Attacks on Medical Installations in the Gaza Strip

During the Israeli attack on Gaza damage was caused to clinics, hospitals, and other
medical installations. In some cases the installations came under direct fire, while in
others they were damaged by attacks on adjacent areas. The World Health
Organization reported that 34 medical installations were attacked during the course of
the war, including eight hospitals and 26 primary health clinics57. Medical
installations are supposed to enjoy neutrality and special protection in view of their
status. During combat, all sides are required to make every effort to avoid injury to
medical crews and damage to medical installations. The deliberate bombardment of
medical installations is an offence under international law.

Israel claimed several times that Hamas operatives were hiding in hospitals in the
Gaza Strip58. These claims were never proved, however, and were denied forcefully
and publicly by the directors of the hospitals during the course of the fighting59. In
just one case it was alleged that shots were fired at army forces from the Al-Quds
Medical Center (see details below). The information gathered by PHR-Israel from
crews in the field, physicians, patients, and so forth does not provide any evidence
supporting Israel’s official claim that hospitals were used to conceal political or
military personnel.

International humanitarian law addresses the subject of attacks on medical centers:

Article 18 of the Fourth Geneva Convention expressly states that “Civilian hospitals
organized to give care to the wounded and sick, the infirm and maternity cases, may
in no circumstances be the object of attack, but shall at all times be respected and
protected by the Parties to the conflict.”60

Article 19 of the same convention states that “The protection to which civilian
hospitals are entitled shall not cease unless they are used to commit, outside their
humanitarian duties, acts harmful to the enemy. Protection may, however, cease only
57
"Health Situation in the Gaza Strip", World Health Organization, 19-20 February 2009
58
http://www.ynet.co.il/articles/0,7340,L-3647934,00.html
59
Mr. Hassan Khalaf, deputy Minister of Health in Gaza, denied the accusations in a report on Channel
10 Israeli television, 4.1.2009. He also addressed these accusations in an interview to www.ynet.co.il.
see: http://www.ynet.co.il/articles/0,7340,L-3648269'00.html
60
See http;//www.btselem.org/English/International_Law/Fourth_Geneva_Convention.asp

41
after due warning has been given, naming, in all appropriate cases, a reasonable time
limit, and after such warning has remained unheeded.” The convention adds: “The
fact that sick or wounded members of the armed forces are nursed in these hospitals,
or the presence of small arms and ammunition taken from such combatants who have
not yet been handed to the proper service, shall not be considered to be acts harmful
to the enemy.” 61

The following are examples of attacks on medical installations as reported to PHR-

Israel:

27 December – damage caused to a Palestinian Red Crescent building
and the administrative building for rescue vehicles. In the afternoon
two medical installations were damaged by an Israeli air force
bombardment directed at the former central base of the Preventative
Security service in the Tal al-Hawa neighborhood of Gaza City.

28 December – damage caused to the Al-Sarani Clinic. The Al-Sarani
clinic in the Shaja’iya neighborhood was badly damaged by an Israeli
Air Force bombardment aimed at the police station in the
neighborhood. As a result of the attack, Rawiya Ud, a pharmacist who
was working in the clinic at the time, sustained critical injuries.

30 December – damage caused to the main building of the Gaza
Mental Health Center. The bombardment of a traffic police station on
Al-Rashi Street in Gaza City seriously damaged the adjacent main
building of the Gaza Mental Health Center. Information provided to
PHR-Israel by representatives of the center stated that windows and
doors were shattered, walls were cracked and perforated, and most of
the computers in the center were rendered inoperable. The reports also
stated that the attack led to the complete cessation of operations at the
center, including the provision of psychological and psychiatric
services for the civilian population.

4 January – attack on Al-Raeiya Medical Center and mobile clinics.
On the night of 4-5 January, Al-Raeiya Medical Center was bombed.
The center is adjacent to Shifa Hospital in the center of a residential

61
Ibid,

42
 neighborhood. There are no government buildings or military
positions in the area. According to initial estimates, the damage
caused to the center and the mobile clinics totalled approximately $
800,000. The center provided various outpatient services – specialist
clinics in internal diseases, a pediatric clinic, a gynaecology and
prenatal clinic, an urology clinic, neurosurgery, and emergency
services. All the services were halted, including the use of the center’s
three mobile clinics, which were completely destroyed.

On the night of 9 January the medical centers Sabha al-Harazin and
Hala al-Shawa, which are operated by the Palestinian Ministry of
Health, were damaged by Israeli artillery fire.

On 10 January artillery fire destroyed the northern wall of the
European Hospital in Khan Yunis. The main water pipes were
damaged, as was the hospital generator, leading to a power cut. One
of the maintenance workers suffered a traumatic response.

On 13 January a clinic in the Shaja’iya neighborhood used as a mental
health and child health center was destroyed by Israeli missiles.

On 13 January the Mohammed al-Dura Children’s Hospital sustained
a direct hit. There were eight patients and medical staff on the
premises at the time.

