Israeli security forces endangered patients’ lives at al-Makassed hospital, East Jerusalem

10 August 2017

B’Tselem’s investigation reveals that in their raid of the hospital, Israeli security forces hampered medical treatment, assaulted staff and intimidated patients.

On Friday, 21 July 2017, at approximately 3:40 P.M., dozens of Israeli police officers entered the al-Makassed hospital compound in East Jerusalem, seeking to arrest a young Palestinian who had been wounded by gunfire – Muhammad Abu Ghanam (20) from a-Tur. When they entered the courtyard, youths and hospital guards tried to prevent them from going inside the building. The officers responded with stun grenades and sponge-round fire. About half of the force entered the building, where they split up and searched various wards for the injured youth. B’Tselem’s investigation, detailed below, revealed what took place in the hospital over the next forty minutes or so – in an emergency room (ER), in an operating room, in the blood bank and in various wards.

The Israeli security force violated the fundamental human principle, which is also enshrined in international law, that medical facilities are protected areas dedicated to caring for the sick and wounded. This is not the first time Israeli forces entered al-Makassed to arrest injured Palestinians, and such incidents have been reported in the past. A week earlier, on 17 July, during the previous round of clashes in the Old City, Israeli police reportedly entered the hospital to arrest a seriously injured person.

Breaching the boundaries of a medical facility in such circumstances cannot be justified, nor can the forces’ violent, life-endangering conduct. Violating the rule that security forces do not enter hospitals is one aspect of the overall policy and routine conduct of the Israeli authorities, which clarifies to hundreds of thousands of Palestinians from East Jerusalem that they are unwanted in their own city and their lives are disregarded.

Reception and ER:

A large contingent of police officers and Border Police went into the entrance hall leading to the reception area and to the ER on the ground floor, at the entrance to the hospital. Doctors, medical staff and other people who were there tried to push the wounded Abu Ghanam, who was lying on a bed hooked up to oxygen and a blood transfusion, into an elevator to take him to an operating room on the second floor. The officers tried to forcefully seize the bed and assaulted medical staff, including two nurses, a volunteer nurse, a doctor and several other individuals. In the commotion, the doctors noticed that Abu Ghanam’s condition was deteriorating and took him into an X-ray room near the elevator, where they tried to resuscitate him. The attempt failed and the doctors declared him dead. At that point, several youths took the body, carried it out of the hospital through a fence and transported it for burial, so that the police could not take it.

Blood bank:

Some fifty people were waiting in the two blood bank rooms near the ER, on the ground floor, including medical staff, volunteers, and citizens who had responded to the hospital’s call for more blood donors. When the staff heard that security forces were in the hospital, they closed the door to stop the officers from entering. About eight officers forced the door open and ordered all those present to leave, except for three people who were giving blood at the time and three staff members. The officers closed the door from the inside and prevented entry. They stayed in the blood bank for about ten minutes without saying a word to the persons locked in with them, and then opened the door and left.

Department of surgery and operating room:

The hospital’s operating room is on the second floor, opposite the department of surgery. Five police officers entered the department and ran into a nurse on a break. They asked him where the wanted injured man was and pushed him out of the way when he replied that he did not know. The officers then went through the emergency door leading into the operating room. Three of them tried to force open the main, electric door into the room. A nurse who was inside the operating room opened the door for fear they would break it down. There was no surgery underway in the room at the time.

Maternity ward:

The department is on the first floor and comprises 13 patient rooms and a nursery. When the nurses learned that security forces were in the building, they gathered all the patients in the visitors’ room and took all the babies from their mothers, placing them in the nursery for fear they would be harmed. Six police officers entered the department, where they went from room to room searching for the injured youth for some 15 minutes. In one room, which was empty, they sprayed pepper gas.

* * *

The day of the raid – Friday, 21 July – a Muslim prayer was held outside the al-Aqsa compound in East Jerusalem, after the Israel Police breached the status quo by placing metal detectors at the entrance to the compound, after Palestinian citizens of Israel killed three Israeli police officers there. When the prayer was over, Palestinian youths began clashing with the police forces. The Red Crescent reported taking some 40 wounded persons to hospital that day. Many were taken to al-Makassed hospital, which is located in the neighborhood of a-Tur.

Muhammad Ghanam, the youth that the police were seeking, came with his friends earlier that day to a junction between the neighborhoods of a-Tur and a-Swaneh. Four or five Border Police officers were standing in a lot nearby. Shortly before 3:30 P.M., clashes developed between Border Police officers, who fired teargas grenades, and the youths, who threw stones and flares at them. Abu Ghanam and his two friends ran towards a-Sheikh ‘Anbar Street in the neighbourhood. Ghanam paused momentarily and tried to light a flare to throw at four Border Police officers who were several meters away. Some of the officers opened fire, injuring him. After he fell to the ground, they stood by for 5-10 minutes without offering him medical assistance. At that point, a Red Crescent ambulance with three medics approached and was blocked by a Border Police vehicle in the middle of the junction. Officers threw a stun grenade towards the ambulance, without hitting it. The medics got out of the ambulance to tend to Abu Ghanam, and managed to get him into the ambulance and drive away despite attempts by the police to prevent them. The injured Abu Ghanam arrived at al-Makassed hospital at approximately 3:40, at which point the hospital was raided as described above. The doctors found that he had been hit in the chest by a live bullet that entered his spine. Abu Ghanam was pronounced dead some 15-20 minutes after arriving at the hospital.

B’Tselem’s investigation found that, while leaving the hospital compound, the security forces acted violently towards people who had gathered outside, including firing stun grenades and sponge rounds at them. Several individuals were lightly injured and treated immediately at the hospital’s ER.

