physicians for human rights-israel: ill morals - grave violations of the right to health during the...

8/8/2019 Physicians for Human Rights-Israel: Ill Morals - Grave violations of the right to health during the Israeli assault on g

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"Ill Morals":

Grave Violations of the Right to Health during the Israeli Assault on

Gaza

March 2009

Written by: Dan Magen

Preface written by : Dr. Ze'ev Winer and Hadas Ziv

Research: Tom Mehager, Reut Katz, Eyal Niv, Miri Weingarten, Salah Haj-Yahya,

Ran Yaron

Editing: Ran Yaron

English Translation and Editing: Saul Vardi, Tami Sarfatti, Gila Norich


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Table of Contents

Preface 3

Summary . 6

Introduction 9

Gaza Health System on the Eve of the Crisis ......... 12

Evacuation of the Wounded to Medical Centers Outside the Strip.... 15

Attacks on Medical Crews ... 25

Evacuation Inside the Gaza Strip Injured and Trapped Civilians ... 34

Attacks on Medical Installations in the Gaza Strip .. 41

Injury to Chronically and Acutely Ill Patients....... 45

Conclusion . 51

Appendices 55


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Preface

During its attack on Gaza, Israel put in place various obstacles, such that Palestinian

civilians found themselves under a state of siege for hours and sometimes days,

without water food or electricity. The wounded too were forced to wait long hours,

even days, for evacuation. Medical crews and facilities sustained direct fire. The

testimonies presented in this report underscore the suspicion that a qualitative

transformation occurred in the armys ethical conduct vis--vis civilians injured

during the fighting. This report limits itself to a discussion of the ways in which the

army related to injured civilians, and does not discuss the broader topic of the change

in the means and methods of fighting.

Many works that deal with the moral and ethical dilemmas which have arisen due to

the change from conventional to urban warfare, like that employed in the fighting in

the Occupied Palestinian Territory ask the question of whether the ethical

considerations guiding the Israeli military should change as well. 1 In reality, it seems

that the question has been answered and Palestinian civilians are paying for it with

their lives. The Israeli publics perception of its enemy as one which does not value

human life (whether by attacking Israeli civilians or using its own civilians as

human shields), has brought about a change in the conduct of the Israeli military

The army has found partial endorsement in controversial ethical codes like those

justifying targeted assassination, in contradiction to international law. This, in

addition to on-going demonization of Palestinians 2, erosion of moral considerations as

the conflict wears on, and disappointment arising from the seeming absence of a

1 See Nevo Baruch, Shor Yael, Musar, Etica ve-Mishpat bi-Lehimah, (Morality, Ethics and Law inWarfare), The Israeli Institute for Democracy: Army and Society Project, (2003).2 See for example: There are enemies that are personally in an ethnic or religious confrontation withus. Their goal is to kill as many Jews as possible, to deliver us from our land or to take away ourindependence. They are willing to commit suicide to this end and to make an effort to their last breathin order to execute their attacks. An enemy of this kind, even when wounded, continues to be anenemy. [and is therefore not under the defence of international treatise]. The oath of the paramedicdoes not distinguish between an enemy and a friend, and in that it stands in contradiction to Jewish law[Halachah] that does make that same distinction. Due to the fact that every Jew is under oath sinceBiblical times to follow the laws of the Torah, this paramedic oath is not binding by Jewish law. Inaddition one might comment that nowadays medical treatment and life-saving procedures are very

expensive. The Paramedic Oath reflects a superficial kind of morality, and is irrelevant in modernreality. " Rabbi Dror Baramah, answering a soldier's question. http://www.ynet.co.il/articles/0,7340'L-3439603,00.html


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political solution; as well as systemic forgiveness awarded to all deviations from

stated military norms. 3 All these have led to a situation in which the lives of civilians

have been sacrificed.

