GAZA, 18 October 2005 — “My life is at risk,” says 60-year-old Gaza heart patient Khalil Al-Khatib. “I need to go for a test so they can see if my arteries are blocked. But they won’t give me a permit to enter Israel, and I can’t do it in Gaza.” Khatib, who once had bypass surgery in Israel, is one of thousands of Palestinians in the Gaza Strip who seek permission to enter the Jewish state each year for medical care unavailable in impoverished Gaza.
But Israel, which has battled a Palestinian uprising for the past five years, has denied many permits on security grounds. Signs are it is becoming even harder for Palestinians in Gaza to enter now that Israeli settlers and troops have been pulled out of the territory after 38 years of occupation.
Building up the health sector is a major challenge for Gaza as it tries to increase self-reliance in a narrow, coastal strip, which Palestinians hope to make a model for the statehood they also seek in the occupied West Bank.
Israel’s treatment of Palestinian “humanitarian cases” while occupying Gaza has led many in the territory to expect access to a level of specialist care usually unavailable to residents of the developing world.
The entry of Palestinians for medical treatment — Israel has put the figure at approximately 7,000 a year — has traditionally been seen across the Israeli political spectrum as helping to boost the country’s image.
But since the Israeli pullout, the main crossings from Gaza northward to Israel and to Egypt on the southern frontier have been very difficult to get through.
Military sources said dozens of patients were currently allowed to use the Erez crossing to Israel daily, compared to an average of more than 100 before. Israel’s Physicians for Human Rights said the number was at times as low as three or four.
Looking ahead, the group estimates that $2.5 billion would be needed over 10 years to bring the level of care in Gaza to that in nearby Jordan.
The Palestinian Health Ministry’s annual budget of $55 million does not even cover the $90 million it costs to send patients abroad for treatment.
Other offices pay the rest. Four in 10 people seeking medical care in Gaza need to be sent outside, the Health Ministry said.
Gaza hospitals lack technology for heart surgery, organ transplants, brain surgery or treating burns. Tests like catheterization, to check for clogged arteries, and body scans are also unavailable.
Israeli Foreign Ministry spokesman Mark Regev said Israel wants to offer health services to Palestinians as best it can. “But unfortunately there is a very severe security problem. We cannot offer an open-door policy because then we have terrorists exploiting that policy,” he said.
Regev cited the case of a would-be suicide bomber who was arrested at the Gaza border in June with explosives in an undergarment. She later said she had planned to blow herself up at the hospital in Israel where she sought treatment.
Israel also has shut the southern Rafah crossing to Egypt, the only other way out of Gaza, before removing forces under a plan it billed “disengagement” from conflict with the Palestinians. Crowds briefly forced the border open after the pullout, but it has since been closed except for a few short openings that have allowed some humanitarian cases through.
Discussion continues on reopening Rafah, possibly with foreign security monitors to address Israeli concerns over arms smuggling. Palestinians rejected Israel’s proposal for a new terminal that would have given it control.
Regardless of how soon the border issue is resolved, Gaza cannot afford to depend on Egypt in the long term.
Patients, whose treatment in Egypt or Israel is subsidized by the Palestinian Health Ministry, would still be at the mercy of closures, while some are not stable enough for the 350-km ambulance ride to Cairo.
Several new hospitals are planned in Gaza over the next two years, including specialist units for burns and cardiac cases, but Planning Minister Ghassan Al-Khatib said there were no formal long-term plans for developing Gaza healthcare.
“It’s not just dependent on financial capability, but it’s also a matter of human resources,” he said.
Billions of dollars pledged for Gaza by international donors — who have demanded an end to corruption and called for greater financial transparency in the Palestinian Authority — have yet to come through.
Meanwhile, Gaza’s population is growing far faster than the number of doctors. In 2004, there were 0.75 doctors per thousand Palestinians in Gaza, down 13 percent since 1998.
That compares to about 4 per thousand in Israel, which give it one of the best ratios in the world, World Bank figures show.
There is no medical school in Gaza and the border restrictions have made it tougher for students to learn outside. Many who do go abroad never return, while others find a lack of well-paid medical jobs when they come home.
“The gravity of this situation cannot be overstated,” Physicians for Human Rights said in a report. “If no systematic solution is found, a situation will be created in which many Palestinians will die.”
One woman clad in a black headscarf and Islamic dress shed tears of despair outside Gaza’s flagship Shifa Hospital as she sat with her 5-year-old son, who was unable to get the treatment he needed there.
“He has a problem in the brain, but we were not allowed to cross the checkpoint into Israel,” the boy’s mother said. “I don’t know what to do.”