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רוזאן א-נג'אר באוהל הרפואי בהפגנות השיבה. צילום: עבד אל-עזיז א-נג'אר

Open-Fire Policy

Israeli soldiers deliberately and fatally shot Palestinian paramedic Rozan a-Najar in the Gaza Strip

When people were called on to come to the Return Marches on the Gaza Strip border, Rozan was among the first to go help because she believed in humanitarian work. She was motivated by believing the march to be safe and that she would be safe as a member of a medical crew. I saw her when she volunteered at the protests. She flitted around like a butterfly, running back and forth to care for the injured. When Rozan was in the field, I was proud and calm, because she was a paramedic, and I believed the Israeli military wouldn’t harm her. This account was related by Rozan a-Najar’s mother, Sabrin a-Najar, a 43-year-old married mother of six who lives in Khuza’ah. Rozan, 20, was a volunteer paramedic who was fatally shot on 1 June 2018. She was shot at the protest that took place north of Khuza’ah and east of Khan Yunis, as part of the Return March protests, which have been held in Gaza since the end of March. During the protest, in which thousands participated, some protesters torched tires and threw stones at Israeli security forces stationed on the other side of the fence separating Israel and the Gaza Strip. The troops fired teargas canisters and live rounds at the protesters. After the late afternoon prayers, more people came and joined the protest. Paramedics cared for protesters suffering from teargas inhalation. At around 6:00 P.M., a group of paramedics approached the fence to evacuate two young men suffering from teargas inhalation. The paramedics were wearing identifying uniforms and, as they approached, kept their hands up in the air. Rami Abu Jazar, 29, from Khan Yunis served as a volunteer paramedic with Rozan a-Najar. He described the incident in a testimony he gave B’Tselem field researcher Khaled al-‘Azayzeh on 3 June 2018: On Friday, 1 June 2018, I came to the protest tent area, as I’ve been doing for the last few weeks. I sat down in the ambulance that was parked nearby. It was about 4:30 P.M., shortly after the late afternoon prayers. My colleague, Rozan a-Najar came and we talked a little. She was in a good mood because she’d bought a new cell phone. She asked me to hold on to it for her because she was going to go help demonstrators and was afraid she’d drop it. Because I was going to go along with her, I gave the phone to another colleague of ours. Rozan took the first aid kit. Then, she and I and the other paramedics went to treat the injured who were starting to come in as the clashes between the protesters and the soldiers escalated. There were about 70 protesters who were suffering from teargas inhalation. On the other side of the fence, there were a few jeeps. Soldiers who were inside the jeeps were firing teargas canisters. I also saw soldiers firing teargas from special guns. Next, I went with a few other paramedics, including Rozan a-Najar, Rasha Qdeih, Rida a-Najar and Mahmoud ‘Abd al-‘Ati, toward the protestors. We stood close to the protesters and heard people crying out that two guys had fainted near some concertina wire that had been laid on the ground about 10 meters away from the fence with Israel. We decided to go over there to give them treatment. Rozan and I walked first. We raised our hands up above our heads to set the soldiers at ease, to make them see we’re paramedics. We were all wearing medical vests with first-aid crew symbols on them. We got to the two young men, and when we started evacuating them, the soldiers started firing a heavy barrage of teargas canisters at us. I think they were firing from one of the military jeeps. Rozan and Rasha started choking. I asked Mahmoud to care for Rozan and I took care of Rasha. Then, the four of us moved away from the fence. The young men and other paramedics who stayed behind managed to get out the two guys who’d been hurt by the gas. After we had moved away, we started feeling better and decided to go closer to the protesters. We stood about 10 meters away from them, which was about 25 meters away from the fence. There were no protesters near us. At around a quarter to six, we saw two soldiers get out of a military jeep, kneel and aim their guns at us, taking up a sniper stance. Rozan was standing to my right and Rasha was behind me. We were talking. Suddenly, they fired two live bullets at us. I looked at Rozan and saw her point to her back and then fall down. A second later, I fell too, because I had been hit above the left knee. I was later told that Rozan had been hit in the left side of the chest. Mahmoud was hit by shrapnel in the right hand and the pelvic area. Mahmoud ‘Abd al-‘Ati, a 34-year-old paramedic from Khan Yunis also gave an account of the incident to B’Tselem field researcher Khaled al-'Azayzeh on 3 June 2018: Shortly after 5:30 in the evening, we heard that two young men were choking on teargas near the barbed wire fence that’s located about 10 meters from the main fence. One of them was unconscious and the other was signaling to us with his hands so we realized that he needed help. I walked over with a few other paramedics. We were wearing paramedic vests with a logo of the Palestinian Medical Aid Society on them. I was with Rami Abu Jazar, Rasha Qdeih, Rozan a-Najar and several other paramedics. We were holding our hands above our heads. We got to the two injured men, and then suddenly, a volley of teargas canisters was fired straight at us from a military jeep. Rozan and Rasha choked on the teargas. I gave Rozan first aid by spraying alcohol up her nose to rouse her and bathing her face with saline solution to alleviate the stinging. Rami gave first aid to our colleague Rasha. We were about 20 meters away from the concertina fence. The rest of the team evacuated the two guys who’d been hurt by the