The Israeli military's code of ethics, The Spirit of the IDF 4 constitutes the official

educational foundation for soldiers. The "Purity of Arms" clause states: "A soldier

will use his weapons and his might only to fulfill the task at hand, to the extent

required, and will maintain his humanity even in combat. The soldier shall not use his

power and his weaponry to harm those who are not combatants or who are taken

prisoner, and will do all within his ability to prevent harm to their lives, bodies, honor

and property." The clause dealing with human life states: "a soldier will act rationally

and safely in all his actions, by acknowledging the utmost importance of human

life..." In 2004, in a controversial attempt to adapt the code of ethics to the reality of

the war against terror fought in civilian population centers, the Israeli military

established a forum comprised of officers and professionals whose mandate was to

draft The Ethical Code for the War on Terror, to be used as an addendum to the

official code of ethics. It states, among other things, that "soldiers are obliged to

provide adequate health services as conditions allow, equally to themselves and to the

enemy." 5

Within the military forces as a whole, medical personnel have a special role to protect

civilians. Their unique profession and role necessitates a heightened level of ethical

conduct as compared to other fighters. They are obliged to care for the wounded and

the sick, regardless of the individuals political, national, religious, racial or sexual

affiliation. This position is expressed in numerous codes and treatises, from the

3 At the beginning of the Al Aqsa Intifada the Military Attorney office has changed its policy inregards to opening investigations by the military Criminal Investigation Division (CID) in cases of death of Palestinian civilians. During the first Intifada the army opened investigation in each case of aPalestinian civilian's death except in cases when the victim took part in combat. With the beginning of this Intifada the military attorney declared that CID will open investigations only in such cases where"soldiers will severely deviate from rules of opening fire and cause injury to body and soul." SeeBtselem site: http://www.btselem.org/hebrew/Accountability/Investigation_of_Complaints.asp . Seealso Yesh Din, "Irregularities: putting soldiers on trial during the second Intifada and after, 2000-2007"September 20084

The Israeli Defense Forces. Spirit of the ISRAELI ARMY.http://dover.Israeli Army.il/ISRAELI ARMY/English/about/doctrine/ethics.htm5 http://he.wikipedia.org/wiki/%D7%A8%D7%95%D7%97_%D7%A6%D7%94%22%D7%9C


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Hippocratic Oath to the International Code of Medical Ethics formulated by the

World Medical Association. The latter states:

"A physician shall always bear in mind the obligation to respect human life. A

physician shall give emergency care as a humanitarian duty unless he/she is assured

that others are willing and able to give such care." 6

This statement asserts that in times of war, the ethical obligation to provide optimal

medical assistance to the population in a war zone falls under the responsibility of the

fighting powers in general and to medical teams in particular. An enemy that does not

comply with these stipulations makes their implementation extremely difficult.

However, this should not preclude the Israeli military from acting in accordance, in

light of the moral, judicial and ethical reasons fundamental to all who wish to

preserve the character of Israeli society and the state as one that respects human rights

and complies with international declarations which defines it as part of the modern

community of nations.

In light of the Israeli militarys course of action, one which necessitated close contact

with civilian populations, the army should have included, from the early training

stages of soldiers and officers all through their military service, the rules for caring for

civilians in a time of war. To do so requires not only the intervention of the army, but

that of the political echelons as well. For it is evident that there is a close connection

between political decisions and demands placed on the army and the means by which

they are put into practice. There is a need to rethink and examine the changes in the

Code and ethical conduct of the armed forces; not only with regards to the impact on

the change on the fighting itself, but out of consideration for the long term effects on

the character of Israeli society and its ability to recognize the humanity of those it

defines as the enemy. For it is with that enemy with whom we will eventually talk

peace.

6 http://www.wma.net/e/policy/c8.htm


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Summary

The International Code of Medical Ethics formulated by the World Medical

Association states that in times of war, the ethical obligation to provide optimal

medical assistance to the population in a war zone falls under the responsibility of the

fighting powers in general and of medical teams in particular. Numerous international

treatises assert the obligation to give medical care without discrimination to all

victims in a war zone. More specifically, the Israeli army's code of ethics asserts that

the soldier will maintain his humanity even in combat; he will acknowledge the

utmost importance of human life and will not use his power and his weaponry to harm

those who are non combatants. In a later addendum to the code, that relates to the War

on Terror the Israeli army's code asserts that soldiers are obliged to provide adequate

health services, as conditions allow, equally to themselves and to the enemy

The purpose of this report is to call attention to occurrences of violations of the

international humanitarian law and the Israeli army's ethical code during the course of

