Jerusalem - "Jerusalem" dot com - Muhammad Abu Khdeir - "B'Tselem" organization warned of the collapse of the health system in the besieged Gaza Strip as a result of the policy applied by Israel, and said that these measures are far from meeting the needs of the besieged Palestinians, and cause serious repercussions as a result of preventing Gazans From treatment in hospitals in Jerusalem and the West Bank.

B'Tselem confirmed that Israel has created, through its policies, a reality that makes it difficult for the health system in the Gaza Strip to carry out its functions, and there are many patients for whom treatment is available only outside the Strip, but the Israeli authorities, instead of facilitating their exit to receive treatment that is available only a few kilometers away, obstruct their exit through Various arbitrary instructions, conditions and procedures, thus dooming them to suffer from illness until death.

B'Tselem explained that patients in the Gaza Strip who need treatment are forced to submit requests for permits to access hospitals in the West Bank, Jerusalem, Israel or other countries, noting that thousands of patients submit such requests every year, but approval is very few compared to the number of requests and patients, especially Cancer patients.

B'Tselem confirmed that Israel does not rush to approve applications, and only accepts permits for treatments considered "life-saving", according to the Israeli military government's claim. As for patients who meet the very narrow Israeli conditions set by Israel, they are forced to face the hardships of a bureaucratic process that is managed in an arbitrary manner. Where they know nothing about him and are not guaranteed to get the permit they crave.

According to WHO data for the year 2021, 15,466 patients from the Gaza Strip submitted requests for treatment abroad, and more than half of the requests (8,661 or 56%) were for treatment in hospitals in Jerusalem, and 30% of the requests (4,639 requests) were for treatment in other hospitals in the West Bank. And only 14% of them (2,165 requests) were for treatment within the "green line".

In the vast majority of cases, B'Tselem said, applicants receive a response one day before their treatment appointment, via a phone message informing them whether their application has been approved or rejected by the Israeli authorities, or that it is "still under examination." During the year 2021, 37% of applications were submitted. Israel informed its applicants that it was rejected or that it was “under review” or that the applicants did not receive a response, and 38% of the applications of pediatric patients (4,145 applications) and 24% of the applications of patients over the age of 60 (2,906) were rejected or their applicants did not receive a response.

She added, “Patients who do not receive a permit until the date set for their treatment are forced to go through the whole bureaucratic process again – assigning a new role in the hospital, then obtaining a financial commitment paper from the Palestinian Authority, then submitting a new permit application with the Authority’s Civil Affairs Department in the Gaza Strip.” Gaza, which in turn submits applications to Israel through the Israeli Directorate of Coordination and Liaison, and then again begins the waiting period for a response amid great concern about the possibility of not obtaining approval in a timely manner, and in this case some patients despair and refrain from submitting a new application, and others give up their right If they are accompanied by companions, they submit a permit request for themselves only, and if their request is approved, they will be forced to travel and receive treatment on their own, and this is reflected in the data of the World Health Organization, according to which Israel rejected in 2021, 60% out of 18,632 permit requests for companions submitted by patients.

B'Tselem referred to the death of Mahmoud al-Kurd, a Gazan resident of Deir al-Balah, who died on 16 December 2022 at the age of 45, due to advanced lung cancer and malignant metastases in his brain. He left behind a wife and six children.

In August 2020, cancerous tumors were discovered in al-Kurd's lungs and throat, and he received chemotherapy treatments in various hospitals in Gaza. However, his health condition worsened, and about a year after his diagnosis, he traveled to Egypt for three months, where he underwent examinations and received additional chemotherapy treatments.

He added, "The disease spread and metastases appeared in al-Kurd's chest and brain, and he was referred to receive radiotherapy treatments in hospitals in Nablus and Jerusalem, due to the unavailability of these treatments in the Gaza Strip . His family members submitted five requests to obtain a permit for him to enter the West Bank, but Israel rejected all requests or I announced, close to the deadline, that the application is "still under examination."

Only on 14 December 2022, after submitting the sixth request and pressure exerted by Al-Mezan and Physicians for Human Rights, were the Kurds allowed access to treatment at Augusta Victoria Hospital (Al-Mutalaa) in Jerusalem. However, the doctors were unable to stabilize his condition, and he died about 24 hours later, on 16 December 2022.

