Physicians for Human Rights-Israel: Medicine Under Attack - Critical Damage Inflicted on Medical Services in the OPT - April 2002

8/8/2019 Physicians for Human Rights-Israel: Medicine Under Attack - Critical Damage Inflicted on Medical Services in the OP

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30 LEVANDA st., Tel Aviv , 30,66020Tel: 6873718-03 :687371803Fax: 03-6873029 :687302903

E-mail: [email protected] : il.org.phr.wwwwebsite

Medicine Under AttackCritical Damage Inflicted on Medical Services in the

Occupied Territories:An Interim Report

April 4, 2002

Written: Hadas ZivResearch: Hadas Ziv, Salah Haj Yahya

English translation: Shaul Vardi


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Background

In recent months, critical damage has been caused to medical services in theOccupied Territories. Infringements of human rights in the field of medicinehave occurred throughout Israels occupation of the Territories, andparticularly since the outbreak of hostilities in September 2000. However,after Israeli security forces entered the Palestinian cities (Jenin and Tulkaremat the beginning of March, and again recently), we have reached anunprecedented low in terms of disrespect for human life and gross violation ofmedical neutrality. Before Israel entered the Palestinian cities, the

infringements were mainly the result of the policy of imposing internalclosures, manned checkpoints and physical roadblocks in the Territories.This led to delays in the passage of sick people, women in labor and medicalperson at the checkpoints; in some cases, passage was completelyimpossible. Fatalities caused in these conditions reflected the high price paidfor this policy. The responses of the IDF and the security forces to complaintsagainst this policy showed that the authorities failed to respond seriously toissues in the medical sphere, despite their repeated promises to clarify theprocedures ensuring the passage of sick persons and medical personnel.

After the IDF invaded the Palestinian cities, infringements became evenworse, leading to the almost total paralysis of medical services. Severalgrave incidents in which medical personnel came under fire reflected thedeteriorating situation. On March 4, 2002, a Red Crescent ambulancecarrying three crew members and a physician set out for Jenin refugee campwith the goal of evacuating injured persons. The departure of the ambulancewas coordinated with the Red Cross and the Israeli Civil Administration.Despite the coordination, the security forces opened fire on the ambulance,which exploded. Dr. Khalil Suleiman was trapped in the ambulance andburned to death. The other occupants of the vehicle were able to jump out,thus saving their lives. All three sustained serious burns. There was no-one

in the ambulance other than the medical personnel. The announcement ofthe IDF Spokesperson that the explosion was caused by hidden explosiveswas contradicted by a later announcement by the IDF Spokesperson claimingthat the explosion had been caused by an oxygen tank. A few days later, onMarch 8, 2002, the securities forces opened fire on an UNRWA ambulance inthe Tulkarem area. As the result of the firing, the driver Kamal MuhammedSalem was killed and two crew members were injured. At the same time, aRed Crescent ambulance also came under fire; the driver Ibrahim Muhammed


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Saada was killed and two crew members were injured. In both cases, thedeparture of the ambulances had been coordinated in advance.

[I feel] betrayed by the behavior of the IDF, which has willfully and brutallytrampled on the rules of the Geneva Convention I was shocked by the fearI saw in the eyes of the ambulances drivers. It is sad. The Head of the RedCross Delegation to the Occupied Territories and Israel, Ren Kosiernick(Haaretz, March 20, 2002), when asked to speak of what happened to the[Palestinian] crew members hit by the IDF stated that they had beenmurdered.

The apologies offered by the security forces are shameful, and place theblame on the alleged use of ambulances to carry wanted persons andammunition. No evidence has been offered for this sweeping allegation. Thesingle case publicized by the security force cannot be taken as the rule; thisincident was condemned by the Red Crescent (see the attached statement).

