Consider This from NPR - Following The Journey of One Palestinian Seeking Medical Care In Gaza

Episode Date: April 27, 2022

One Palestinian man's struggle to get life-saving medical care while living in the Gaza Strip highlights many lesser-seen victims of the Israeli-Palestinian conflict: Since the militant group Hamas took over Gaza 15 years ago, Israel's travel restrictions have resulted in many barriers for Palestinians seeking critical health care.Palestinians can try to get medical treatment both in and outside of Gaza, but need a travel permit to choose the latter. And while Israel grants thousands of travel permits a year, the timeline for securing one can be long. Some doctors have also fled Gaza. All of these factors can pose dangerous delays for vital treatment.NPR Jerusalem Correspondent Daniel Estrin followed one patient's difficult journey to get heart surgery.In participating regions, you'll also hear a local news segment to help you make sense of what's going on in your community.Email us at [e-mail] more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

This message comes from Indiana University. Indiana University performs breakthrough research every year, making discoveries that improve human health, combat climate change, and move society forward. More at iu.edu forward. Yousef Al-Kurd is Palestinian and has been called one of the most famous audio technicians in Gaza. That's Kourd's son, Ibrahim. Ibrahim says his dad studied electrical engineering in Germany, then he returned home to a career fixing sound systems in Gaza. Sound systems like the Mosk loudspeakers you're hearing right now.

Kourd was a technician for 30 years before retiring. He trained his sons to be audio engineers. And in his son Ibrahim's workshop, Kourd had his first heart attack in 2020. Suddenly, one day from nowhere, he just started to feel the cardiac attack. He survived, but a doctor said he'd need heart surgery. Kord put it off due to fears of COVID, but when his condition worsened, Kord's sons rushed him back to Gaza's Shifa hospital.

The surgery is very urgent, Ibrahim said, but they couldn't find many doctors who could help, and his family was struggling to get Israeli permission to travel to a hospital in the West Bank. Getting life-saving care has become so difficult in Gaza, there are thousands trying to get treatment elsewhere. It's exactly the kind of story you would stumble upon in Gaza, as NPR's Daniel Estrin did. I hear these stories, people struggling to get health care for themselves or for someone in their family, they're caught up in this web

of conflict and suspicion and geopolitics. And it's been getting worse over the course of 15 years. If you're really sick, you are bound to get caught up in it. Consider this. Any medical crisis can be unpredictable and scary. For Palestinians in the Gaza Strip, that unpredictability often means dangerous delays in treatment because of travel restrictions into Israel. From NPR, I'm Ari Shapiro. It's Wednesday, April 27th. This message comes from WISE, the app for doing things in other currencies. Send, spend, or receive money internationally, and always get the real-time mid-market exchange rate with no hidden fees. Download the Wise app today or visit wise.com.

T's and C's apply. It's Consider This from NPR. Since Hamas took over Gaza 15 years ago, Israel and much of the world have tried to isolate it. Israel imposed a blockade, and Egypt restricted its border too. Israel says that blockade is necessary to contain Hamas, which is considered a terrorist group by Israel, the U.S., and the EU. But two million Palestinians live there, and human rights groups call it collective punishment. Well, if you want to have a deeper understanding of how this conflict is playing out, you could definitely start with the question, what if someone gets sick, like really sick? I wanted to understand what it takes for someone in Gaza to get care.

That's NPR Jerusalem correspondent Daniel Estrin. He and colleague Anas Baba set out to report at Gaza's main hospital late last year. And that's where, by chance, they found Yusuf Al-Khurd with his son Ibrahim in the waiting room. At this point, the family had been trying desperately to get Israeli permission to leave Gaza for surgery. Wow, everyone is crowding here. Security guards are trying to control the crowds, clamoring to see a doctor. Can we ask someone what they're doing here? And in a sea of patients, we approach one man with a

trim beard and a gaunt face. I haven't slept since yesterday, he says. His name is Yousef Al-Kurd. He's 70 years old, and he's with his son Ibrahim. Why did you come here? He needs heart surgery. Three months. We are

suffering for three months now. We just want him to be operated. Should we take his number? Daniel Estrin did take their number and he ended up following the family's struggle to find care in Gaza, including how the doctor they had been working with had left.

Daniel picks up the story from here. We went back to Dr. Mohamed Nassar, and I was totally shocked and surprised that Dr. Mohamed Nassar left Gaza forever. The head of cardiac surgery had left for Spain, following the path of many doctors fleeing Gaza's tough conditions over the last few years. A new doctor was put in charge. Hello, my name is Dr. Saher Abughali. I'm 40 years old. He was one of only four remaining cardiac surgeons in Gaza.