Israel's attack on Gaza named Operation Cast Lead. These violations included attacks

on medical personnel; damage to medical facilities and indiscriminate attacks on

civilians not involved in the fighting. Furthermore, Israel placed numerous obstacles

in the course of the operation that impeded emergency medical evacuation of the sick

and wounded and also caused families to be trapped for days on without food, water,

and medications. PHR-Israel believes these violations and the humanitarian crisis that

they entailed should take center stage in the moral reckoning that should take place

within Israeli society as a whole, and especially within its armed forces.

The report focuses on the medical aspects of the crisis and is based on numerous first

hand testimonies that were brought to the attention of PHR-Israel during the attack.

These testimonies formed a picture that the state of Israel made a considerable effort

to conceal through the sweeping prohibition on the entry of international media into

the area and its vague responses given to the High Court.

The report begins by describing the situation of the health system in Gaza on the eve

of the attack. Gaza's health system suffered from acute shortage of medical equipment

and medication due to the blockade imposed by Israel since June 2007. Its medicalstaff training too was hindered by prohibitions that made professional connections and


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training outside Gaza almost impossible. It is this system that was to face the

enormous challenge of having to provide treatment to thousands of wounded; a

challenge that would have overwhelmed any health system. The healthcare for the

chronically ill was severely restricted due to the emergency state and the higher

priority given to life threatening injuries of the attack, as well as due to the closure of

the crossings through which these patients were previously able to have access to

medical treatment outside Gaza.

The report further calls attention to the problems caused by the obstacles to referrals

of the attack victims outside Gaza. Many of those suffering severe injuries and who

were in need for emergency referrals to more advanced medical centers, suffered from

the bureaucratic impediments imposed by Israel and Egypt during the first days, and

the Palestinians reluctance to cooperate with Israel in the treatment of the injured

later. The prompt televised evacuation of three members of Dr. Abu Al'Aish's family

in Israeli ambulances and helicopter, demonstrated that when Israel's image was at

stake it found the way to overcome all obstacles.

The report shows how medical staff became a legitimate target to the attacks of the

Israeli forces. According to a WHO report 16 medical personnel were killed and 25

wounded while being on duty. PHR-Israel documented 12 such incidents and they are

brought in the report. The attacks on medical staff occurred both before and after an

appeal to the Israeli High Court by PHR-Israel and other Israeli human rights

organizations. In addition to attacks on medical personnel and emergency vehicles,

many medical facilities were destroyed as a result of direct attack on them or as a

result of attacks on their vicinities. Israel's accusation that the heads of Hamas were

hiding in hospital basements was strongly denied by directors of hospitals with whom

PHR-Israel kept in contact throughout the Israeli offensive.

Access to the wounded and evacuation of the dead were held back by these ongoing

attacks. Ambulance operators of MoH, PRCS, Civil Defence and UHWC all reported

areas that could not be reached at all. As a result, the wounded waited for hours and

days for evacuation.

The report uses two examples to demonstrate, step by step, the resulting tragedy of these impediments to evacuation. The first case is that of the Al'Aeidi family whose


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twenty members, some of them wounded, were trapped for seven days; the second

example is that of Mr. Shurrab and his two sons who were shot by Israeli soldiers on

January 16, as they were in their car on their way to Khan Yunis. One of the sons died

immediately, the other bled to death for twelve hours. All that time the Israeli

soldiers were within a short distance from the Shurrabs but did not provide any

assistance despite the father's repeated requests.

It is PHR-Israel's belief that in moral terms Israels image has been stained by the

manner in which it pursued the attack; by its disproportionate use of force; and by its

gross disregard for requests from local and international human rights organizations in

the face of the humanitarian crisis in the Gaza Strip. The process of demonization of

Palestinians bears a heavy price for Israeli society. This process reached its nadir

when soldiers in an army that flaunts its morality declined to help evacuate injured

civilians and trapped families; when soldiers acted in trigger-happy manner as they

opened fire on ambulances, medical installations, and medical personnel; and when

Israels leaders employed doublespeak in order to deny the existence of a

humanitarian crisis in the Gaza Strip.


