The Gaza Strip, Gaza City — How does a 70-year-old man in Gaza, an area with only two cardiac surgeons left, manage to undergo bypass surgery when the territory is cut off from the rest of the world?
Patients with their health emergencies make for a crowded waiting area. To convince Palestinian officials to use some of their meager resources to pay for his operation in another country, his medical condition would have to be particularly bad or he would have to have political connections. Even getting permission to drive the hour or so outside of Gaza to a hospital that can conduct his procedure without any trouble requires haggling with Israeli border officials for security clearance.
The last few years have proved that no part of the world is immune to a health crisis. While a global pandemic is a contributing factor, it is the people of Gaza who are truly to blame for the ongoing tragedy. Although media attention is focused on the victims of Gaza’s catastrophic armed confrontations, a major factor in disease and death in Gaza is the lack of access to medical treatment.
When patients are critically ill, they are sometimes allowed to leave Gaza immediately, but other times they must wait months, pleading for permission to do so. According to data compiled by the World Health Organization, the vast majority of seriously ill people do make it into Israel. However, thousands of people annually experience dangerous Israeli delays and denials, as documented by a 2021 WHO research.
The situation hasn’t always been this way. Gaza’s waterfront once served as a key connection to the rest of the world. There is a school of thought that suggests the name “gauze” was originally applied to a fabric produced and exported from the Gaza Strip many decades ago. Until the mid-2000s, Gaza even had its airport. However, the Palestinian Islamist party Hamas took control of Gaza 15 years ago this month after winning elections, and its borders were subsequently sealed off by Israel and Egypt, cutting off the territory’s ability to do business or travel.
Israel maintains the blockade because Hamas, which has attacked Israel, is labeled a terrorist organization by the United States and the European Union. The siege of Gaza is seen by Palestinians as a kind of collective punishment. The UN reports that the situation in Gaza is dire, with poverty, starvation, power outages, and unclean water. Even when there is a lull in the fighting, it is difficult to get the care you need.
A group of NPR reporters randomly approached a man in a crowded Gaza hospital waiting room in the late year of 2021 and then followed him and his family for months as he pleaded with the government to allow him to leave Gaza for surgery that was readily available at hospitals just a short drive away.
The heart attack
Yousef Al-Kurd provided the background music for life in Gaza. After completing his engineering degree in Germany, he spent the next three decades working in Gaza, repairing loudspeakers for places of worship, classrooms, and street vendors.
Yousef Al-Kurd and his son Ibrahim wait in Gaza for medical treatment. On April 1, 2020, Al-Kurd suffered an unexpected heart attack and required emergency open-heart surgery.
He retired in 2018, and the following year, on April 1st, 2020, he had a heart attack while helping his sons with their electronics workshop. Seventy-year-old diabetic and smoker Al-Kurd underwent life-saving open-heart surgery. His children allege that Al-Kurd delayed treatment because he was afraid of the hospital and frightened about contracting COVID. Al-sons Kurds took him back to the hospital when his condition deteriorated a year later. They needed to see their doctor, who was the chief of cardiac surgery at Shifa Hospital, Gaza City’s largest medical facility.
It turned out that Gaza’s best heart surgeon had left for Spain. His colleagues say he joined a recent exodus of doctors, but he and his family haven’t responded to pleas for comment. They were able to leave Egypt because of the country’s loosened immigration policies, and they’re now making their way to safer ground in Europe and the United Arab Emirates.
Few surgeons remain
After the previous top cardiac surgeon left Gaza in June 2021, Dr. Saher Abu Ghali, then 40 years old, was elevated to head of cardiac surgery at Shifa Hospital. A physician in the division, however, passed away from cardiac arrest a few months later. Then someone else was lost to COVID.
From his little hospital office, Abu Ghali announced, “From four, we became three, and now we are two.” Shifa Hospital’s heart surgery department is led by Dr. Saher Abu Ghali. Among Gaza’s 2 million people, he is one of just 2 cardiac surgeons. In other words, “this is not the only problem,” he said. “You’re missing several key instruments. You are limited in the tools at your disposal.”