teargas, getting them to a safe spot, far from the fence. We went back and stood northwest of the protesters, about 10 to 20 meters away from the concertina fence. At around 5:45 P.M., two soldiers got out of a military jeep and pointed their guns at us. They fired two bullets at us. One hit Rozan in the left side of the chest and exited out her back. At the very same time, I was hit by shrapnel from live rounds. I was hit in the pelvic area and in the right hand. My colleague Rami was hit in the top part of his left leg and by shrapnel in the right leg and left arm. A medical crew took the unconscious Rozan a-Najar to a medical tent in the tent compound. From there, she was taken by ambulance to the European Hospital south of Khan Yunis. After about thirty minutes of resuscitation attempts, she was pronounced dead. Rami Abu Jazar and Mahmoud ‘Abd al-‘Ati were also taken to the European Hospital, where they received treatment for the shrapnel wounds and other cuts they had suffered. They were discharged from hospital the same day. In a testimony given to B’Tselem field researcher Olfat al-Kurd on 1 July 2018, Sabrin a-Najar spoke about her daughter: Rozan was a naive child. She loved life and was always smiling. She dreamed of studying nursing at the university, but our finances wouldn’t allow it so she made do with first aid courses at Naser Hospital in Khan Yunes. The program lasted two years and it was rigorous. All the doctors at the hospital thought well of her. Rozan was driven to prove herself in the nursing field and make up for not being able to go to university. On Friday evening, a neighbor phoned to tell us Rozan had been injured. I called my husband Ashraf and we drove over to the European Hospital south of Khan Yunes right away. At the hospital, we found her in the intensive care unit. I told the guards I wanted to see her, but they wouldn’t let me. I wouldn’t listen to them. I pushed the door open and went inside. I saw her lying there, lifeless. I took her in my arms and said: “Rozan, wake up. It’s just teargas. You’re fine. Get up. Get up, my love.” Her clothes were covered in blood. I started crying and screaming. My spirit broke. I knew I’d never see her again. That I’d lost my daughter and I’ll never get her back. I’ll never be able to hug her ever again. Life ever since Rozan died has been very difficult for me. Sometimes I call her when it’s time to eat, because I feel that she’s with us and she hasn’t died. The whole family is having a really hard time. Her little brother, Amir, tells his father to call Rozan to come eat with us. Her sister Ri’an cries all the time, and I see her wearing Rozan’s clothes. Her brothers Amir and Rama can’t comprehend that she’s not coming back. My husband is broken. He cries all the time and misses her badly. I keep praying for her to receive the grace of God and go to heaven. Losing her is terrible. What wrong did Rozan commit that she had to be killed? The IDF Spokesperson tried to clear the military of responsibility for a-Najar’s death, initially saying that soldiers did not fire at the spot where she had been standing. Later, the military said a-Najar might have been killed by a ricochet, before finally accusing her of serving as a human shield for rioters. Contrary to the many versions offered by the military, the facts of the case lead to only one conclusion. An investigation conducted by B’Tselem proves 20-year-old a-Najar was fatally shot by a member of the security forces who was aiming directly at her as she was standing about 25 meters away from the fence, despite the fact that she posed no danger to him or anyone else and was wearing a medical uniform. The killing of a-Najar is a direct result of the open-fire policy Israel has been implementing since the protests began. The lethal results of this policy are well known: Since the protests began on 30 March 2018, 127 Palestinian protesters have been killed – including at least 18 minors – the vast majority of whom posed no danger to the Israeli security forces stationed on the other side of the fence. In addition, about 4,100 people have been wounded by live fire. Medical staff were among the casualties. On 14 May 2018, two weeks before a-Najar was killed, security forces killed another paramedic, Musa Abu Hasanin, 34, at a demonstration near Jabalya R.C. According to figures up until 10 July 2018 as released by the World Health Organization, 357 medical staff had been hurt: 26 by live fire; 37 were directly hit by teargas canisters; 12 were hit by shrapnel; no details were given for the rest. In addition, 58 ambulances sustained damage. The disavowal of responsibility for a-Najar’s killing by the IDF Spokesperson and other Israeli state officials should not be construed as an instance of the competent authorities informing the public of the facts. Far from it. They are simply part of the efforts made by the authorities responsible for this policy to mitigate the damage to Israel’s image by hiding and whitewashing the facts. Yet, propaganda and reality are two different things. In reality, Israel is indifferent to the killing of Palestinians. Otherwise, it would long ago have changed its open-fire policy and stopped shooting at unarmed protesters on the other side of the fence who pose no danger to anyone. Evidence of this criminal policy is found time and time again as the military persists in implementing it unchanged, enlisting its whitewashing apparatus to back it up, which almost always ensure no one will be held accountable for the killing of Palestinians even in outrageous circumstances such as a-Najar’s killing. Update: On 29 October 2018, media reports stated that a criminal investigation had been launched. On 15 March 2021, the MAG Corps informed B'Tselem the case had been sent to a military prosecutor for review. On 1 June 2022, the IDF Spokesperson informed B’Tselem that the case had been closed without an indictment.