15 January – direct attack on Al-Quds Hospital. In the afternoon the
Israeli army hit the hospital, operated by the Palestinian Red Crescent
in the Tel al-Hawa neighborhood. The attack destroyed the
administration floor completely. A fire erupted in another section of
the hospital. Some 300 people were present in the hospital at the time,
including 40 medical personnel and several dozen patients, including
15 connected to medical machinery. Fighting continued for hours
around the hospital compound, which was surrounded by army forces.
Most of the patients and the hospital staff were taken down to the
basement to hide during the attack. Patients in the intensive care ward
were left in their beds since they could not be disconnected from the
machinery. Three people were slightly injured during the attack. The
army claimed that shots were fired at its soldiers from the hospital.

43
Al-Quds Hospital following the army bombardment

Photo: World Health Organization

On 1 January PHR-Israel wrote to the minister of defence and demanded an end to

attacks on medical installations.62 A written reply was received 17 days later from the
Ministry of Defence, just two days before the end of the war. The reply stated that
“since the subject is pending before the Supreme Court, the position of the defence
system will be presented to the Supreme Court in accordance with usual practice.”63

***

The large number of incidents reflects the trigger-happy behaviour that characterized
the army’s actions during the attack on Gaza. The large number of medical crews and
centers attacked during the course of the fighting suggests that the army forces failed
to take sufficient steps to prevent injury to personnel and damage to installations. This
behaviour further impaired the functioning of the health system, which was already
forced to cope with impossible conditions.

62
See http://www.phr.org.il/phr/article.asp?articleid=1027&catid=26&pcat=1&lang=HEB
63
From the letter of Ms. Ruth Bar from 18.1.2009, see appendix. Details of the petition and the State's
reply see below.

44
 Injury to Chronic and Acute Patients
After the hospitals in the Gaza Strip began to operate in an emergency format, chronic
and acute patients did not receive proper medical care during the fighting (even if they
were not actually injured by the army attacks). Moreover, the coordination
mechanism for the exit of patients via Erez Crossing for treatment outside the Gaza
Strip ceased to function during the attack. The roads leading to Erez Crossing were
blocked, as was the crossing itself for protracted periods during the attack. As a result,
patients who had routinely left the area for treatment were now unable to do so.

From the beginning of the Israeli attack against the Gaza Strip, the hospitals were
forced to send many patients home without treatment due to the shortage of hospital
beds and medical crews. The United Nations Office for the Coordination of
Humanitarian Affairs (OCHA) published a report on 5 January stating that “patients
in stable condition are being released as soon as their condition permits in order to
make room in the hospitals.” Moreover “there is an urgent need for surgeons from the
fields of neurology, vascular medicine, orthopaedics, and open heart surgery.”64 As
of 11 January, Shifa’ Hospital was attempting to keep the bed occupancy rate to no
more than 75 percent in order to enable the intake of additional injured persons.65 Of
primary health clinics, 34 out of a total of 58 were functioning on a partial basis by
the end of the war.66 As a result, the World Health Organization reported that the
medical treatment of approximately 40 percent of chronic patients was impaired.67

Dr. Hassan Khalaf, Palestinian deputy health minister in the serving government in
Gaza, alerted representatives of PHR-Israel as early as 28 December to the serious
problems facing the hospitals, noting that many patients had been sent home due to
the state of emergency. “The heavy patient load and grave shortage of operating
theaters has led to a situation in which four delivery rooms in the maternity ward have
been converted into general operating theaters, and maternity patients are not
currently being admitted to Shifa’ Hospital.” The outpatient departments in the

64
Gaza Situation Report by the Humanitarian Coordinator,, OCHA, January 5, 2009
65
Health Situation in the Gaza Strip, World Health Organization, (WHO), January 11
66
Health Situation in the Gaza Strip, World Health Organization, (WHO), January 8
67
Health Situation in the Gaza Strip, World Health Organization, (WHO), January 14

45
hospital, as well as four intensive care stations in the burns ward, have been turned
into hospitalization wards for those injured by the Israeli attacks.”68

An injured patient in hospital

According to figures from the Palestinian Ministry of Health, as of 15 January there

were 321 patients in the Gaza Strip who had been registered as requiring medical
treatment outside the area and who had been prevented from departing following the
collapse of the Palestinian-Israeli coordination mechanism69. Half the above-
mentioned patients were women and children, of whom over 90 percent were cancer
patients. Following the invasion of the Gaza Strip, and through 15 January, the
departure of patients was coordinated in just 20 cases and just seven patients were
authorized to depart. In practice, however, not a single patient was able to leave due to
the failure of attempts to coordinate departure through Erez Crossing. This
information was forwarded to PHR-Israel by the Palestinian Ministry of Health.
Throughout the Israeli invasion of the Gaza Strip, of 90 requests submitted for
passage through Erez Crossing, departure was coordinated for just 30 patients.70

The collapse of the Palestinian coordination mechanism

68
See: http://www.phr.org.il/phr/article.asp?articleid=1017&catid=26&pcat=6&lang=ENG
69
PHR-Israel received the data on January 15 from the Palestinian Ministry of Health
70
Gaza: initial health needs assessment, WHO, January 29, 2009, p. 14

