Caught between a rock and a hard place: Health care in Gaza under fire from both sides of the wall

Erez crossing

Barzilai is a hospital in Israel that lies just 12 km from the border with Gaza, just on the other side of the Erez crossing.  It is one of the three Israeli hospitals that receive most Gazan patients and, because of its proximity, sees the most severe cases.  Dr. Ron Lobel, the deputy director, says that there are anywhere between five and 15 Gazan patients at any given time, and that doctors never ask patients how they got their injuries or if they belong to a militant group.  “Even if they’re terrorists they’re treated like any other person being brought into the emergency room.”1

Barzilai is a rare window into human compassion within the war-torn public health landscape in Gaza.  After Hamas won the democratic election and took over the Gaza strip in June 2007, Israel and Egypt closed off border crossings. Israel declared the strip a “hostile entity,” restricting the entry of goods and cutting fuel supplies.2  Additionally, a highly controversial military offensive in December 2008/January 2009 and subsequent military blockade has further aggravated the strip’s deteriorating health system.  In an interview with Global Health TV, Merlin’s Fiona Campbell describes the effect of Israel’s military offensive against Hamas: in addition to over 1,300 deaths and 5,500 people being injured, half of the hospitals, one third of the health centers, and one fourth of the ambulances in the Gaza Strip were destroyed.3  The blockade makes it difficult to get supplies such as medical equipment and building materials – she tells the story of how it took four months to get a piece of equipment for a Merlin blood bank.  Specialist care is very difficult to get in the strip, and the quality of care suffers because the few specialists there cannot get across to get medical training.

People needing medical treatment must apply for a permit to be able receive medical care in Israel.  The application process is complicated and time-consuming; according to the WHO, 32 patients died between October 2007 and March 2008 while waiting for permission to cross into Israel to receive care.1  While Israel approves most of the permit requests (over 7,000 were approved in 2007 vs. approximately 1,600 denied), the WHO complains that the proportion of permits denied increased from 10% in 2006 to 18.5% in 2007.  Israel counters that it must balance Gaza’s humanitarian needs with security measures, because militants are constantly trying to exploit its permit policy. 

Unfortunately, the view of the public health situation in Gaza tends to be obscured by accusations of war crimes4 and, more recently, botched assassinations.5   In addition, care for Palestinians also faces difficulties from the other side of the wall: Hamas’s repeated bombardment of checkpoints means that they are frequently closed down, and it is impossible for both people and supplies to cross.  Because Barzilai is so close to Gaza, it is perpetually in danger of being hit by militant rockets.  “It’s absurd,” says Dr Lobel. “We’re treating Gazans while coming under fire from their own back yards.”

Photos courtesy of ICRC

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