Select Committee on International Development Written Evidence

Memorandum submitted by Physicians for Human Rights—Israel


  PHR-Israel was established in 1988 as a non-partisan, non-profit organization. It brings together volunteer health workers and human rights activists who work against abuses of human rights in general, and champion the right to health in particular, in Israel and the Occupied Territories. Its members and staff attach great importance to close cooperation with Palestinian civil society, human rights activists and medical organizations and workers. In our medical and human rights work we strive to build, even if only on a small scale, an alternative to violence and hostility, thus showing that such an alternative is possible.

  We are addressing only those issues with which we are acquainted through our work.

Issue 2.   The impact on Palestinian trade, employment and economic development of customs duties and taxes, and controls on the movement of goods and people at Israeli ports and airports and points of entry to the West Bank and Gaza

  Medicines: Based on the Paris Protocol (April 1994) the import of medicines and raw materials to the Palestinian pharmaceutical industry via international borders is subject (like the rest of the Palestinian industries) to the supervision and authorization of the Israeli authorities. This protocol established a model of "customs union" intending to preserve the Palestinian economy as integrated and dependent on Israel's economy[236]. This, as well as the favoring of Israeli distributors, brings us to the conclusion that there is an economic and political aim to the restrictions described.

The Situation of Shipping of Pharmaceuticals to Gaza:

  Over the past few years, products from the West Bank could be sent via Israel to Gaza through Karni crossing. Trucks were sealed by Israeli officials at the Israeli border checkpoint (near Modi'in) to ensure that no products were leaked into Israel. At Karni, trucks waited in line to unload for an average of 2-5 days. On various occasions, drivers slept on the border for weeks.

  Israeli products, including pharmaceuticals waited considerably less time. In effect, a system favouring Israeli products was established under the pretext of security.

  Eg: On 15 April 2003 a Pharmacare driver was killed while he waited to unload his goods. Following this incident, Karni crossing was closed until 3 May. New orders were enacted according to which trucks are allowed into Gaza only with a special permit[237].

  Karni crossing was completely closed several more times during this period, even to trucks with a permit. Example: an application for a permit was sent on 02/09/2003, a permit was issued for the 15/09/2003 but on the 14/09/03, companies were informed that Karni crossing is closed until further notice.

  Periods when Karni crossing was closed—May: 3 days; June: from the 7th to the 18th and again from the 21st to the 29th; July: reopened after ceasefire. August: closed for 3 days; September: closed from the 1st to the 7th and then again from the 10th.

  It should be noted that Erez checkpoint is accessible for Israeli pharmaceuticals, as in the case of TEVA, so while Karni is closed, Israelis can send their products to the Gaza Strip via Erez.

Import of Raw Materials:

  Palestinian manufacturers are subjected to special regulations pertaining to import of raw materials according to which an import license of the Israeli Ministry of Health is required for raw materials an Israeli manufacturer can import without such a license. Processing the license usually requires 1-2 weeks. Due to lengthy Israeli security checks, clearance from custom is extremely lengthy. Example: In May 2002, all imports were suspended by order of the Israeli Ministry of Defense. Manufacturers had to prove that raw materials do not have any dual use in any arms related industries. This took around one month to clear. Palestinians estimate that, on average, it takes them three weeks longer to process their shipments than it takes Israeli manufacturers. PHR-Israel itself has handled several cases of medical international donations. For instance, two vehicles donated by the British Council to the Palestinian MOH were not released from customs for over six months, for no apparent reason. As a result many products arrive either expired or with short expiry dates. In many cases, customers over stock to ensure continued supply.

Effect on the Palestinian Private Sector:

  The pharmaceutical industry estimates that Israeli limitations lead to a 22% increase in distribution costs. As to raw materials, these new practices have increased the costs of their import by 4-6%.

Employment in the Pharmaceutical Sector:

  The total number of employees in the pharmaceutical industry is 680. Around 300 additional individuals are employed by the various drug stores in the distribution/marketing of pharmaceuticals. Hence, a total of 1,000 individuals are employed in this sector.

Individual Import:

  The Israeli imports policy creates absurd situations even in individual cases: Dr Hassan Barghouti, a lecturer at Al-Quds University in Jerusalem, was suffering from cancer, and his situation was deteriorating. A hospital in Jordan sent medicine at the recommendation of his physician in Ramallah. A special courier from the Jordanian hospital came to Allenby Crossing with the medicine, but was not permitted to cross to Ramallah. Instead, he left the medicine at the Israeli desk at the crossing. The Union of Palestinian Medical Relief Committees (UPMRC) contacted PHR-Israel and asked us to help release the medicine for this patient. At first, the Israeli Civil Administration demanded that we arrange for a vehicle to come to the Crossing to collect the medicine. They could not decide, however, whether the vehicle should be Israeli or Palestinian, and whether it should be a private vehicle or an ambulance.

