“Sometimes patients die”: Barriers facing Palestinian ambulances entering East Jerusalem

With many medical specialties such as radiotherapy and heart surgery only available in Palestinian hospitals in East Jerusalem, it is vital that patients are able to travel there unimpeded.

Last month Medical Aid for Palestinians (MAP) met with staff from the Palestine Red Crescent Society (PRCS) Emergency Medical Centre in Jerusalem to discuss barriers to ambulance access and how, for Palestinian patients, the process of entering East Jerusalem is fraught with obstacles. 

Mohammed, a paramedic, and Ibrahim, the head of volunteers, work for the PRCS Emergency Medical Centre in Jerusalem which provides emergency medical services and transfers patients from checkpoints to hospitals.

Where are the patients you support from?

Mohammed: "We transfer Palestinian patients from the West Bank to Jerusalem and Israel. We also transfer patients from Gaza to hospitals in the West Bank, including East Jerusalem, and Israel."

What are the most common cases you see?

Ibrahim: "From Gaza we overwhelmingly receive l patients who need medical transfers. For instance, we transfer cancer patients from Gaza to Augusta Victoria Hospital in East Jerusalem, as it is the main cancer treatment centre in the occupied Palestinian territory (oPt) and the only Palestinian hospital able to offer radiotherapy."  

Mohammed: "We receive trauma cases mainly in Jerusalem, who need immediate first aid."

How do you transfer patients to hospitals?

Mohammed: "We have a process for transferring patients. It’s called “back-to-back” ambulance transfer. To transfer a patient from the West Bank to Jerusalem is a long and tough process. First of all the patient needs permission from the hospital which will receive them. The patient should contact the hospital and send them copies of their medical records and get agreement and permission to come."

"After that they need financial permission, to show they have the money to cover the treatment costs."

"After this the patient needs security permission from the Israeli Military District Coordinating Office (DCO). They call the DCO and give them their name and ID and they do a security check on them. After that they give permission to the patient, or they can refuse for them, to go to the hospital in East Jerusalem."

How long does the “back-to-back” process take?

Mohammed: "The process can take hour to days. It does not depend on the case, it depends on how the Israeli military collects the patient’s information."

What happens after a patient is given security permission to receive medical care at a hospital in East Jerusalem?

Mohammed: "If a patient from the West Bank gets security permission from the DCO they should travel by Palestinian ambulance to one of the main Jerusalem checkpoints. When a patient arrives at the checkpoint they wait to get permission from Israeli soldiers to enter the changing area. The soldiers check the patient’s ID, the number of the ambulance, the ambulance staff’s IDs and connects with the DCO. If the soldier gives permission, the patient and ambulance can move to the changing area."

"When the ambulance reaches the changing area it is parked parallel to our ambulance and we transfer the patient from the Palestinian ambulance to our ambulance."

Ibrahim: "There is no privacy for patients, there are soldiers, security personnel and people around the checkpoint who can see the patient."

"We have to transfer patients between ambulances in all weather conditions, hot and cold. My colleague asked to cover a patient with an umbrella and was refused so he had to transfer the patient in the pouring rain."

Mohammed: "After transferring the patient from the Palestinian ambulance to our ambulance we set off to the hospital."

Do patients from Gaza also undergo the “back-to-back” process?

Mohammed: "Yes, it is a very tough process. The patient enters the changing place at Erez terminal not by car or ambulance but with a medic from Gaza who walks for one and a half to two kilometres pushing the patient in a bed."

"It is forbidden to get out or take any mechanical medical tools to the other side. For example, if there is a patient with a mechanical ventilator it is forbidden to enter to the Israeli side with it or for us to send our mechanical ventilator to the Gazan side."

Ibrahim: "Imagine you have a patient and only one medic can enter with them, so the medic is pushing the bed and trying to operate a hand ventilator at the same time."

Mohammed: "Sometimes when we arrive to the Israeli side we see the Israeli security personnel telling the medic to go to the inspection area so he has to leave the patient on their own. We are not allowed to go over to the patient. A lot of patients are dead in the terminal and our staff have to carry out CPR."

"We receive neonates, babies who are just two or three hours old who have to be transferred from one incubator to another. They are transferred in cold or hot weather with contamination all around them. During this process they face a lot of diseases and dangers."

How long is the medic from Gaza able to stay with you?

Ibrahim: "At Erez checkpoint when the medic brings the patient to us immediately they are ordered to go back to Gaza by the security officer. Sometimes we don’t even get the information about a patient, including information about their case, what medication they are taking and what happened to them."

How does the “back-to-back” process impact the care of Palestinians patients?

Ibrahim: "With life threatening cases, for example people involved in car accidents, they need to enter the hospital immediately so the “back-to-back” process is very tough for them."

Mohammed: "Some cases are very critical, like patients reliant on mechanical ventilators who cannot breathe by themselves, those in a coma who are connected to a machine to keep breathing. The “back-to-back” process is very hard for these patients and sometimes they die at the checkpoint while we are transferring them."

Ibrahim: "Also for patients with spinal injuries, when we are transferring them they faces additional risk by being changed from one ambulance to another. Before we used to wheel the beds from one ambulance to the other, but now we have to change the patient from one bed to another."

Do you face any additional barriers during the ‘back-to-back’ transfers? 

Mohammed: "We face some tough issues like the mood of soldiers. Sometimes we are going to a checkpoint, we have permission from the DCO and we have arranged to transfer the patient. But when we arrive at the checkpoint the soldier can refuse to let the patient through and say there is no permission and we have to reconnect with the DCO and the hospital and it takes some time, three, four, five, six, even seven hours."

"And during this time the two ambulances, the Palestinian ambulance and our ambulance, are stopped, just waiting. Sometimes I need my ambulance to go to an emergency elsewhere but it is stuck at the checkpoint because of the mood of the Israeli soldier, they say “no permission”."

Is the availability of ambulances an issue for you?

Mohammed: "To transfer a patient you have to make sure there are two ambulances available, our ambulance and an ambulance from the West Bank. Sometimes there is a lot of work here in Jerusalem and we have to tell a patient at a checkpoint to wait because we have no ambulances available. If there was no ‘”back-to-back” process the ambulance from the West Bank would be able to take the patient immediately to the hospital."

Read MAP’s new report, Health Under Occupation, to find out more about barriers to healthcare in the oPt.

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