JERUSALEM (AP) — Jalal al-Masri and his wife spent eight years and their savings on fertility treatments in order to have their daughter, Fatma. When he was diagnosed with a congenital heart defect in December, they waited another three months to obtain an Israeli permit to take him out of the Gaza Strip for treatment.
The permit never came. The 19-month-old died on March 25.
“When I lost my daughter, I felt there was no life in Gaza,” al-Masri said, his voice shaking. “My daughter’s story will happen again and again.”
Israel is granting permits for what it defines as life-saving treatment to Palestinians in the Gaza Strip, which has been under a crippling Israeli-Egyptian blockade since the Islamic militant group Hamas took power in 2007.
But families must negotiate an opaque and uncertain bureaucratic process. Applications are submitted through the Palestinian Authority, reports must be stamped and documents processed. In the end, all al-Masris received was a text message from the IDF saying the request is “under review”.
COGAT, the Israeli military body that oversees the permit system, did not respond to multiple requests for comment.
Of Gaza’s more than 15,000 patient permit applications in 2021, 37% were delayed or denied, according to World Health Organization figures.
Al-Mezan, a Gaza-based rights group that has helped the al-Masris and other families, says at least 71 Palestinians, including 25 women and nine children, have died since 2011 after their demands were been rejected or delayed.
This does not necessarily mean that Israel’s decisions were responsible for the deaths – even the best hospitals cannot save everyone. But the families of the sick had to deal with the added stress of negotiating a complex bureaucracy – and the uncertainty of whether things could have turned out differently.
In December, doctors in the city of Khan Younis diagnosed Fatma with atrial septal defect, a hole in her tiny heart. Gaza’s health system has been damaged by the 15-year blockade and four wars between Israel and Hamas. So they referred her for treatment at a Palestinian-run hospital in East Jerusalem, annexed by Israel, which offers pediatric heart surgeries.
Her father took the medical report and rushed to a small office in Gaza City run by the internationally recognized Palestinian Authority. Hamas ousted the PA from Gaza in 2007, limiting its authority to parts of the Israeli-occupied West Bank, but it continues to serve as a liaison between Gazans and Israeli authorities.
A few days later, al-Masri was informed that the request had been approved. The PA made an appointment at Makassed Hospital in East Jerusalem on December 28 and agreed to pay for the treatment. The toddler’s grandmother accompanied him.
All they needed was a security permit from Israel.
Israel captured Gaza, along with the West Bank and East Jerusalem, in the 1967 Middle East war. The Palestinians want the three territories to form their future state. Israel withdrew its troops and settlers from Gaza in 2005, but it still severely restricts the movement of people and goods in and out of the narrow coastal strip.
Israel says the blockade is necessary to contain Hamas, which Western countries consider a terrorist group because of its long history of deadly attacks on Israelis. Critics see the blockade as a form of collective punishment for Gaza’s 2 million Palestinian residents.
Israel denies permits to Palestinians it considers a security threat. But in the case of 19-month-old Fatma and her grandmother, it was simply stated that the application was under consideration.
The hospital has kept the appointment open until Jan. 6. Then Jalal applied again. Same story.
He made a third appointment, for February 14. Still no permit.
He made a fourth, for March 6.
This time, he was told that Israel needed another 14 days to process the request, so he rescheduled the appointment to March 27. PA’s financial coverage expired, so he reapplyed. The Israelis said they needed a new medical report because the December one had expired.
“I’ve spent the last three months going back and forth,” he said. “I told everyone I saw: do the impossible, get her out. Take her alone, unescorted, and drop her off at the hospital.
He made a sixth appointment, for April 5.
On Friday March 25, Fatma woke up early. She played with her dad and hugged her newborn baby brother. She wanted chicken wings for lunch, so her dad went to get some.
Everything for his little girl.
While he was out, his brother called and said that Fatma looked tired. When he got home, his relatives were waiting outside for the ambulance. At the hospital, she was pronounced dead upon arrival.
The medical report stated that the cause of death was cardiac arrest, caused by the enlargement of the heart, caused by the atrial septal defect.
Jalal is said to have added Israel to the chain of events.
“This is intentional murder. My daughter was a victim of the blockade and the closure,” he said. “What did she do to deserve this? She had all the papers.
Dr Merfeq al-Farra, a pediatrician who has seen Fatma several times in his clinic, said the hole in her heart caused pulmonary hypertension, putting her at risk of a stroke.
“If the hole is 4 millimeters, we can treat it in Gaza, but the hole in his heart was big, 20 millimeters, and it requires specialized open heart surgery for children which is not available in Gaza,” he said. he declared. “That’s why the hospital issued him at least four urgent referrals.”
Dr. Abraham Lorber, former head of pediatric cardiology at the Rambam Health Care Campus in Israel, said ASD alone is rarely fatal. Doctors often recommend elective surgery later in life to prevent symptoms from developing. Sometimes they discover the congenital defect in adults.
This could have led Israeli officers assessing Fatma’s treatment to conclude that her life was not in danger.
But Lorber, who did not treat Fatma, said ASDs can make other heart and lung conditions worse. In this case, it must be treated quickly, especially if the patient has difficulty breathing.
“It wouldn’t just be about correcting ASDs. The patient probably would have needed other interventions, not just surgery,” he said. “This patient most likely had underlying conditions.”
Whatever the diagnosis, he said, his chances of survival would have been much better at the Jerusalem hospital.
That day, in the emergency room in Gaza, Jalal would have tried everything.
“I said to the doctor, take my heart and put it in him,” he said. “I felt like it was me who would die, not her.”
Ten days after his daughter died, he received another text message from Israel. The request was still pending.
Akram reported from Hamilton, Canada.