By Mel Frykberg
GAZA CITY, May 21 (IPS) - The lives of hundreds of critically ill Gazans continue to be jeopardised by the power struggle between rival Palestinian factions Hamas and Fatah, and political blackmail by Israel.
Mohammed Zibdeh, 12, who has cancer of the brain is waiting in Gaza city for a permit to travel to Israel for advanced treatment. He is dependent on a ventilator connected to his throat for survival.
Last year Mohammed was able to secure a permit to travel to an Israeli hospital where he received chemotherapy for his brain tumour, causing the tumour to shrink significantly.
However, a power struggle between Fatah and Hamas over the issuance of exit permits for patients, and Israel's reluctance to issue visas for Gazans on the basis of alleged security, means Mohammed has to now wait for a new permit to return to the Israeli hospital.
"I'm worried for my son's life," says his father Riyad, who fears the tumour is once again growing to its original size.
He has reason to worry. Eight seriously ill Gazans lost their lives from late March to late April after they were unable to secure the necessary documentation to leave the Gaza Strip for urgently needed medical treatment abroad.
The situation was temporarily alleviated over the weekend when Egypt opened its borders and allowed hundreds of Gazans to enter Egypt. But the border was shut soon thereafter, bringing the situation back to square one.
The UN Office for the Coordination of Humanitarian Affairs (OCHA) stated in a recently released report that only 90 patients crossed the Erez crossing into Israel during April. This compares with 325 in March and 258 in February.
These figures, however, fall far short of the many hundreds who apply monthly to leave Gaza for medical treatment.
Patients requiring advanced medical treatment for cancer and kidney diseases are some of the many Gazans unable to obtain treatment in the coastal territory.
Gaza's dilapidated medical system, and a critical shortage of equipment due to Israel's embargo on the strip, has forced many to seek travel to neighbouring Arab countries, Israel and further abroad for treatment.
But for a patient to leave, both the Israelis, who control the northern Erez crossing, and the Egyptians who control the southern Rafah crossing into Egypt, require the Fatah-affiliated Palestinian Authority (PA), which controls the West Bank, to approve exit documentation.
Following Hamas's takeover of the Gaza Strip in June 2007, the Egyptians and Israelis refuse to recognise the legitimacy of the Islamic resistance organisation, even though it won democratic elections at the beginning of 2006.
A Referral Abroad Department (RAD), comprising Gaza-based PA officials who liaise with the West Bank's Ramallah government, was subsequently established by Hamas officials to coordinate the transfer of patients out of Gaza.
However, on Mar. 22, Hamas dismissed RAD's PA officials and replaced them with its own employees. The dismissal was based on Hamas accusations of nepotism and political favouritism by the PA in the issuance of the exit permits.
Hamas also refused to cover the travel expenses of patients as the PA had previously done. The Egyptian authorities, under pressure from Ramallah, then refused to allow those Gazan patients with Hamas documentation to cross over into Egypt.
Following the intervention of human rights organisations and Egyptian civil rights groups, a compromise was reached Apr. 26 allowing a number of patients to once again leave Gaza.
The compromise involved Hamas reinstating the PA officials, and the PA agreeing to establish a non-partisan medical committee to approve the referrals abroad. Hamas has expressed reservations about the new committee.
Some patients who managed to cross the border with Hamas documentation were, however, turned away at Egyptian hospitals because the hospitals demanded PA references.
The situation has been exacerbated by the issuance of passports on a haphazard and sporadic basis by the PA government in Ramallah, leaving hundreds of Gazans without a travel document.
Prior to Hamas's takeover, the PA automatically sent thousands of blank passports to Gaza to be filled out there.
The PA's reputation in handling seriously injured Gazans took another battering during the Gaza war when the PA announced it would no longer pay for wounded Gazans to receive treatment in Israel because the costs were too high.
Yet another hurdle awaits those critically ill Gazans who manage to overcome all the political and bureaucratic red tape represented by inter-Palestinian rivalry.
Israel's domestic security service, the Shin Bet, has been forcing a number of patients to provide information on resistance fighters before they will approve security clearance.
Physicians for Human Rights-Israel (PHRI) released a report several weeks ago stating that data collected "indicates a rise in the number of Palestinian patients interrogated and forced to provide information as a precondition to exit Gaza for medical care.
"Between January 2008 and March 2009, at least 438 patients have been summoned for interrogations as a precondition for the review of their applications for an exit permit for the purpose of accessing medical treatment outside of the strip," the report said.
Last year PHRI intervened in the case of 58-year-old cancer patient Mahmoud Abu-Amro who had been receiving chemotherapy for several years in an Israeli hospital before the Shin Bet stopped him entering Israel on the grounds of "security". He died before the permit was issued posthumously.
Hamas Health Minister Dr Bassem Naim has accused the Israeli authorities of blackmailing Palestinians, and says 324 sick Palestinians have died since Israel enforced its blockade.
Read more from Inter Press Service.