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Introduction

On December 27 Israel began a military attack on Gaza, (referred to as Operation

Cast Lead), which lasted until January 18. The following table and figures include

data collected by the Palestinian Centre for Human Rights in Gaza (PCHR) which

reflects the number of casualties on the Palestinian side, 7 as compared with the

number of casualties on the Israeli side, as reported in Israel. 8

Causualties

Israeli Palestinian

Civilians 0.207% 66.344%

Police 0.000% 16.517%

Combatants 0.691% 16.240%

Total 0.898% 99.102%

The wounded Palestinians numbered 5,303 individuals (including 1,606 children and

828 women). 9 186 Israelis were reported wounded, and an additional 584 individuals

diagnosed as anxiety stricken. 10 To these numbers one should add tens of thousands

of Palestinians that, if diagnosed, would have probably been defined as 'anxiety

stricken' as well. In addition, hundreds of public buildings, including medical

facilities were damaged or were completely destroyed. More than 100,000 people

were left without shelter.

During the days of the attack, PHR-Israel received many appeals, reports, and

testimonies regarding obstacles set in place by Israel preventing the Gaza Strip Health

System from providing proper response in accordance with the circumstances of the

military operation. Many were trapped for hours and sometimes days without water,

food, shelter or electricity, without any way to escape attacks. The price was

especially paid by the wounded that appealed to PHR-Israel to assist in evacuations to

medical centers within the Strip and were forced to wait hours and even days for

evacuation that in the end, often arrived too late. Other injured and chronically ill

7 http://www.nrg.co.il/online/1/ART 1/865/601.html?hp=0&loc=3&tmp=76528

Haaretz, January 19, 20099 See note 710 See note 8


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patients requested evacuation to advanced medical centers outside the Strip to no

avail. Medical personnel and facilities paid the price ass well. Many were hit by the

Israeli army.

The information received by PHR-Israel presented in this report paints a picture of

systematic breaches of International Humanitarian Law concerning health and

medicine in times war, to which, as signatory to the Geneva Convention, the State is

obliged to uphold. On the other hand, the firing of missiles by the Hamas to the south

of Israel, was too a severe and systematic violation of International Humanitarian

Law.

This report seeks to focus on cases and events brought to PHR-Israel during the days

of the attack on Gaza, specifically issues of health and medical care. It aims to supply

information on PHR-Israel's actions during the period of December 27 th- January

18th, and to paint a picture for the reader of the realities on the ground, based on facts

revealed to the organization from first hand testimonies. The violations in the area of

health and medicine, part of which are described in this paper, deserve centre stage in

any and all future public moral debates which we hope will take place in Israeli

society, the army, and within the security system.

The character of the information and the type of the appeals received by PHR-Israel

during this period focus on six main issues and are discussed in this report as follows:

The situation of the health system in Gaza on the eve of the

crisis

Impeded evacuation of wounded to medical centers outside theStrip

Attacks on medical personnel Impeded evacuation of wounded to medical centers within the

Strip

Attacks on medical facilities Harm inflicted on chronically ill patients


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This report does not pretend to cover all aspects of the health system that were

affected by the Israeli attack, only those that were dealt with directly by PHR-Israel,

information brought to us through first hand accounts. In order to form a more

comprehensive picture about the health system during those days, and to understand

the context within which PHR-Israel operated, this report utilizes information

gathered by other organizations, Israel and international, and by doctors and officials

within the Palestinian Ministry of Health.

PHR-Israel corresponded with different parts of the Israeli government during the

offensive on Gaza regarding various issues that now appear in this report. The

responses of the Israeli authorities are brought in the appendix to this report.

The last chapter of this report presents an analysis of the conclusions reached by

PHR-Israel regarding violations of human rights committed by Israel during the

attacks, particularly concerning the field of health. The conclusion relates to specific

considerations which both guided Israeli policy and deviated from the official line.