46
Contrary to the situation regarding Palestinians injured by army attacks, the
mechanism for the passage of chronic and acute patients should ostensibly have
continued to function during the attack on the Gaza Strip, since no decision was taken
to stop the referral of patients to Israel. However, although the patients held medical
referrals from the Palestinian Ministry of Health ( including an appointment, financial
undertaking, and medical opinion), they were unable to submit applications for
passage to the head of the Palestinian Civilian Committee, Mr. Rif’at Muheisin, for
the following reasons:
1. The Office of the Palestinian Civilian Committee and the Ministry of Health in
Gaza were closed. Following the army bombardments, the offices closed at the
beginning of fighting on 27 December and could not be used to forward requests to
the Israeli side for departure from the Gaza Strip. In these circumstances, patients had
no address to which they could submit requests.
2. Inability to access the Palestinian coordinator. Due to the closure of the
Palestinian Civilian Committee, the head of the committee in Gaza remained in his
home in the Shaja’iya neighborhood of Gaza throughout the war. There was no
electricity in his home for most of this period and he could not be reached by
telephone. His home address or fax number were not known to patients and their
families, and in any case most residents could not have reached his home due to the
fighting. During the course of the fighting, the authorities at Erez Crossing informed
PHR-Israel on several occasions that the coordination of departure of sick residents
would be possible only through Mr. MuheisMn, whom they defined as the only
person in the entire Gaza Strip with whom they were willing to cooperate. In the
situation that emerged, however, Mr. Muheisen was unable to perform his function.
Moreover, he was also responsible for coordinating the passage of ambulances and
the evacuation of injured persons within the Gaza Strip, and for the passage of
patients to Egypt. This is a heavy burden for one individual in the absence of any
other alternatives.

After PHR-Israel contacted the Minister of defenCe on 15 January, the Gaza DCO
stated on the following day that it would receive requests to leave the area directly
from PHR-Israel. Again, however, this step was inadequate to solve the problem. The
submission of requests to the Gaza DCO was not sufficient – patients were in any

47
case unable to reach Erez Crossing due to the blockage of the access roads, and since
the crossing was closed for part of the time.

Blockage of the access roads to Erez Crossing and closure of the crossing
After the coordination mechanism for the departure of patients ceased to function, a
very small number of applications from patients to leave the Gaza Strip via Erez
Crossing were approved during the course of the fighting. However, various obstacles
prevented even those few patients who secured a permit from leaving the area:
1. The access roads to Erez Crossing were blocked by Israeli Military forces and by
large earth piles.
2. A closure was imposed on the crossing without prior warning. On 13 and 14
January, for example, Erez Crossing was closed after a closure was imposed on the
north of the Gaza Strip.
3. The passage of civilians – including sick persons – through combat areas was
possible only in ambulances or international vehicles belonging to UNRWA and the
ICRC, and only with prior coordination. Due to the state of emergency in the Gaza
Strip, there was a shortage of rescue vehicles available to evacuate patients who had
not been injured by the army attacks.71

71
According to the WHO data of January 13, fifteen ambulances of the Palestinian Health Ministry
were hit and were out of service. In its report summarizing the fighting in Gaza it wrote that at least 29
of the 148 ambulances in the Gaza Strip were destroyed or damaged.

48
A.A.R, a ten year-old boy, has been suffering from neuroblastoma cancer for the past
five years. He has been undergoing experimental treatment at the Hematology
Department in Rambam Hospital for several years. Since this is an experimental
treatment, the hospital itself has been financing the treatment; the applications for the
passage of the patient have been submitted by PHR-Israel. On 24 December PHR-Israel
submitted an application on behalf of A.A.R and his grandfather, who accompanies him
to the treatments, in order that they could attend further treatment in Israel on 5 January.
After the request was approved, on the morning of 5 January – the intended day of
treatment – the PHR-Israel representatives were informed that the departure of the boy
and his grandfather had been approved and that they could leave for Israel. However, the
boy’s father, Khalid, was afraid to leave his home in their car since any car not identified
as belonging to the international organizations was liable to be shot at by the army.
During the day PHR-Israel representatives attempted to coordinate the departure of the
patient and his grandfather in an ICRC vehicle. As the coordination efforts continued,
however, notification was received from the Gaza DCO that “their departure would not
be possible” due to “problems on the road” – i.e., the road to Erez Crossing had been
blocked by the army. In a telephone conversation on 6 January, A.A.R’s father described
to PHR-Israel representatives the difficulties they were facing. His son A.A.R could not
undergo treatment in Israel since the road to Erez Crossing was blocked by army tanks.
The father attempted to reach the European Hospital in Khan Yunis on foot – a distance
of some eight kilometers – in order to secure treatment for his son and receive additional
medication.

After carrying his son to the hospital on his back (since the roads leading to the hospital
were also blocked), the father learned that not only was the required treatment
unavailable, but that the medication had also run out. Thus his son was left without
treatment or medication.

***

Thus it can be seen that access to medical care was impaired in the Gaza Strip not
only for those injured by the attack, but also for sick persons. The hospitals were
unable to admit the sick due to the continuous intake of those injured in the attacks.