17 July 2018

מוסטפא ד'אהר בבית החולים עם בן דודו מוחמד. צילום: אולפת אל-כורד, בצלם, 6.5.18

Open-Fire Policy

Thus shall it be done: How Israel punishes boys for protesting their confinement to Gaza

Since 30 March 2018, Gazans have been holding a series of protests along the Gaza perimeter fence, with anywhere between hundreds to tens of thousands of people participating. To date, scores of people, including at least 12 minors, have been killed by live ammunition Israel security forces fired; more than 3,600 have been wounded by live gunfire. According to figures published by the World Health Organization (WHO), as of 22 May 2018, Gaza doctors had performed 32 amputations, 27 of them of lower limbs. Testimonies collected from Palestinians injured during the protests indicate they were shot while posing no mortal danger to anyone, including some who were shot when they were hundreds of meters away from the fence. In at least some cases, Israeli security forces fired at persons who were trying to reach the wounded to help them. This mindboggling number of casualties at protests is virtually unprecedented. It is the result of the manifestly unlawful orders given to security forces, allowing the use of live fire against unarmed protestors who pose no danger to anyone and are on the other side of the fence, inside Gaza. All relevant Israeli officials refuse to change these orders, even in the face of their predictable outcome. They continue to argue that the orders are legal and even defend them in court, where the justices of the Supreme Court have given this reality their seal of approval. The serious injuries are merely the tip of the iceberg in this saga. Even an advanced, functioning healthcare system would have been sorely tried when faced such a large number of casualties. However, even before the protests began, Gaza’s healthcare system was already on the verge of collapse. As a result, many of the wounded do not receive the care they need. According to figures released by the World Health Organization (WHO), as of 22 May 2018, 257 essential drugs and 247 types of disposable medical equipment were out of stock and needed immediately. Gaza physicians told Physicians for Human Rights – Israel that they reuse disposable equipment over and over again and that there is a shortage of antiseptics, disinfectants and anesthetics. The collapse of Gaza’s health care system is largely the result of the Israel-imposed blockade on Gaza. The blockade includes restrictions on replacing broken medical equipment, importing advanced medical equipment and drugs, and travel by physicians for professional training outside Gaza. In addition, Gaza’s intermittent power supply, again largely Israel’s doing, also disrupts the work of hospitals. Israel’s unlawful policy has caused the injuries and its blockade keeps the wounded from receiving the medical care they need. Israel also refuses, as a general rule, to allow these individuals to travel just a few kilometers through Israeli territory in order to get to hospitals in the West Bank, where at least some of them would be able to receive the care they need. Since the demonstrations began, B’Tselem field researchers have collected scores of testimonies from people who sustained live fire injuries and from eyewitnesses, including teenagers who were shot by Israeli security forces at various distances from the fence. In their testimonies, the boys describe how they were wounded, the difficulties they faced obtaining the medical care they desperately need and the long and costly rehabilitation facing them. We bring you the stories of three of these boys: Muhammad al-‘Ajuri, 16, was injured east of Jabalya Refugee Camp on 30 March 2018 Muhammad al-‘Ajuri is 16 years old. An eleventh grader from Jabalya R.C., he is also a member of the Palestinian Athletics Association. On Friday, 30 March 2018, at around 11:00 A.M., al-‘Ajuri arrived with several friends at the protest that was taking place near the perimeter fence, east of Jabalya R.C. They advanced to a distance of a few dozen meters from the fence, in order to hand out onions to protestors to relieve symptoms of teargas inhalation. After security forces fired a great deal of teargas at the area he was in, al-‘Ajuri moved back. When he was about 300 meters away from the fence, a member of the Israeli security forces fired a live bullet at his right leg. In a testimony he gave B’Tselem field researcher Olfat al-Kurd on 17 April 2018, he described how he was injured: I went up to a distance of about 50 meters from the fence to hand out onions to the protestors. I saw a few people who’d been injured, including an older man who’d been hit in the left leg. The bone in his leg was showing and he was bleeding badly. Most of the injuries I saw were to the legs. The soldiers were firing a barrage of tear gas canisters and I nearly choked, so I turned around and started moving away. When I was about 300 meters away from the fence, I was shot from behind and hit in the right leg. I didn’t fall down. I stayed standing where I was, and my leg was bleeding. My father came to help me, and then a few young guys came and gave me first aid. They tied a strip of cloth around my leg to stop the bleeding and took me by motorcycle to an ambulance, which was about 250 meters away. Muhammad’s father, Hani al-‘Ajuri, 39, also went to the demonstration. He was a volunteer providing first aid. When his son was shot, Hani al-‘Ajuri was standing about 300 meters away from the fence. In a testimony he gave B’Tselem field researcher Olfat al-Kurd on 3 May 2018, he described seeing his son being hit: When I saw my three sons at the protest, I had them move back to the tent area, which was about 700 meters away from the perimeter fence, because I was worried they’d get hit by live fire or teargas canisters. Later, a young man I know told me Muhammad had gone very close to the fence to give first aid and hand out onions to some young guys who had passed out from the teargas. When I looked over toward the fence, I saw soldiers were firing a heavy barrage of teargas at the protestors near the fence. I saw my son Muhammad running towards me. When he was a few meters away, a sniper stationed on a sand mound on the other side of the fence shot him. I went up to him and put my arms around him. I saw he’d been hit in the back of his right leg. It had a big hole in it and he was bleeding. His leg looked terrible, and I was afraid they’d have to amputate. I managed to bandage his leg with a strip of cloth and tied it up to stop the bleeding. After that, I couldn’t take it any longer, I completely broke down. I couldn’t help him any more. A few young guys arrived, put him on a motorcycle and took him to an ambulance. I went to the Indonesian Hospital near Jabalya R.C., but I didn’t find him there. I went to al-‘Awda Hospital, which is in Beit Lahiya. The doctors told me he had been brought there, but because of his serious condition, he had then transferred been to a-Shifa’a Hospital in Gaza City. I went there, looking for Muhammad, but I couldn’t find him. I looked for him in the operating rooms, but no one knew anything about him. I saw a doctor coming out of an OR and asked him about my son. He said there was no one by that name, but that there was one young man that hadn’t yet been identified. He was unconscious and didn’t have an ID on him. The doctor had a picture of him on his phone. He showed it to me. It was Muhammad. At the hospital the doctors found that an artery in his leg had been hit and the leg was broken and he underwent surgery. However, the doctors determined there was a risk his leg would be lost and that in order to save it he would have to undergo further surgery at a Ramallah hospital. Israel refused to let him out of the Gaza Strip. On 8 April 2018, human rights NGOs Adalah and Al-Mezan filed a High Court petition on behalf of al-‘Ajuri and another injured man. The justices dismissed the petitioners’ motion for an urgent hearing. In the meantime, al-‘Ajuri’s condition took a turn for the worse, and on 9 April 2018, the doctors had to