Miri Weingarten [Coordinator oPt Department,
Physicians for Human Rights-Israel]: "PHR-Israel has been immersed in the crisis that has engulfed Gaza since the takeover by Hamas in June 2007, and the resultant closing by Israel of all crossing points to goods and persons. Patients who prior to June had the possibility of accessing Egypt for medical care found this way barred from the 9th of June, leaving the Erez Crossing the only point of exit for patients.

In order to enter Israeli hospitals or to cross Israel into medical centers in the West Bank, East Jerusalem or Jordan, patients are required to undergo elaborate, opaque and ever-multiplying bureaucratic procedures in order to procure an exit permit. Patients whose requests are rejected due to a "security prohibition" or whose requests are so delayed as to cause repeated re-scheduling of appointments apply to PHR-Israel for redress.

Since June, the number of patients' applications from Gaza to PHR-Israel has increased dramatically. Whereas from January to May 2007 PHR-Israel fielded 20-40 applications each month, in June this figure increased to 60 per month, and in October a peak number of 160 applications was recorded.

Increases in negative or delayed responses correspond closely to Israeli policy decisions: The first increase corresponds to the closing of the Erez and Rafah Crossings while the second corresponds to the Israeli declaration of Gaza as a hostile entity and its declared decision to impose collective measures against the civilian population.

On the ground, PHR-Israel has met increasing difficulties in ensuring access to healthcare of Gaza patients who need care in external medical centers. Since September 2007, even life-threatening conditions have been refused exit repeatedly. Nine of the patients who applied to PHR-Israel have died while waiting for a permit.

In its work, PHR-Israel applies to the High Court of Justice (HCJ) as a last instance to ensure access of patients to medical care that is unavailable within Gaza. When analysed, the Court rulings are shown, overall, to echo deteriorating State policy. High Court judges voice attitudes ranging from total identification with State policies to confusion rather than courage:

• In June, after PHR-Israel together with partner organization "Gisha" submitted an urgent petition to the HCJ demanding that the Erez Crossing be opened to patients in need of care unavailable in Gaza, the State responded that it no longer bore any legal responsibility toward the civilians of Gaza, that patients would be permitted entry as a "humanitarian gesture" only, and that only life-threatening conditions would merit permission. Danger of amputation or of the loss of an eye, for example, would be defined as endangering "quality of life" and not life itself, and therefore would not justify entry. In its ruling the Court questioned this distinction between life and limb, but did not intervene on behalf of the 26 patients in the petition, and refused to rule either on the policy of access to health care of patients from Gaza, or on the legal status of Gaza itself.
• In November, the cases of 11 patients in life-threatening condition were heard. Two separate hearings were held, delaying the court decision. While waiting for a ruling, 21-year-old cancer patient Nael El Kurdi died at home in Gaza. This did not persuade the Court to oblige the State to formulate a policy ensuring access of patients to medical centers outside Gaza.
• In December, Justice Elyakim Rubinstein ruled that "even a total criminal" had a right to access to care, if in urgent and life-threatening condition, and asked that the State examine the possibility of ensuring access to Egypt or to Jordan of several specific patients in life-threatening condition. He too refrained from addressing policy.
• In January 2008, the previous ruling was overturned by three judges, who reviewed the cases of 8 patients, all in urgent life-threatening condition, and "were persuaded that there are no grounds for our intervention in the decision of the Respondents to prevent the entry of these appellants into the territory of Israel." (HCJ ruling 11105/07, 8.1.08).
• Less than a fortnight later, leukemia patient Amin Fayyad was also refused redress by the Court. Justices Prokatcha, Alon and Naor saw no grounds for intervention and suggested that his case be reviewed "by the end of February" (HCJ ruling 559/08, 22.1.08) — thus justifying a delay that could cost the patient his life.

The possibility of legal redress for Palestinians has been seriously eroded by this process, raising grave questions regarding the independence of the judiciary system in Israel. PHR-Israel reiterates its demand that the State of Israel ensure the access of Gaza patients to medical care unavailable in Gaza in external medical centers, as a matter of policy."