The Invasion of Ramallah and Other Palestinian CitiesIn recent weeks, following the invasion of the Palestinian cities, PHR-Israelhas received dozens of complaints reflecting grave injury to medical services:ambulances, hospitals, medical personnel, the evacuation of the injured, the

transfer of the sick and the provision of food. Existing infringements, such asdelaying and preventing the passage of sick persons and medical personnel,were exacerbated still further and new infringements were seen, includingshooting at medical personnel and shelling hospitals. Below we present theprincipal infringements in the medical sphere, with reference to theinternational conventions providing protection against such infringements.The cases reported below are only examples dozens more cases havebeen reported to PHR-Israel and processed by the staff members over thepast week.

Destruction of Civilian Life

Since the Israeli security forces took control of the cities, the infrastructure ofthe Palestinian Authority has been completely paralyzed. This situationprevented the operation of civilian mechanisms vital for everyday life. Suchconditions have always typified armed conflict and occupation and areaddressed in international law:

Art. 43. The authority of the legitimate power having in fact passed into thehands of the occupant, the latter shall take all the measures in his power torestore, and ensure, as far as possible, public order and safety, while


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respecting, unless absolutely prevented, the laws in force in the country.(Convention (IV) respecting the Laws and Customs of War on Land and itsannex: Regulations concerning the Laws and Customs of War on Land. TheHague, 18 October 1907, ANNEX TO THE CONVENTION : Regulationsrespecting the laws and customs of war on land #Section III : Military authorityover the territory of the hostile state.)

Art. 18. Civilian hospitals organized to give care to the wounded and sick, theinfirm and maternity cases, may in no circumstances be the object of attackbut shall at all times be respected and protected by the Parties to the conflict.

Art. 19. The fact that sick or wounded members of the armed forces arenursed in these hospitals, or the presence of small arms and ammunitiontaken from such combatants which have not yet been handed to the properservice, shall not be considered to be acts harmful to the enemy.

In reality, however, hospitals have become the targets of various forms ofattack, reflecting a perspective that denies any special protection to medicalinstitutions. Tanks have been deployed alongside a large number of medicalinstitutions, including Red Crescent stations, the government hospital inRamallah, the Medical Relief center in Nablus and others. Sick persons are

denied free access to these medical centers and the departure of ambulancesis prevented.

On March 31, 2002, at 10 pm, security forces accompanied by dogsundertook a search of the Arab Care center. We were informed that themedical staff, physicians and nurses were taken into one room and theirhands tied behind their backs. Staff were prevented from makingtelephone contact with anyone outside the hospital. One of the members ofthe medical staff managed to call a member of the staff of PHR-Israel, Salah

Haj Yahya, and to provide these details, which were confirmed by arepresentative of the Red Cross to whom I spoke. We were later informedthat a magnetic disk had been taking containing the personal and medicaldetails of all patients hospitalized at the hospital.

On the night of April 3-4, the government hospital in Jenin was shelled andsurrounded by tanks. The supply of oxygen, water and electricity has been


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disrupted and the north-facing windows shattered. At 9:30 pm on April 4, Dr.Nader Rashayed informed us from inside the hospital that the staff andpatients were crowded on the internal staircase of the hospital, sheltering fromthe continuous shelling and firing. The 35 patients at the hospital were joinedby 14 injured persons.

On April 4 at approximately midday, the Israeli security forces entered theRed Crescent maternity hospital in El-Bireh. Some twenty five soldiersentered the building, and roughly the same number stood in the courtyard of

the hospital. The soldiers gathered together all the workers and patients inthe hospital, including women who had given birth and new-born babies agedbetween 3 and 10 hours. The soldiers subsequently demanded that thedirector of the hospital, Dr. Auda Abu Nahla and another staff memberaccompany them as they searched the hospital rooms. When unable to opendoors, the soldiers broke them down with large metal bars. The soldiers alsoentered the surgical theaters, the treatment rooms for premature babies andthe delivery rooms.

At a later stage, all those present in the hospital were concentrated in the

entrance area close to the information desk and a process of humiliationbegan. Some of the soldiers photographed themselves with the group, whilethey laughed among themselves. About seven of those present, including thedirector of the hospital, were asked to stand to one side. Their eyes werebound and the hands tied behind their backs, after the soldiers removed theirrobes and their Red Crescent emblems. Dr. Abu Nahla and a cleaning workernamed Haled were then released. The remaining Palestinians were taken toan armored troop carrier and the soldiers left the hospital, after some twohours.