amputate his leg. He was discharged from hospital three days later. The other petitioner also had a leg amputated. Hani al-‘Ajuri recounted in his testimony: When the doctors told me they would have to amputate Muhammad’s leg I wouldn’t consent. I was worried about him living as a disabled man for the rest of his life. I couldn’t deal with it. Finally, the doctors convinced me there was no other choice because if they didn’t amputate the leg, the infection would spread to the rest of his body. I became resigned to this fate and consented. I was heartbroken about the future he faced. It’s very painful for me to see my son without a leg. Muhammad was my right hand man. He was an athlete and loved soccer. He was on the Palestinian sprinting team and won first place at school. Muhammad Musbah, 17, was injured north of the town of Khuza’ah on 5 April 2018 On Thursday, 5 April 2018, at around 4:30 in the afternoon, Muhammad Musbah, 17, a twelfth-grade student, from ‘Abasan al-Kabirah, and his uncle, Wasim Musbah, 22, went to the protest area north of the town of Khuza’ah. After spending a short while in the tent area, about 400 meters from the fence, Muhammad and another young man went up to an older woman who was standing near a coiled barbed-wire fence the military had laid on the ground. She was carrying a Palestinian flag. The two took the flag from her and walked toward the coiled fence, which is about ten meters away from the perimeter fence. In a testimony he gave B’Tselem field researcher Khaled al-‘Azayzeh on 2 May 2018, Muhammad Musbah related: We went to the coiled barbed-wire fence, which was about ten meters away from the perimeter fence, and I hung the flag on the coiled fence. Suddenly, a soldier who was on a dirt mound on the other side of the fence shot me. I was hit by a bullet in the right leg and fell to the ground. The young man who was with me, whom I don’t really know, sat down beside me. I lay there on my back for about twenty minutes. The young men who were standing in the back couldn’t get to us, because every time they tried to, soldiers fired at them. That whole time, I felt like an electrical current was running through my body, and I was bleeding badly. It was only about twenty minutes later that some young guys managed to get to me. They put me on a tuk-tuk [a three-wheeled vehicle], which took me about 600 meters away from there, to the eastern edge of Khuza’ah, because they couldn’t find an ambulance any nearer. Wiam Musbah, 23, from ‘Abasan al-Kabirah, is volunteer paramedic who was working in the tent area of the Return March. At the time, he was standing with some other paramedics a few dozen meters away from the fence. In a testimony he gave B’Tselem field researcher Khaled al-‘Azayzeh on 2 May 2018, he recalled: At around 4:30 P.M., I saw two young guys take a Palestinian flag from an older woman who was close to the coiled fence that was on the ground. They went up to that fence, which was about ten meters away from the perimeter fence. They put the flag on the barbed wire fence, and then I heard a few shots and saw one of them fall down. The other guy lay flat on the ground beside him. A few young men tried to reach them to give them first aid but the soldiers fired live rounds and teargas canisters around them. I advanced toward the spot with the first-aid team. The soldiers fired live rounds near us to warn us not to approach. One of the women on the emergency team put up her hands to set the soldiers minds at ease and let them know we were a medical crew, and we kept advancing, but the shooting continued near us and over our heads. The soldiers also fired teargas canisters behind us. Despite this, we managed to get to the two guys. I found that the guy who was injured is a relative of mine, Muhammad Musbah. He had been hit by a live bullet in the right leg and was lying on his back. His leg was completely torn up below the knee and he was bleeding badly. I bandaged the wound with medical gauze and Wasim Musbah, who was with us, brought the stick the Palestinian flag had been tied to, broke it in two and tied it to the injured leg as a splint for support. The entire time we were caring for him, the soldiers kept firing above us. A few young guys moved forward till they reached us, and together we lifted Muhammad and got him away from the barbed wire fence and on to a tuk-tuk, because there was no ambulance there. Muhammad Musbah was taken from the tuk-tuk and put into a Red Crescent ambulance, which took him to the European Hospital south of Khan Yunis, where his right leg was amputated below the knee. He was discharged after being hospitalized for more than three weeks. In his testimony he recounted: When I came to after the surgery, I found my father beside me. He said the doctor had had to amputate my right leg below the knee because it had taken in a lot of shrapnel that severed the arteries and nerves and shattered the shin bone. I was very sad. I felt I couldn’t breathe. I realized I would never play soccer again. I love playing so much. Before my injury I’d play every day. There’s a special field near us, and I played defense for the neighborhood team. I’m still getting treatment, and go back to the hospital every few days for checkups. I’m taking three different kinds of antibiotics. I’m also on painkillers because my leg still hurts. I can hardly sleep, and only with sleeping pills. The pain gets worse in the afternoon and at night. All the kids in my grade are getting ready for final exams, but I can hardly read because the pain is so bad. I couldn’t study at the hospital either because of the injury. I don’t know if I’ll be able to handle the exams this year, or how long rehabilitation will take before I can go back to normal life. It never occurred to me that a day would come that I would be a disabled person. I’m still in shock over what happened to me. Mustafa Dhaher, 15, was injured east of Jabalya R.C. on 2 May 2018 On the afternoon of Wednesday, 2 May 2018, Mustafa Dhaher, 15, his cousin Mahmoud Dhaher, 14 and Yusef Abu Mansur, 17, all from Jabalya Refugee Camp went to the tent area east of the camp to attend a memorial service for people who died during the “Return Protests.” A short while later, the three boys advanced to a spot a few hundred meters away from the fence. Mustafa Dhaher advanced even farther, up to a few dozen meters from it. At around seven o’clock in the evening, the boys decided to go home. In a testimony he gave on 6 May 2018 to B’Tselem field researcher Olfat al-Kurd, Mustafa Dhaher recounted: There were soldiers on dirt mounds on the other side of the fence. The air was completely filled with teargas that had been fired from military jeeps. There was also heavy live gunfire. At around seven o’clock I called out to my friends: “Mahmoud, Yusef, we have to go home. Enough, I’ve had enough”, and I was going to leave. As soon as I turned around, the soldiers shot my left leg, in the thigh. The bullet wen through my left leg and hit the right. I felt like there was an electric current running through my whole body, and I fell down. Yusef and Mahmoud came to me. I was bleeding heavily and I put my hands on the wounds to stop the bleeding, but it didn’t help. Yusef bandaged my legs, one with a kaffiyeh and one with his shirt, and that did help. A few minutes later, Mustafa Dhaher’s friends and some young men who were in the area evacuated him on a stretcher to an ambulance which took him to the Indonesian Hospital, near Jabalya R.C. He underwent surgery on his right leg and needs another operation on his left. In his testimony he said: I’m still in hospital and have to have another surgery, after my hemoglobin level goes up. I’m in pain a;; day long now. I cry and scream and then they give me painkillers. It hurts especially when they change the bandages. All I did was go to a memorial service for the martyrs. I didn’t do anything that threatened the lives of the Israeli soldiers. I didn’t even wave a flag. I didn’t throw stones. I was just watching the young guys protesting near the fence, and still the soldiers shot me.

