there for 17 December 2020. But both my mother, who was supposed to accompany me, and I didn’t get the permits. I was scheduled for 11 January 2021, and again the Israelis refused to issue us permits. I was devastated.

I need the treatment to recover from this disease. I’m constantly exhausted, I’m very skinny and keep vomiting. I can’t eat a lot of things, such as dairy, cereal and meat. I wish this suffering will end and I can go back to normal. I want to continue my studies, which have suffered a lot since I became ill.

Meanwhile, I have another appointment for 30 March 2021 and I’ve applied for permits. I’m still waiting for an answer from the Israelis. I need six rounds of biological treatment for the suffering to end.

Riham al-Ghalban was not granted a permit to attend her appointment on 30 March 2021. As of 18 April 2021, she is being treated in the Gaza Strip and is trying to make set another appointment.

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The Gaza Strip

Israel preventing 8-year-old Palestinian from leaving Gaza for medical treatment

Bilal al-Masharawi (8) from the a-Zeitun neighborhood in Gaza City has a respiratory disease and chronic pneumonia. The treatment he needs is not available in the Gaza Strip. All the adults who applied to escort him to East Jerusalem have been rejected. In February, the human rights organization Gisha filed a petition to the Beer Sheva District Court demanding that Bilal's mother be allowed to exit Gaza to accompany him to the hospital in Jerusalem, after a request she submitted for a permit was refused by the Israeli authorities on the grounds of a "security block." A request submitted by Bilal's father had also been refused on the same grounds. In a court hearing on the petition, which took place at the very same time as Bilal's hospital appointment, the state attorney tried to claim that the mother cared more about accompanying her child herself than her son's health, given that there are some 20 other relatives in Gaza who the state is willing to allow out, though he refused to reveal their names. Despite Bilal's difficult medical condition, the judge, Chana Slotky, accepted the state's position denying the mother access. All attempts by Gisha and Bilal's parents since then to find out which members of the extended family can, as far as Israel is concerned, exit Gaza as Bilal's companions have been unsuccessful. In a testimony she gave B’Tselem field researcher Olfat al-Kurd on 14 March 2023, his mother, Aya (28), who also has three other children, said: My son Bilal has had chronic lung infections since birth, which have caused bronchial tube expansion, phlegm and shrinkage of the right lung. We’ve been monitored and treated in Gaza hospitals ever since he was born. All he gets there is inhalation and an injection that calms his lung. Sometimes, he’s admitted for a few days. He’s treated every month or month and a half. Because of the bad cough, he now has red spots on his face and bloodshot eyes. The infections are so bad he’s developed a small hole in his heart. In December 2022, we got to a-Rantisi Hospital in Gaza. He had a lot of tests done and the doctor told us he had a very weak immune system and lung problems, and that he couldn’t accurately diagnose him because there isn’t the right equipment in Gaza. He referred us for treatment at al-Makassed Hospital in Jerusalem. The same month, that doctor gave me a No. 1 form [referral] and a financial coverage guarantee from the Palestinian Authority, and we were given an appointment at the hospital for 8 January 2023. We already applied for an exit permit in December. At first, we put down my husband, Muhammad (30), as the escort. After we were told the application was under review, we filed another one and put my name down as the escort. But the day before the appointment, I got a text message on my phone saying I was under review and denied on security grounds, and that Bilal was also under review by the Israeli authorities. I went to the Gaza Coordination Office right away and put down my mother, Sanaa Subhi al-Masharawi (52), as Bilal’s escort. Two days later, my mother got a text message on her phone saying she was denied. While we were waiting for the permit, Bilal was monitored and treated at the hospital in Gaza. He received inhalation, antibiotic spray and an immune system boost. Every time his pain got worse and his fever went up, I took him to a-Rantisi Hospital right away for inhalation and monitoring. On 15 February 2023, at around 2:00 P.M., I went to a meeting with the Israel Security Agency at Erez Crossing. It was a very long day. I was inspected at the checkpoint, and then they put me in a room and the interrogator asked me about people I know. I told him my son was sick and needed treatment. He asked about my other children and their health. I told him my son Mu’az (11) has had pelvic issues since birth and that Asil (6) has vision problems. The questioning took a long time, and when it was over they took my ID card, which stressed me out because I was afraid they would arrest me. After about half an hour, they gave me back my ID and I went home. It was almost 6:00 P.M. We missed the first appointment and made a new one for 19 February 2023. Again, at first we put down my husband as the escort and then me, and again, we got text messages to my phone and my husband’s phone that both he and I were denied for security reasons. We went to the Gaza DCO to see what else we could do, and they told us they’d done everything possible and there was nothing more they could do. When I was in their office, I asked the clerk to check more family members. I gave him the ID numbers of Bilal’s grandparents and aunts on my husband Muhammad’s side and on my side. We checked about 20 names, and he told me everyone was denied. Bilal was discharged from a-Rantisi Hospital on 19 March 2023, after a five-day stay due to high fever and severe coughing. He is still waiting for an appointment at al-Makassed Hospital. The family received another referral and another appointment for 9 April 2023.