49
Moreover, passage to the neighboring countries – including Israel – was blocked for
protracted periods. Although a handful of patients left the area during the course of
the fighting, they constitute no more than a drop in the ocean.

50
 Conclusion
Through the 22 days of the Israeli attack against the Gaza Strip, the State of Israel
made a considerable effort to conceal the actions of its army in the area and the
humanitarian crisis that prevailed. The sweeping prohibition on the entry of
international media into the area and the vague responses given to the High Court of
Justice were just two of the mechanisms used to secure this objective. With regard to
the issues examined by this report, the events constituted a humanitarian crisis that
was exacerbated due to the attack, causing extensive damage and injury.

The Palestinian health system in the Gaza Strip was already facing a
shortage of medical knowledge and equipment after eighteen months
of siege. In its debilitated condition, the system was unable to provide
proper medical care for thousands of residents injured by the army
attacks. The volume of injured persons was one that even an advanced
health system such as that in Israel would have found it difficult to
cope with.

During the early days of the fighting, many injured persons,

particularly those with head injuries who were unconscious and
required ventilation could not be treated by the health system in the
Gaza Strip and required transfer to advanced medical centers outside
the area. The imposition of bureaucratic obstacles by Israel and Egypt
in the initial phase, and the refusal of the Hamas authorities to
cooperate with Israel at the expense of injured civilians in the latter
phase, led to defective medical care, impairing the health of many of
those involved. The rapid evacuation of the injured relatives of Dr.
Az-Addin Abu AlAish proved that in certain cases Israel was able to
remove patients rapidly from the Gaza Strip when this served its own
interests. The opening of the clinic alongside Erez Crossing during the
last few days of the fighting was “too little too late” and was also
undertaken for considerations of image.

Medical crews came under attack during the entire period of fighting,
and appear to have been regarded as legitimate targets by the army

51
 forces. According to the report of the World Health Organization, 16
medical personnel were killed and 25 injured while performing their
duties. The state’s response to the petition submitted to the Supreme
Court by PHR-Israel, Adalah, and other organizations was considered
satisfactory by the judges, who refused to intervene in the matter
despite ruling that it was within the court’s sphere of jurisdiction.
Perhaps the clearest evidence of the inadequacy of the coordination
mechanisms that were supposed to reduce, at least, injuries to medical
personnel, was that even after the Supreme Court’s decision, medical
personnel continued to be injured as they traveled to rescue the
injured. At least five cases of injury to medical personnel occurred
after the first hearing in the petition. On the basis of earlier reports
published by PHR-Israel, a dangerous and retrograde trend can be
identified of an increasing disregard for the obligation to protect
medical personnel during Israeli military operations. It seems that
army soldiers no longer regard medical personnel as entitled to the
special protection they are granted during the performance of their
duties.

As a result of the growing fear of attack by army forces against

medical crews, many injured persons remained trapped in their homes
without any possibility of evacuation. According to the ICRC, the
average time required for the evacuation of the injured after the
beginning of the ground offensive was between two and ten hours.
More seriously still, in some cases Israeli military forces were only a
few meters from injured Palestinian civilians yet failed to provide
medical assistance (see the cases of the Shurab family and the Al-
A’ida family), contrary to international law and to basic human
values.

Medical installations were damaged both by direct attacks and

indirectly. During the course of the fighting, Israel reported that
Hamas leaders were hiding in the basements of the hospitals. These
charges were vigorously denied by the directors of the hospitals with

52
 whom PHR-Israel was in contact in the Israeli and foreign media. At
least six medical installations – hospitals, clinics, and medical
equipment storerooms – were damaged during the fighting despite the
protection such sites enjoys under international law. Even if the
damage to these installations was not caused deliberately, the
impression is that the army forces did not take special care when
firing in areas adjacent to medical installations.

As a result of the enormous pressure facing the hospitals and the

closure imposed on the Gaza Strip, patients who were not injured by
the army attacks did not receive proper medical treatment. Particular
damage was caused to the health of chronic patients requiring
treatment outside the Gaza Strip. Although a handful of patients
managed to leave the area during the course of the fighting, such
instances were extremely rare and did not meet the real needs of
patients in the area at the time.

It is not the purpose of this report to establish whether the army forces committed war
crimes. This is a question that must be examined by legal experts in this field after
exhaustive investigation. It can be stated with certainty, however, that violations of
international humanitarian law occurred during the course of the attack. These
violations included attacks on medical personnel; damage to medical installations;
indiscriminate attacks on civilians not involved in the fighting; and the delaying of
medical treatment of the injured.

In moral terms Israel’s image has been stained by the manner in which it pursued the
attack; by its disproportionate use of force; and by its gross disregard for requests
from local and international human rights organizations in the face of the
humanitarian crisis in the Gaza Strip. The process of demonization of Palestinians
bears a heavy price for Israeli society. This process reached its nadir when soldiers in
an army that flaunts its morality declined to help evacuate injured civilians and
trapped families; when soldiers acted in trigger-happy manner as they opened fire on
ambulances, medical installations, and medical personnel; and when Israel’s leaders

53
employed doublespeak in order to deny the existence of a humanitarian crisis in the
Gaza Strip.