31 May 2018

Yusef al-Kurunaz. Photo by Olfat al-Kurd, B'Tselem, 16 April 2018

The Gaza Strip

Failing Gaza healthcare system after 10-year blockade barely handling 2,000+ live fire injuries

Since 30 March 2018, Gazans have protested along the fence with Israel every Friday, with anywhere between thousands and tens of thousands of people participating. At least 39 people have been killed by live fire shot by Israel security forces and, according to Palestinian Ministry of Health statistics, some 8,000 people have been wounded, more than 2,100 of them from live rounds. According to the media, Gaza doctors report particularly serious injuries, mostly to the lower extremities, which, “include an extreme level of destruction to bones and soft tissue, and large exit wounds that can be the size of a fist”. According to Palestinian Ministry of Health Data, as of 30 April 2018, Gaza doctors had performed 24 amputations on wounded individuals, 19 of them of lower limbs. Even an advanced, functioning healthcare system would have had difficulties handling such a large number of casualties in such a short period of time. All the more so for Gaza’s healthcare system, which has been in a state of collapse for years, mostly since the Israeli blockade began more than a decade ago. Israeli restrictions apply to replacing broken equipment, importing advanced medical equipment and drugs, travel by physicians for professional training outside Gaza and more. In addition, Gaza’s intermittent power supply, largely Israel’s doing with the High Court’s seal of approval, also disrupts the work of hospitals. In these conditions, it is impossible to provide the wounded with adequate care. According to figures released by the World Health Organization (WHO), as of 28 April 2018, 75 drugs and 190 types of disposable medical equipment were immediately needed. Doctors are also in short supply. In the entire Gaza Strip, with its population of two million, there are only ten vascular surgeons, which means it is impossible to provide immediate care for all the wounded in the weekly mass casualty incidents. According to reports coming out of Gaza, to relieve the pressure on the system, hospitals try to release many of the previous week’s wounded on Thursday, in preparation for the influx of new patients expected the next day. Israel’s blockade includes a ban on travel out of Gaza for medical treatment in Israel or transit through Israel for treatment in the West Bank (including East Jerusalem) or abroad, except in rare cases and according to strict criteria. Since the demonstrations began, it has come to light that Israel has chosen to ignore even the narrow criteria it had put in place. On the first week of protests, Israel denied applications to allow demonstrators who had been hurt to exit Gaza for urgent medical treatment in a West Bank hospital. On 8 April 2018, the Adalah and Al-Mezan centers petitioned Israel’s High Court of Justice on behalf of two wounded men, Yusef al-Kurunaz, 19, and Muhammad al-‘Ajuri, 16, since amputation could not be avoided with the care available in Gaza. In response, the state told the court the applications had been rejected, “given the policy of the Minister of Defense on the issue, whereby, as a rule, entry into Israel shall not be granted to persons injured while taking part in the violent public disturbances organized by Hamas, where the concrete medical circumstances were not deemed to warrant considering a departure from said rule, as there is no real danger to any of the petitioners’ lives”. The state said it had “also warned Gaza residents against participating in the demonstrations”, as if this was a justification for denying them access to adequate medical treatment. The justices refused to schedule an urgent hearing and, with the legal proceedings stretching out,z the doctors had no choice but to amputate the leg of each patient. More than a week after the petition was filed, the High Court ordered the state to allow al-Kurunaz to travel to a hospital in Ramallah, where doctors were able to save his other leg. The justices did state, however, that this was an exceptional case and that they were not taking a stand on Israel’s overall policy toward injured protestors. According to figures released by WHO, by 28 April 2018, 27 urgent applications to exit Gaza for medical treatment had been submitted since the start of the demonstrations. At least one was approved following the court case. Eighteen were rejected and the rest were approved only after a lengthy process of applying to the DCO for the permit, receiving a rejection, contacting human rights organizations and them contacting the State Attorney’s Office, which finally resulted in the much needed approval (without court intervention at this point). This complicated bureaucracy delays the necessary treatment, may cost the health, perhaps the lives, of the wounded and puts unnecessary added strain on their families. The serious injuries, particularly in cases of leg amputations, necessitate lengthy rehabilitation. However, rehabilitation options in Gaza are limited and there is only one prosthetic center. It is also costly and due to the dire economic situation in the Strip, another direct result of the blockade, most of the wounded cannot afford it. Despite the fact that in the vast majority of the cases their injuries were a result of unlawful use of fire by Israel, they will not receive compensation as Israel has given itself a near complete exemption from payment of compensation to Palestinians it harms. Israel has created this reality and only Israel can change it. It is Israel that instituted an open-fire policy that has resulted in an incomprehensible number of live-fire injuries – a policy it has refused to change despite the clear results. It is Israel that is denying the wounded passage, for just several dozen kilometers, through its territory to reach the West Bank, where they can receive the necessary treatment. And it is Israel’s decade-long blockade on Gaza that has made it the major culprit in the collapse of the healthcare system there. Israeli