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For those seeking medical care, a request to leave Gaza can mean life or death

ARI SHAPIRO, HOST:

We're reporting this week about how hard it is for Palestinians in the Gaza Strip to get lifesaving medical care. And, Daniel, yesterday on this program, you introduced us to a 70-year-old man you met in Gaza who needs heart bypass surgery.

DANIEL ESTRIN, HOST:

Right. His name is Yousef al Kurd. He's a retired audio engineer, and he's trying to get permission from Israel to leave Gaza and travel to the West Bank for his surgery. When we meet him at the hospital in Gaza, his face is gaunt, and there are big ulcers on his legs. The stakes for him and his family are really high.

IBRAHIM: (Through interpreter) If they just cancel it, I do believe that my father will pass away. He will die.

ESTRIN: That's his son, Ibrahim, who is speaking through an interpreter.

SHAPIRO: Now, you reported yesterday that the doctors in Gaza could not do the surgery he needs.

ESTRIN: Right. The health system in Gaza has been worn down because, remember, Hamas took control there about 15 years ago. It's launched attacks on Israel from there. And Israel and Egypt keep it blockaded. Even the Palestinian Authority sees Hamas as a rival and withholds some support to Gaza. So all of that weakens the health system there. And doctors have fled.

SHAPIRO: And people can't just move back and forth. So what otherwise might have been a routine referral to someplace else becomes a lot more difficult.

ESTRIN: Yeah, it's very hard for anyone to go in and out of Gaza. And even medical patients need special approvals. So that is what today's story is about. This is what it takes to get the approval.

(CROSSTALK)

ESTRIN: 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 al Kurd, who we're following.

Thank you for seeing us.

HAITHAM AL HIDRI: You are welcome.

ESTRIN: Thank you.

When we visit the office, it's Dr. Haitham Al Hidri (ph) 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.

UNIDENTIFIED PERSON: (Non-English language spoken).

ESTRIN: As we're talking, his colleague comes in the office with an urgent case.

AL HIDRI: This life example now.

UNIDENTIFIED PERSON: Lifesaving.

AL HIDRI: Lifesaving example.

ESTRIN: There's is 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. Hidri calls the young man's doctor in Gaza.

AL HIDRI: Hello? Doctor...

ESTRIN: And he asks him, is it really urgent?

AL HIDRI: (Speaking Arabic).

ESTRIN: 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.

AL HIDRI: OK.

ESTRIN: So he's not bleeding.

AL HIDRI: He is not in active bleeding; some oozing from the site of the surgery. So it's not active bleeding, so it's not top emergency. We can wait, and we...

ESTRIN: 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.

AL HIDRI: Top emergency cases, I can deal smoothly with these patients.

ESTRIN: But here's the thing with heart patient Yousef Al Kurd - 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 anyone in from Hamas-controlled Gaza. I talked about this with an Israeli researcher at Tel Aviv University, Moshe Chorev (ph).

MOSHE CHOREV: It is not self-obvious that Israel will provide its enemy the treatment they need. They can go to Egypt, for example.

ESTRIN: About 1 in 5 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.

CHOREV: 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.

ESTRIN: 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.

RAN GOLDSTEIN: It's really a black hole for us to understand the criterias.

ESTRIN: That's Ran Goldstein (ph). He directs Physicians for Human Rights - Israel. They try to help Gaza patients get permits.

GOLDSTEIN: Many, many of cases are not really security issues because when we intervene, suddenly the person receives the permit.

ESTRIN: 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 Yousef Al Kurd. Israel didn't grant him a permit in time for his surgery. His son Ibrahim rebooked it; still no permit. He got a third appointment. The whole time, Israel said it was reviewing the request.

IBRAHIM: (Through interpreter) the Israelis always postpone. And this is just slaughtering us from the inside and the outside.

ESTRIN: About six weeks passed 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 Centre for Human Rights in Gaza to intervene.

MOHAMMED AL ALAMI: (Speaking Arabic).

ESTRIN: Lawyer Mohammed Al Alami (ph) shows us the letters he sent to the Israeli authorities.

ALAMI: Very urgent.

ESTRIN: 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...

ALAMI: (Speaking Arabic).

ESTRIN: 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.

ALAMI: Every day like this - every day.

ESTRIN: 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 Yousef 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 lawyer say nothing was missing, and Israel never mentioned that to them. While Yousef Al Kurd is awaiting the permits, 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.

IBRAHIM: (Through interpreter) Yousef Al Kurd, we approved you traveling.

ESTRIN: An Israeli travel permit - that's more than two months since they first applied. He can finally go to the hospital to get his surgery. It's a glimmer of hope as his health is getting worse.

[POST-BROADCAST CORRECTION: A previous version of this story misidentified a Tel Aviv University expert as Moshe Chorev. The correct name is Harel Chorev.]

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.