But a doctor in his department died, actually, of cardiac arrest. A month after that, another died of COVID. From four, we became three, and now we became two. Only two heart surgeons are left in Gaza for a population of two million. That's what Dr. Abu Ghaili told me when we spoke earlier this year, and it's still the case. He thinks Gaza needs 10 surgeons. In the U.S. and Europe,

the accepted ratio is about 55. Not only we are, the number of the surgeons is just only two. This is not the only problem. You don't have all the instrumentation. You don't have all the resources. Israel restricts the import of medical devices, like some x-ray equipment. It says Hamas could convert for military uses. And the Palestinian authority in the West Bank doesn't give Gaza enough medical supplies. The reason for that might be that it's rivals for power with Hamas. So there are chronic shortages of supplies, like something called a cannula, the thin tube they place in your heart during bypass surgery. Dr. Abu Ghali says you're supposed to only use them once and throw them away.

Here, every cannula is re-sterilized more than 100 times. Yes, this is true. This is Gaza. Because if you want to use it once and throw it out, you will not operate. You will never operate. Now, Israel does let doctors into Gaza to help a few days a month, but that's not enough. And with the blockade, Israel doesn't let out Palestinian doctors very much to get training. With the health system stretched so thin, it's too risky to do a lot of complex procedures in Gaza. Yousef Al-Kurd needs coronary artery bypass surgery, and Dr. Abu Ghali can't do it. It's difficult to be done safely in Gaza. We need heart surgeons, we need vascular surgeons, we need the instrumentations.

It was a very high-risk surgery for us. The doctor recommends he go to a better-equipped Palestinian hospital in the West Bank, a Palestinian territory not controlled by Hamas and not under blockade, less than two hours away. But when I meet him in that waiting room in the hospital, he's stuck, waiting for Israeli permission to get out to the West Bank. He's already scheduled the surgery a couple of times but missed it each time. He didn't have the Israeli permit he needed for

travel. The surgery is very urgent, his son says. He's afraid if his father doesn't get an Israeli travel permit for surgery, he might not live much longer. Let's pause the story here to note, Israel does grant thousands of permits a year, but they're often delayed and they are closely screened. First Palestinian Authority doctors have to approve the treatment. The PA pays for the care under its government-run healthcare system. But the money, a lot of which comes from international donors, is tight. And the doctors know Israel only grants permits for dire cases. Daniel Estrin talked to a Palestinian doctor who has to make the difficult choices. We start in the West Bank at the Palestinian Health Ministry,

where they review referrals sent by doctors in Gaza. Most are cancer cases. There's very little chemotherapy in Gaza and no radiation therapy. The second most common patients are heart patients, like Yousef Alkord, who we're following. Thank you for seeing us. You are welcome. Thank you.

When we visit the office, it's Dr. Haitham Al-Hidri in charge of granting the final approval for medical coverage. He tells us he has to say no a lot. They have a tight budget, mostly from the U.S. and other international donors. And Israel only allows critical cases to cross the border. The competition is so intense, he's fired clerks who took bribes to put patients on the list. As we're talking, his colleague comes in the office with an urgent case.

There's a 25-year-old on the operating table in Gaza with a life-threatening vascular problem in his jaw. His surgeon can't handle it and wants to send him to an Israeli hospital right away. Dr. Hidry calls the young man's doctor in Gaza. And he asks him, is it really urgent? He tells the Gaza doctor, I know the patient's family is pressing, everybody's pressing to get him to Israel. If he's bleeding, I'll let him out. If he's not bleeding, I won't let him out. You're the doctor in charge of him. You must give the last word. So he's not bleeding. He is not inactive bleeding, some oozing from the side of the

surgery. So it's not active bleeding. So it's not top emergency. We can wait and we... Oozing, not bleeding. It's an example of just how selective he has to be. In the end, he decides not to take chances. He approves the coverage and coordinates the patient's quick transfer to an Israeli hospital. He says Israel does grant permits for most of the really urgent cases. Top emergency cases, I can deal smoothly with these patients. But here's the thing with heart patient Yousef Al-Khord. His surgeon didn't fast-track him because he thinks he can wait a month for bypass surgery. In the meantime, he tries to get an