Injury to Medical Personnel and the Operation of Ambulances

Medical personnel, particularly those staffing ambulances, inevitably findthemselves moving through cities at the same time as the IDF either inresponse to urgent calls to evacuate the injured, or in response to routinebut no less vital calls: births, cardiac arrests and so on. It is thereforeinevitable that ambulances will come into contact with the Israeli securityforces. The numerous cases of attacks on these staff reflect a lack of


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attention and the absence of clear policy protecting medical staff in the courseof their work. Here, too, international law explicitly states (in the FourthGeneva Convention) that:

Art. 20. Persons regularly and solely engaged in the operation andadministration of civilian hospitals, including the personnel engaged in thesearch for, removal and transporting of and caring for wounded and sickcivilians, the infirm and maternity cases shall be respected and protected.

The International Medical Association has also discussed this matter andexplicitly determined that:

The members of medical and auxiliary professions must be granted theprotection needed to carry out their professional activities freely. Theassistance necessary should be given to them in fulfilling their responsibilities.Free passage should be granted whenever their assistance is required. Theyshould be afforded complete professional independence. (Regulation in Timeof Armed Conflict, WMA 1956, 1957, 1983 Rules governing the care of sickand wounded particularly in time of conflict).

Ambulance crews coordinate their departure to collect sick persons, deliverfood and care for the injured with the Israeli security forces, through theoffices of the Red Cross. This coordination is time consuming and effectivelyprevents any possibility of effective and prompt evacuation. Not only doescoordination cause delays, but even after these delays ambulances are stillstopped, either at roadblocks or by tanks, and are prevented from progressingfor many hours and even days. The ambulance crews are treated in ahumiliating and violent manner, and each response to a call for help takesplace in an atmosphere of terror.

March 30, 2002: Five members of a Red Crescent ambulance crew werearrested by the IDF. The five were arrested while on their way to evacuate a

woman in labor from the old quarter of Ramallah (the lower town). The RedCrescent is unaware where the employees are being held. Three of the crewmembers were seen by a Red Cross representative on March 30, handcuffedand blindfolded in a Ramallah apartment. Since then, however, they havebeen transferred elsewhere. The ambulance itself was returned to the stationby the Red Cross. According to eyewitnesses, this ambulance was stoppedby a military convoy and forced to serve as a human shield as the convoyprogressed through the streets of Ramallah. The same use was made of an


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ambulance belong to the Palestinian Ministry of Health, whose crew was alsoarrested.

March 31, 2002: At approximately 8 pm an ambulance from Sheikh ZayedHospital in Ramallah left for the Muktaa compound with food, medicines andwater, after proper coordination. The driver, Sami Hamdan, transferred thesupplies to the office of the President of the Palestinian Authority and left thesite. While returning to the hospital the ambulance was stopped by tanks afew hundred meters from the building and was not permitted to proceed,despite the fact that the same roadblock had permitted the ambulance toenter the compound. In a conversation with the ambulance driver (at 8:50 pm

on March 31), he told me that he had reached a distance of 20 meters fromthe tanks before they blocked his passage. He left the ambulance with hishands raised and said that he must return to the hospital. The soldiersshouted at him to return via a different route. His efforts to explain that all theother roads were blocked were to no avail. The soldiers fired warning shots inthe air in order to force him to retreat. The ambulance was now 500 metersfrom the tanks and unable to return to the hospital. A further conversationwith the driver (at 10:15 am on April 1) revealed that he was still waiting forthe Red Cross to coordinate his return to the hospital. In the meantime,he had found shelter for the night with a local family. He was finally releasedat approximately 3:30 pm, after waiting for some 19 hours.