Recommendations
1. Israel must enable injured Palestinians to reach advanced medical centers
outside the Gaza Strip and must loosen security criteria in light of grave injuries.
2. Israel must enable advanced medical equipment to be brought into the Gaza
Strip and must enable Palestinian physicians to leave the area in order to acquire
advanced medical knowledge elsewhere so that they may facilitate the
development of an independent health system.
3. The army must reiterate to its soldiers the protection granted to medical
personnel performing their duties, under international law, and must prosecute
those who violate these provisions.
4. The Supreme Court must not confine itself to accepting the state’s position
that guidelines were issued not to harm medical personnel. It must ensure that
such cases do not reoccur. It must also ensure that the state enforces the judges’
decision regarding the need to investigate the circumstances surrounding attacks
on medical personnel and installations.
5. In any future armed conflict, the army must refrain from damaging medical
installations.
6. Soldiers, and in particular medical personnel serving in the army, must
provide medical attention for any injured person in their vicinity, provided this
is possible under the given circumstances.
7. In the absence of a proper Israeli investigation, PHR-Israel demands that a
neutral, independent international body carry out a thorough investigation.
Should this investigation find Israel had violated the International Law, the
Customary Law and the Israeli Law, those responsible for these violations
should be brought to justice and Israel should be held responsible for the
rehabilitation of the victims of these violations.

54
 Appendices

Ministry of Defense

Office of the Minister of Defense

Kiriya 8 Tevet 5769

Date: 4 Jan. 2009

Ran Yaron
Physicians for Human Rights
9 Dror St.
Jaffa – Tel Aviv 68135

Re: Application to Transfer Rawiya Ud to Hospital in Israel

I hereby confirm receipt of your letter dated 31 December 2008 to Minister of

Defense Mr. Ehud Barak.

Sincerely,

Attorney Ruth Bar

Assistant to the Minister of Defense

55
 Israel Medical Association

5 January 2009

Mr. Yaron Ran

Physicians for Human Rights - Israel

Dear Sir,

I received a copy of your letter to the minister of defense regarding damage to

medical installations during Operation Cast Lead in Gaza.

I shall send a letter in similar spirit to the minister of defense and the chief of staff.

Separately from my response as above, it is jarring, irritating, and annoying that you
do not take the trouble to mention in your letter to the minister of defense that the
damage to medial installations is the result of attacks on other installations that were
proper targets for attack, and whose proximity to medical installations forms the real
and intolerable problem in terms of the behavior of Hamas.

To the best of my knowledge, there has not been and will not be any decision to attack
medical institutions by the IDF as a target in their own right; I hope you too believe
this.

Furthermore – the proportion of your response to the ongoing firing of missiles at the
communities around the Gaza Strip is very very disturbing and bothersome, to put it
mildly.

As an Israel, albeit from Physicians for Human Rights, your approach and that of your
organization to the exposure of a civilian population and civilian installations in
Israel, such as kindergartens and schools, medical and other installations, should be in
a proportion and degree of severity that at least approaches the subject of your clarion
call.

Israelis – Jews, Arabs, and Bedouin – also have rights that are supposed to be on the
agenda of your organization during the conflict with the terror / organization –
Hamas.

Sincerely,

Dr. Yoram Blachar

Chairperson, Israel Medical Association

CC: Minister of Defense – Mr. Ehud Barak

Chief of Staff – General Gabi Ashkenazi

56
 Unclassified

Office of the Chief of Staff

Israel Defense Force

Office of the Chief of Staff
Secretariat of the Supreme Command
10 Tevet 5769
6 January 2009

Ms. Miri Weingarten

9 Dror St.
Jaffa – Tel Aviv 68135

Dear Ms. Weingarten,

I would like to confirm receipt of your communication dated 6 January 2009

addressed to the Office of the Chief of Staff.
Your communication has been forwarded to the relevant bodies for examination and
we shall reply once their examination is completed.

Sincerely,

Neta Shmariyahu, Major

Assistant Secretary to the Supreme Command

57
 Ministry of Defense

Office of the Minister of Defense

Kiriya 15 Tevet 5769

Date: 11 Jan. 2009

Reut Katz
Physicians for Human Rights
9 Dror St.
Jaffa – Tel Aviv 68135

Re: Evacuation of the Al-A’idi Family from an Area of Firing in Gaza

Your letter dated 6 January 2009

Further to your letter as above, the Office of the Coordinator of Operations in the
Territories has informed us that the members of the family have been evacuated from
their home to the nearby hospital in Gaza in order to receive medical treatment.

Sincerely,

Attorney Ruth Bar

Assistant to the Minister of Defense

58
 Ministry of Defense

Office of the Minister of Defense

Kiriya 18 Tevet 5769

Date: 14 Jan. 2009
Physicians for Human Rights
9 Dror St.
Jaffa – Tel Aviv 68135

Re: Passage of Patients for Life-Saving Treatment in Israel

Your letter dated 30 December 2008

Further to your letter as above, the following is the response of the Coordinator of
Operations in the Territories:

Ahmad Abu Hawaij – entered for medical treatment at Rabin Hospital on 31

December 2008.
Sari Sama’ana – entered for medical treatment in Israel at Tel Hashomer Hospital on
31 December 2008.
Mohammed Sawafiri – entered for medical treatment in Israel at Tel Hashomer
Hospital on 31 December 2008.
Rawiya Ud – Gaza DCO contacted the organization and requested medical
documents, the request has not yet been met.
Fatima Salam – according to the organization she has been transferred to Egypt for
medical treatment.
Akram al-Khatib – according to the organization he does not require medical
treatment in Israel and the request is therefore immaterial.

