Iraq News Now

When Palestinian preschooler Aisha a-Lulu came out of brain

surgery in a strange Jerusalem hospital room, she called out for her mother and

father. She repeated the cry over and over, but her parents never came.

Instead of a family member, Israeli authorities had approved

a stranger to escort Aisha from the blockaded Gaza Strip to the east Jerusalem

hospital. As her condition deteriorated, the child was returned to Gaza

unconscious. One week later, she was dead.

A photo of Aisha smiling softly in her hospital bed, brown

curls swaddled in bandages, drew an outpouring on social media. The wrenching

details of her last days have shined a light on Israel’s vastly complex and stringent

system for issuing Gaza exit permits.

It is a bureaucracy that has Israeli and Palestinian

authorities blaming each other for its shortfalls, while inflicting a heavy

toll on Gaza’s sick children and their parents.

“The most difficult thing is to leave your child in the

unknown,” said Waseem a-Lulu, Aisha’s father. “Jerusalem is just an hour away,

but it feels as though it is another planet.”

So far this year, roughly half of applications for patient

companion permits were rejected or left unanswered by Israel, according to the

World Health Organization. That has forced over 600 patients, including some

dozen children under 18, to make the trek out of the territory alone or without

close family by their side.

The system stems from the Hamas militant group’s takeover of

Gaza in 2007, when it violently ousted the Western-backed Palestinian

Authority. Israel and Egypt responded by imposing a blockade that tightly

restricted movement in and out of Gaza.

The blockade, which Israel says is necessary to prevent

Hamas from arming, has precipitated a financial and humanitarian crisis in the

enclave. For years, Gaza’s 2 million residents have endured rising poverty and

unemployment, undrinkable groundwater and frequent electricity outages. Public

hospitals wrestle with chronic shortages of drugs and basic medical equipment.

Israel blames Hamas, which it considers a terrorist group, for the crisis.

In what it portrays as a humanitarian gesture to help Gaza’s

civilians, Israel permits Palestinian patients to seek medical treatment at

hospitals in Israel and the West Bank once they pass a series of bureaucratic

hurdles. COGAT, the Israeli defense body that issues the permits, says it

insists that all patients cross with an escort, usually a close relative,

unless they wish to go alone or require immediate treatment that doesn’t allow

time for security screening.

In order to get a permit, patients must first submit a

diagnosis to the West Bank-based Palestinian Health Ministry, proving that

their treatment isn’t available in Gaza. Then a Palestinian liaison requests

exit permits from COGAT, which reviews the applications and passes them to

Israel’s Shin Bet security agency for background checks.

According to WHO, the approval rate has plummeted in recent

years.

It said that in 2012, Israel allowed in 93% of patients and

83% of their companions for treatment. For the month of April 2019, the figure

stands at just 65% of patients and 52% of their companions.

A COGAT official disputed the figures, saying they don’t

take into account that the number of permit applications has grown as Gaza’s

health care system deteriorates, and that Israel has started issuing permits

less regularly but for prolonged stays. The official, speaking on condition of

anonymity under agency rules, said COGAT has tried to ease restrictions by

designating a permit specifically for parents of child patients.

The agency said it issued 4,000 permits for patient escorts

in the first quarter of 2019, including 1,398 for parents of sick children.

After being diagnosed with brain cancer, Aisha received

immediate approval to get out of Gaza for what was hoped to be life-saving

surgery. But when her parents approached the Palestinian Civil Affairs

Commission for escort permits, their process ground to a halt.

To their bewilderment, Palestinian officials told them not

to apply, saying it was too risky.

At 37, Waseem is below the age that Israel deems acceptable

for swift entry on security grounds. Today, all men under 55 require extra

screening, which means waiting, usually for months, according to Mor Efrat, the

Gaza and West Bank director for Physicians for Human Rights Israel. As for

Aisha’s mother, Muna, a quirk of her upbringing in Egypt left her without an

official Israeli-issued ID card required to receive a permit.

“We tell families to find a companion that won’t give Israel

any reason to refuse,” said Osama Najar, spokesman for the Palestinian Health

Ministry. “We want to save the child and, yes, that can mean sending them

alone.”

In this sense, the Palestinian Authority “acts as a

subcontractor for Israel,” said Efrat, forcing parents to make a difficult

choice: delay their child’s urgent care, or search for someone else that Israel

would be more likely to let cross.

Aisha’s parents said they scoured for alternatives, applying

for an aunt and her 75-year-old grandmother, but Israel rejected both.

The girl’s only remaining hope, the Palestinian office told

them, was to apply for as many older women as possible from their extended

social network. A permit for Halima al-Ades, a remote family acquaintance whom

Aisha had never met, was approved.

Muna said she had no choice but to sign COGAT’s consent form

and whisk her daughter out of Gaza for immediate treatment. She said the

frustration of the sprawling bureaucracy, and the painful memory of her

5-year-old daughter crying for her on the phone during her last days, haunts her.

“It was the hardest time of my life,” she said. “My heart

was being ripped out every day and every hour.”

The Shin Bet declined to comment on the case. But in a

statement, it emphasized Israel’s security concerns about Gaza patients and

their companions. “The terrorist organizations in the Gaza Strip, headed by

Hamas, are working tirelessly to cynically exploit the humanitarian and medical

assistance provided by Israel,” it said.

This means that Palestinians are often turned down without

explanation or for reasons out of their control. “I feel confident telling you

that most of these rejections are arbitrary,” said Efrat, of Physicians for

Human Rights Israel.

Israel denies any official change in policy.

Alon Eviatar, a former high-ranking official with COGAT,

said the goal remains the same. “On the ground, this means to make daily life

as difficult as possible for Hamas, without crossing the red line to

humanitarian disaster,” he said.

Eviatar acknowledged that the Israeli permit system was

ineffective, inefficient and overburdened. “We are desperate for an

alternative, to get Gaza to take care of itself and stop relying on Israel,” he

said.

Aisha’s doctor in Jerusalem, Ahmad Khandaqji, said he has

treated countless lone patients from Gaza over the past year, but that Aisha’s

story stuck with him. “She felt abandoned and betrayed,” he said. “We saw how

that directly impacted her recovery.”