The report concludes with recommendations issued by PHR-Israel which the

organization believes should be adopted by the State in order to prevent such

violations from occurring in the future.


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Gaza Health System on the Eve of the Crisis

At the beginning of the Israeli attack on Gaza on December 27, 2008, the Health

System in the Gaza Strip was already on the verge of collapse. Since June 2007, the

Israeli blockade of the Gaza Strip restricted the proper functioning of the entire health

system. Development was hindered by lack of knowledge, expertise and experience as

well as reoccurring power cuts preventing medical staff to treat complex illnesses and

injuries. 11 Adding to the situation was a severe shortage of medical supplies 12, and a

shortage of adequate personnel. 13 It is within the context of these and other dire

conditions that the Gaza health system was forced to cope with complex cases and

multiple injuries.

Wounded in hospitals

Photo: Salah Haj Yahya

11 For information on medical fields of expertise lacking in the Strip see PHR-Israel published report:The Disengagement Plan and its Affects on the Right for Health in the Gaza Strip, (January 2005)12 For example: in the field of oncology, there is no access to equipment used for nuclear medicine,isotope examinations, and radiotherapy because of Israels refusal to let this equipment along withknowledge of its operation to enter the occupied Palestinian territories.13 Since June 2007 Israel fully prevented the medical community in Gaza from establishing contactwith their colleagues in the West Bank, Israel, and the rest of the world. Three requests submitted by

PHR-Israel on behalf of three medical personnel who wished to exit the Strip for the for professionalreasons, were refused by the Israeli army which claimed that these requests did not pertain to theStates humanitarian criteria for granting exit out of the Strip.


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A number of organizations have documented the dismal situation of the Palestinian

health system in Gaza. The UN Office for the Coordination of Humanitarian Affairs

(OCHA) reported on December 15, 2008 that the quality of health services was

severely affected as a result of the blockade imposed on the Gaza Strip by Israel in

June 2007 and the recent strike of medical personnel between the months of August

and November 2008. Over this time, medical equipment had broken down due to

reoccurring power shortages, lack of spare parts and maintenance. Between

September and November 2008 only three trucks carrying medicine were sent from

the Ministry of Health in Ramallah to Gaza. As a result, the overall supply of

available medicines was expected to last only a month, while 20% of essential

medication was at zero level". 14

Between August and October 2008, the World Health Organization (WHO) reported a

gradual rise in the percentage of medications and essential medical equipment missing

entirely from the Ministry of Healths storage facility. In August, a 11.5% shortage

was reported; in September the number had risen to 15% and by October, 22.6% of

essential medications and equipment were reported lacking or in short supply. 15

Between 18-20 th December, prior to the attack on Gaza, a delegation of PHR-Israel

doctors had visited the Gaza Strip and reported a shortage of approximately one

quarter or 105 various medicines ordered by the Ministry of Health in Gaza, thirty of

which are required for life-saving treatment and twenty one of which are needed to

treat cancer liver and/or kidney disease. Two hundred and twenty types of medical

equipment needed to perform operations and operate Intensive Care Units were

completely unavailable. The delegation also reported that several appliances at the

Pediatric Hospital used to purify breast milk had stopped functioning. 16

14 Gaza Humanitarian Situation Report: The Impact of the Blockade on the Gaza Strip. (OCHA,December 15, 2008)15 Http://www.emro.who.int/palestine/reports/monitoring/WHO_monthly_monitoring/Gaza%20Strike_nov08.pdf 16 The shortage had already been reported in June 2008 on the occasion of a previous delegation of PHR-Israel in Gaza. That delegation reported that out of 72 dialyze machines in the Strip, 13 were outof use and therefore only 59 machines cater to a population of 450 kidney patients. In addition, the

delegation found that 91 types of essential medical equipment were unavailable at all, while 173 othertypes were available in amounts that would be sufficient for one to three months. See PHR-Israel:The Gaza Strip Medicine under 9.7.2008


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The number of injured and the insufficient number of operating rooms has caused us

to convert 4 delivery rooms in the maternity ward into operating theatres, and as of

today, we cannot admit women in labor to the hospital. Our day clinics and our four

ICU for burn victims have all been admitting individuals injured by the Israeli

attacks."

