Aryeh Dayan


You can’t show medical papers to concrete blocks and deep trenches

(24 June 2001)


HA’ARETZ (English Edition), Sunday, June 24, 2001
Ha’aretz English website (

For a decade, the Physicians for Human Rights organization has petitioned the High Court, demanding that formal crossing rights be arranged for Palestinians who require emergency medical treatment and who need to pass through Israel Defense Forces checkpoints.

Responding to each High Court petition, the IDF has claimed that procedures for such emergency crossings are already in place; for the Court, the army’s promise to publish these existing procedures anew has sufficed. Yet a June report published by B’Tselem, the Israeli Information Center for Human Rights in the Occupied Territories – “No Way Out: Medical Implications of Israel’s Siege Policy” – documents eight cases in which infirm Palestinians found that their shortest road to medical treatment was blocked. In two cases, the patients died.

Zarifa Hassan Anis a-Sa’ad, 49, from Silat al-Harthiyal in the Jenin region, is a housewife, and the mother of nine. She suffers from cancer. After her brain tumor was discovered three years ago, she underwent two operations at the government hospital in Ramallah, along with radiation treatment at Assouta Medical Center in Tel Aviv. She had scheduled another operation at the Ramallah hospital for March 14, this year. Aware that IDF enforced closures have made it hard for Palestinians to travel from Jenin, in the northern part of the West Bank, to Ramallah in the center, a-Saad’s neighbors advised that she leave for the operation two days in advance. A-Saad and her husband heeded their counsel.

The start of the journey went well. They left their home at Silat al-Harthiyal at 7:30 a.m. on March 12, and reached Jenin in a taxi after less than half an hour. But during the next taxi trip, from Jenin to Nablus, the neighbors’ pessimism seemed prescient. The 40-kilometer journey between the two cities lasted more than three-and-a-half hours; the two main roads which run between Jenin and Nablus were blocked-off by the IDF, and so the cab driver had to wend his way to Nablus on rough, dirt roads.

At the Nablus central bus station, they embarked on a bus slated for Ramallah; but the bus only made it as far as the Burin junction, about halfway between the two cities. IDF soldiers at the Burin checkpoint ordered the bus driver to turn around and head back to Nablus. The driver did what he was told to do. So at 3:00 p.m. a-Saad and her husband found themselves back in Nablus. They decided to sleep at a relative’s house, and to resume the journey to the Ramallah hospital the next morning.

On March 13, the couple tried the sherut, the taxi service, which runs between Nablus and Ramallah. The cab driver bypassed the Burin checkpoint by using dirt roads. After a journey of three hours, a-Saad was waylaid by a new obstacle: concrete blocks and dirt trenches at a roadblock near the al Jalazun refugee camp.

Passengers in the cab decided to get out and cross the roadblock by foot; they hoped to find another cab on the other side.

At this point, “my head hurt terribly,” a-Saad testifies in the B’Tselem report. Weakened by her disease, she couldn’t walk on her own, and needed to be carried by her husband and two other passengers. They found a cab, which took them as far as the Surda village; at Surda they were derailed because the IDF had dug up the road as part of the closure policy, to prevent cars from going to Ramallah. Once again, a-Saad had to be carried by her husband and passengers to the other side of an IDF roadblock. There she boarded another cab – the third taxi of the morning – and was taken to the Ramallah hospital. She arrived seven hours after her departure from Nablus.

Hers is not the only such story. Litfiyeh Ibrahim ‘Abdallah Jaludi, 41, a married mother of six from the Pequ’a village in the Jenin region, undergoes dialysis treatment for her kidney ailment three times a week at Nablus’ Altuni Hospital. Instead of the relatively short route she took prior to the eruption of the Intifada, her current agonizing, twisting journey along back roads lasts between three to four hours. “The great trouble and difficulty in getting to the hospital is too much for me,” she told B’Tselem.



No entry: Go back

A-Saad’s and Jaludi’s stories are two of the eight cases examined in the new B’Tselem report. In two of the other six cases, patients whose paths to hospitals were impeded died. The B’Tselem report analyzes how the IDF closures, which cut-off cities and villages from surrounding areas, can be truly hazardous to the health of residents of the territories.

“Israel’s siege policy impairs the ability of the sick to reach hospitals for treatment and of ambulances to transport the sick and wounded. It also creates other health problems,” the report declares.