On 11 December 2022, al-Kurd's wife, Amah Abd al-Rahman al-Kurd, spoke to B'Tselem field researcher about the delay in issuing a permit to enter Israel. She said: "My husband, Mahmoud, was working in an administrative position at a university in the Gaza Strip. In October 2020, he began to suffer from a severe cough. At first he took antitussives and painkillers, and after several tests it was found that he had a cancerous tumor in the trachea and a tumor in the right lung, and he received a series of seven chemotherapy treatments, but his condition did not improve.In June 2021, Mahmoud received a referral for examinations and treatment in a hospital in Egypt. He traveled there with his brother Tariq, and they stayed there for about three months, during which he received chemotherapy there.

Mahmoud returned from Egypt in a worse condition, as his weight, about 130 kilograms before he got sick, dropped to 60 kilograms. In the Strip, he continued to receive chemotherapy, but only once every two weeks, and sometimes only once a month. Once we waited four months for a treatment appointment.

She explained, "Since his return from Egypt, we have submitted four requests to the Israeli military government for treatment in hospitals in Jerusalem, and each time we received, a day before the scheduled treatment date, a negative answer or a notification stating that the request is still 'under examination'." On 25 November 2022, Mahmoud was not feeling well. He had convulsions and lost consciousness. I called an ambulance and took him to Al-Aqsa Hospital in Deir al-Balah, where it was found that he also had brain metastases, which caused convulsions. On the same day, we submitted another permit application so that Mahmoud could receive treatment at al-Mutala' Hospital, and they made an appointment for him there for 29 November 2022. However, a day before the appointment, we received a refusal from Israel again. Mahmoud was in Al-Aqsa Hospital for three days, then he was transferred to the Turkish Hospital in Gaza for another four days.

She continued, “On 8 December 2022 we submitted another application for a permit and the next day, on 9 December 2022, Mahmoud’s condition worsened again. He had pains all over his body, a headache, his stomach was swollen and he was unable to eat or I called an ambulance and took him to Al-Aqsa Hospital, where they gave him painkillers and took a CT scan.

The wife said: "We received a refusal from Israel again, but we submitted another request with an urgent referral to Al-Mutala' Hospital in Jerusalem. In return, I tried to obtain permission for treatment abroad through the Department of Medical Treatments Abroad in the Palestinian Authority. We also approached two human rights organizations. Insan - Physicians for Human Rights and Al Mezan - tried to put pressure on the Israeli side, but we were refused again.

She added that during that difficult period, Mahmoud returned home, but his condition was still critical. He lived on painkillers and kept having severe spasms. He wasn't sleeping or eating, and he felt an urge to vomit all the time.

His condition is deteriorating. It hurts me so much that I can't help it. He's an academic and he's not affiliated with any organization, and I don't understand why he wasn't given permission. He suffers a lot.

In another testimony, she said: On Wednesday, 14 December 2022, we were suddenly informed that Mahmoud had obtained a permit to travel for treatment at Al-Mutala' Hospital in Jerusalem, thanks to an appeal submitted by Physicians for Human Rights and Al-Mezan. The next day, Thursday, 15 December 2022, Mahmoud and I took an ambulance to the Erez Crossing. We got there around 11:00 and waited there until 15:30 because the army said we had to wait in line. In the end they let us through. We arrived at Al-Mutala Hospital around 17:00.

Mahmoud was in a very dangerous condition. It's hard for me even to describe. They did a CT scan of him, and it turned out that there were metastases in the left lung as well. The next day, Friday, 16 December 2022, Mahmoud was sedated and given oxygen. At about 17:00 he woke up and asked to pray. He prayed in his bed, then fell asleep again, and at 22:30 they informed me that he had passed away. I was completely shocked. I didn't know what to do. I wasn't even able to scream or cry. I started repeating: “Thank God.”

I did not agree to return to the Strip without Mahmoud, and I stayed in his room after they moved his body to the cold room. I called the family to inform them that Mahmoud had passed away. It was horrible to tell the kids about it. When Muhammad heard that his father had passed away, he wept and cried, "O Allah!" On Sunday, December 18, 2022, I returned with Mahmoud's body in an ambulance to the Strip. On the same day, we buried him in the cemetery in Deir al-Balah. My daughter Afnan has not stopped screaming and crying since she was informed of her father's death. She hardly eats and drinks. I hope that my husband, Mahmoud, will be blessed with the mercy of heaven, and that I will know how to be patient with our children after his death.