28 March 2023

משפחת אבו סאע בימים יפים יותר. התמונה באדיבות המשפחה

The Gaza Strip

Married but apart: Women from Gaza with spouses from the West Bank forced to raise children alone

Israel’s apartheid regime prevents thousands of Palestinian families, in which one spouse is from the West Bank and the other is from the Gaza Strip, from living together as a family in the West Bank. These families are forced to make an impossible choice between living together in Gaza – at the cost of separating from family in the West Bank and enduring the harsh living conditions and financial hardships in Gaza – or living apart, with one spouse raising the children on their own. The ban is part of Israel’s separation policy, designed to isolate the Gaza Strip and implemented since the 1990s. Israeli-imposed restrictions were tightened when the second intifada began in September 2000, peaking in 2007, when Israel put the Gaza Strip under a blockade, imprisoning residents inside it. Since then, Israel has allowed residents to leave Gaza only in rare, exceptional cases it defines as “humanitarian,” treating these permits as a gesture of goodwill towards the recipients rather than their right. Israel has made it clear that, as a rule, marriage does not justify passage between the Gaza Strip and the West Bank, and the Israeli Supreme Court upheld this position, giving it a legal seal of approval. This state of affairs belies Israel’s claim that it has no responsibilities towards Gaza’s residents after having implemented the disengagement plan in 2005. Using its near complete control over all crossings – in both the West Bank and the Gaza Strip – and over the Palestinian population registry, Israel dictates Palestinian subjects’ daily lives and meddles in their most basic relationships: with spouses, parents and other relatives. The main victims of this Israeli policy are women from the Gaza Strip who married residents of the West Bank. They are left to raise their children alone in the harsh conditions of the Gaza Strip, with no hope or certainty regarding their future. B’Tselem collected testimonies from some women forced to live in this way. Yasmin ‘Abd al-Basset (35), a resident of Gaza City, lives with her four children in the Gaza Strip. Her husband lives in the West Bank. On 6 September 2022, she told B’Tselem field researcher Khaled al-’Azayzeh how Israel has repeatedly refused her applications for a permit to travel to the West Bank, so the family can live together: I came with my family from Saudi Arabia to the Gaza Strip in 1994. In 2009, I married my husband, Muhammad ‘Ali ‘Abd al-Basset ( 37), who is originally from ‘Azzun’ Atmah in Qalqiliyah District and has a West Bank ID card. Before the wedding he entered Gaza through Rafah Crossing, alone, without his relatives from the West Bank. We lived in Gaza until 2016, and during that time had three sons; ‘Abd al-Karim, who is now 12 years old, ‘Ali, now 10, and ‘Amru, now 8. At the time, my husband worked in bookstores and at a glass workshop. In March 2016, his father fell ill, so he applied for a permit to cross over to the West Bank for me and for our three sons. The applications were approved, but when we got to Erez Crossing with the children that month, we waited for four hours and were then informed that I was denied passage and wouldn’t be able to cross. They gave no explanation. In the end, my husband crossed the checkpoint with ‘Abd al-Karim and ‘Ali. I wouldn’t let him take ‘Amru, who was still nursing and stayed with me. It was awful being separated from my two sons. I collapsed. I was afraid I’d never see them again. I had hoped to leave Gaza with my husband and the boys, but then everything went black. ‘Amru and I went back to my family’s house. I couldn’t stop crying and didn’t eat for several days. I felt that we were a burden for the family. It was terribly crowded in the house. Three weeks after my husband left, ‘Ali got sick. He had a throat infection and was admitted to hospital in Qalqiliyah for ten days. I asked my husband to send me his medical reports and applied for a permit to travel to the West Bank so I could be near ‘Ali, but my application received no response. My husband filed several applications for me to go to the West Bank, but they were all rejected by Israel. After about two months, in May 2016, my husband returned to Gaza with ‘Abd al-Karim and ‘Ali. They came in through Erez Crossing, and we all lived together in an apartment we rented. We also bought furniture and