Female patients from Gaza and Israel's medical exit permit policy
Authors: Dana Moss, Mor Efrat, Dani Filc, Nadav Davidovitch
Journal: The Lancet Global Health (2019)

Nearly 20 years have passed since UN Resolution 1325 on Women, Peace and Security, 10 years since follow-up UN Resolution 1889, and 11 years since the imposition of the blockade on Gaza by Israel. These UN resolutions recognise that violent conflicts affect women and men differently and call on States and civil society organisations to assess the unique needs of women in conflict and post-conflict areas, as a precondition of policy change that accounts for women's needs. Meanwhile, the World Medical Association has urged constituent members to “insist on the rights of women and children to full and adequate medical care”.1WMAWMA resolution on access of women and children to healthcare and the role of women in the medical profession. The World Medical Association, 2017https://www.wma.net/policies-post/wma-resolution-on-access-of-women-and-children-to-health-care-and-the-role-of-women-in-the-medical-profession/Date accessed: April 1, 2019Google Scholar Gaza's health-care system is nearing collapse. According to WHO, a “chronic shortage of medicines and medical equipment” exists in Gaza. Patients must travel elsewhere, including to East Jerusalem and the West Bank, for medical care when none is available locally. To leave Gaza, they must undergo a lengthy bureaucratic process that includes securing a permit from the Israeli Coordinator of Government Activities in the Territories. Since 2013, there have been increasing restrictions on medical exit permits by the Israeli authorities, with WHO documenting that only 54% of patients applying for a medical exit permit received one in time for their medical appointment in 2017, compared with 92% in 2012.2WHO Regional Office for the Eastern MediterraneanRight to Health 2017. World Health Organization, 2018http://www.emro.who.int/images/stories/WHO_Right_to_health_Book_for_web.pdf?ua=1Date accessed: March 25, 2019Google Scholar, 3WHORight to Health: barriers to health access in the occupied Palestinian territory, 2011 and 2012. ReliefWeb, 2013https://reliefweb.int/report/occupied-palestinian-territory/right-health-barriers-health-access-occupied-palestinianDate accessed: March 24, 2019Google Scholar Since 2017, Physicians for Human Rights Israel (PHRI), an Israeli organisation focused on the right to health that helps patients with permit requests, has tried to help more than 250 women overturn permit decisions by the Israeli authorities. We discovered that women are affected by medical permit denials in three ways. First, female patients with cancer are facing severe restrictions. Equipment, such as nuclear medicine scanning, radiotherapy, and various surgeries are unavailable locally, as are many chemotherapy drugs. In 2017–18, 129 women from Gaza contacted PHRI after their permit was denied or delayed for several months. Second, some exit permit criteria affect women twice as often as men. In 2018, 13 patients, of whom five were women, contacted PHRI and al Mezan Center for Human Rights—a Palestinian human rights organisation—after their permit was denied on the claim that they had “family proximity to Hamas”. Freedom of information requests revealed not only that a dramatic increase occurred in the use of this criterion in 2018, but that it was used twice as often on women. In 2017–18, 969 patients were denied on the basis of this criterion, of whom 608 were women, presumably because men are denied on the basis of security reasons instead. PHRI, together with other organisations, successfully appealed to the High Court of Justice to overturn the use of this criterion on behalf of five female patients with cancer. Third, women have been affected by the Israeli army's refusal to give medical exit permits until relatives allegedly living illegally in the West Bank or Israel return to Gaza. This interpretation of illegality is based on a stipulation in the Oslo Accords that, at the time, gave Israel the power to reject changes the Palestinian Authority made to its population registry. The application of conditions such as these to medical exit permits includes the claim that, if these patients received permits, they would move their residence to the West Bank. Roughly 50% of permit denials based on this criterion affect women, according to a response to a freedom of information request made by PHRI in December, 2018 (Ministry of Defense, personal communication). Most of the relatives who moved to the West Bank from Gaza are men, therefore this policy punishes women for the actions of men. The effects of Israel's policy can be seen in cases such as that of Fada Nassar. Fada, 28 years of age, suffers from kidney problems. She requested a medical exit permit for treatment in East Jerusalem in March, 2018, and was rejected. Following PHRI's intervention, it emerged that she was refused because her husband had allegedly illegally moved to the West Bank, even though PHRI emphasised that they are separated. Only after media exposure did Fada finally receive a permit in October, 2018, 7 months after she initially applied. In February, 2019, she contacted PHRI again after she was refused a permit for follow-up treatment. Fada was finally given a permit in June, 2019. Israel's medical institutions have largely stayed silent regarding the effects of the medical exit permit policy on women. The Israeli Medical Association, which was approached several times regarding the plight of female patients with cancer, has not taken a systematic stance regarding their rights. Alongside a comprehensive study on the effects of the blockade on women in Gaza, a new policy is required, one that abolishes the existing system and allows medical patients access to treatment outside Gaza without delay. We declare no competing interests.