On the same day, Dr. Zaki Zakzuk, a senior oncologist in the European Hospital in

Khan Younis, told a representative of PHR-Israel: "As of today we have thirty

wounded individuals in very grave condition. Most of them are suffering from head

and neck injuries and urgently require complex neurosurgical treatment. All of them

are in need of ICU beds for ventilation machines, but because of the lack of such

equipment only half of them are able to receive the ventilation treatment while others

are resuscitated manually. In addition, there is an extreme need for additional blood

units, especially type O Negative. The lack of refrigeration equipment and emergency

vehicles is making it impossible for us to transfer blood units from Shifa Hospital."

Dr. Khalil Nakhali, from the Intensive Care Unit at Shifa Hospital told

representatives of PHR-Israel on 30 December, just three days after the beginning of

the Israeli attack: "the situation is very serious because we do not have any vacant

beds. All beds in our unit, 10 in number are occupied by the most gravely wounded.

The hospital has taken 15 more beds from our other departments and utilized them as

Intensive Care beds, and now, all 25 are occupied. Yesterday, for example, 3 or 4

severely wounded people arrived, and we did not have a place for them. After some of

the wounded were transferred to Egypt, some beds were freed up and at the moment,

there are no wounded waiting for intensive care beds. The hospital is now operating in

emergency mode meaning we cannot accept patients with basic injuries. We accept

the urgent cases for life saving efforts, operations etc., and if possible we transfer

them to other hospitals. At the moment 9 wounded individuals remain in Intensive

Care, 6 them are children and two women are being resuscitated."

After only three days of combat, the health system in Gaza was forced to treat about

1,700 wounded suffering various levels of injury. At that point there were 362


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casualties of whom 15% were women and children. 20 The inability of the medical

centers in Gaza to provide adequate relief to the large numbers of injured from the

attack and to patients, who had been hospitalized prior to the attacks, created an

urgent need to refer patients to medical centers outside the Strip. This was not only

due to the lack of medical services available in the Strip, but also due to the

insufficient number of hospital beds and operating rooms available to cope with the

high volume of victims. In addition, impeded evacuation due to the lack of

coordination with the Israeli authorities and other general problems of communication

brought the health system in Gaza to a point where it was increasingly difficult to

respond to the needs of the population on its own.

Wounded in Shifa hospital

Photo: AP

20 This item of data was given by Mr. Hamam Nasman , spokesperson for the Ministry of Health inGaza, on December 30, 2008.


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Evacuation of the wounded to Medical Centers outside the Strip

On Friday January 16, three members of Dr. Az-Addin Abu AlAish's family were

evacuated to an Israeli medical center by ambulances of the Magen David Adom .21

This doubled the number of wounded Palestinians evacuated to Israel since the

beginning of the offensive to six. Considering the dire situation of the health system

in Gaza on the eve of the attack and the large numbers of individuals wounded in the

Israeli offensive, there was an urgent need to refer many outside the Strip at the very

beginning of the offensive, yet this only occurred on the 20 th day of fighting, two days

before the ceasefire. The delay in referring the injured to hospitals in Israel will be

elaborated in the following section. As for the option to evacuate injured to Egypt, it

is important to note that on the crucial first days of the Gaza operation, with Gaza

hospitals filled to capacity, all regional players choose to keep the crossings to Egypt

and to Israel closed.

Closing the Crossings

Erez Crossing, the only crossing point for residents of Gaza into Israel, and from there

to the West Bank, East Jerusalem and Jordan, was closed on December 26, its staff

dismissed. 22 The following day, Israel began its air attacks on the Gaza Strip. In

response to an inquiry made by PHR-Israel, the Israeli intervention officer at the

District Coordination Office (DCO) informed PHR-Israel that the army was still

receiving exit requests from the sick and the wounded but that actual exit was not

possible. No information was provided as to when the Erez Crossing would again re-

open. 23 Mr. Rif'at Muheisen, the head of the Palestinian Civil Affairs Committee in