security forces have been following manifestly unlawful orders for a month now, using live fire against unarmed protestors located on the other side of the fence and posing no danger to anyone. State officials refuse to change these orders, even in the face of the deaths and hundreds of injuries they have caused, claiming they are legal and defending them in court. However, as Justice Benjamin Halevy ruled in the Kafr Qasem case back in the 1950s, the illegality of these orders “pains the eye and outrages the heart, if the eye be not blind and the heart be not callous or corrupt”. Therefore, these orders must not be issued and must not be obeyed. East of Rafah, 30 March 2018: On 30 March 2018, at around 10:00 in the morning, ‘Alaa a-Dali, a 20-year-old resident of Rafah and a member of the Palestinian bicycle team in Gaza, arrived at the protest area east of the city of Rafah. At around 12:30 P.M., after midday prayers, and while some of the protestors were throwing stones at the Israeli forces stationed on the other side of the fence, a live round entered a-Dali’s right leg. He was taken, unconscious, to the field hospital that had been set up nearby and from there to the European Hospital south of Khan Yunis. A-Dali remained unconscious for two days, and the doctors spent two weeks trying to save his leg. In a testimony he gave to B’Tselem field researcher Muhammad Sabah on 18 April 2018, a-Dali recounted: I tried to get a payment guarantee for surgery in a Ramallah hospital. After I got it, and the surgery was scheduled, I applied to the Israeli officials for transit permits for my mother and me. Both applications were denied. After that attempt failed, the doctors decided to amputate my leg at the knee. When I heard about the decision, I cried a lot. I thought about my bike and my dream of becoming a cycling champion, which was suddenly cut short without any advance preparation. I felt that my life was over, my whole world turned upside down, and that I would never ride a bike again. I had been training for a race in Jakarta in August 2018, and I was hoping to take part and wave the Palestinian flag, but that will never happen at any race anywhere in the world. I realized I would never walk on two legs again and that from now on, my whole life would focus on the leg that’s about to get amputated because of a bullet fired by an Israeli soldier. I consented to the amputation because there was no choice. On 8 April 2018, my leg was amputated at the European Hospital. When I saw the amputated leg I went into shock. I cried and it was very painful. About a week ago, I was transferred to al-Quds Hospital in Gaza, and I’m still here. I’m supposed to be released today but when I get out of here, I won’t be the same person I was before 30 March 2018. I’ll leave with no leg, no dream, no future. My life will become difficult and lose meaning because the Israeli military made a decision and acted on it. I’d only ridden my bike and raced inside Gaza. I couldn’t race anywhere outside Gaza. I tried to get to a race in Tunisia, but I didn’t make it because of the Rafah Crossing closure and because I didn’t get a permit from Israel to travel through Erez Crossing. Two other cyclists who ride with me didn’t get a permit either. The Israelis also wouldn’t let us travel to the West Bank to participate in the Jericho Marathon, or another contest between the Gaza Strip and the West Bank. We weren’t allowed to go to a race in Egypt either. East of al-Bureij Refugee Camp, 30 March 2018 Yusef al-Kurunaz, a 19-year-old media student from al-Bureij, went to the protest area east of al-Bureij R.C. at around noon on 30 March 2018, as a volunteer photographer for the national press agency. About two hours later, live rounds were fired at both his legs, injuring him. In a testimony he gave B’Tselem field researcher Olfat al-Kurd on 16 April 2018, he described what he has been through since: I was taken to the ICU at Shuhada al-Aqsa Hospital in Deir al-Balah, but the doctors there couldn’t treat my injury and decided to transfer me to a-Shifaa Hospital in Gaza. At a-Shifaa, I was taken into the ICU and from there to the OR, where the doctors stopped the bleeding. I was in the OR for six hours and received about 18 blood units during the surgery, but the doctors at a-Shifaa couldn’t handle my injury either. I woke up the next day at nine o’clock in the morning. The doctors told me I’d been hit in both legs. They told my father I had to get treatment abroad because the injuries were so severe. After a week at the hospital, I got a referral for treatment at a hospital in Ramallah that specializes in such cases. My leg grew blacker by the day and was in critical condition. The Israeli side refused to let me enter through Erez Crossing. My father told the doctor to do whatever he had to do. On Sunday, 8 April 2018, the doctor told my father they had to amputate the leg, otherwise I would get gangrene and blood poisoning. Because of my leg’s serious condition, he agreed. I was taken into the OR for the amputation the next day. I came out about two hours later. After the doctors told me my leg had been amputated, my mental state deteriorated severely. Even before that I couldn’t look at my leg, which had blackened and looked terrible. After the surgery I felt unbearable pain, and my mental state was terrible. I stayed in hospital for about two more weeks – one at the ICU and one in orthopedics. Now I’m home, and I need urgent care abroad for the right leg, so it doesn’t get amputated too. I’ve tried to make arrangements to travel through Rafah five times, but have had no luck so far. On 16 April 2018, after the High Court ruling, al-Kurunez was taken to hospital in Ramallah, where he underwent surgery on his leg and remains hospitalized for follow-up care. East of Rafah, 31 March 2018: On 31 March 2018, Haitham Naser, a 19-year-old blacksmith from Rafah, arrived at the protest area around noon. A live bullet entered his right leg. He was taken to a-Najjar Hospital in Rafah, and from there to the European Hospital south of Khan Yunis. He was diagnosed with a