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Palestinian Patient Dies After Israeli Authorities Delay Medical Permit

12:00 Aug 9 2020 Rantisi Hospital, Gaza City

Palestinian Patient Dies After Israeli Authorities Delay Medical Permit Palestinian Patient Dies After Israeli Authorities Delay Medical Permit Palestinian Patient Dies After Israeli Authorities Delay Medical Permit Palestinian Patient Dies After Israeli Authorities Delay Medical Permit Palestinian Patient Dies After Israeli Authorities Delay Medical Permit
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Jalal Sharafi, 22. Credit: Courtesy of the Sharafi family. Published by IMEMC News and Haaretz
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by IMEMC News
AUG 13, 2020

A heartbreaking report by Israeli journalist Gideon Levy has laid bare the story of 22-year old Jalal Sharafi, who died last month when his urgent application to transfer to an Israeli hospital for a bone marrow transplant was delayed.

According to Levy, Jalal’s life could probably have been saved if the Civil Administration in the territories had allowed him to be moved to an Israeli hospital on time.

Jalal was an otherwise healthy young man who was stricken with an unknown illness in mid-March – he felt weak, his skin was pale, he was worried that it might be cancer.

So his father, 47-year old Nasser Sharafi, immediately brought him to the Inodnesian Hospital in Gaza, where he works as head of the Maintenance Department.

Jalal, who just graduated from Al-Quds University in the Department of Education and planned to become a teacher, on July 16th became the latest victim of the Israeli military government that rules every aspect of life for Palestinians in the West Bank and Gaza.

Israeli officials attempted to put the blame on the Palestinian Authority for having recently announced that they will no longer coordinate the Israeli military’s obtuse and difficult permit process on their behalf. But the Palestinian Authority officials say the blame lies squarely on Israel, which has maintained its brutal and despicable martial law over the Palestinian Territories since occupying the Territories with its military in 1967.

In his article, Levy detailed the process that led to Jalal’s premature and preventable death:

He writes, [Jalal] “was diagnosed with aplastic anemia, a disease in which the bone marrow does not produce enough blood cells, of all varieties. Sharafi’s doctors promised him that he would not die; his disease could be treated…

“From that day, March 23, until the day he died, Sharafi remained in Rantisi Hospital. His immune system became impaired and there was concern of infections.

“He received all of the treatment Rantisi could provide, but his body did not respond and his condition did not improve. A few weeks later, the hospital reached the conclusion that only a bone-marrow transplant could save him. On May 4, Sharafi was given a referral by the hospital for a transplant at Sheba Medical Center, Tel Hashomer. His condition begin to deteriorate, he had a constant high fever, but overall the situation was still not dire.

“On July 7, Sharafi was told that he had an appointment for further diagnosis and a bone-marrow transplant at Sheba on July 12. He and his family looked forward to the day eagerly. They had heard that Sheba was one of Israel’s biggest hospitals and hoped its staff would save his life. Like all young Gazans, Sharafi had never been outside the Strip; his whole life had been spent between Gaza City and Rafah.

“The personnel in Sheba tried to arrange for the new patient’s arrival via the Israeli District Coordination and Liaison Office, but it emerged that Sharafi was denied entry for ‘security’ reasons. Although he was by now almost completely bedridden, he apparently still constituted a clear and present danger to the safety of the State of Israel.”

In addition, Israeli authorities denied a permit for his mother to accompany him, saying she was also banned for undisclosed “security reasons”. The family turned to Physicians for Human Rights – Israel, who managed to get Jalal’s permit approved – but not his mother’s.

As the appointment was quickly approaching, the family scrambled to find another family member who would be acceptable to the Israeli authorities – but had no idea what criteria would deem a family member acceptable to the Israeli military security.

They tried a 60-year old uncle – but his application was denied for ‘security reasons’. Finally, they found a distant relative who would be acceptable to Israel – Rawaida Sharafi, 60. By the time her permit was approved, however, the border had closed for the night and the appointment at the hospital would need to be rescheduled.

So when the ambulance finally arrived to take Jalal from Rantisi Hospital in Gaza City to cross through the Erez checkpoint into Israel to get to Sheba hospital for a bone marrow transplant, it was already too late.

Jalal had taken his last breath just an hour before the ambulance arrived.

According to Physicians for Human Rights, during June and July, the organization handled 195 urgent requests of seriously ill patients, most of them suffering from cancer – five times more than the usual. Only half the requests were approved by Israel.