Gaza, confirmed the information that the Crossing had been closed, and that as for

that hour, no coordination was possible with the Israeli Army. 24

For the first three days of the attack, while the Rafah Crossing remained closed, there

was no possibility to transfer wounded patients to Egypt. On 30 December, the

Egyptian President formally declared that the Rafah Crossing would remain closed to

Palestinians as long as Hamas remained in power over Gaza, however, in practice, the

21 Magen David Adom is the Israeli Emergency Evacuation Service22 PHR-Israel knows of one cancer patient that was able to exit on the morning of December 26 to

receive treatment in Israel.23 Telephone conversation between Tom Mehager and Irit Raz,24 Telephone between Mr. Muheisen and a representative of PHR-Israel on December 28, 2008.


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Egyptian President was willing to open the crossing for the evacuation of the injured

to Egypt. 25 After three full days of fighting therefore, the first wounded, 22 in

number, were referred for treatment to Egypt. 26 Though discrepancies exist regarding

the exact numbers of wounded patients who passed through the Rafah Crossing

during the attack, hundreds of patients were able to access care via this passageway.

The Palestinian Ministry of Health in Gaza reports 1003 individuals passed through

for treatment in Egypt, in several cases from there on to other countries. The World

Health Organization reports 608 individuals crossed the border for medical care. 27

The same day as President Mubarak opened the crossing to injured victims, PHR-

Israel appealed to the minister of defense to authorize the passage of six individuals

who had sustained head injuries and were in a coma 28 for treatment in Israeli medical

centers who had agreed to admit them on that very day. 29 Among the six injured were

two women, a man, and three children, ages 5, 7, and 8. Dr. Fauzi Nabulsiah, Director

of the Intensive Care Unit at Shifa Hospital, had informed PHR-Israel that their

critical condition did not allow their referral to Egypt 30 and therefore could only

receive proper care in Israel.

Israel conditions exit on prior financial obligation by the Palestinian Authority

According to reports received by PHR-Israel from hospitals in Gaza, correct to

December 31, out of the 1800 wounded, as reported by Gaza health officials and

international organizations, only three individuals were referred to Israel. 31 In

December 31 telephone conversation PHR was informed by Lieutenant Colonel Uri

25 http://dailystaregypt.com/article.aspx?ArticleID=1878426 http://www.shanghaidaily.com/sp/article/2008/2008122008/20081230/article_386441.html27

The WHO reports that 608 wounded exited Rafah Crossing: 512 were transferred to Egypt, 61 toSaudi Arabia; 9 to Turkey; 8 to Jordan; 8 to Libya; 6 to Belgium and to 4 Morocco. The informationwas received from Ms. Dalia Salahah, a representative of the WHO in Gaza.28 For a copy of the letter please refer to:http://www.phr.org.il/phr/article.asp?articleid=1020&catid=26&pcat=1&lang=HEB29 After an urgent appeal to PHR-Israel from Dr. Fauzi Nabulsiah, Director of the ICU at ShifaHospital on December 29, PHR-Israel appealed to three Israeli hospitals that agreed to accept thepatients. Prof. Raphael Walden, Vice Director of Tel Hashomer Medical Center stated that the hospitalwould accept one patient. Dr. Yitzhak Berlovitz, Director of Wolfson Hospital, agreed to receive onepatient from the proposed list, Dr. Yuval Weiss Director of the Medical Centre at Hadassah Ein Karem,Dr. Turc and Dr. Ido Yatsiv from the Pediatric ICU said there was an open bed that could accept one of the injured.30 One of the injured, Ms. Fatmeh Salem, 45, was transferred to Egypt on the evening of 31.12.08

through the Rafah Crossing because her state had deteriorated.31 This information is taken from the daily briefing of the Palestinian Red Crescent Society. 31.12.08.The information was valid for 10:00 a.m. on that day.


