Ilia Yefimovich / Getty Images

In Gaza, medical permits linked to intelligence gathering

Thousands apply for permission to leave Gaza every year, and those who are rejected say they are never told why

GAZA CITY, Gaza Strip — Ramzi Kamal remembers his one encounter with an Israel Security Agency (ISA) officer at Erez crossing, the only passenger terminal between Gaza and Israel. It was early 2014, and he was in urgent need of ear surgery that could not be performed in Gaza. Kamal, a soft-spoken 31-year-old Palestinian plumber (whose name has been changed for his protection, along with those of several other sources), applied to the Israeli military for a permit to exit Gaza in order to have the surgery in East Jerusalem. In June he was instructed to report to Erez for a security interview without being offered a reason.

Kamal arrived at the crossing and, after being strip-searched, was led underground to an ISA officer for his interview. The initial questions were about his work. As a plumber, he must have been inside the homes of Hamas members — what did he see there? Who participated in Hamas military parades? Kamal insisted that he had seen nothing and knew nothing.

“I want to treat you, to make the surgery,” the ISA officer said. “If you serve the state of Israel, the state of Israel will serve you.” After more questioning, during which Kamal maintained he knew nothing, the ISA officer abruptly denied him a permit to cross.

The pain in his ear has increased since then, and the infection has spread. He has repeatedly reapplied for a permit, and in August, Physicians for Human Rights (PHR)–Israel took his case to an Israeli court. His case was denied in early October, and his requests were rejected. The reason given was security, but he has a different explanation. “Because I didn’t speak,” he said.

An empty, temporary hospital built by the Israeli army to assist Palestinians in Gaza, Aug. 1, 2014.
Eddie Gerald / Getty Images

Kamal is one of 18,266 Palestinians from Gaza who submitted applications in 2014 requesting to cross at Erez in order to access medical treatment outside Gaza’s collapsing health care system. Israel grants permission to most Gazans who apply to cross at Erez for medical care; last year more than 80 percent of requests were approved. Yet 528 patients were denied, 86 of them children, and 2,817 other patients had their treatments delayed while waiting for a response.

Reasons for denial, aside from security, are not provided. This lack of transparency is what is so maddening and frustrating for patients and their advocates. According to a report published by PHR-Israel, a typical rejection notice reads, “We would like to inform you that after considering the request, the competent authorities have decided to turn it down for security reasons, which cannot, naturally, be divulged.” Including Kamal, 179 of the patients who applied to leave Gaza for medical care in 2014 were summoned for ISA interviews.

Mor Efrat, a co-director of the occupied territories department for PHR-Israel, said security interviews violate medical ethics and exploit patients’ vulnerability. “The Israelis are using [patients’ need for treatment] in order to interrogate them and sometimes to tell them that they have to collaborate in order to get their permits,” she said, though she emphasizes that not all interviews rely on extortion or threats.

The ISA declined to respond to Al Jazeera America’s queries, but in a May 22, 2008, letter to PHR-Israel, regarding the organization’s concerns, the ISA wrote that it “does not make receipt of an entry permit into Israel for humanitarian reasons contingent on an applicant’s willingness to submit any information … The evaluation procedure, of which the security questioning is part, is a professional procedure intended to evaluate the degree of danger posed by the applicant.” That narrative was upended in July, when a representative of the Israeli prime minister’s office had a televised conversation with the family of Avera Mengistu, an Israeli presumed kidnapped in Gaza. “When people who are relatives of Hamas managers … wanted to come into Israel and receive medical care in Israel,” the representative said, “we told them, ‘No, give us information about Avera.’”

The year before, 43 veterans of an elite Israeli intelligence unit disclosed the use of blackmail in the country’s intelligence work, including on people in need of medical treatment outside Gaza.

They published an open letter stating that they “refuse to continue serving as tools in deepening the military control over the occupied territories.” One soldier revealed details of a recorded intelligence interview with a Palestinian. After telling the man that he knew his brother-in-law had cancer, an Israeli officer, according to the soldier, “said something like, ‘Our hospitals are good’ … He was clearly offering something to the Palestinian or threatening him.” Another soldier noted that any information that could be used for extortion was considered relevant in interrogations. 

Regev, one of the authors of the open letter, elaborated over Skype. He finds these practices problematic, he said, “exactly because the people who might be under this type of pressure are not protected by any rights.” Though he believes Israel has real security concerns and that aspects of intelligence work play an important role in preventing attacks, he said that many practices regarding Palestinians are not about defense but “about maintaining and continuing the operation of the occupation. And infiltrating all parts of Palestinian society to make sure that it continues.”

The officer knew Saber’s entire medical history and had intimate knowledge about his family members, including the names of his nephews, where in Russia his brother had studied and that his father, a former teacher, recently died.

In 2014, Hazem Saber (whose name has been changed for his protection) applied for permission to travel to the West Bank for surgery on a ruptured knee cartilage. Days before his security interview, a stranger reached out to him on Facebook with many personal questions. When he tried to pretend he was not in Gaza, the stranger replied that he knew where Saber was and which town he was from. “I know who you are,” the stranger wrote. “Finally he asked if I was willing to work with [the ISA] in order to get my permission,” Saber said, assuming the stranger was an Israeli security operative.