Israeli travel permit. And Israel is wary of letting in anyone from Hamas-controlled Gaza. I talked about this with an Israeli researcher at Tel Aviv University, Haral Khorev. It is not self-obvious that Israel will provide its enemy the treatment they need. They can go to Egypt, for example. About one in five patients does go to hospitals in Egypt, but they're much farther away, and Palestinian health authorities prefer to keep patients inside their own system. And that means going through Israel. But there have

been isolated cases where Israel has accused patients of smuggling explosives or spying for Hamas. The whole thing is about trust. But once you break that trust, once you break it, then you send someone with cancer with TNT, and he's being caught, you know, obviously it does a lot of damage. Israeli officials say they allow in only humanitarian and exceptional cases, more than 10,000 permits last year. But rights groups say the screening process is a mystery. It's really a black hole for us to understand the criterias. That's Ron Goldstein. He directs Physicians for Human Rights Israel. They try to help Gaza patients get permits. Many, many of cases are not really security issues because when we intervene, suddenly the

person receives the permit. Now Israel does grant most permits, but the World Health Organization says about a third of applications was delayed or denied last year. The WHO estimates it's thousands of people who have to reschedule things like surgery or chemo, and they often get more and more ill as they wait. That's exactly what happened with Yusuf Al-Khord. Israel didn't grant him a permit in time for his surgery. His son, Ibrahimbrahim rebooked it, still no permit. He got a third appointment. The whole time, Israel said it was reviewing the request. The Israelis always postpone, and this is just sluttering us from the inside and the outside. About six weeks pass with no answer. Remember, his doctor said he shouldn't wait for surgery for more than a month.

And so Kurd's son asks the Palestinian Center for Human Rights in Gaza to intervene. Lawyer Mohamed Al-Alami shows us the letters he sent to the Israeli authorities. Two more weeks go by with no permit. And remember, this is just a permit for travel. Israel is not involved in providing the treatment. So the lawyer calls his Israeli contact and asks her, why the delay? What's the security risk with a 70-year-old man?

The lawyer says the officer told him, Kurd has six phone numbers registered under his name. The Palestinian lawyer thinks Israel reviews patients' phone calls and multiple phone numbers raises questions. The Kurd family says there's a logical explanation. Each family member uses a different number, like a family plan. So the lawyer sends that info to his Israeli contact. Every day like this. Every day. Pleading is part of the job in trying to get these permits. One Palestinian official takes pictures of patients with their bulging neck tumor, their sick baby.

He says that tends to win Israeli officers sympathy. I asked the Israeli agency in charge of Yusuf Al-Kurd's case. They said there was missing paperwork. They say that's a common reason why they delay permits. But the family and their lawyers say nothing was missing, and Israel never mentioned that to them. While Youssef Al-Kurd is awaiting the permit, his blood pressure suddenly drops. He stops urinating. A couple more days go by, and then his son Ibrahim says they get a text message with some good news. An Israeli travel permit, more than two months since they first applied. He can get to the

hospital in time for his surgery. It's a glimmer of hope as his health is getting worse. Kurd waited for more than two months before he got Israeli permission to leave Gaza for a Palestinian hospital in the West Bank. And that's where we turn as this story comes to an end. The next time we meet Kurd, he's making the journey from Gaza to the West Bank, through Israel, to get to the hospital. The Erez Crossing is one of the world's most heavily fortified border crossings. It's Israel's one civilian crossing with Gaza. Hamas, committed to armed conflict with Israel, is contained on the other side.

So are two million Palestinian civilians. Israel's policy is to keep the Palestinian territories divided to seal Gaza off from the West Bank. I'm on the Israel side of this crossing, waiting for 70-year-old Yusuf Al-Khurd, who's waited for months for this moment. A Palestinian lawyer pleaded with Israeli authorities to give him security clearance to get heart surgery. And finally, he's allowed to cross with his wife, Faiza. I'm weak, he says. At 5.30 a.m., he said goodbye

to his children and left home, waited hours at the Hamas checkpoint leaving Gaza. Then at the Israeli crossing, he had to raise his arms in a full body scanner and he crumpled to the floor. Israeli attendants rushed him a wheelchair. No one told his family they could arrange an ambulance. But there is a driver here, and he's Israeli. He volunteers with a peace group called Road to Recovery.

They're Israelis who drive Palestinian patients to their medical appointments. This driver is named Arnon Avni. He's nearly 70 years old. He's a graphic designer and a political cartoonist. Okay, let's get them in. And we are ready to go. Should we pull the seat up a little bit? Okay.

Okay. Oh. Oh, yeah. Should we pull the seat up a little bit? Okay. Yusuf Al-Kurd is in pain. Takumir. The Israeli volunteer driver puts the destination in his navigation app, a checkpoint in the Israeli-occupied West Bank. Do you speak any Arabic, or no? No, a few words. Not really speaking.

Do you speak English? Half-half. Half-half. And Yousef, do you speak English? Deutsch. Deutsch? Deutsch. Oh.