That means only two heart surgeons serve a population of two million in Gaza. Around 55 surgeons are needed to treat such a large population, according to standards used in the United States and Europe.
The problem, as Abu Ghali put it, is not limited to this, though. “You are missing certain key pieces of equipment. That’s a lot of resources, and you don’t have them all.”
Israel has placed restrictions on the import of medical equipment, including X-ray machines, because of concerns that Hamas may utilize the technology for military purposes. WHO claims that not enough medical supplies are being sent to Gaza by the Palestinian Authority in the West Bank, which is responsible for health services but is in a power struggle with Hamas.
Consider, as an illustration, the cannulas inserted into the heart during bypass surgery. They are used once and then thrown away by hospitals all over the world.
Here, each cannula undergoes more than a hundred rounds of sterilization, as Abu Ghali explained. Dr. Saher Abu Ghali, a heart surgeon in Gaza, sits down with a patient’s loved ones. “Indeed, this is the case. The Gaza Strip, “Laughing, he said it. “You can’t function if you just plan on using it once before tossing it. You’re hopelessly incapable of medical practice.”
Israel restricts the movement of Palestinians, including medical professionals, to prevent Palestinian doctors from leaving the Gaza Strip to receive continuing medical education in other countries. A few days a month, Israel allows delegations of Israeli Palestinian surgeons into Gaza to provide much-needed surgical care. Foreign medical professionals from other specialties also frequently travel here for surgery. There is a shortage of supply compared to demand.
Yousef Al-Kurd required coronary artery bypass surgery, a procedure that is routinely performed in modern, well-equipped institutions. But the Italian-educated Dr. Abu Ghali indicated that he couldn’t do it with the resources available in Gaza. “It’s hard to do in Gaza because of security concerns. There is a critical need for cardiac surgeons. A vascular surgeon is required. To put it simply, we require the instruments, “Says Ghali.
Al-Kurd was advised by his doctor to travel to a Palestinian hospital in the Israeli-occupied West Bank, which is not under Hamas’s authority and is not under blockade. Even though the trip takes less than two hours in the car, it may be a real pain to get there.
The first hurdle
A patient in need of medical care outside of Gaza must first obtain permission from Palestinian health officials before applying for an Israeli travel visa. If a patient needs medical attention that is not available in Gaza, the Palestinian Authority will cover the cost. Donations from the United States and other countries are welcome, but funds are limited. And only the most extreme cases are allowed to leave Israel.
Cancer patients make up the bulk of those who travel outside of Gaza for treatment, as the territory’s healthcare system is woefully inadequate. Patients with cardiac conditions, like Al-Kurd, make up the second-largest group of people who seek care outside of their home country.
Take this one instance: in early December, a health official raced into the office of Dr. Haitham Al-Hidri, who managed financial coverage for Palestinian medical referrals at the Palestinian Ministry of Health headquarters in the West Bank.
A physician in Gaza just phoned to say that he was operating on a 25-year-old man with a potentially fatal vascular condition in his jaw. The Gaza doctor requested Dr. Al-permission Hidri to transfer the patient to an Israeli hospital because he was overwhelmed. Dr. Al-Hidri contacted the boy’s physician in Gaza to inquire as to the seriousness of the situation.
“The only way I’ll release him is if he’s bleeding to death inside. I won’t allow him out of here unless he’s bleeding to death. To put it simply, you’re his attending physician. It is incumbent upon you to have the last say, “During a phone conversation, Al-Hidari informed him. “It seems that the bleeding has stopped for the time being. Exuding in places, “The physician elaborated. “So it’s not a critical situation. Waiting is not a problem at this point, “Expression: he said.
Ultimately though, Al-Hidari chose to play it safe. He gave his blessing for covering and arranged for a speedy transfer to an Israeli hospital. According to him, Israel issues permissions in most circumstances where they are truly necessary.
It has been known for some time that patients who wished to obtain treatment outside of Gaza could bribe clerks at the Palestinian health ministry to advance the referral.
Patients from West Bank public hospitals might, with the correct connections, receive preferential treatment in private Palestinian and Israeli hospitals at the Palestinian Authority’s expense.