The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) announced on July 21st the establishment of a temporary coordination mechanism by the end of July. This mechanism was supposed to function in place of the PA-Israel coordination mechanism which was suspended in June due to Israeli Prime Minister Benjamin Netanyahu’s annexation plan.

Under the new mechanism, the United Nations – through the World Health Organization (WHO) – was to mediate between the Palestinian Civilian Affairs Committee, which is responsible for filing permit applications on behalf of the PA, and the Israeli authorities at Erez Crossing. However, despite the UN’s statement and its efforts to launch the temporary coordination mechanism, the mechanism has yet to begin operations.

Even though Israel currently permits treatment only in urgent cases, only half of the applications submitted via Physicians for Human Rights – Israel in June and July received approval. In most of these cases, Israeli authorities did not provide an answer in time so that patients missed their scheduled appointments and were forced to re-apply. At least three Gaza patients – two infants and a 22-year-old man – died after being referred for urgent, lifesaving treatment outside Gaza that they were denied by Israeli authorities.

Delays at Erez Crossing: In some cases, even though their permit request had been approved, patients who arrived at Erez Crossing were detained there for a long time before being allowed through the crossing, while others were even sent home. The paper also reports the case of a patient with leukemia who was detained at Erez Crossing for four hours and was questioned by the ISA (Israel Security Agency) as he lay in an ambulance – in contravention of medical ethics – before being allowed to leave Gaza to receive his medical treatment.

Recently Israeli authorities have instituted the stipulation that applications would not be reviewed unless patients provide the results of medical tests they have undergone, such as MRI, X-rays and biopsies. This requirement constitutes a further burden on patients and in many cases causes delays in handling the applications.

Bogus claims that treatment is available in the Gaza Strip: In order to obtain medical treatment outside Gaza, patients must prove to the Israeli authorities that the therapy they need is unavailable in the Gaza Strip. Over the past two months, several cases have been documented of oncology patients who were refused permits to leave Gaza on the grounds that the therapy they need is available in Gaza, even though this was not the case.

Providing last-minute answers: In a substantial proportion of applications, a decision is only given at the very last minute, sometimes as late as the day that the patient has to leave for treatment. This situation does not give patients the opportunity to properly prepare either for the trip or for the duration of hospitalization or treatment, and imposes additional strain and tension to an already stressful situation.

PHRI stated: “Every day that goes by without the international mechanism in operation takes a toll in human life. Ultimately, since Israel has control over the crossings and decides all matters regarding patients’ travel for treatment, Israel must act to safeguard patients’ lives until a solution is found. In the long run, such a solution necessitates lifting the blockade imposed on Gaza and ensuring free access between the Gaza Strip, the West Bank and East Jerusalem. Until that time Israeli authorities must rescind the stringent criteria it has imposed and also allow patients in non-emergency situations to leave Gaza for treatment. In addition, Israel must revise the online form for applying for permits to leave Gaza for medical treatment so that patients can easily check on the review status of their application. Finally, Israel must ensure that responses to applications are provided in a timely manner that is compatible with the urgency of the medical condition.”
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By the Time Israel Finally Allowed Him in for Urgent Care, This Young Gazan Was Already Dead

After months of hospitalization with a blood disease in the Gaza Strip, Jalal Sharafi needed a bone marrow transplant, which is unavailable there. By the time Israel relented, and gave him an entry permit for treatment here, it was too late

by Gideon Levy for Haaretz
Published on 09.08.2020

Jalal Sharafi died young. He died because he was imprisoned in a besieged Gaza Strip. He’s one of many. His life could probably have been saved if the Civil Administration in the territories had allowed him to be moved to an Israeli hospital on time. But the bureaucracy of the occupation has considerations and a pace of its own, which take no account of seriously ill Palestinians.

Sharafi was condemned to die in Gaza. All the urgent requests of his parents, of the International Red Cross and especially of the organization Physicians for Human Rights, to transfer him immediately to Sheba Medical Center outside Tel Aviv to save his life, were met with refusals and foot-dragging. For six days the race against time and against callous indifference continued, until the bad, bitter end.

The requests were submitted on Monday, July 13, but it was not until the following Sunday that all the necessary Israeli authorizations were received – grossly and heartbreakingly late. About an hour before the ambulance finally arrived to take him from Rantisi Hospital in Gaza City to the Erez checkpoint on the way to Sheba, Sharafi died.