appliances, and my husband went back to work at the glass workshop. Our son ‘Iz a-Din was born on 20 February 2021. In October 2021, my husband’s father took a turn for the worse and became fully paralyzed. This time, my husband applied for a permit for himself only, in order to visit him. He received the permit and went to the West Bank. After about a month, in November 2021, he renewed his ID card and applied for a change of address for me and for the children, but we’re still waiting for the request to be approved. Now my husband is in the West Bank, taking care of his father together with his brother, and I live in Gaza with our four sons. I’m suffering terribly from our family being torn apart. My son ‘Abd al-Karim is going through puberty, and it’s hard for me to deal with him alone. He feels like he’s a grown-up, doesn’t listen to me and complains that his father is not around. He has a problem with his left eardrum and needs regular check-ups, so I take him once a month for a check-up. I noticed he has facial tics and when I ask him why, he says it’s because he’s tired and also because he misses his dad. When ‘Amru talks to his father on the phone, he’s angry, and sometimes tells him that he hates him for leaving and abandoning us, but keeps asking when he’ll take us to the West Bank to be with him. When my husband returned to the West Bank at the time, ‘Iz a-Din was only eight months old. He basically doesn’t know his father. I’m supposed to take him to a-Shifaa Hospital next week for surgery on his testicles. It’s hard for me to take responsibility for everything on my own, while their father is supposed to be by my side and helping me raise our children. I do everything I can to provide for my children, even though their demands are increasing day by day. Our financial situation is tough. I work as a librarian and my husband sends us money from the West Bank every month, but it’s not enough. My father, who lives off aid from the Welfare Ministry, can’t help. I signed the boys up for a soccer club in the summer, but because I don’t have enough money, they’ll have to stop going. In July 2022, I heard that Israel approved applications for permits to visit family in the West Bank, so I submitted an application with the Civilian Affairs department in Gaza, but I haven’t received an answer yet. I stay on top of the news to see if I can apply for a change of address. I’m still hopeful it can happen. Muna al-Astal, a 36-year-old mother of four from Khan Yunis, spoke about the difficulty of raising children alone, as her husband is in the West Bank and Israel refuses to allow the family to join him, in a testimony she gave B’Tselem field researcher Khaled al-‘Azayzeh on 6 June 2022. My husband Riyad (47) and I got married in 2004 in Gaza. Riyad has a West Bank ID card and shortly after we got married, he went back to the West Bank and started working in Israel, and I stayed in the Gaza Strip. He managed to visit us in Gaza a handful of times, sometimes via Erez Crossing and sometimes via Rafah Crossing. There were two years in a row when he didn’t visit at all. The last time I saw him was a year ago. About 12 years ago, my husband submitted an application for me and for our four children, who were all born in Gaza, to register our address in Qalqiliyah. About 10 months ago, in October 2020, the request was approved. I cried for joy and prayed and thanked Allah. I sent my old ID card to my husband, so he could go to the Ministry of the Interior in Qalqiliyah and change the address, but they only changed the address of two of our four children, ‘Abd al-Jawad (15) and Dima (12). For Muhammad, who was three years old, and Maram, who turned 16 just months earlier, they did not change the address. All my joy was gone in an instant. After about eight months, they registered Muhammad on my ID card, but to this day they haven’t added Maram, even though her father and I and all her siblings are registered in Qalqiliyah. About seven months ago, I had to get Maram a new ID card with a Gaza address. Right after that, her father submitted another application for her to change her address to Qalqiliyah. Until her change of address is approved, the children and I will remain in Gaza, away from my husband. I can’t leave Maram alone in Gaza. Our youngest, Muhammad, is already four years old. He doesn’t know his father and calls my husband’s brother “Dad.” Maram has become very sensitive and cries every time she sees her friends spending time with their parents. Her