Sincerely,

Attorney Ruth Bar

Assistant to the Minister of Defense

59
 Unclassified

Office of the Chief of Staff

Israel Defense Force

Office of the Chief of Staff
Secretariat of the Supreme Command
19 Tevet 5769
15 January 2009

Ms. Miri Weingarten

9 Dror St.
Jaffa – Tel Aviv 68135

Dear Ms. Weingarten,

Further to your communication dated 6 January 2009 and addressed to the Office of
the Chief of Staff, I should like to respond. In your communication, you requested
that the evacuation of Palestinians injured during the fighting currently taking place in
the Gaza Strip be facilitated so that they may obtain medical treatment in Israel and in
Judea and Samaria, given the inability of the Palestinian health system to cope with
caring for the large number of injured.

In opening we wish to note that our position (contrary to that stated in your letter) is
that Israel is not responsible for treating injured residents of the Gaza Strip. At the
most, this was the situation during the period in which the Gaza Strip was subject to
the military administration that operated in the framework of the laws of belligerent
occupation in international law. As is well known, in September 2005 the military
administration in the Gaza Strip ended, and since then these laws no longer apply to
the IDF operations (as established in the ruling of the Supreme Court – HCJ 913207
Al-Basiuni et al. v Prime Minister et al.). The IDF operations in the Gaza Strip are
now regulated solely by the laws of combat, which do not require a party to an armed
conflict to enable subjects of the opposing side to enter its territory in order to obtain
medical treatment.

Alongside the above, it should be clarified that despite the absence of a legal
obligation to attend to the well-being and welfare of the civilian population in the
Gaza Strip, the State of Israel is making every effort to alleviate the humanitarian
situation prevailing in the area. This despite the fact that the sole responsibility for the
situation of the population rests with Hamas, due to its cynical use of civilians for
despicable purposes.

In this context it should be noted that of the applications forwarded to the

coordination and liaison functions over the past three weeks relating to the entry of
residents of the Gaza Strip into Israel for the purpose of obtaining medical treatment
for injuries caused during the operation, not a single application has been refused
(some have been approved and others are still being processed).

60
Moreover: since the beginning of Operation Cast Lead, the coordination and liaison
functions have contacted the Palestinian health bodies on their own initiative and have
specifically offered to coordinate the transfer of injured persons from the Gaza Strip
to medical treatment in Israel and in Judea and Samaria. Despite this, the Palestinian
bodies have unequivocally rejected the said offers, and have replied that they are not
interested in transferring patients to Israel or to Judea and Samaria, but prefer to
transfer them to Egypt and Jordan via Rafah Crossing (and, indeed, figures in our
possession show that over 200 persons have already been transferred to Egypt for
medical treatment).

In light of the above, we do not feel that there are any additional steps that can be
taken at the present time. As may be seen, and even in the absence of formal
responsibility, the State of Israel does not ignore the situation of the civilian
population in the Gaza Strip. In this framework, and although the IDF is in the midst
of fierce and intensive fighting against a terror organization that attacks the residents
of the State of Israel, and exploits the residents of the Gaza Strip to this end, we are
making every effort to minimize the injury to the latter and to offer them assistance
insofar as possible.

Sincerely,

Neta Shmariyahu, Major

Assistant Secretary to the Supreme Command

61
 Ministry of Defense

Office of the Minister of Defense

Kiriya 22 Tevet 5769

Date: 18 Jan. 2009

Ran Yaron
Physicians for Human Rights
9 Dror St.
Jaffa – Tel Aviv 68135

Re: Your request to the Minister of Defense regarding damage to medical installations
Your letter dated 1 Jan. 2009

Since the subject is pending before the Supreme Court, the position of the defense
system will be presented to the Supreme Court in accordance with usual practice.

For your information.

Sincerely,

Attorney Ruth Bar

Assistant to the Minister of Defense

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Written testimony by Muhammad Shurrab