On April 2, three Red Crescent ambulances departed to evacuate sick andinjured persons. The ambulances were stopped by Israeli tanks at 9 am. Thecrews including Mr. Younis Al-Khatib, president of the Red Crescent wereordered to leave the ambulances and to crawl in the rain toward the tanks, adistance of 50 meters. At 7:30 pm the crew was released. Four members ofthe crew required medical attention. This is not the only case whereambulances have been delayed and their crews held for interrogation. Thisbehavior constitutes the use of threats against medical personnel by thesecurity apparatus, which is supposed to provide protection in order that they

can carry out their function without fear.

Injury to Sick and Injured Persons and to Pregnant WomenThe inability of hospitals and ambulances to provide reasonable medicalservices for the population constitutes a grave injury to sick persons, includingthe chronically ill, to women in labor and to injured people, all of whom do notreceive treatment within a reasonable period of time. In addition to theseinfringements, sick people have also been injured directly when their vehicleshave come under fire as they attempted to reach hospital. Physical obstacles


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have delayed or prevented their journey to hospital. All these circumstancesare in complete contravention of the protection such persons are affordedunder international law:

Art. 16. The wounded and sick, as well as the infirm, and expectant mothers,shall be the object of particular protection and respect.

Art. 17. The Parties to the conflict shall endeavor to conclude localagreements for the removal from besieged or encircled areas, of wounded,sick, infirm, and aged persons, children and maternity cases, and for thepassage of ministers of all religions, medical personnel and medical

equipment on their way to such areas.

March 31, 2002: At 9:55 pm PHR-Israel received a report from Sheikh ZayedHospital in Ramallah that injured and killed persons in the center ofRamallah (in the vicinity of Walid Nazer Hospital and the Ramoni and Al-Asirabuilding) are not receiving treatment because ambulances were notallowed to reach the scene. A similar report was received from Dr. MustafaBarghouti of Medical Relief, and was confirmed by the Red Crossrepresentative in Al-Bireh. The Red Cross representative added that the

mechanism for coordination with the Israeli side had broken down during thepast few hours, and there was no possibility of coordinating the movement ofrescue teams. At 10:15 pm, after I left a message on his pager, theSpokesperson of the Civil Administration, Peter Lerner, contacted me andconfirmed that there was indeed a mess. In contrast, the Assistant to theGovernment Military Secretary, Mr. Yossi Lahmani, with whom I spoke at10:50 pm, characterized these facts as despicable Palestinian lies.However, the facts were confirmed in a conversation with the Spokespersonfor the Coordinator of Operations in the Territories, Ofir Hacham, who blamedthe far from simple situation in the field for the fact that ambulances wereunable to arrive. According to reports, ambulances were eventually permitted

to enter the area at about midnight, but were only able to evacuate the dead,since the injured had been taken by the IDF.

On April 4, 2002, the Red Crescent station and the ambulance station ofMedical Relief in Nablus were surrounded, with the result that the movementof ambulances was completely paralyzed. In a conversation with PHR-Israel,Dr. Ghassan Hamdan of Medical Relief stated that on attempting to depart in


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response to an urgent call, soldiers in tanks ordered him to return. The entirestaff of Medical Relief had taken shelter in the building. He stated that therewas no fighting in their vicinity, yet the tanks and guns were still firing. Inanother conversation at 11 am the next morning, Dr. Muhammed Karainareported that he was at home, along with a person named Dweikat who hadbeen injured by machine gun fire and was suffering from open fractures andsevere bleeding. Dweikat had been injured at 11 pm the previous night, butdespite his call for help no ambulance arrived. Dr. Karaina came on foot fromAskar refugee camp, but could offer the patient no more than infusions.Another injured person was lying in the street a few meters from his home, butDr. Karaina was unable to reach him. The man lie bleeding for several hours

before he passed away. Dweikat was eventually evacuated by a RedCrescent ambulance on the evening of April 4, approximately one whole dayafter he sustained his injuries.