daughter Maram (16) described the rift in her family in her testimony: Only my mother and my brothers received permission to change their address to Qalqiliyah, where my father has lived for a long time. The Israeli occupation refused to let me move there with them, and I’m the only one still registered in Gaza. My father lives a few kilometers from Gaza, and I can’t get to him just because there’s a checkpoint. I’m not a terrorist. I just want to live with all my family together. It’s my right to travel through all Palestinian cities without obstacles and reach him. I can’t remember the last time I woke up and hugged my father like other children. I also can’t remember the last month of Ramadan when Dad sat with around the table with us during the breakfast meal. I only see him on the phone screen, which is very hard for me because it’s not real. I wish I get the permit and we can all move in together. Hanan Abu Sa’ (34), a resident of Gaza, lived in the United Arab Emirates with her husband and three children for seven years. After her husband was laid off during the coronavirus pandemic, they had to return to the Occupeid Territories – he to Tulkarm and she to Gaza with the children. On 5 June 2022, she spoke with B’Tselem field researcher Khaled al-‘Azayzeh about the difficulty of raising the children without their father and Israel’s refusal to approve their applications for family reunification. I met my husband, Ayman (34), in the United Arab Emirates and we got married there. We lived there until 2019 with our three children, who were born there: Jud (9), Ahmad (7) and Ward (5). When the coronavirus pandemic broke out, problems started at my husband’s workplace. He was working as an electrical engineer and was eventually laid off. The children and I went back to live in the Gaza Strip, and my husband returned to Tulkarm, where he was born and where his family lives. That’s how our family was torn apart. He found a job there, and he in a rental with roommates to save money. He sends about half of his salary to us. The last time we met was in October 2019, when I went with the children to meet their father in Turkey. Ward, who was two years old at the time, squealed with joy when she saw her dad at the airport. We spent three months there together, and then I went back with the children to Gaza and my husband returned to Tulkarm. Traveling with the children was very difficult, especially through Rafah Crossing. Ahmad keeps recalling the experiences he had with his father and says the only thing he wants is his dad. One night, Ward fell and hit her head and I had to take her to hospital, so I left Jud and Ahmad, who were very small, alone at home. It’s very hard to cope with the kids without my husband, especially now that Jud has a thyroid infection. She has to get surgery to remove a tumor on her neck. I’m afraid of the responsibility of consenting to the surgery alone, without my husband, because the doctors say it’s an operation that can put her at risk. Our family is in pieces. The children suffer from their father’s absence, so I try to call him whenever there’s s a good internet connection. Sometimes my husband gets within a few kilometers of Gaza and calls to say he’s close by. It makes me cry, knowing he’s so close to us but we can’t see him. I know his family in Tulkarm is also giving him a hard time because we’re torn apart. I’m scared that in the end, we’ll have to get divorced and there will be no solution. Because I live alone, people are constantly checking on me. Because of the mentality in Gaza, it’s hard for me to be independent and sometimes I have to come home before it gets dark, even if I haven’t finished my errands. It’s been almost two years since my husband last filed for a change of address for me and the children, and we haven’t received an answer yet. Update: Hanan Abu Sa’ traveled with her children to Egypt hoping to reach Jordan and from there enter the West Bank. However, she reported that after an exhausting journey and difficulties at the crossing, the Jordanian authorities denied them entry and they had to turn back. Marwah Abu Hamadah is a 37-year-old mother of three. In 2019, she and her second husband, a resident of Bethlehem, got married in Cairo. She lived with him in the West Bank for about two years, without an official status and in constant fear of being deported along with the baby she had meanwhile. When her father fell ill, she returned to Gaza, but Israel rejected all her applications to return to