In the name of allah, the merciful, the compassionate

Friday ,as we all know, is God's day for the Moslems. We began, my sons and I, Qassab ,
graduate of the faculty of engineering, department of construction engineering ,at the Islamic
university, and Ibrahim, first year at the faculty of accountancy, at "AlAzhar" university. It
was a beautiful warm day. I awoke in the morning as usual, did the things that I needed, and
then the boys awoke, and I asked them to do some chores for me. I decided that, with the help
of allah ,we would set out for the city together, before the end of the humanitarian
ceasefire/truce that the Israeli army declared while it was entering the AlFukhary
neighborhood, which is on the border of my private farming land .
And so it was, after the Friday noon prayers, we took the things we needed for home and set
out in the car, and after 200 meters, we passed a route that was blocked because of tanks and
heavy mechanical equipment which had been used to surround the area in the night before,
and we managed despite the digging works to pass another 700 meters, and then we found a
route that was being used by heavy mechanical equipment, it was a harder way than the one
before, but because our car was a land rover jeep I managed to go through it, and I said to my
children, "I am going to cross this road-hump, which looks like a sand roadblock" and I
continued and said "I am not driving a Subaru" and I called for the help of allah.
All the way I took care to go according to the instructions, as they were written for me, from
the AlUmur Mosque "AlReda" route we passed through the" Electricity" square ['Muhawal
alQahraba'], I proceeded straight on, intending to pass through a side alley that I know well. I
was surprised to discover an empty area, and when I looked to my left, I was surprised to see
two soil roadblocks, with a tank in one of them. This was an unexpected surprise. I raised my
hand as in greeting, no one stopped me. I continued driving for another 50 meters and then
bursts of gunfire were shot at me.
I immediately told my sons "bend down". The shooting continued in our direction. I thought
it was warning shots, until I was amazed to hear a voice of someone ,shouting "get down, son
of a bitch", I said to my sons, get down, bend down, get down from the car, and lie down on
the ground. I bent down, and I could not see me son Qassab who had been sitting next to me
and I did not know how he got down or how he behaved, but Ibrahim who was sitting
behind, and was unhurt, opened the door of the car and got out, and then suddenly he started
shouting "I'm hit". I looked at him and saw that he had been injured in the leg, below the
knee. I said to him, "never mind, it is a light injury, not lethal ."
The soldiers shouted at me "get out of the car" and shot at the car where it was standing, so
that I could not get out of the car because of all the bullets that were being fired being shot at
me. Then I started to feel hot blood dripping from my left arm. I looked in my clothes to see
where I had been hit and I saw that my left arm was injured, above the elbow, and then I
leaped over the passenger seat and out of the car and lay down flat on the ground, all while
the shooting was continuing.
At the same time, Ibrahim was screaming, "I'm hit, ambulance, I'm hit", and then I heard the
soldier say to him "shut up or I will shoot you ."
I asked Ibrahim to be quiet and to crawl toward the fence, and then he answered me, "father,
call an ambulance". I answered that I did not know the number, and he said it was 101. I said,
can you call them, I'm hit the arm. While he was trying to call, the soldier shouted at him,

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"don't talk, I'll shoot you, throw away the phone." Ibrahim threw away the phone and sat
there bleeding .
I shouted, I called the soldiers, "I have an injured person here, I am also hurt ,get us a
paramedic, wound dressings, an ambulance". They answered, "shut up or call an ambulance".
I called an ambulance and they answered me that they cannot come, and that only the Red
Cross could do it, by coordinating with the] Israeli] army commanders, who had refused to
authorize their passage.
Time passes and my son is bleeding. Qassab lies on his stomach, I don't know if he is alive or
dead. I tried to crawl toward him and then one of the soldiers told me not to move and fired a
warning shot .
Ibrahim bled, and no ambulance or medic could be seen. The soldiers took over a house just
40 meters away from us, no more. I see them and they see me. I hear them and they hear me,
and so I called them, "the boy is bleeding, send a paramedic to do something," and at the
same time I was phoning for an ambulance more than 20 times, until they told me there is not
much they can do, and that they would pass on my issue to the media. Time passes, and
sunset is near, and I and my two sons, bleeding, started to feel the cold of January, I felt that I
was in a race against time. And my younger son is calling to me every 5 minutes, begging
"father call 101", and I would call, because of his shouting and begging, to no avail, the
evacuation authorities told me they were aware of the situation I was in, and asked me to
keep my phone available, so that local press and radio could contact me, so I could explain
the situation to them, and call for our rescue ,so that perhaps everyone would hear and could
help .
It was already dark, and there was no one to help, only the sounds of the cellphone ringing all
the time, whether from a local radio station, or a satellite station, or a human rights
organization, and other bodies .
I gathered courage and crawled toward my eldest son, when I saw some cats wandering
around him. One of the soldiers shouted at me, and said in Arabic "go back to your place or I
shoot you". So I answered him, "you can shoot me if you want". I reached Qassab, who lay
on his stomach, I looked for the place where he was injured, and then I discovered with
certainty that he was dead. His body had become hard. I turned him on his back and covered
his face with his coat. He was lying one meter away from the jeep, and I thought "Qassab is
dead, Ibrahim remains" – or Abbas as we used to call him. I went back to Ibrahim, and then
he asked me, "how is my brother Qassab, is he still alive?" I answered, Qassab is dead [was
martyred], and we are next ."
"Bless him father", that's what my younger son said to me. I answered "how can I not bless
my martyred son, who was murdered by the enemies of God with no justification?" And then
again he asked me to call 101, I said "I will call, and you talk to them, maybe they will take
more account then". But he answered me that he could not talk. I phoned and phoned
countless times, and each time they told me this was the last time, and I said to them "I beg
you for help, you respect neither Man nor humanity". And they answered me weakly and
helplessly ,and swore… Believing or not believing [them], it was all the same to me. And
here, my younger son, asking me "are you satisfied with me father," and again" are you
satisfied with me father", and I repeated my answer over and over .