ruptured leg and a fractured knee and underwent surgery. In a testimony he gave B’Tselem field researcher Khaled al-'Azayzeh on 1 May 2018, he spoke about his hospitalization: When I came to after the surgery, I discovered the doctors had put a brace on my right leg. Between then and yesterday I had a series of operations on the injured leg. The doctors transplanted arteries from my left leg into the right one. I suffered complications because of the drug shortage. My family cannot afford strong antibiotics, so the wound got infected and the transplanted arteries ruptured. Because of this, they tried to use a synthetic artery, but it didn’t work either. Yesterday, I was taken into the OR and the doctors amputated my right leg above the knee. Now I’m lying here in bed at the European Hospital. I need many treatments that unfortunately my family cannot afford. For now, I’m given sedatives and sleeping medication most of the time. My father works as a taxi driver and barely comes home with ILS 20 (USD 5.60) a day. It’s not enough to buy drugs, or even food. We live in a rental that costs us ILS 500 (USD 140) per month. I don’t know how long I’ll stay here at the hospital and I’m very worried and anxious about the future. I don’t know if I’ll need long physical and mental rehabilitation. I’ve become very irritable and I’ve been fighting with my family members and escorts over everything. Sometimes I rip off my feeding tubes. Before my leg got amputated, the hospital made a request to Israel to have me transferred to a hospital in Ramallah for treatment. Israel refused and my condition kept getting worse, and ultimately, they had to amputate my leg. I made a new appointment to complete treatment in Ramallah and I’m now waiting for an answer from the Israeli side. East Gaza City, 30 March 2018: ‘Abdallah Darwish, a 22-year-old student from Beit Lahiya, arrived at the protest area at around 3:00 in the afternoon on 30 March 2018. About two hours later, Darwish was shot in the right leg and taken to the Indonesian Hospital located near Jabalya R.C., where he underwent leg surgery and was fitted with platinum implants. In a testimony he gave B’Tselem field researcher Olfat al-Kurd on 19 April 2018, he said: After I came out of the OR, the doctors told my father I was in very serious condition and that I needed a referral for treatment abroad. We received approval for treatment at al-Istishari Hospital in Ramallah from the Palestinian Authority. Because I had bad circulation in the leg and a blood clot in the artery, the doctors asked to expedite processing, otherwise they would have to do an angioplasty on the leg artery. Because Israel would not let me cross, the doctors performed the angioplasty on 21 April 2018. Before the surgery, to be prepared for the worst, my father signed a consent for an amputation from the knee. Thank God, the surgery was a success and circulation came back. On Saturday, 21 April 2018, they’ll transfer me to a-Shifaa Hospital in Gaza for a tissue transplant in the leg. Now I need a referral for treatment abroad for orthopedic and neurological issues with the leg. I’m going to need a few more operations because there is ruptured tissue. Even though the protests were peaceful, the soldiers, who were in no danger, used massive fire against us. My leg injury was very dangerous. My life was in danger. Despite this, the Israeli side wouldn’t let me access treatment in the West Bank. North of Khuza'ah, 13 April 2018: On 13 April 2018, at around 1:00 P.M., Ahmad ‘Afaneh, a 30-year-old married father of three from Khan Yunis, arrived at the protest area north of the town of Khuza'ah. A few hours later, at around 5:00 P.M., ‘Afaneh was shot in the right leg and taken to the European Hospital south of Khan Yunis. In a testimony he gave B’Tselem field researcher Olfat al-Kurd on 30 April 2018, he said: The doctors told me they were taking me into the OR because my injury was severe. I heard one doctor tell another “amputation”. That was the last thing I heard. Then they injected me with the anesthetic and took me into the OR. I stayed in there for about six hours. When I came to, I found myself in the surgical ward. I started saying: “My leg, my leg”, because I thought I’d lost it, but it turned out they didn’t end up amputating it during surgery. An hour after the surgery, the leg started hemorrhaging and they took me back into the OR. After they stopped the bleeding, they took me to the ICU because I was in serious condition and my hemoglobin level was down. Two days later, I was transferred from the ICU back to the surgical ward. I had more operations on my leg. They put in a platinum implant and closed a ruptured vein. After that, they cleaned the wound every day. I lost sensation in my leg. For ten days, they cleaned the wound and gave me pain killers. On 23 April 2018, in the afternoon, I felt something warm underneath me. I lifted the blanket and saw the leg was bleeding hard. I was taken to the OR, where they found out the vein that had been closed had ruptured again, which was what caused the bleeding. They stopped it, but at that point, the doctors lost all hope and told me the leg would have to be amputated because they were worried about the impact on the rest of my body. Even though I knew from the start that amputation was a possibility, my parents and I refused to believe it and adamantly objected. But when things got really bad, I agreed, also because of the excruciating pain which didn’t stop the entire time I was in the hospital. The doctors amputated my right leg the next day. I went into the OR at ten o’clock in the morning and came out at noon. When I came out, my doctors told me my medical condition was good. My family took the amputated part of the leg for burial. I’m still at the European Hospital. My wound gets cleaned every other day. It has to close, to heal, and then I can have plastic surgery on the leg. I’m very frustrated and find it hard to cope with losing my leg, but that’s my fate. I hope I’ll recover soon, and get a prosthetic leg so I can walk again and have a normal life.

10 May 2018