Sharafi was a 22-year-old student who liked to watch Syrian television series in his spare time. He graduated a few weeks ago cum laude from the Faculty of Education at Al-Quds University in Jerusalem and dreamed of becoming a teacher under the auspices of UNRWA, the United Nations relief agency, in one of Gaza’s refugee camps.

Dreams never to be fulfilled.

He fell ill in mid-March. His skin turned pale and he felt very weak. His father, Nasser Sharafi, 47, who is head of the maintenance unit at the Indonesia Hospital in northern Gaza, lost no time in taking his son there for tests. Speaking by phone from the family’s home in the Tufah neighborhood of Gaza City, he told Haaretz that Jamal had been stricken with fear: He was certain that he had cancer and that his days were numbered.


The youth was hospitalized and a week later was moved to Rantisi, which is better equipped. There he was diagnosed with aplastic anemia, a disease in which the bone marrow does not produce enough blood cells, of all varieties. Sharafi’s doctors promised him that he would not die; his disease could be treated. Hearing this, his son felt calmer, his father recalls.

From that day, March 23, until the day he died, Sharafi remained in Rantisi Hospital. His immune system became impaired and there was concern of infections.

A video clip from April shows him lying in his bed in the hospital. He is talking animatedly with his 3-year-old sister, Hala, lying next to him . His condition was good then. He was able to take the university exams online from his bed. He got used to life in the hospital, his father says. He received all of the treatment Rantisi could provide, but his body did not respond and his condition did not improve. A few weeks later, the hospital reached the conclusion that only a bone-marrow transplant could save him. On May 4, Sharafi was given a referral by the hospital for a transplant at Sheba Medical Center, Tel Hashomer. His condition begin to deteriorate, he had a constant high fever, but overall the situation was still not dire.

On July 7, Sharafi was told that he had an appointment for further diagnosis and a bone-marrow transplant at Sheba on July 12. He and his family looked forward to the day eagerly. They had heard that Sheba was one of Israel’s biggest hospitals and hoped its staff would save his life. Like all young Gazans, Sharafi had never been outside the Strip; his whole life had been spent between Gaza City and Rafah.

The personnel in Sheba tried to arrange for the new patient’s arrival via the Israeli District Coordination and Liaison Office, but it emerged that Sharafi was denied entry for “security” reasons. Although he was by now almost completely bedridden, he apparently still constituted a clear and present danger to the safety of the State of Israel.

There was more to come. His mother, Naama, 46, was also denied entry to Israel. She would not be able to be by his side during the most trying moments. She, too, was a security risk, according to the inaccessible, classified information in the hands of the Shin Bet security service, which has the power to decide who shall live and who shall die. Without an escort, the young man was incapable of leaving the Gaza Strip. He missed his appointment at Sheba; a new appointment was made for July 16. His condition worsened.

Sharafi’s parents then appealed to Sheba, to the International Red Cross and to two human rights organizations in the Gaza Strip. The civilian coordination between the Palestinian Authority and Israel is no longer functioning. The Gaza-based organizations suggested that the family turn to Physicians for Human Rights. The organization’s permits coordinator, Celine Jaber, received the request on July 13. She had to work quickly so Sharafi could make it to Sheba for the new appointment, then just three days away. She transmitted an urgent request to the Gaza coordination office. Jalal’s entry into Israel was approved – but Naama’s request was again rejected.

Serious concern continued to prevail about the immediate security danger she posed to Israel, even as her son was fighting for his life and about to undergo a bone marrow transplant.

Here’s what Lt. Shoval Yamin, public inquiries officer in Gaza’s District Coordination and Liaison Office, wrote to the permit coordinator of Physicians for Human Rights about Naama Sharafi: “First, we remind you that according to the work protocol agreed upon with the Palestinian Authority, all requests for entry to Israel territory must be made to the Palestinian Civilian Committee… Within this framework, we wish to update you that in the wake of the PA’s decision [to cease coordination with Israeli authorities], requests for entry to Israel are not being transmitted of late.

“At the same time, and even though a request in the matter was not submitted to the Coordination and Liaison Office from the Palestinian Civilian Committee, the authorized bodies decided exceptionally to examine the substance of this request. This was done taking into consideration the circumstances of the request and the medical condition of the resident involved.