He studied to be an audio engineer in Germany decades ago. He and Avni don't share a language, but they do have some things in common. They're about the same age, and Avni's father died of a heart attack. Oh, he's complaining about his chest. That's a contact. I'm sorry. Oh, my God. The pain is severe, he says. Kurd's wife Faiza is in Israel for the first time in her life. She's 58. She says it's another world. It's clean, it's wide, it's open. It's not everyone is squished together

like in Jabalia refugee camp where she lives. I see the eyes of all of my passengers, all my travelers. All of them feel the same. She asks, what's that bridge? She's never seen an overpass before. Her husband is one of thousands each year who have to reschedule their surgery and treatments over and over until Israel grants them a security clearance to leave Gaza for the hospital. Advocates have raised this issue for years, and volunteers like

this Israeli driver try to help. She said, bless you, it's a humanitarian action, what you're doing. Avni lives right next to Gaza. Mortar shells landed outside his home last year. And five decades ago, a Palestinian from Gaza planted explosives in their kibbutz, and his own brother died. Avni drives Gaza patients to the hospital to try to make things better. Some people call me a traitor. A traitor. We are in minority, but I believe that we do the right thing for Israel. An Israeli road sign warns Israelis not to enter the Palestinian territory, so Avni can't take them all the way to the hospital. We drop them off just on the other side of the checkpoint.

Yeah, the speed bumps at the crossing are a little hurting him. He's suffering. Yeah, the speed bumps at the crossing are a little hurting him. He's suffering. We flag down a Palestinian driver and then help Kurd get out of the Israeli driver's car and into the Palestinian van. We say our goodbyes before they drive off to the hospital in the West Bank city of Hebron. Tell them I wish them all the best.

I wish you all the best. to the hospital in the West Bank city of Hebron. She's happy to meet you and she wishes you all the best. But this moment of hope quickly fades. Kurd doesn't end up getting the surgery he's been waiting for. Hours after he arrives in the hospital, he has multiple system failure. Two days later, his son Ibrahim in Gaza gets a phone call from the hospital. Ibrahim, how are you? The doctor says. Oh God, the son replies.

I'm with your mother now, the doctor says. Your father, may he rest in peace. He played this phone call for me when we were visiting the family in December, a few weeks after the funeral. For the first time, I see Faiza cry. I'm so sorry. phone call for me when we were visiting the family in December, a few weeks after the funeral. For the first time, I see Faiza cry. I'm so sorry. I turned to her son. I'm so sorry about your father. I was so hopeful that he would get the treatment he needed and that this would be a happy ending. I was just like you, Daniel.

I was hoping for the happy ending. As we gather our belongings to leave, his 24-year-old son, Raji, who's been silent nearly the whole time, speaks. I just want to ask you, put yourself in my shoes. Would you like to face those circumstances? Would you like to see one of your beloved facing those circumstances? I spoke with Daniel about Kurd's story and asked whether there could have been anything done to possibly save him. I asked health experts about that, and no one can really say for sure.

There were a lot of factors. Kurd had diabetes. He was a smoker. He went a year without getting the surgery his doctor had ordered. And then the medical system in Gaza is poor. There was very little patient follow-up when his condition got worse. His son thinks it's the Palestinian doctor's fault, that the doctor should have marked the cases urgent, and then Israel would have let him in immediately. But when I asked the World Health Organization about that, they said even some urgent cases get delayed and denied by Israel. What we do know, Ari, is that in general, these kinds of delays can be deadly. The WHO studied Gaza cancer patients and found that they have died at a higher rate when their

Israeli permits were delayed or denied. This system clearly fails a lot of patients. What can be done to fix it? Well, the World Health Organization says Israel can do a lot. Israel does let in thousands of Palestinian patients every year. But the WHO says the permit process can be sped up. The criteria can be made clearer. And it says Israel should end its restrictions, which Israel says it needs for security, on importing some medical equipment into Gaza. The WHO also says the Palestinian Authority can also help. It can get more medical supplies into Gaza. And in my own reporting, Ari, I heard accusations of corruption in how Palestinian officials select patients for travel.

So there are very, very specific things that can be fixed. But the WHO has been documenting these problems for years. Why hasn't the system changed? Well, each side blames the other. You know, if only Israel would end the blockade of Gaza, or if only Hamas would stop attacking Israel and cede control, then it wouldn't be this way. But you see, the system is just resistant to change. What I learned following this one man's

story is that on a person-to-person level, you can bend the rules. You know, Palestinian advocates can send frantic WhatsApp messages to Israeli border authorities. They send photos of sick patients to Israelis and get their sympathy. And Israeli advocates even petition their own courts and manage to get patients through. So it's easier to win an exception to the rule than to change the rule. Really, Ari, it's just one way to summarize the entire dynamic between Israelis and Palestinians. That's NPR Jerusalem correspondent Daniel Estrin. You're listening to Consider This from NPR. I'm Ari Shapiro.