Dr. Al-Hidri, who took office in 2019, claimed he had cleaned house upon his arrival, dismissing clerks who had accepted bribes and preventing unnecessary medical referrals, so saving the cash-strapped Palestinian Authority tens of millions of dollars.
When Yousef Al-Kurd needed coronary artery bypass surgery outside of Gaza, Dr. Haitham Al-Hidri arranged for Palestinian medical referrals and financial assistance.
NPR’s Daniel Estrin
It was early this year that Al-Hidari was suddenly demoted and transferred.
Minister of Health Mai Al-Kaila explained the change as part of the “regular rotation” of leadership for a position of such “sensitivity” and responsibility for such a huge budget.
However, a health official who spoke on condition of anonymity to discuss the sensitive issue claimed that Al-reassignment Hidari was due to his preparation of files alleging corruption in the health ministry, specifically that several thousand patients, many of whom with important political clout, were transferred to private hospitals and granted unnecessary private medical treatment, costing tens of millions of dollars from international donor money.
Two health officials recently disclosed medical records to NPR, which appear to back up charges of favoritism. Officials claim that Palestinian public hospitals are unable to treat ailments like stroke or kidney cysts, but the documents show that at least three patients with high-level ties to the Fatah party, which is affiliated with the Palestinian Authority president, received subsidized, costly private medical care in Israel or the West Bank to treat these conditions.
Each paper bears Health Minister Mai Al-signature Kaila’s and the scribbled comment, “To be transferred” in Arabic.
The health minister admitted to approving Palestinians’ use of private medical treatment, but she maintained that these decisions were made as political favors. After claiming that public hospitals are already at capacity, she justified sending “the poorest of the poor” to private facilities when “prominent persons in the country” pushed on their behalf by saying that such facilities have more room to accommodate them.
According to Al-comments Kaila’s to NPR, “under our system, the minister has the power (to provide an exemption). I am committed to the health and well-being of all people.
A black Hole.
Yousef Al-Kurd, who suffered a heart attack, has no political ties. However, he did have valid reasons to leave Gaza, namely, to have bypass surgery. His procedure was scheduled in Al Mezan, a Palestinian hospital in the West Bank city of Hebron. To get there, he needed to transit through Israel, which entailed obtaining for an Israeli travel permit.
Israel is leery of letting in anyone from Hamas-controlled Gaza.
“It is not self-obvious that Israel will provide its enemies the therapy they need,” said Harel Chorev, an Israeli researcher at Tel Aviv University. “They can go to Egypt, for example.” According to the World Health Organization, about one-fifth of Gaza’s patients travel to hospitals in Egypt. However, these facilities are significantly further away, and Palestinian health authorities would rather keep patients within their system.
There have been sporadic situations where Israel has suspected patients of carrying explosives or spying for Hamas. Israeli authorities have granted permission for certain patients to leave Gaza for medical care, but the patients haven’t come back. They may have left for the West Bank in search of better economic conditions or to escape family vendettas or personal issues.
“Put simply, faith is central to the situation. But obviously, it does a lot of damage once you break that trust, once you send someone with cancer with TNT (explosives) and he’s been discovered “This is what Chorev made a statement about.
Israeli authorities insist that they issue permits in only extraordinary and humanitarian circumstances, although over 10,000 people were granted entry in 2017. There is typically a lack of transparency around the security clearance process.
Physicians for Human Rights Israel, an advocacy group assisting Gaza patients in obtaining permits, had Ron Goldstein say, “It’s truly a dark hole for us to understand the requirements.” When we step in, the person almost always ends up with permission, thus “many, many… situations” aren’t truly security concerns.
According to the WHO, while the majority of permit applications are granted, around a third of them were either delayed or denied in 2021. As they wait for Israeli security permission to travel, WHO estimates that hundreds of individuals have had to postpone surgery or treatment. WHO noted that throughout this period, patients frequently deteriorated.
Such was the case with Yousef Al-Kurd. According to the Palestinian office that files permit requests to Israel, he asked for a permit on September 12. However, Israel denied his request for a fast-track visa in time for his September 15 operation. His son Ibrahim rescheduled his operation for October 12 without hearing back about a permit. He scheduled a third consultation for November 1 but was unable to secure a permit in time.