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"I'm cold, you and I are wounded, we are close to our end", he said to me, and I answered
"no, you were injured in the leg, below the knee, this is an injury that does not cause death",
and then he asked me about my injury, and I answered that I was fine, See, I'm with you now .
I asked him often if he was cold, and he answered that he was, so I put my bloodstained
jacket on him, I leaned against the wall, stretched by legs forward, and placed his head on my
lap, so he would be close to me, and feel some warmth. But, while shivering, he said "father,
you are more sensitive to cold than I, take me to the jeep, maybe I will feel warmer there. We
sat in front of the car that had crashed into the concrete fence/wall, I said to him" stand on
your good leg, and I will help you". The moment we moved from our place, one of the
soldiers shouted "get away, I'll shoot you". I took no notice of him, and I shouted "Bring me a
paramedic, a blanket, something to tie the place of the wound with, bring me some kind of
help, you who call yourselves modern people." One answer was all I got: "call an
ambulance". I felt that this answer could be considered permission to use my mobile phone, it
was already dark, and colder, I suffered from a terrible cold, and all the body of my sone
shivered from the cold and the bleeding. I listened to sounds, hoping to hear a car, but there
were only the sounds of tanks or bulldozers destroying people's homes and trees. I threw the
bag of dirty washing to my son and told him to use it as a pillow, and I took out some of the
clothes to cover his body and his leg. We were in the car. I sat in the back seat and he sat in
front. I put his head on the headrest of the seat, and started to rub his back and his trembling
body with my fingers. I asked him every five minutes "are you cold? Does it hurt?" and he
would answer with only one sentence: "call the rescue teams or."101
I was in a bad condition, and despite my own injury I did not worry about myself for a
moment, although I could feel that I was bleeding, and that the blood had wet all my clothes,
until it was dripping from the palm of my hand. Through all this, whether the blood was
flowing or drying up, I was not afraid for myself. I was afraid only for my son .I kept
stroking him and talking to him, and I didn't know the seriousness of his condition, all I knew
was that an injury to the leg could not cause death.
Around ,20:00 I received calls from local radio stations and from bodies claiming to be
human rights organizations, and I asked them all "save us, we are behind a base of tanks,
before a group of snipers, who are able to help us, but they have not given us anything but
killing and fear." I asked everyone I talked to on the phone, "help transfer the bleeding
wounded person, because perhaps in an hour or less you will not be able to talk to me
because I will not be alive".
My left arm began to tremble. I felt a numbness in my arm, in my hand and in my fingertips.
I kept receiving calls, "I'm from the radio… I'm from a foundation …we will talk live now,
you can call for help directly…" I was tired, I wanted ,before our time was out , paramedics,
nothing more .
It was already ten o'clock. Night and cold. The dead one was lying in the street ,and the
wounded and the bleeding one, and me and the persecuting Jew, who was ready with his
weapon to finish living people at any moment, so when he wants to reach satisfaction through
killing, I know it, and I shouted at them, "death at this moment is a great peace/rest". I called
in a clear, sad and trembling voice, "IDF, if you were modern, or human, or grandchildren of
Abraham, my son Ibrahim is dying, you murdered my son Qassab, and my life is in your
hands .Either you do something, or you let me rest/die." I heard only one answer: "let the
ambulance come and take you".

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I was certain the end had come, my mobile phone with which I received or made calls, its
battery was finished, and I had no way of calling others. Before this I had told the human
rights organizations that were dealing with the issue after being told about it by the rescue
teams, that between me and the biggest hospital in the Gaza Strip there were less than 1,000
meters, that is one kilometer, but the power of the soldiers and the power of Israel persisted in
their intention of deliberate murder .
At midnight, AlJazeera called me, and asked me to talk. At that moment Ibrahim was
breathing. When I finished the interview, I could not feel his breath. I thought he had fallen
asleep. I called him and I asked him the same question, if he was cold, but he didn't answer. I
put my hand on his forehead, it was warm. Then I moved my hand to his mouth, but I could
not feel his breath. So I knew he was dead. Ibrahim was dead. Abbas was dead. My son. Both
were gone. The first was lying in the street, the second was lying in the front seat of the care.
Many people called, radio stations, bodies, organizations, I said to them all: "I am not OK,
both my sons were martyred. Our rights as human beings do not exist here. I am going to die
of the cold, and I don't care if I die, because I am no better than my sons, who died in front of
me. My pain is harder than death, I wish for a speedy death, so I can have some rest".
I shouted at the soldiers, who were coming out of the house they had taken over .There were
about 30 soldiers, with full kits. They went away for about an hour and came back. Then I
shouted, "why are you leaving me behind? Finish me off ,let me rest, just one bullet, it will
cost you no more than pressing the trigger. Do it, cowards". None of them paid attention to
my words. They don't care what I say. They did what they did, the bodies of my two sons are
in front of them, they understood they had fulfilled their aim, murdered my sons, the young
ones, the homeland…

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