Dialysis patients cannot reach hospital. Coordination and numerous contactsare required in order to find solutions. After the passage of ambulances wasstopped for two days in Bethlehem, preventing any possibility of reachinghospital, passage of ambulances was finally restored on April 4, albeit withnumerous restrictions and protracted coordination. Five patients were able to

reach hospital and receive treatment. In Tulkarem, however, not a singledialysis patient has been able to receive treatment. If the movement ofambulances is not rapidly restored, the lives of some 40 patients in an aroundJenin will be jeopardized. Pregnant women are also unable to reach hospital:PHR-Israel has already heard of several cases in which women who werescheduled for caesarian sections were unable to reach hospital after enteringlabor.

The Response of Professional Medical Bodies in Israel

Faced with the gross violation of medical neutrality and critical damage tomedical services in the Occupied Territories, medical organizations in Israelhave reacted with silence at best and collaboration at worst.

Magen David Adom: Professional Betrayal

Magen David Adom remained silent in the face of the grave attacks onambulances, and failed to express solidarity or demand that ambulance crewsbe protected. Following a protracted propaganda campaign by the Israeli


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security forces against the Red Crescent, alleging that ambulances are beingused to transport weapons and armed activists, Magen David Adom broke itssilence by issuing a condemnation of the Red Crescent, which it accused ofthe illegal use of ambulances. Magen David Adom accepted all the claims ofthe IDF (see enclosed announcement). Moreover, after the president of thePalestinian Red Crescent was beaten and detained for hours by the securityforces, the president of Magen David Adom, Dr. Moshe Malloul, made noeffort to express solidarity with his Palestinian counterpart.

PHR-Israel believes that such grave violations of international law and thedistress faced by patients and physicians alike in the Occupied Territoriesdemand a forceful, rapid and unequivocal response. PHR-Israel urges MagenDavid Adom to retract its sweeping allegations against the Palestinian RedCrescent allegations that jeopardize the work of ambulance crews and eventheir lives.

The Israel Medical Association: All quiet while the guns roar

Medical crews are gravely injured; physicians are prevented from working

safely to help their patients; hospitals are shelled; and medical personnel arekilled while performing their duties yet the Israel Medical Associationremains silent. Recently, after numerous calls by PHR-Israel, a forum wasconvened to discuss the position of the IMA in the face of the attacks onhealth services in the Territories. After almost two years of conflict, includingworsening infringements in the health sphere, the IMA failed to express evenonce its solidarity with its colleagues. We believe that the IMA should adoptan unequivocal stance; as the representative body of the medicalestablishment in Israel, this might go some way to correct the deterioration inthe behavior of the Israeli security forces toward Palestinian health andrescue services. Given the severity and scope of these incidents, the IMA

must act immediately, unequivocally and clearly to condemn injury tohospitals, ambulances, medical personnel and sick persons. To adopt anyother position would be to betray the IMAs mission, and would jeopardize theIMAs membership of the World Medical Association.


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PHR-Israel Demands an Immediate End to Attacks on MedicalInstitutions and Crews

Ambulances responding to urgent medical calls should be allowed tomove freely.

Ambulances held by the IDF should be returned and the removal ofambulances from service prevented in the future.

The Israeli authorities should permit the delivery of medical suppliesand ensure that hospitals can respond effectively to the emergency

situation. There is no justification for jeopardizing the supply ofoxygen for patients.

Medical personnel, sick persons and women in labor must bepermitted to pass through roadblocks.

Medical personnel, medical institutions and those hospitalized thereinshould not be attacked.

Immediate assistance should be provided by all available means toassist the injured and sick.

The Israeli government must ensure the supply of food to residentsunder military occupation who are unable to secure provisions due torestrictions on freedom of movement and protracted curfew.

In addition, the authorities should announce the location and condition of alldetainees, particularly medical personnel. The absence of medical workersnot only raises concern for their well-being, but also gravely impairs thefunctioning of medical services and constitutes a form of threat against theircolleagues.

Documents

Physicians for Human Rights-Israel: Medicine Under Attack - Critical Damage Inflicted on Medical Services in the OPT - April 2002