the West Bank. For over a year, she and her infant daughter were separated from her husband. On 26 July 2022, before her application to return to the West Bank was approved, Abu Hamadah told B’Tselem field researcher Olfat al-Kurd about the hardship and uncertainty in her life: My husband, Muhammad a-Sha’er (52), a resident of Bethlehem, and I met at Cairo University in 2017, where we completed our Ph.D.s that same year. After two years, we got married in Egypt. We wanted to return to the West Bank, but it was difficult to get an entry permit because I’m registered as a resident of Gaza. Ultimately, we managed to get the permit, and I crossed Allenby Bridge on 28 August 2019. We arrived in Bethlehem, and on 9 October 2019 filed an application to change my address from Gaza to Bethlehem. The application still hasn’t been approved. We lived in Bethlehem for two years. I worked as a lecturer at Palestine Ahlia University. On 15 December 2020, I gave birth to our daughter, Misk, in Bethlehem. Because the address on my ID card is in Gaza, every time we drove to the university was hell. We took detours to avoid checkpoints, and were constantly afraid soldiers would arrest me or deport me back to Gaza without the baby. We were afraid the army would raid our house, as they sometimes do in our neighborhood. In May 2021, my father, Khalil Abu Hamadah (74), fell ill and I was afraid he would pass away before I could say goodbye to him. I decided to go to Gaza to visit him and took Misk with me. We entered Gaza without prior coordination, and got in easily because I’m registered as a resident there. I only found out later that Misk’s address is also listed in Jabalya, Gaza, and not in Bethlehem. My sons from my previous marriage, Muhammad (16) and Majd (13), live in Gaza. It had been nine years since I left Gaza to study in Cairo, and they stayed with their father, my ex-husband. When I lived in Bethlehem, I tried calling them almost every day, but he wouldn’t let me talk to them. I sometimes managed to communicate with them through my sister Najwa. Since I returned to Gaza, I’ve been seeing them twice a week. The condition Majd has had in his left ear from a young age has grown worse. His ossicles are eroding, and he has trouble hearing from his right ear. He needs surgery to remove part of the ossicle. Almost a year ago, on 31 August 2021, I heard on the news that Israel was going to approve changes of address. I applied to the Ministry of Civil Affairs in Gaza, and my husband applied at the same time to the DCO in Bethlehem. I also submitted a request to return to work at the university in Bethlehem, after the management contacted the DCO on 10 September 2021. On 7 October 2021, the DCO informed me that my request was denied as it did not meet the criteria. I filed another application on 10 October 2021 and got a security refusal on 24 October 2021. My name wasn’t on the list of 4,000 applications for changes of address by Gaza residents that Israel approved. I didn’t receive any response to my last application, from 28 October 2021. Later, on 21 June 2022, I filed to change Muhammad’s address from Gaza to Bethlehem, so he can move in with me as soon as my application to return is granted. Majd doesn’t have an ID card yet, so there’s no need to submit an application for him. I lost my job at the university and can’t find work in Gaza. My husband sends us money so I can provide for Misk, but our relationship is suffering and I feel that everything is falling apart, that my life is torn between Gaza and the West Bank. I live under terrible pressure and don’t know how much longer I can go on like this. People in Gaza look down on me because I’m far from my husband, and everyone keeps asking me why I live like this. It’s been over a year since Misk and I returned. She was five months old at the time,and since then, she’s only seen her father on the phone screen. Sometimes she grabs the phone from my hand and calls out to him: “Baba! Baba!”. My top priority now is to get Majd the best medical care and go back with Misk to my husband and to my work in Bethlehem. I ask all relevant parties to pressure Israel to help the women who are stuck in Gaza. I know of hundreds of similar cases. In what country does a woman live with her children in one place while her husband lives in another? Update: Marwah Abu Hamadah managed to book her son Majd an appointment to be treated in Bethlehem on 17 August 2022 and receive entry permits for him, her daughter Misk and herself.