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Zinger, a representative of COGAT 32 that the army would deal with exit permit

requests only for injured individuals who had been guaranteed financial undertakings

from the Palestinian Authority. 33 When PHR-Israel requested that patients be allowed

to pass through Erez Crossing without prior financial undertaking, their requests went

unheeded. In response to PHR-Israel's efforts to further clarify the issue of referrals,

Mr. Hezi Levi, Director of Medicine at the Ministry of Health, reported that the Israeli

Health System had prepared in advance for the possibility of accepting referred

patients from Gaza, and had even set aside space for them at one of Israels leading

medical centers. The problem, he said, was that the Palestinian Civil Affairs

Committee had been unwilling to submit permit requests to the Israelis at the Erez

Crossing. 34

Palestinian Authority in Ramallah Refuses to Refer Wounded Patients to Israel.

On December 31, representatives of PHR-Israel appealed to the Director of the

Palestinian Civil Affairs Committee in Gaza, an office under the authority of the

Ministry of Health in Ramallah. 35 Mr. Muheisen confirmed the decision of the

Ministry of Health in Ramallah not to refer the wounded to Israel, only to Egypt. On

the same day, PHR-Israel petitioned the Israeli Minister of Defense and the Israeli

Minister of Health with a requesting to eliminate financial coverage as a pre-condition

for the referral of wounded to Israel. 36

This policy of the Palestinian Authority was later repeated by Dr. Fathi abu Mughli,

the Palestinian Minister of Health in Ramallah in his reaction to the establishment of

an Israeli clinic at the Erez Crossing to treat Palestinians wounded in the attacks. The

minister gave a statement in which he strongly criticized the armys initiative, calling

it deceptive propaganda meant to hide their horrible crimes. He further concluded,

32 This is the military office of Coordinator of Government Activities in the Territories33 The phone conversation on 31.12.2008 was held between Ran Yaron, PHR-Israel representative andMajor General Uri Zinger.34 The phone conversation between Mr. Hezi Levi and Ms. Hadas Ziv from PHR-Israel occurred on31.12.08.35 The conversation was with Mr. Rif'at Muheisen, of the Palestinian Civilian Committee for Health.36

To read the letters see:http://www.phr.org.il/phr/article.asp?articleid=1024&catid=26&pcat=_.1&lang=HEB . To this day,there has been no response from either the Ministry of Defence or the Ministry of Health.


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The occupying forces that brought on such massive devastation, have no right to

treat our wounded. 37

On March 3, 2009, Deputy Minister of Health in Ramallah, Dr. Anan al-Masri

officially confirmed this policy in a meeting with representatives of PHR-Israels

Occupied Palestinian Territory Department. On January 22, 2009, 4 days after the

military operation had ended, Mr. Itshak Herzog, the recently appointed Minister of

Humanitarian Issues told a representative of PHR-Israel that the financial

precondition for referral of the injured has in fact been eliminated. 38

Three Wounded Palestinians Referred to Israel

On December 31, PHR-Israel was informed that three injured individuals were

referred for medical treatment in Israel. This occurred only after external

organizations intervened with a pledge to pay for treatment. On December 29, a 16

year old boy was referred to Ichilov Hospital in Tel Aviv. UNRWA pledged to

finance the case. On December 31 two more children were referred to an Israeli

hospital. Their treatment was financed by the Peres Center for Peace. 39

At that point in the military campaign a high number of severely injured required

referrals and visa for outside care. The Palestinian Ministry of Health told PHR-Israel

that between the 29 and 30 of December, 54 patients had been referred to Egypt,

fifteen of which were in Intensive Care. 40

The three patients mentioned above, whose emergency medical care was covered by

UNWRA and the Peres Center for Peace were the only patients referred to Israel for

the first 21 days of the Israeli attacks. On Thursday, the 22nd day of the attack, Israel

finally evacuated three more wounded, all of them family members of Dr. Abu

AlAish. Details of this significant turn of events appears in the following section.

37 The full statement was received by email at PHR-Israel and is available.38 This was said in a meeting between Minister Herzog and representatives of Israeli Human Rights

organizations: Gishah, Btselem, PHR-Israel and the Association for Civilian Rights.39 The children were referred to Shiba and Schneider Hospitals in Israel.40 http://www.phr.org.il/phr/article.asp?articleid=1024&catid=26&pcat=6lan=HEB

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