“No Way Out” is not B’Tselem’s first analysis of the impairment of medical treatment in the territories. Responding to the human rights organization’s previous report on the subject (which was released in January 2001), the IDF Spokesman said: “There are orderly procedures whose goal is to guarantee checkpoint crossings in cases of medical emergency.” But B’Tselem’s new report suggests that any such existing procedures are of little help to Palestinians: residents of the territories usually risk aggravating their health problems by making arduous journeys along rough, dirt roads which skirt around IDF checkpoints; bypassing the IDF soldiers, they prefer not to try to ascertain whether any emergency crossing clearance procedures are in effect.

Though such behavior might, at first glance, appear irrational, there are actually some compelling reasons to warrant it. In recent years, the Physicians for Human Rights organization has compiled reams of data attesting to harassment and obstruction policies enforced by IDF authorities at checkpoints.

Established in response to the first Intifada uprising, Physicians for Human Rights has devoted much of its effort to the legal sphere, hoping to formulate crossing rights for the infirm in written, binding laws. In this effort to finalize procedures which would be honored by IDF soldiers at roadblocks, the Physicians group has turned to the High Court four times. In each instance, the IDF has countered by claiming that crossing procedures are already in place – each time, the Court has gone along with the army, and quashed the petition.

Two weeks ago, more than 10 years after the Court’s discussion of the first emergency crossing petition, one B’Tselem field worker witnessed Litfiyeh Ibrahim ‘Abdallah Jaludi attempt to cross an IDF checkpoint en route to dialysis treatment in Nablus. “Do they want to go the hospital,” an IDF soldier asked B’Tselem’s Hashem Abu Hassan, who took Jaludi in his car. Suggesting that the answer to his question was irrelevant, the soldier then said: “No, there’s no entry by car, turn around, go back.”

The IDF continues to claim that such occurrences never, or shouldn’t, happen. This week the army said once again that there are emergency crossing procedures, and that it is doing its utmost to ensure that soldiers at checkpoints know about them.



The first petition

Closure policies in the past months whereby main access roads to many Palestinian communities have been blocked by deep trenches and concrete blocks have rendered this argument about crossing procedures a moot academic exercise. In the past, when they came up to manned roadblocks, Palestinians sometimes found soldiers who responded positively to their medical papers and needs, and allowed them to go through.

Under the new closure policy, however, there’s no depending on the kindness of strangers in army uniform: You can’t show medical papers to concrete blocks and deep trenches.

The Physicians for Human Rights group submitted its first emergency crossing petition in February 1991, at the time of the Persian Gulf War. The petition was prompted by the wide-scale curfews and closures which were clamped on the West Bank when the war erupted. The Physicians organization asked the Court to allow medical crews free movement to and from hospitals; the demand derived from a specific incident in which a girl from Hebron died when her parents were held up at a checkpoint, despite their plea that they needed to get to a hospital.

By the time the High Court got around to the petition, the Gulf War had ended. Thus, it seemed that the various West Bank closure and medical issues raised by the petition had been resolved in the absence of a legal ruling. Though they ordered that the petition be withdrawn, the High Court justices instructed the IDF to take steps to prevent the re-occurrence of similar problems when closures might be enforced anew in the territories.

“It seems to us,” wrote a three-justice panel led by then Supreme Court President Meir Shamgar, “that the subject raised by the Physicians movement and patients at the time of the past closure should be addressed via the publication of a special, comprehensive order formulated in Hebrew and in Arabic. As a supplement to this listing of procedures, examples should be given of documents provided to medical crews and ambulances. Most importantly, there should be a detailed explanation of courses of action available to a patient and his family members when they find themselves in a dire situation, needing medical help at a time when a closure is in effect.”

The three-justice panel explicitly stated that newly formulated medical-emergency crossing procedures “should serve as permanent directives enjoining soldiers who are deployed at roadblocks.”



Born and died at a checkpoint

Five years went by before another incident highlighted the need for formal, accepted crossing procedures. In September 1996, Faiza Abu-Dahauk reached an IDF roadblock on the outskirts of Jerusalem, near the Ramot neighborhood. Her brother-in-law drove the car, and her mother accompanied her. About to give birth, she asked to be allowed to travel to Augusta Victoria Hospital; but the IDF soldiers stopped her. The same thing happened at two other army checkpoints when the Abu-Dahauk family begged to be let through – both at the A-Ram junction, and at the roadblock near the Ras al-Amud neighborhood. In the end, she gave birth near the Ras al-Amud roadblock, and then proceeded to set off to the hospital by foot, carrying her child. By the time they reached the hospital, the infant was dead.

Also in autumn 1996, a similar tragedy befell Hanan Zair, from the Hussan village: her twins died shortly after birth, during a journey from their home to Bethlehem.

These two tragedies stirred Physicians for Human Rights into action once again. Once more, the organization petitioned the High Court, demanding that clear crossing procedures be formally adopted.