Israel had been giving him the runaround the whole time, saying that they were looking into his request. An Israeli travel visa was all that was required of Al-Kurd; Israel had no role in actually providing him with medical care.
“The Israelis constantly postpone,” Ibrahim Al-Kurd claimed. To put it bluntly, “This is killing us.”
The surgeon should not make Al-Kurd wait longer than a month, according to his doctor. After waiting for a response for six weeks, Al-son Kurds contacted the Palestinian Centre for Human Rights in Gaza, where attorney Mohammed Al-Alami rushed a letter to the Israeli border authorities. A lawyer for the Palestinian Centre for Human Rights in Gaza named Mohammed Al-Alami wrote an urgent letter to Israeli border authorities pleading for permission to bring heart sufferer Yousef Al-Kurd to the West Bank.
So the lawyer got on the phone with his Israeli friend and asked, “What’s the holdup?” How much of a threat is a 70-year-old male, exactly?
According to the Israeli official, six phone numbers were registered to Al-name, Kurd as reported by Al-Alami. The attorney believes that Israel monitors patient calls and that providing different phone numbers raises red flags. The Al-Kurds have offered a reasonable explanation: they have a family phone plan in which everyone has their number. The legal advisor communicated this to his Israeli counterpart.
“Daily, just like this. Every day,” Al-Alami remarked.
Pleading is part of the task of seeking to secure Israeli permissions. Taking images of patients with enormous neck tumors or sick babies, one Palestinian official told NPR, tends to earn the sympathies of Israeli troops. For years, the World Health Organization has documented barriers to receiving health care for Palestinians. The entire dynamic of Israeli control over Palestinian life is based on the adage that it is easier to win exceptions to the norm than it is to change the rule.
After being contacted by NPR, COGAT, the Israeli agency in charge of processing travel permits for Gaza patients, explained that the lack of required documentation in Al-request Kurds was a common cause of visa delays. However, the family and their attorney maintained that no items were ever reported missing to them by COGAT.
While waiting for a permit, Al-Kurd felt his blood pressure drop dramatically. His bladder control suddenly failed. Several more days passed. Then, on a Saturday afternoon, the family received some encouraging news: the permit had been accepted for the following Monday.
Al-Kurd was able to reach the hospital in time for the life-saving operation. After over two months of begging and waiting, a ray of hope finally appeared. However, Al-condition Kurd was deteriorating.
Yousef Al-Kurd and his wife Fayeza left their children behind the following morning at 5:30 a.m. They stood in line at the Hamas barrier for hours while thousands of Palestinian workers with Israeli work permits entered the country first.
Then they arrived at the Erez crossing, one of the world’s most heavily protected border crossings and the only civilian crossing between Israel and Gaza.
NPR’s Daniel Estrin
Hamas, which seeks to destroy Israel through military means, is contained on the other. Two million Palestinian civilians are as well. Since Hamas’s control, Israel has publicly declared that “separation” is its policy, effectively cutting off access between Gaza and the West Bank.
Inside the checkpoint, Al-Kurd was subjected to a full-body scan that required him to lift his arms. On the floor, he collapsed in a heap. Israeli medics hurried over to get him into a wheelchair. It was never mentioned to his loved ones that they could have called ahead and scheduled multiple ambulances to take him to the emergency room.
However, a driver was waiting for Palestinian patients on the opposite side of the border: Arnon Avni, 69, an Israeli graphic designer and political cartoonist who volunteers with Road to Recovery. NPR noted that Al-Kurd had arrived while the group was waiting at the checkpoint. A ride was offered, and Al-Kurd and his wife accepted.
Avni threw the booster seat for his grandchildren into the trunk and helped Al-Kurd, who was moaning in pain, into the car by putting the seatbelt on him.
An Israeli security checkpoint in the Israeli-occupied West Bank was the driver’s destination, which was entered into his GPS app.
Arnon Avni, a 69-year-old Israeli graphic designer, and political cartoonist drives Palestinian patients to their medical appointments as a volunteer with Road to Recovery. Yousef Al-Kurd, a resident of Gaza, needed a trip to the West Bank so he could have heart bypass surgery, and Avni kindly offered to take him there.
