Since Israel's closure of the Gaza Strip in 2007, only severely sick Palestinians have been allowed to seek medical attention elsewhere provided they receive authorisation and security clearances from the Israeli authorities.
|Short on supplies and facilities, Gaza's hospitals cannot treated the most severe cases [GETTY]
However, getting the special permit that allows patients to leave Gaza for medical treatment is a bureaucratic hassle and, many Gazans say,
comes with strings attached.
According to the Israeli organisation Physicians for Human Rights (PHR), Palestinian patients are increasingly being asked to make an impossible choice: Either to become collaborators with the Israeli intelligence apparatus - or to remain in Gaza without medical treatment.
Al Jazeera spoke with Hadas Ziv, the director of PHR.
Al Jazeera: Your organisation has collected dozens of testimonies of patients who were pressured to collaborate with the Israeli General Security Services. How did you find out about this? A Palestinian will not easily admit he or she has been asked to become an informant.
Ziv: True; it is not a subject people talk about easily and it happened gradually. Our organisation tries to support Gazan patients who were prevented by the Israeli authorities from treatment in Israel, or from crossing Israel on their way to hospitals in the West Bank.
Instead of clear rejection or admittance, the Israelis started saying: "permit pending interrogation". The permit became conditional - not so much on individual health conditions, but on the outcome of the interrogation at the Erez Crossing.
Then, many of the patients we were in touch with came back from interrogation and told us they did not get the permit: "They tried to extort me to collaborate and I wasn't willing to give them information, so they sent me back to Gaza."
When more and more people told us the same story, we understood that this was a new policy.
How do you know the testimonies are true?
The testimonies come from very different people, of different ages, different political opinions and from different towns in the Gaza strip. To believe that there is such a high degree of co-ordination among all the patients is pretty far-fetched. But more importantly, it needs a lot of courage to speak to us about this.
Some of the patients have a lot to lose if they talk.
You started collecting testimonies in the summer of 2007. But when do you think this practice started?
Very soon after the Hamas takeover of the Gaza Strip. Since then Israel sees Gaza as an enemy entity, as something that has to be closely monitored and controlled.
And since then, it has become more difficult for the General Security Services (GSS) to gather intelligence from Gaza. They have little direct contact with Palestinians.
The only ones who are still allowed to cross Erez, even if they also have a lot of difficulties, are the patients. They are an easy prey for the GSS. They are very vulnerable - for some, getting out of Gaza can be a question of life and death.
The GSS is using this situation to exert pressure.
Is there a standard procedure for these interrogations?
It varies. The newest development is that you have a specific appointment for interrogation and it's not on the day of your treatment. But there are also cases where people think they have a permit and can go out, but then they are suddenly being taken to interrogation. Sometimes the patient has to wait in a room for several hours, without his family.
Then, they take him to another room for interrogation. They may ask just a couple of questions to find out if you know any Hamas members or they may suggest a deal for long term co-operation: "If you help us, we will help you. You need a treatment, we need information. We will give you a number, you call us once a week and give us information about your neighbours."
If you refuse, they become more blunt: "Okay, go back and die in Gaza."
What happens back in Gaza?
The patients are in a lose-lose situation. If they refuse to co-operate with the Israelis and are sent back, they may die because they can't get appropriate treatment in Gaza.
If they do manage to get the permit, they will be branded as potential collaborators.
Whether you really did it or not is not so important. If people think you collaborated, your life may be at risk. In the end, everyone suspects everyone else. It's like Orwell's 1984.
And this is the objective - humiliation and fragmentation.
Isn't the objective in the first place a more immediate one - simply gathering intelligence?
That's just the surface.
I think the main goal is to break the cohesiveness and solidarity among Palestinians. This way, it's much more difficult for them to unify and to struggle for a common cause.
What already happens between Fatah and Hamas then also happens between neighbours, between families ... and this is good for the one who tries to control you.
But the Israeli government says it wants a partner for negotiations and thus a united Palestinian position.
What troubles me most as an Israeli citizen is that we suffer from a kind of collective psychosis.
We are governed by fear and manipulated by fear. Security is everything.
But what we are being offered is a very narrow definition of security. No one has the courage to say that long-term security is security for everyone, not just for us but also for Palestinians. But we are obstructed from seeing this, because we let fear govern our lives.
We constantly have something to fear. If one fear stops, another comes up. When Hamas took over the Gaza Strip, it was very convenient for the Israeli government to use this. Hamas is being presented to the Israeli public as an entity that you cannot talk to. But 20 years ago, we claimed Fatah could not be talked to. Every time, a situation is being created in which you claim you have no one to talk to.
How are your views received by other Israelis?
When I argue with people they tell me I should be grateful to the people who defend me. That the GSS may be saving my life through these interrogations. They say I'm naive, that I am not patriotic and things like that.
But I think my point of view has the same legitimacy as others.
In Israel, if you mention the word "security", no further arguments are needed. They say patients may come to Israel to organise terror attacks. In this case, Israeli society does not demand further explanation.
The result is that even things that we wouldn't think about doing with convicted criminals, these things are suddenly permissible when it comes to Palestinians. It is as if we had two different sets of values. And this is only possible because we constantly dehumanise the Palestinians. If we would consider them as normal human beings, it would not be possible.
Everything is conditioned according to us. To our needs and our security. I think this is not justifiable. Not just because the victims suffer. Of course, the victims' suffering is unimaginable.
It is beyond what I can express. Imagine you are the mother of a 17-year-old girl who has cancer, needs urgent treatment and is being extorted by the GSS. You, as a mother, are in a different room and you don't know what your daughter is going through. This is unimaginable to me.
But it is also unimaginable to me what future my society has if it continues to act like this. I'm afraid for my society as well. I think we are at a crossroads. We have to choose. If we want to remain human, we cannot continue like this.
In a written statement given to Al Jazeera, the Israeli defence ministry has denied all the allegations made by Ziv.
"These charges are false. The only considerations Israel has are humanitarian and security-related ones," the statement says.
"There is no truth to the contention that other factors are involved. The reason why clarifications are conducted by our security personnel is to ensure that those granted medical entry permits are indeed in need of such permits, and to ensure that those planning on abusing these permits to foment terror in Israel cannot gain entry into Israel."