In Gaza, an application goes awry and a small child dies

JERUSALEM (AP) – Jalal al-Masri and his wife spent eight years and their life savings on fertility treatments to have their daughter, Fatma. When she was diagnosed with a congenital heart defect in December, they waited another three months for an Israeli permit to take her for treatment outside the Gaza Strip.

The permission never came. The 19-month-old died on March 25th.

“When I lost my daughter, I felt that there is no more life in Gaza,” al-Masri said in a trembling voice. “The story of my daughter will happen again and again.”

Israel grants permits for what it defines as life-saving treatment to Palestinians from the Gaza Strip, which has been under a crippling Israeli-Egyptian blockade since the Islamic militant group Hamas took power there in 2007.

But families need to negotiate an opaque and uncertain bureaucratic process. Applications are submitted through the Palestinian Authority, reports must be stamped, paperwork processed. In the end, al-Masris received only a text message from the Israeli military saying that the application was “being processed.”

COGAT, the Israeli military body overseeing the licensing system, did not respond to further requests for comment.

Of the more than 15,000 applications for patient permits from Gaza in 2021, 37% were delayed or rejected, according to figures from 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 their applications were rejected or delayed.

This does not necessarily mean that Israel’s decisions were responsible for the deaths – even the best hospitals can not save everyone. But the sick families faced the extra stress of negotiating a complex bureaucracy – and the uncertainty of whether things could have been different.

In December, doctors in the city of Khan Younis diagnosed Fatma with an atrial septal defect, a hole in her little heart. Gaza’s health system has been hit by the 15-year blockade and four wars between Israel and Hamas. So they referred her for treatment at a Palestinian-run hospital in Israeli-annexed East Jerusalem, which offers pediatric heart surgery.

Her father took the medical report and ran off to a small office in Gaza City run by the internationally recognized Palestinian Authority. Hamas drove the PA out of Gaza in 2007 and limited its authority to parts of the Israeli-occupied West Bank, but it continues to act as a liaison between Gaza and the Israeli authorities.

A few days later, al-Masri was informed that the application had been approved. The PA booked an appointment at Makassed Hospital in East Jerusalem on December 28 and agreed to pay for the treatment. The toddler’s grandmother would accompany her.

All they needed was a security clearance from Israel.

Israel conquered Gaza along with the West Bank and East Jerusalem in the Middle East War in 1967. The Palestinians want all three territories to form their future state. Israel withdrew 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 curb Hamas, which Western countries 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 Gaza’s 2 million Palestinian residents.

Israel denies permits to Palestinians, which it sees as a security threat. But in the case of 19-month-old Fatma and her grandmother, it just said the application was under consideration.

The hospital kept the agreement open until January 6th. Then Jalal searched again. Same story.

He made a third appointment on February 14th. Still no permission.

He made a fourth for March 6th.

This time, he was told that Israel needed 14 more days to process the application, so he postponed the appointment until March 27. 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’ve 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, without an escort, and drop her off at the hospital.”

He made a sixth appointment for April 5th.

On Friday, March 25, Fatma woke up early. She played with her father and kissed her newborn little brother. She wanted chicken wings for lunch, so her dad went out to get some.

Everything for his little girl.

While he was out, his brother called and said Fatma seemed tired. When he got home, his relatives were waiting outside for the ambulance. At the hospital, she was pronounced dead on arrival.

The medical report listed the cause of death as cardiac arrest, caused by dilation of the heart, caused by atrial septal defect.

Jalal would have added Israel to the chain of events.

“This is a premeditated murder. My daughter was a victim of blockade and closure,” he said. “What did she do to deserve this? She had all the papers. ”

Dr. Merfeq al-Farra, a pediatrician who saw Fatma several times at her 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 treat it in Gaza, but the hole in her heart was big, 20 millimeters, and this requires specialized open-heart surgery for children, which is not available in Gaza,” he said. “That’s why the hospital issued her at least four emergency referrals.”

Dr. Abraham Lorber, the former head of pediatric cardiology at Israel’s Rambam Health Care Campus, said ASD alone is rarely fatal. Doctors often recommend elective surgery later in life to prevent symptoms from appearing. Sometimes they detect the congenital defect in adults.

It could have led the Israeli officers who weighed Fatma’s course of treatment to conclude that her life was not in danger.

But Lorber, who did not treat Fatma, said ASD can aggravate other heart and lung diseases. In that case, it should be treated quickly, especially if the patient has trouble breathing.

“It would not just be a matter of correcting ASD. The patient would probably have needed other procedures, not just surgery,” he said. “This patient most likely had underlying conditions.”

Regardless of the diagnosis, he said, her chances of survival would have been much better at the hospital in Jerusalem.

That day in the emergency room in Gaza, Jalal would have tried anything.

“I told the doctor, take my heart and put it in her,” he said. “I felt like it was me who died, not her.”

Ten days after his daughter’s death, he received another text message from Israel. The application was still being processed.


Akram reported from Hamilton, Canada.

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