NPR’s Daniel Estrin
Although they did not speak the same language, Al-Kurd and Avni had many cultural and linguistic connections. A heart attack took the life of Avni’s father when the two were roughly the same age.
Al-Kurd said, “The pain is intense” as the car continued to drive down Israeli streets.
Fayez, his 58-year-old wife, was making her first trip to Israel.
She then remarked, “It’s another universe.” Not like the crowded confines in Gaza’s Jabalia refugee camp, she remarked.
She turned to Avni and inquired, “What is that bridge?” He merely said that it was an overpass. This was the first time she’d ever seen one, and the thought made her laugh.
Avni, speaking from behind the wheel, remarked, “I see the eyes of all of my passengers on my excursions.” “The roads, the vehicles, and the latest models all have the same generic feel. It’s not what you think it is. For me, it’s the equivalent of going to New York or somewhere along those lines.”
Avni resides in Kibbutz Nirim, which is close to Gaza. He had mortar bombs land outside his house last year, and his brother was assassinated by explosives hidden in their kibbutz by a Palestinian from Gaza fifty years ago.
Saying, “Some people call me a traitor,” he continued. As far as I’m concerned, we’re acting in Israel’s best interests.
Avni couldn’t accompany Al-Kurd and his wife to the hospital because an Israeli road sign at the Tarkumiya checkpoint near Hebron advises Israelis not to enter the Palestinian region. He let them out on the other side of the border patrol.
After saying their goodbyes, the Al-Kurds were quickly carried away in a Palestinian van to the hospital.
Hope quickly Fades
Unfortunately for Al-Kurd, he was not selected for the surgery he had been hoping for. There was a complete breakdown of his bodily systems only hours after he was admitted to the hospital. Two days later, the hospital called his son Ibrahim in Gaza, and Ibrahim recorded the conversation.
The doctor greeted Ibrahim by asking his status.
Oh, God, Ibrahim exclaimed in response.
The doctor added, “I’m with your mom now,” and paused. May your dad’s soul find eternal peace.
What could have been done?
Medical professionals are divided on whether or not Al-Kurd might still be alive had he been able to visit Israel sooner. The list of contributing factors is long. Given his history of diabetes and smoking, Al-Kurd represented a particularly high-risk patient. Fearing open-heart surgery and COVID, he waited an entire year before undergoing the procedure that his doctor had initially advised in Gaza. Due to Gaza’s subpar healthcare system, his deteriorating condition received little attention.
Ibrahim Al-Kurd, Al-son, Kurd accuses the Palestinian doctor of failing to treat the situation as an emergency, for which Israel should have granted expedited entry. However, medical professionals believe that may not have made a difference because Israel routinely delays or outright denies care for the most critically ill patients.
According to research conducted by the WHO between 2015 and 2017, individuals with cancer in Gaza were roughly 1.5 times more likely to die between months and years if their Israeli permits were delayed or denied.
WHO doctor Benjamin Bouquet, who co-authored the paper, said, “This is the only study that has been done at the population level to look at the implications on survival or on health outcomes of these patients that encounter delays and denials of licenses.”
The international community is making fresh attempts to assist the Palestinians in strengthening their health care system. Exorbitant costs associated with transporting patients elsewhere have been cited by the International Monetary Fund as a major contributor to the present Palestinian financial crisis.
To decrease Palestinians’ reliance on Israel and other nations for health care, the European Investment Bank and the WHO signed a partnership agreement in May.
Rik Peeperkorn, who heads the WHO office in the Palestinian territories, has observed, “The whole referral system is a significant load on the Palestinian health sector.” Since Al-death, Kurd’s other people in Gaza’s hospitals have passed away while waiting for clearance to receive treatment outside of Gaza for ailments including cancer or congenital heart defects.
A few weeks after his father’s death, Raji Al-Kurd, then 24 years old, gathered his family in the living room and asked a question. Imagine yourselves in my position, he pleaded. “Think you could handle being in that situation? Is that a situation you’d want a loved one to go through?”