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For those seeking medical care, a request to leave Gaza can mean life or death: NPR

A Palestinian man struggles to get permission to leave the Gaza Strip and go to hospital for heart surgery as his health deteriorates.


We report this week on how difficult it is for Palestinians in the Gaza Strip to get life-saving medical care. And, Daniel, yesterday on this show you introduced us to a 70-year-old man that you met in Gaza who needs heart bypass surgery.


To the right. His name is Yousef al Kurd. He’s a retired sound engineer, and he’s trying to get permission from Israel to leave Gaza and go to the West Bank for his operation. When we meet him in the hospital in Gaza, his face is thin and he has big ulcers on his legs. The stakes for him and his family are really high.

IBRAHIM: (Through interpreter) If they cancel it, I think my father will die. He will die.

ESTRIN: It is his son, Ibrahim, speaking through an interpreter.

SHAPIRO: Now, you reported yesterday that the doctors in Gaza couldn’t do the operation he needed.

ESTRIN: It’s true. The health system in Gaza is worn out because, remember, Hamas took over about 15 years ago. He launched attacks against Israel from there. And Israel and Egypt maintain the blockade. Even the Palestinian Authority sees Hamas as a rival and refuses to support Gaza. So all this weakens the health system there. And the doctors fled.

SHAPIRO: And people can’t just come and go. So what might otherwise have been a routine referral to another location becomes much more difficult.

ESTRIN: Yes, it is very difficult for anyone to get in and out of Gaza. And even medical patients need special approvals. So that’s what today’s story is about. That’s what it takes to get approval.


ESTRIN: We start in the West Bank at the Palestinian Ministry of Health, where they review referrals sent in by doctors in Gaza. Most are cancer cases. There is very little chemotherapy in Gaza and no radiotherapy. The second most common patients are heart patients like Yousef al Kurd, whom we follow.

Thank you for receiving us.

HAITHAM AL HIDRI: You are welcome.

ESTRIN: Thank you.

When we visit the office, it is Dr. Haitham Al Hidri (ph) in charge of granting final approval for medical coverage. He tells us he has to say no a lot. They are on a tight budget, mostly from the United States and other international donors. And Israel only allows critical cases to cross the border. The competition is so intense that he has fired employees who took bribes to put patients on the list.

UNIDENTIFIED PERSON: (non-English language spoken).

ESTRIN: As we speak, his colleague comes into the office with an urgent case.

AL HIDRI: This example of life now.


AL HIDRI: Saving example.

ESTRIN: There is a 25-year-old man on the operating table in Gaza with a life-threatening vascular problem in his jaw. His surgeon can’t take it anymore and wants to send him immediately to an Israeli hospital. Dr. Hidri calls the young man’s doctor in Gaza.

AL HIDRI: Hello? Doctor…

ESTRIN: And he asks her, is it really urgent?

AL HIDRI: (Speaking Arabic).

ESTRIN: He says to the doctor in Gaza, I know the patient’s family is pressing. Everyone is pushing to bring him to Israel. If he’s bleeding, I’ll let him out. If he’s not bleeding, I won’t let him out. You are the doctor responsible for him. You must give the last word.


ESTRIN: So he’s not bleeding.

AL HIDRI: He is not bleeding actively; some oozing from the surgery site. So it’s not an active hemorrhage, so it’s not an absolute emergency. We can wait, and we…

ESTRIN: Seeping, not bleeding – that’s an example of how selective he has to be. In the end, he decides not to take any risks. He approves the treatment and coordinates the rapid transfer of the patient to an Israeli hospital. He says Israel grants permits for most really urgent cases.

AL HIDRI: Top emergencies, I can take care of these patients gently.

ESTRIN: But here’s the thing with heart patient Yousef Al Kurd — his surgeon didn’t rush him because he thinks he can wait a month for bypass surgery. In the meantime, he is trying to get an Israeli travel permit, and Israel is wary of letting anyone in from Hamas-controlled Gaza. I talked about it with an Israeli researcher from Tel Aviv University, Moshe Chorev (ph).

MOSHE CHOREV: It is not clear that Israel will provide its enemy with the treatment it needs. They can go to Egypt, for example.

ESTRIN: About 1 in 5 patients go to hospitals in Egypt, but they are much further away. And the Palestinian health authorities prefer to keep patients inside their own system. And that means going through Israel. But there have been isolated cases where Israel has accused patients of smuggling explosives or spying for Hamas.

CHOREV: It’s all about trust. But once you break that trust, once you break it, then you send someone with cancer with TNT and they get caught, you know, obviously it does a lot of damage.

ESTRIN: Israeli officials say they allow only in humanitarian and exceptional cases – more than 10,000 permits last year. But rights groups say the selection process is a mystery.

RAN GOLDSTEIN: It’s really a black hole for us to understand the criteria.

ESTRIN: This is Ran Goldstein (ph). He directs Physicians for Human Rights – Israel. They are trying to help Gaza patients get permits.

GOLDSTEIN: Many, many cases are not really security issues because when we intervene, all of a sudden the person gets the permit.

ESTRIN: Today, Israel grants most permits, but the World Health Organization says about a third of applications were delayed or denied last year. The WHO estimates that thousands of people have to postpone things like surgery or chemo, and they often get sicker and sicker while they wait. This is exactly what happened with Yousef Al Kurd. Israel did not grant him a permit in time for his operation. His son Ibrahim changed his reservation; still no permit. He got a third date. All the while, Israel said it was considering the request.

IBRAHIM: (Through interpreter) Israelis always procrastinate. And that only slaughters us inside and out.

ESTRIN: About six weeks went by with no response. Remember, his doctor said he shouldn’t wait more than a month for an operation. This is how the son of a Kurd asks the Palestinian Center for Human Rights in Gaza to intervene.

MOHAMMED AL ALAMI: (Speaking Arabic).

ESTRIN: Lawyer Mohammed Al Alami (ph) shows us the letters he sent to the Israeli authorities.

ALAMI: Very urgent.

ESTRIN: Two more weeks pass without a permit. And remember, this is just a travel permit. Israel is not involved in providing the treatment. So the lawyer calls his Israeli contact and asks him…

ALAMI: (speaking Arabic).

ESTRIN: Why the delay? What is the security risk with a 70 year old man? The attorney says the officer told him that Kurd had six phone numbers registered under his name. The Palestinian lawyer believes Israel is reviewing patient phone calls and that several phone numbers raise questions. The Kurdish family says there is a logical explanation. Each family member uses a different number, like a family plan. The lawyer therefore sends this information to his Israeli contact.

ALAMI: Every day like that – every day.

ESTRIN: Advocacy is part of the job of trying to get those permits. A Palestinian official takes photos of patients with their bulging neck tumors, their sick babies. He says this tends to win the sympathy of Israeli officers. I asked the Israeli agency in charge of Yousef Al Kurd’s case. They said there were missing papers. They say this is a common reason they delay permits. But the family and their lawyer say nothing was missing, and Israel never told them. As Yousef Al Kurd waits for permits, his blood pressure drops sharply. He stops urinating. A few more days pass, and then her son, Ibrahim, says they get a text message with good news.

IBRAHIM: (Through interpreter) Yousef Al Kurd, we have approved your trip.

ESTRIN: An Israeli travel permit – it’s been over two months since they first applied. He can finally go to the hospital for surgery. It is a beacon of hope as his health is deteriorating.


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