Al Mezan Center for Human Rights presents its 2017 documentation in a new report that looks at the impact of Israel’s complex movement restrictions on medical patients in the Gaza Strip. The findings are alarming: 2017 marks the lowest recorded approval rate of patient permit requests and a sharp increase—to 20 deaths—of patients who are awaiting Israeli-issued exit permits. The restrictions have compounded the suffering of thousands of patients who would otherwise have access to hospitals that are a one- to two-hour drive away. The international community must urgently bring the closure and blockade of Gaza to an end and ensure the population’s unimpeded access to healthcare.

This report emphasizes that the protracted humanitarian crisis in Gaza is principally the combined result of the Israeli-imposed closure and blockade and the systematic destruction of public and private infrastructure. It is rooted in these practices and maintained through the severe restrictions on movement of people and goods. Included in this report are the profiles of the 20 medical patients from Gaza, including 11 women and three children, who died after their permit requests to exit Gaza for medical care were delayed or rejected by the Israeli authorities. This figure is up from two patient deaths in 2016 and speaks to the stringency of Israel’s current closure restrictions.

With total control over Gaza’s border crossings with Israel, the Israeli authorities use Erez crossing to regulate movement in and out of Gaza, with individuals—particularly patients—often detained, and sometimes ill-treated and coerced by Israeli security agents to give information in exchange for crossing permits. Patients who secure referrals and financial coverage from the Palestinian Authority and appointments at hospitals are allowed to submit requests for permits that, if issued, would allow them access to hospitals. Increasingly, the processing of the permit is delayed or rejected by Israeli authorities, leaving patients to face a serious deterioration in their health condition, or death.

By imposing a system that severely restricts access to healthcare, Israel is in serious violation of its obligations as an occupying power and a duty bearer under international law. These obligations, significantly, include the fundamental right to life and the absolute prohibition on the use of torture and other cruel, inhuman or degrading treatment or punishment. While restrictions on movement can be applied in certain conditions, which respond to justified military necessity and/or are for the benefit of the civilian population, a blanket ban on the movement of the entire civilian population, with limited exceptions, stands out as a form of unlawful collective punishment.

This report recommends that:

• - The international community and international organizations and agencies respect their obligations towards Palestinian civilians in the oPt, including the Gaza Strip, in accordance with international law. International humanitarian law must be respected and human rights should not be politicized.
• - The international community promptly intervenes to end the Israeli closure and blockade imposed on the Gaza Strip, where no effective redress is available for the victims.
• - The international community work towards ending Israel’s violations and efforts to prevent Palestinians from enjoying their right to health; enhance work that would improve Gaza’s health sector; secure unimpeded access of patients to hospitals, especially Palestinian hospitals in the West Bank, including East Jerusalem; and prevent detention and ill- treatment of Gaza’s patients at Erez crossing. 
• - The High Contracting Parties to the Fourth Geneva Convention take effective steps to ensure the application of the Convention’s humanitarian provisions regarding protected persons’ access to adequate medical care in Gaza; and
• - The international community take action to ensure that international justice mechanisms are used to seek accountability and to bring those who are found to have committed gross human rights violations and/or grave breaches of international humanitarian law to justice.