“We wish to clarify that this was done beyond the letter of the law and in light of the exceptional humanitarian circumstances that are indicated by the request. Following a substantive examination of the request, those authorized decided to reject it for security reasons, which by their nature cannot be divulged.”

Now a race against time began to find a different escort for Sharafi, who could not be sent alone to his fate, and whom the Israeli authorities would not have permitted to be transferred in his condition by himself. His father was ruled out in advance, for fear that he, too, would be refused entry.

On July 15, Physicians for Human Rights submitted a request for a new escort for Jalal. The family suggested a 60-year-old relative whose name was also Jalal Sharafi, but he too was disqualified by the Shin Bet. Another threat to Israel’s security. Night fell. July 16, the date of the appointment at Sheba, dawned. The family looked high and low for someone who would agree to accompany the patient, care for him day and night in the hospital, probably without being able to leave it for a lengthy period, and who would also undertake to self-isolate for 21 days upon returning to Gaza, as is required there.

Finally the family found Rawaida Sharafi, 60, also a relative, who agreed to go with Jalal. She was cleared of all suspicion by the Shin Bet, but by now it was 9 P.M. – too late to leave for Sheba. The Israeli District Coordination and Liaison Office asked Sheba for a date for a new appointment; only on its basis would it be possible to issue a new permit.

The next day, Friday, there was no reply from the hematology unit at Sheba. The family would have to wait until Sunday. But on Saturday, Sharafi’s condition took another turn for the worse. He called his father and asked him to come to the hospital quickly. He was suffering from a rapid heartbeat, high fever and weakness. His father recalls having the impression that his son’s voice wasn’t the same. At one point he also lost his power of speech.

“When will we go for the treatment?” were his last words to his father. “Inshallah, tomorrow you will go,” his father replied. At that point, Sharafi was still completely conscious. The next morning confirmation of a new appointment that same day was sent from Sheba and the entry of the patient and his escort was authorized anew. It was clear that he would have to be moved via the “back to back” method – from a Palestinian ambulance to an Israeli ambulance that would be waiting on the other side of the Erez checkpoint. Sharafi could no longer stand up.

Toward noon, as they were waiting for a final phone call from the Red Cross to set the process in motion, Jalal’s heart suddenly stopped beating. The team at Rantisi tried to revive him as the Palestinian ambulance waited to take him to Erez, and an Israeli ambulance made its way to the checkpoint to pick him up.

Nasser was outside the hospital room, praying for his son’s life, when he heard the cries of Jalal’s mother and sisters, who were at his bedside when his heart stopped.

Jalal Sharafi was buried that afternoon.

A spokesman for the unit of the Coordination of Government Activities in the Territories had the following response to Haaretz’s query about the handling of Sharafi’s case: “Jalal’s first request was received at DCL Gaza on July 14, and after being examined by competent officials, his request to exit for lifesaving medical treatment was approved for July 16, but this permit was not utilized for reasons unrelated to the Israeli side.

“On July 16, a new request was received to coordinate the patient’s exit via an ambulance after his health deteriorated. Due to suspension of coordination by the Civilian Committee, the organization that made the request was asked to provide the missing details. On July 19, the missing details were received and his exit for treatment was approved immediately. Following the approval of the request, DCL learned that the aforementioned had died. We wish to express our condolences at Jalal’s death.

“The unit for the Coordination of Government Activities in the Territories will continue to work in cooperation with the relevant bodies in order to allow even at this time the entry of residents of the Gaza Strip for lifesaving medical treatment.”

An update published last week by Physicians for Human Rights relating to the new situation that has been created in the absence of coordination between the PA and Israel, states that during June and July, the organization handled 195 urgent requests of seriously ill patients, most of them suffering from cancer – five times more than the usual. Only half the requests were approved by Israel.

Tears well up in the eyes of Celine Jaber, the permit coordinator for PHR, as she speaks with Nasser Sharafi and reconstructs what happened. He is convinced that if his son had been able to get to the original appointment at Sheba, his life would have been saved.

“The whole matter of the rejections is terrible,” he says bitterly. “Sometimes there is a rejection and a few days later an approval arrives. In the meantime, the appointment is canceled. This is their method for making people suffer. Sometimes people also die because of it.”

A video clip he sends us of his son’s funeral shows a few dozen young people standing silently in a circle around the freshly dug grave. They too are without a present, without a future, and without tears.
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