When Saber entered the Erez crossing, two officers led him into a tiny room, where they instructed him to strip. He was taken to meet an intelligence officer. “I know you,” the officer said. Saber had heard stories of Gazans being investigated, and so he believed the man to be Abu Karem, the pseudonym of the Israeli intelligence officer who focused on his town.

The officer knew Saber’s entire medical history and had intimate knowledge about his family members, including the names of his nephews, where in Russia his brother had studied and that his father, a former teacher, recently died. The officer even knew who watched the World Cup at Saber’s home the previous night and what the person wore.

The officer asked to see Saber’s bad knee, so he rolled up his trouser leg. Then, Saber said, the officer kicked his knee, and he passed out from the pain. When he awoke, he was back in the main terminal. His ID was returned, and he left Erez. He reapplied for a permit the following spring but was told that he was barred on security grounds.

Saber, who walks with a severe limp and relies on pain medication, insists that he’s willing to undergo another security interview and has nothing to hide. He has another medical appointment in mid-November and is waiting to hear if he will be permitted to cross Erez this time.

The Coordination of Government Activities in the Territories, the Israeli military unit that implements civilian policy in the Palestinian territories, said Israel assists patients “due to an understanding of the current limitations of the medical system within Gaza.” However, the unit states that it has no obligation to facilitate medical care for Palestinians in Gaza, referring to Israel’s unilateral 2005 withdrawal from the territory. “The state of Israel is no longer responsible for the welfare of the residents of the Gaza Strip … since it no longer controls the Gaza Strip.”

Human rights organizations disagree, as did an independent report commissioned by the United Nations, which said in June that Israel still exercises “effective control” over Gaza. Samir Zaqout of Al-Mezan Center for Human Rights pointed to Israel’s control over borders, sea, airspace, even electricity. He said that under the Geneva Conventions, Israel is obliged to ensure the population under its control can access health care services. “It’s a legal obligation, not a moral obligation,” he said. 

Hedaya and Sharif Sammur with their 3-year-old Zain. Hedaya was questioned by Israel's Security Agency when she tried to take Zain for treatment inside Israel.
Fadi Abu Shammala

Most patients interrogated at Erez leave after several hours. But some, like 25-year-old Mahmoud Issa (not his real name) endure a much longer ordeal. Issa, from the Beach refugee camp, was approved to travel to East Jerusalem for testicular surgery. Instead of receiving medical care, he was imprisoned for a month.

His ordeal began when he arrived at Erez and, rather than crossing as expected, he was sent for investigation. He remembers four men ripping off his trousers. They told him to remove the bloody bandage over his private parts so they could inspect the aftermath of a previous failed surgery. “I was in shock, and I was in pain,” he said. “I know of many people who had been investigated, but I hadn’t heard that they did this.”

After seven hours of questioning, Israeli officers cuffed his hands and feet, blindfolded him and transported him to a prison in the nearby city of Ashkelon.

Issa was interrogated for 10 days, during which time his testicle became infected and swollen. He was asked questions about his activities as well as those of another prisoner from the Beach camp and was then put in a cell with four people, who introduced themselves as leaders of the prisoners. Only later, after speaking to other former prisoners, did he realize that the men were likely “birds,” the term used for Palestinian informants disguised as prisoners. His week with the “birds” was followed by 10 days of solitary confinement.

He was then taken back to the investigation room. “We can help you get surgery and treatment,” Issa recalled the officers saying. In exchange, they wanted him to take photographs for them. He refused. The following day, he was taken back to Erez and allowed to go home — but not to East Jerusalem for surgery.

He is one of 10 patients and escorts who attempted to cross at Erez in 2013 but were detained for periods ranging from several weeks to over six months. He believes this strategy is related to Israel’s shortage of information about Palestinians in Gaza, since troops are no longer on the ground. “They wanted whatever information they could get. That’s what I felt,” he said.

Children seeking treatment aren’t interviewed by ISA, but their parents sometimes are. Lina al-Nadi, who has two children in need of ongoing eye treatment, remembers her interrogator asking about one of her husband’s in-laws, a former prisoner released in a 2011 prisoner exchange. In an affidavit, she told Defense for Children International–Palestine that the officer said to her, “Tell me where Mohammad goes and with whom, and I’ll treat your daughter.” When she denied knowing anything, he said, “It seems you don’t want your children to be treated in Israel.” Since then, the children have not received any medical assistance.

Hedaya Sammur, who works for the Interior Ministry in Gaza and whose son Zain was born with a congenital heart ailment, said she was contacted by a woman who identified herself as an employee of the Erez crossing. According to Sammur, the woman offered to provide her with access to an American doctor to treat her baby. But beforehand, Sammur said, the woman asked to meet for lunch or coffee, calling her “educated and open-minded.” She left Sammur — whose 3-year-old still hasn’t received the necessary follow-up surgery — with words similar to those spoken to Kamal at Erez: “Cooperate with us, we cooperate with you.”

With reporting contributed by Fadi Abu Shammala

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