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OPT: Wounded and in a catch-22

Research: Salah Haj Yehyeh, Reut Katz: Hadas Ziv: Ran Yaron

Contextual Information:

Hamam Nasman, spokesperson for the Palestinian Ministry of Health, and in charge of coordinating all incoming information from Gaza hospitals spoke to us from Shifaa Hospital in Gaza: Bombing continued into the night, targeting government buildings and homes. Residents received warnings to leave their homes immediately, 5-10 minutes later the homes were bombarded.

Medical Assistance: Aid dispatches from Saudia Arabia, Qatar, and Libya entered Gaza through Rafah and Kerem Shalom Crossing late last night. The dispatches are extremely important but cannot provide adequate response to an entire medical system already on the verge of collapse due to ongoing closures especially in the face of the complex needs of the critically injured persons.

Inability to admit patients: Dr. Khalil Nahleh, from the Emergency Room in Gaza informed us that the situation in Emergency rooms is very bad considering they have no empty beds. All ten beds in the emergency room are occupied by people with severe injuries. The hospital took another 15 beds from other departments and has been utilizing them for emergency cases. All 25 beds are currently in use. Yesterday, for example, 4 critically injured people were brought in and there were no beds. After some of the patients left for Egypt however, these patients were admitted.

The hospital itself is in a state of emergency. Lightly injured or sick persons are no longer admitted. Urgent cases are accepted on a life-saving basis or for surgery. If possible, they are referred to other hospitals.

There are currently 9 patients in intensive care: including 6 children and two women on ventilators. The hospital has approached the Peres Center for Peace regarding the transfer of the children to Israeli hospitals. At this time they are still awaiting further coordination.

Government Hospitals: According to Mr. Nasman, out of 13 public hospitals only ten are able to admit wounded persons. So far, 362 people have been killed, 15% of them are women and children. 1, 700 people have been injured.

Irrregurlar supply of Electricity, Generators and Gasoline: Gaza hospitals are currently receiving 6-8 hours of electricity per day. This has resulted in power outages in Gaza hospitals and poses a grave danger to the lives of critically wounded individuals who are completely dependant on ventilators and other electrical equipment. Generators have been in use for extremely long periods of time, and require repairs, oil and additional spare parts which are not available.

Transfer of wounded persons through Rafah Crossing:

A Saudi plane has been positioned on the Egyptian side of Rafah Crossing to shuttle wounded victims to medical centers. Gaza's medical centers are still awaiting necessary permission from Egyptian authorities and have so far not been able to transfer patients. Dr. Hassan Halaf, the Deputy Minister of Health and the Executive Director of Shifaa Hospital notified us that yesterday afternoon, Monday December 29th, several ambulances with 27 wounded persons, 8 in critical condition and in need of emergency support left Rafah in the direction of El Arish. El Arish Hospital is not properly equipped to treat critical injuries and it is unclear if the patients will be referred to other advanced centers. For this reason, Dr. Halaf indicated that they are currently not referring critically injured patients to El Arish because it is unclear whether they will indeed reach the appropriate centers.

Coordination of Patients and wounded through Erez Crossing:

PHR Israel initiated a call to the Israeli Ministry of Health regarding the transfer of wounded persons to Israel for medical care, the medical administration director has informed us that Israel was indeed ready to accept patients from Gaza and even prepared space for them. Apparently - he claimed - the Palestinian Civil Affairs Committee has decided against submitting requests on behalf of wounded persons to the Israeli District Coordination Office (DCO).

Upon receiving this information PHR-Israel contacted the Palestinian Civil Affairs Office in Gaza, (under the direction of the Palestinian Ministry of Health in Ramallah) and was informed by its representative that it has indeed decided not to refer wounded persons to Israel, only to Egypt. With regards to sick patients, he stated that he would put in a request with Israeli authorities only regarding life saving cases. Since the beginning of attacks, no permit requests have been submitted to Israeli authorities.

The Public Appeals Officer of the Israeli District Coordination Office (DCO) has now agreed to take on urgent cases and if they receive security clearance and administrative authorization, they will allow the transfer of sick patients and the wounded through the Erez Crossing. The Israeli Ministry of Health stated that in light of the impending crisis and due to the fact that the Israeli Health System is also on high alert, all security and technical coordination will indeed be done within the DCO office, though the decision of where to refer patients will be taken within the Ministry of Health.

On Monday, December 29th, an ambulance carrying a young Gazan man 16 years old, wounded in the air attacks, reached Ichilov Hospital in Tel Aviv. Only one person succeeded in gaining entry into Israel, despite information from COGAT the that 11 patients were granted authorization to leave the Strip. The youth was injured at the UNRWA school and it was found that he was permitted to exit only after UNRWA agreed to shoulder the costs of his medical care. PHR-Israel has learned, after a thorough inquiry into the matter that wounded persons are not referred to Israeli hospitals due to the decision by the Palestinian Referrals Office in Ramallah that they will not cover the cost of hospitalization in Israel for many reasons, primarily because it regards Israel as responsible for the direct wounds inflicted on the individuals.

PHR Israel's opinion:

Physicians for Human Rights-Israel is adamant that patients and those wounded in the attacks should not become the victim of financial or bureaucratic arrangements. Furthermore, patients should not become an instrument to the conflict. All those with special interests such as Hamas, Fatah Israel or Egypt should leave them aside, and do their utmost to ensure that patients and wounded persons reach immediate and adequate care. Israel bears special responsibility as the occupying power exerting effective control over the Gaza Strip.

A humanitarian crisis of this stature is not the appropriate time for the stubbornness of bureaucratic processes. The sick and wounded can wait no longer!

The high numbers of injuries, compounded with an already devastated medical system necessitates that Israel show responsibility and do all it can to ensure treatment to ailing individuals. If Israel deems itself unable to cope with the crisis it should seek international aid.

Note: we would like to note the difficulties in acquiring information and that things on the ground are constantly changing. We have worked diligently to compare information and explanations received from both Israeli and Palestinian sources. We shall keep you updated.

For more information please contact: Hadas Ziv hadas@phr.org.il + 972-54-6623232 or Ran Yaron ranyaron@phr.org.il