The permission never came. The 19-month-old died on March 25. “When I lost my daughter, I felt that there was no life in Gaza anymore,” al-Masri said in a trembling voice. “My daughter’s story will happen again and again.” Israel has been granting licenses for what it calls “rescue care” for Palestinians in the Gaza Strip, which has been under a mutilated Israeli-Egyptian blockade since the Islamic State militant group Hamas seized power in 2007. But families have to negotiate an opaque and uncertain bureaucratic process. Applications must be submitted through the Palestinian Authority, reports must be sealed, documents must be processed. In the end, all al-Masris received was a text message from the Israeli army saying the request was being “examined”. COGAT, the Israeli military body that oversees the licensing system, has not responded to multiple requests for comment. Of the more than 15,000 applications for patient leave from Gaza in 2021, 37% were delayed or rejected, according to the World Health Organization. Al-Mezan, a Gaza-based rights group that has helped al-Masris and other families, says at least 71 Palestinians, including 25 women and nine children, have died since 2011 after being rejected or delayed. their applications. This does not necessarily mean that Israel’s decisions are responsible for the deaths – even the best hospitals can not save everyone. But the patients’ families faced the added stress of negotiating a complicated bureaucracy – and the uncertainty about whether things could have turned out differently. In December, doctors in Khan Younis diagnosed Fatma with a vaginal septum defect, a hole in her tiny heart. Gaza’s healthcare system has been hit by a 15-year blockade and four wars between Israel and Hamas. She was referred to a Palestinian hospital in Israeli-annexed East Jerusalem for pediatric heart surgery. Her father took the medical report and went to a small office in the city of Gaza run by the internationally recognized Palestinian Authority. Hamas ousted the Palestinian Authority from Gaza in 2007, limiting its power to parts of the Israeli-occupied West Bank, but continues to act as a liaison between the Gaza authorities and the Israeli authorities. A few days later, al-Masri was informed that the application had been approved. PA closed an appointment at Makassed Hospital in East Jerusalem on December 28 and agreed to pay for the treatment. She would be accompanied by the toddler’s grandmother. All they needed was a security clearance from Israel. Israel occupied Gaza, along with the West Bank and East Jerusalem, in the war in the Middle East in 1967. The Palestinians want all three territories to form their future state. Israel withdrew troops and settlers from Gaza in 2005, but continues to severely restrict 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 nations consider a terrorist group because of its long history of carrying out deadly attacks on Israelis. Critics see the blockade as a form of collective punishment for the 2 million Palestinians in Gaza. Israel denies permits to Palestinians it considers a security threat. But in the case of 19-month-old Fatma and her grandmother, she simply said that the application was under consideration. The hospital kept the appointment open until January 6. Then Jalal applied again. Same story. A third appointment was made for February 14. There is still no license. He did a quarter, on March 6th. This time, he was told that Israel needed another 14 days to process the application, so he postponed the March 27 appointment. PA’s financial coverage expired, so he applied again. The Israelis said they needed a new medical report because it had expired in December. “I spent the last three months running back and forth,” he said. “I told everyone I saw: Do the impossible, just get her out. “Take her alone, unaccompanied, and leave her in the hospital.” A sixth appointment has been made for April 5th. On Friday, March 25, Fatma woke up early. She played with her father and kissed her newborn brother. She wanted chicken wings for lunch, so her father went out to get them. Anything 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 the ambulance. At the hospital, she was pronounced dead on arrival. The medical report cited the cause of death as cardiac arrest, caused by the swelling of the heart, caused by the defect of the atrial septum. Jalal would have added Israel to the chain of events. “This is a premeditated murder. “My daughter fell victim to exclusion and closure,” he said. “What did he do to make it worth it?” He had all the papers. ” Dr. Merfeq al-Farra, a pediatrician who saw Fatma several times at his clinic, said the hole in her heart had caused pulmonary hypertension, putting her at risk for stroke. “If the hole is 4 millimeters, we can deal with it in Gaza, but the hole in her heart was big, 20 millimeters, and that requires specialized open-heart surgery for a child who is not available in Gaza,” he said. “That’s why the hospital issued her at least four emergency referrals.” Dr. Abraham Lorber, former head of pediatric cardiology at Israel’s Rambam Health Care campus, said ASD alone is rarely fatal. Doctors often recommend selective surgery later in life to prevent symptoms. Sometimes they discover the congenital defect in adults. This may have led Israeli officers weighing Fatma’s treatment to conclude that her life was not in danger. But Lorber, who did not treat Fatma, said ASD could worsen other heart and lung conditions. In this case, it should be treated quickly, especially if the patient has difficulty breathing. “It would not just be a matter of correcting DAF. “The patient would probably need other interventions, not just surgery,” he said. “This patient probably had underlying conditions.” Regardless of the diagnosis, she said, her chances of survival would be much better at the Jerusalem hospital. That day in the Gaza emergency, Jalal would have tried everything. “I told the doctor, take my heart and put it inside,” he said. “I felt like I was dead, not her.” Ten days after the death of his daughter, he received another message from Israel. The application was still pending.
Akram reported from Hamilton, Canada.