  PHR-Israel insisted that there was no point arranging for a vehicle until authorization was received to release the medicine. The Civil Administration then asked whether the medicine was intended for one patient or more; whether it was donated or purchased; whether it was in a box or a bottle; what legend it bore; who sent it; and so on. The authorities then demanded medical documents proving that this specific medicine was indeed required for Dr Barghouti, as well as the precise name of the medicine. While we were attempting to collect all these details, the authorities informed us that the people who were to come from Ramallah to collect the medicine from Allenby Crossing must leave in a Palestinian vehicle. In Jericho, they must board a bus that would take them to the Allenby terminal. There was no point in their doing so, however, since authorization had still not been granted for receipt of the medicine. The Medical Coordinator for the Civil Administration, Dalia Bassa, also demanded medical documents before approving passage of the bottle—or box. Two days later, we telephoned our colleagues at UPMRC to update them, only to learn that Dr Barghouti had died. At the same time, a telephone call arrived from the Civil Administration, asking for yet another medical document in order to issue the permit for the passage of the medicine. We informed them that the coordination was no longer necessary. Dr Barghouti would probably have died in any case, but the medicine might have alleviated his suffering.

  The Israeli authorities were in no rush, and had every opportunity to ensure that the package did not contain an incendiary device or explosives. Thus they could have protected Israel's security needs and forwarded the medicine without any need for endless interrogations. Could it be that the real factor here was not Israel's security, but rather force of habit: the habit of controlling the life and death of Palestinians?[238]

Further medical education is also restricted:

  Since Israel controls every exit and entry into the Occupied Palestinian Territories, a person wishing to travel to professional conferences, advanced medical studies etc., must be approved by the Israeli security apparatus.

  Dr Iyad Zaqout works as a psychiatrist at the Gaza Community Mental Health Programme. He applied and was accepted for further education in Egypt. His first attempt to leave Gaza was refused by Israeli authorities at Rafah checkpoint due to his age—not yet 35. An appeal by PHR-Israel (24 April 2003) overcame this barrier, and he was told that he could now leave via Rafah. However, when trying to do so (1 May) he was again refused. In an answer to our inquiry, we were told that the Israeli General Security Service has "changed its mind". Following the intervention of an advocate, we received the answer—again—that Dr Zaqout can leave, and he again traveled to Rafah checkpoint (6 May) only to find it completely sealed. Another attempt, (8 May), was again refused. Only following further efforts was he finally allowed to cross (9 May) to Egypt and arrive—late—to his studies.

  Aside from the tedious bureaucracy described, other cases PHR-Israel has encountered show that the permit system is sometimes used by the Israeli security forces as a way to exert pressure on Palestinians requesting permits, to collaborate and provide information.

Issues 3 to 4  The impact of the wall and of the network of settlements in the occupied territories on movement of persons and goods[239]

  We chose to present the wall and settlements together since we believe that the settlements are one of the main reasons for the wall as well as for the internal closure. Israel invests considerable efforts in order to enable freedom of movement for its Jewish citizens in the Occupied Palestinian Territories (army presence to guard settlements and escort of settlers' transportation, building by-pass roads, building the wall to the east of the green line in order to annex de-facto many Jewish settlements—all with significant costs). At the same time, Israel hinders and blocks the Palestinians' freedom of movement, while investing next to nothing in solving the resultant humanitarian crisis[240] Israel's approach was proclaimed by Major Amos Gilad, former Coordinator of Government Operations in the Occupied Territories. According to his vision, Palestinians will be able to "keep their head above the water" even when the IDF is present: "The education, health and municipal services will continue to operate . . . with funding from the international community."[241]

  The policy of prevention of freedom of movement within the West Bank has created economic paralysis and the gradual disintegration of the daily lives of Palestinians. It is impossible to maintain a logical and reasonable medical system with no freedom of movement and decentralization/sharing of resources; it is equally impossible to maintain an economic system, an educational system and family life.

  The security considerations cited justifying this policy seem to be merely a pretext for a system of humiliation and violation of human rights. There is no doubt that a healthy person smuggling explosives with harmful intentions can cross barriers, ditches and mountains and will not bother to apply for a permit or pass through a checkpoint, whereas it is the weak, the elderly, the disabled and the sick, who are denied passage by these obstacles. In this policy the state of Israel deviates from the balance it claims to maintain between its security needs and the humanitarian needs of the Palestinians.