In this case, the State Prosecutor and the IDF didn’t wait for the High Court justices to issue directives. Before the Court started hearings on the case, the army and the State Prosecutor’s office submitted a copy of checkpoint crossing guidelines to the petitioners. Then, following some negotiation with the Physicians organization, a revised set of procedures was furnished to the Court for review.

“In general,” the procedures stated, “the commander at a checkpoint will allow a person to cross for medical treatment purposes, even if that person lacks necessary written authorization, whenever the case is a medical emergency. The checkpoint commander has the authority to decide whether a case is an urgent medical emergency. In an instance when there are questions as to whether or not the case is an emergency, the resident will enjoy the benefit of the doubt.”

The IDF promised the justices that these procedures would be distributed to all soldiers at checkpoints. In exchange, Physicians for Human Rights agreed to revoke its petition.

The third petition was submitted at the end of 1999, in response to two incidents which occurred at an IDF checkpoint that separated two parts of Hebron. Kosmai Sultan, three months old and stricken with pneumonia, who lived in a part of the city under Israeli control, was delayed with his mother for an hour at the IDF roadblock. He died a short time after reaching a hospital in Hebron’s other, PA-controlled, section.

Similarly, Padwah Al-Adam, a pregnant woman who lived in the Israeli-controlled area, wanted to give birth in the hospital on the other side of the IDF checkpoint – she lost her child after IDF soldiers stopped her from going through.

Responding to these cases, Hadas Ziv from Physicians for Human Rights demanded that the IDF put the checkpoint soldiers on trial for violating procedures which the army itself submitted to the High Court three years earlier. The army demurred. So, once again, the Physicians organization went to the Court.

In its petition, the Physicians group argued that the IDF had infringed the promise it had made in 1996. It charged that soldiers at checkpoints weren’t aware of the guidelines which the State Prosecutor and the IDF had submitted to the Court.

During the 1999 hearing, state officials did not entirely deny these charges. “In response to the submission of these charges holding that soldiers weren’t briefed about the set of procedures submitted to the High Court, the IDF has carried out a series of clarifications whose purpose was to determine whether the guidelines were indeed disseminated to the various [army] units, whether the soldiers know about them, and whether measures they take in the field completely match the directives that were submitted to the High Court,” said attorney Shai Nitzan, from the State Prosecutor’s office. He added: “These clarifications have not been completed, and so clear, unequivocal findings cannot be brought to the Court.”

Justice Mishael Cheshin granted the IDF a reprieve, rescuing it from any unpleasantness that might have arisen had findings from this clarification process been made public. In his ruling rejecting the Physicians petition, Cheshin overlooked the question of whether the IDF had reneged its 1996 promise. Instead, the justice thought it was enough to require the army to “complete the [provision of crossing] orders to soldiers by January 13, 2000”.

Less than a year after this deadline date, several weeks after the eruption of the Al-Aqsa Intifada, Physicians for Human Rights submitted its fourth petition. “It is ten months after the date on which the [third petition] respondents were obligated to implement the procedures,” Physicians group attorney Eran Lev noted. “Regrettably,” he continued, “since the outbreak of the recent events, and due to the draconian implementation of the closure policy, the respondents aren’t complying with this obligation.”

The Physicians petition detailed two incidents in which patients were held-up at checkpoints, calling them the “tip of the iceberg of the humanitarian problems created by the enforcement of the new closure policy.” An affidavit filed by Palestinian Red Crescent medical workers which relates to 121 other impairment cases was appended to the Physicians petition.

In this fourth case, state officials argued that IDF soldiers act on the basis of procedures submitted in the past to the Court. They stated that there isn’t a single Palestinian community on the West Bank surrounded on all sides by unmanned (concrete block or trench) roadblocks. And the State Prosecutor refused to relate to the contents of the Red Crescent affidavit, branding it “a scandalously formulated, incendiary and mendacious document.”

Justice Cheshin once again headed the Court panel which considered the Physicians petition. He refused to compel the State Prosecutor’s office to relate to the Red Crescent document – with apparent cynicism, he proposed to the Physicians organization that it submit its own report regarding the 121 cases reviewed by the Red Crescent.

Calling it “too sweeping”, and complaining that it lacked a “factual basis that would suffice for the requested order, Cheshin rejected the Physicians organization’s fourth, and most recent, petition.

Cheshin’s decision was announced on March 21, one week after Zarifa Hassan Anis a-Sa’ad, the ailing cancer patient from Silat al-Harthiyal, embarked on her Via Dolorosa, trudging along bumpy dirt roads for two days, writhing in pain with a brain tumor, trying to get to the Ramallah hospital in time for surgery.


Last updated on 4.8.2001