Eleven years into the siege, the Israeli-led blockade has detrimentally crippled the healthcare system inside Gaza and impacted the lives of over 8,000 cancer patients seeking treatment, who describe themselves as “patients awaiting their death”.

On 11 August 2018, the Gaza Ministry of Health declared the halting of all chemotherapy treatments, putting 8,260 cancer patients, including over 460 children, at risk inside the besieged Gaza strip. This decision came as a result of an 80% depletion of chemotherapy medications inside the strip, a problem exacerbated by Israel’s tightening entry permit policies to access medical treatment outside Gaza.

Medical supplies going into the strip undergo strict surveillance by Israeli authorities, and the latter have recently increased security measures, thus prolonging the period to process patients’ exit applications. They have denied almost half of them since the beginning of 2018.

Accessing treatment inside the Gaza Strip

Due to shortage in medications needed to administer treatment inside Abdel al-Aziz Al-Rantisi Hospital in Gaza, 700 cancer patients, 200 of which are children, missed their chemotherapy session on Monday, 13 August. Hospital Director, Muhammed Abu Silmiya, said that 45 out 60 chemotherapy drugs were out of stock as of Monday morning, which puts the lives of many patients at risk.

Al-Rantisi Hospital in Gaza City is one of two medical institutions inside Gaza qualified to offer cancer treatment, managing up to 6,100 cancer patients, including 460 children. Funded by the United Nations, the European Hospital in Gaza, located in the southern city of Khan Yunis, is the second medical facility qualified for such treatment and treats around 1,700 cancer patients.

In July 2018, Israel partially closed the Karem Abu Salem crossing, preventing essential commodities from crossing to Gaza and allowing in only what Israel deemed as “humanitarian.” These measures have prohibited chemotherapy drugs from entering the besieged strip, alongside other equipment needed to perform radiotherapy and deliver cancer treatment to patients.

Exit Permits and the denial of humanitarian treatment to cancer patients

Since 2012, approvals of medical permits for Gazans to seek treatment outside the strip have witnessed a sharp decline. In 2014, 82% of patients were allowed in, recording a 10% drop from 2012. However, since the beginning of 2018, almost half of all applications for medical permits from Gaza have been rejected without any stated change in policy.

According to the World Health Organization (WHO), as seen below, out of 1,921 entry applications for Gazans to seek medical help in June 2018, with more than a quarter (26%) being for cancer treatment and follow-up, only 63% were approved. 10% of those denied care included patients with appointments for cancer treatment and investigation. Applications that receive no response often force patients to reschedule doctor’s appointments.

Figure 1: Israeli responses to Gaza patients permit application, July 2017 – June 2018.

Over the past year, the processing of exit permit applications for patients in Gaza has experienced long delays with no reply or justification, with some taking more than six months to process.

In order to seek treatment outside the strip, Gazans must get a referral from the Palestinian Health Ministry and a promise that the latter will cover the associated costs. Additionally, they require a travel permit from Israel’s military and intelligence authorities. Shin Bet intelligence Agency, Israel’s internal security service, may demand an interview with patients prior to granting them a permit.

The Defense Ministry unit that oversees the permits, known as the Coordinator of Government Activities in the Territories (COGAT), noted that patients who are first degree relatives of Hamas operatives are not entitled to entry permits to Israel to receive treatment. Moreover, some of those denied entry are not aware of any relation they have to Hamas.

Some NGOs identified these policies as means of pressuring Hamas to return the remains of two Israel Defense Forces (IDF) soldiers killed during the war in 2014. Last year, one of these soldiers’ families petitioned the Supreme Court in Israel demanding that “any humanitarian gesture Israel makes toward Hamas be conditioned on returning the boys home.”

As Israel continues to use humanitarian assistance as a bargaining chip with Hamas, withholding urgent medical treatment adds to the pain cancer patients in Gaza must contend with.

Gaza cancer patients: “It is a nightmare”

On 12 August 2018, 62-year-old Subhi Abu Nour passed away after three months of waiting for his medical permit to receive chemotherapy. Abu Nour was suffering from lymphoma.

Mother of Aseel Mousa, a four-year-old diagnosed with kidney cancer in 2016, expresses grief over the denial of her permit to accompany her daughter on her radiology sessions in East Jerusalem. “How am I supposed to feel when I struggle to provide my child with medication … when I fail to get her medical referrals? It is a nightmare,” she tells Al Jazeera.

There are also documented cases of extortion. Nineteen-year-old Yousef Younis passed away last July after he refused to collaborate with Israel in exchange for a permit to treat his leukemia.

In July, Israel announced a tightening of Gaza’s blockade, further limiting access to goods entering the strip. 80% of Gaza’s population relies on international aid to survive.

The 11-year Israeli-led siege on Gaza violates International Humanitarian Law (IHL), specifically Article 17 of the Fourth Geneva Convention, which calls for “the removal from besieged or encircled areas… and for the passage of… medical personnel and medical equipment on their way to such areas”, as well as International Human Rights Law, specifically Article 12 of the International Covenant on Economic, Social, and Cultural Rights (ICESCR), which ensures the “right of everyone to the enjoyment of the highest attainable standard of physical and mental health.”

Defenders for Medical Impartiality calls upon Israel to grant cancer patients permits to seek medical treatment outside Gaza, and to allow entry of medical assistance, such as chemotherapy medications, to residents of Gaza suffering from cancer.