Medical Referrals within a Fragmented System:

  From 1994 until the outbreak of the second Intifada, the Palestinian Ministry of Health prepared a plan for the development of specialist services at different hospitals. The plans were based on the assumption that patients, physicians and emergency crews would be permitted to move freely. The efficient organization of health services requires a division of functions between different units specializing in different fields. Modern models for the organization of health services seek to ensure that each unit specializes in certain fields. The alternative is that each medical center attempts to provide the full range of medical services available in that country—an illogical demand. Preventing the movement of civilians between one city and another, or between villages and cities, destroys the foundation on which this assumption is based. Today, in order to cope with such a reality, the Palestinian system is obliged to rely on outside aid, and on its own limited resources, in order to replicate services endlessly, to the point at which each field unit can provide a full range of medical services.

  While the decision to refer a patient to a particular medical center should be purely professional, Palestinian medical professionals constantly encounter Israeli military demands that prevent the referral of patients. This creates complex situations relating to movement within the West Bank and Gaza Strip, and at crossing an international boundary.

The permits policy within the West Bank[242]

  While attempting to enable the passage of physicians or patients, or to obtain medicines, the Palestinian health system encounters mountains of bureaucracy that constitutes a grave violation of human rights. Every ambulance that leaves to collect a patient, however urgent the case, now requires prior coordination. Every patient requires a transit permit, as does every physician. Hidden behind the language of procedures, bureaucracy is less glaring than the checkpoint or the individual soldier who beats a civilian. Yet it is no less harmful, and it has a devastating impact on the ability of a health system to function.

Issue 6.   The role of NGOs

  It is our belief that an active NGO culture is a vital pillar for a healthy Palestinian society. In times when the PA and the Israeli government dealt with "security" matters and both were willing to neglect and ignore human rights issues, NGOs were there to criticize. At times when individuals are either too afraid or unable to voice criticism, NGOs are in a better and safer position to do so, partly due to their international support.

  Israel now limits the NGOs activity, in contradiction to its declaration according to which it recognizes the right of human rights organizations to function and to promote their objectives[243]. Limiting the activities of Palestinian organizations, Israel is preventing the functioning of Palestinian civil society, paralyzing its independence and increasing its dependence on external aid. Limiting the activities of Israeli organizations, Israel is preventing all possibility of Israeli society offering an alternative to occupation and violence in the form of acts of solidarity, and preventing criticism from within Israeli society. Limiting the activities of International organizations the state of Israel is preventing provision of direct aid to the besieged population, as well as preventing international criticism.

Issue 8.   The role of aid

  "The sine qua non of economic stability and recovery is the lifting of closure in its various forms, and in particular, internal closure. As long as Palestinian internal economic space remains as fragmented as it is today, and as long as the economy remains subject to extreme unpredictability and burdensome transaction costs, the revival of domestic, economic and Palestinian welfare will continue to decay." (World Bank Assessment, May 2003, xvii).

  It seems people are grateful for any help they receive, particularly humanitarian aid. However, in Palestine, this assistance is problematic, since it addresses a situation to which the solution can only be political. It is important to organize the process so donation will not replace or compete with local products. It is, however, essential that local responses to distress be accompanied by constant pressure to remove the closures that cause this distress.

  PHR-Israel feels that the time has come for the international community to approach Israel's government directly and openly without fear of being regarded as biased. When sending aid, the international community actually commits itself to a critical analysis of the source of the need for the aid. When Sharon requested the UN Secretary General to assist in addressing humanitarian needs arising from the ongoing Israeli-Palestinian conflict, did he not take into consideration that an integral part of assistance has to do with targeting the sources of the needs? We believe that such action is not only for the benefit of the Palestinians, but essential to Israelis as well so as to prevent further deterioration, both moral and practical. As long as the State of Israel feels it is not held accountable (morally as well as financially) to its actions in the OT, there is little motivation for change.

  Written by: Hadas Ziv, Project Director, Occupied Territories.

  We wish to thank Dr Bassem Khouri for making information on the pharmaceutical industry available to us.

September 2003

236 Back

237   The waiting time for the issuance of such permit is 7-20 days for no apparent reason. Back

238   The case appeared in an article by Gideon Levy in Ha'aretz, May 5, 2002, under the title "A Bridge Too Far". Back

239   For a more detailed description of Israel's permits system see "At Israel's Will". Back

240   The cost involved is approximately NIS 12 billion a year, Ha'aretz, 7 August 2002. Back

241   Ha'aretz, 5 July 2002, Uzzi Benziman. Back

242   For a detailed description see annexed At Israel's Beck and Call (Not printed) See Back

243   Israel Report to the UN Human Rights Committee, on the subject of implementation of political and civil rights. Back

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