13 November 2022

The Gaza Strip

The testimony of Du’aa al-Masri, whose daughter Fatimah died at the age of 19 months after Israel refused to allow her to exit Gaza for medical treatment

For eight long years, Du’aa and Jalal al-Masri tried to have children. Du’aa underwent multiple miscarriages and many expensive, painful rounds of treatment. Finally, in 2020, they welcomed their firstborn, Fatimah, pictured here on a family outing to the beach in Gaza. At nine months old she needed lifesaving treatment, but Israeli policies have rendered the healthcare system in Gaza unable to provide the care she needed. Israel would even not permit her to leave Gaza to receive treatment elsewhere, just dozens of kilometers from her home. Last March, at the age of 19 months, Fatimah passed away. In a testimony she gave B'Tselem field researcher Olfat al-Kurd on 30 March Du’aa al-Masri recalled: My husband, Jalal al-Masri (38), and I got married in 2012. For eight years, we unsuccessfully tried to have children. I’ve had several miscarriages and went through lots of treatments, which we sold everything we had to pay for. In the end, I managed to conceive and have Fatimah in 2020, after eight years of suffering from the treatments and medications. She gave me such joy. Fatimah was born healthy, but at nine months old, she started coughing. A cardiologist who examined her found she had a hole in her heart. She was discharged from the hospital with an inhalation device that was supposed to help her breathe. Last October, the doctors told us the hole had grown, and she had to go get treatment at al-Makassed Hospital in East Jerusalem. We got a referral for treatment outside the Strip right away. We made an appointment for her for 28 December 2021, and put my mother’s name down as an accompanying person - Yasmin al-Masri (46). The evening before, my mother got a text message that the application was still under review. We had no choice, and we made another appointment for 6 January 2022, but all we were told was that the application is still under review, so we made an appointment for 13 February 2022, and we missed it again - again we were told the application was under review. Over this time, Fatimah’s condition deteriorated, and she became very sick. The doctors suggested we try to expedite the application. We made another application and got an appointment for 27 March 2022, but the Israeli DCO rejected it because it was less than 14 days since we made the last application. I went back to the hospital and asked for a coverage guarantee for a later date and a new medical report. We filed the application again and got an appointment for 5 April 2022. Fatimah died before, on 25 March 2022. On that day, at 10:30 A.M., Fatimah woke up and had breakfast. I picked her up and washed her face. She said to me: Mama, I love you. I love baba. As I held her, I felt she was already unconscious. I opened the door of the house and started screaming. My brother-in-law Adham (40) took her from me, and we drove to the hospital right away. At the hospital, they told me she had died. I felt that Fatimah passed while still in my arms. I started screaming and crying. I can’t get over the shock and the pain. Fatimah was everything to me. Her voice has gone from the house, and I’ll never hear it again. She won’t call me mama and won’t call her father baba. I can’t look at her toys. I gave them all away, her clothes too. Saying goodbye to Fatimah was hard. She lay in front of me for an hour. I looked at her innocent face. I cried. I held her. My baby died because Israel wouldn’t let her get treatment. All of this time, we kept getting calls from al-Makassed Hospital, telling us they were waiting for us. Every time, we told them the application was being reviewed by the Israeli coordination. Fatimah was an innocent baby. If they had told me I had to send her without an accompanying person, I would have - anything to get her treatment. But they didn’t say.

25 April 2022