According to figures released by the World Health Organization (WHO), in 2018, Gaza residents submitted a total of 25,897 permit applications to travel via Erez Crossing for the purpose of receiving medical treatment in the West Bank or Israel; an average of 2,158 applications were submitted each month. Israel only approved 61 percent of the applications submitted during the year; 31 percent of the applications did not receive an answer in time for the applicants to reach their appointments for treatment outside the Strip, or never received an answer at all. Some 8 percent of the applications submitted were denied by Israel.
The number of applications denied by Israel in 2018 rose by 180 percent compared to 2017. The rate of applications approved in 2018 was similar to that recorded in 2016; it increased by 14 percent in 2018 compared to 2017. The increase in applications approved over the year is reflected in a slight increase in travel through Erez Crossing: In 2018, the monthly average of patients exiting the Strip via Erez for medical treatment was 2,515, compared to a monthly average of 2,043 in 2017.
The dire state of Gaza’s health system, further exacerbated by the ongoing electricity crisis and shortage of fuel used to operate hospital generators, means that certain types of medical treatment cannot be obtained in the Strip. As a rule, Israel only allows entry into its territory for the purpose of transit for medical treatment, if the treatment is “life-saving” or “life-altering,” and on the condition that it is not available in the Strip.
In order to submit a permit application to travel via Erez Crossing for medical treatment, Gaza patients must first obtain a referral from the Palestinian Authority (PA), who covers the cost of treatment, then they must file a permit application with the health coordinator of the Palestinian Civil Affairs Committee (PCAC) in Gaza, run by the PA. The PCAC passes permit applications to the Gaza Civil Liaison Administration, the Israeli authority responsible for processing all permit applications concerning residents of the Strip.
According to a directive introduced by Israel in 2017, Israeli authorities have 23 business days to process permit applications submitted by patients from the Strip in order to reach medical treatment, that is, no less than a month, regardless of the patient’s appointment or condition. WHO data from 2018 indicates that this timeframe, if it is met at all, does not meet the needs of at least 31 percent of Gaza patients seeking treatment that can only be reached outside the Strip.
Permits for travel for medical purposes are often used by Israel as leverage over Gaza’s civilian population: In 2018, Israel denied several hundreds of applications filed by Palestinians from Gaza for medical treatment on the grounds that the permit applicants were allegedly “first-degree relatives of Hamas operatives.” Last August, following a petition filed by Gisha challenging this policy, the High Court ruled that the Israeli Security Cabinet’s decision to deny Gaza patients access to medical treatment as a means of leverage over Hamas was not only ineffective, but also unlawful.