Israel's military killed at least 54 Palestinians yesterday - almost half of them civilians, including four children - in its most violent assault on the Gaza Strip since the Islamic militant group Hamas seized power last June. The latest deaths bring to more than 80 the number of Palestinians killed since a rocket fired from inside Gaza killed a 44-year-old Israeli in the town of Sderot last week. Two Israeli soldiers also died in the fighting.The latest bloodshed comes as an Observer investigation revealed how Israel is again deliberately obstructing the transfer of urgent medical cases for treatment outside Gaza in the latest extension of its policy of collective punishment of Palestinians.
The death toll climbed through yesterday as Israeli troops targeted Palestinian militants who fired rockets and mortar shells into Israel. The operation follows last week's warning by Israel's deputy defence minister, Matan Vilnai, that a 'holocaust' would be unleashed on Gaza if rocket fire was not halted.
One resident described heavy fighting around the Jabaliya camp and horrific conditions for trapped civilians as Israeli forces moved in. The incursion appeared to be a prelude to a possible Israeli invasion, and came just days before US Secretary of State Condoleezza Rice is due to arrive on her latest peacekeeping mission. As the number of fatalities rose, Palestinian leaders threatened to call off talks with Israel.
Meanwhile Israel was accused of ratcheting up its policy of obstructing Palestinian patients requiring care outside Gaza - despite a ruling by Israel's high court 'that even total criminals have a right to medical care'.
Officially, Israel permits hundreds of Palestinians through each month for medical treatment. But beneath that fact, The Observer has established, lies a secretive and increasingly harsh system of judging who is allowed to pass through the main Erez checkpoint by the security officials of Israel's Shin Bet.
The system, Palestinian medical professionals claim, has already caused the premature deaths of a number of Palestinians. And, amid increasing criticism of Israel for its 'collective punishment' of Gazans, this issue has become emblematic of Israel's harsh attitude.
It is a time-consuming lottery where permits can take months and where a name that sounds too similar to that of a wanted militant is enough to block access to treatment - even for life-threatening conditions. Some claim that, during interviews with Shin Bet, they have been pressed to become informers. The allegations are backed by nine affidavits from patients in Gaza, collected by the joint Palestinian-Israeli group Physicians for Human Rights Israel (PHR), who say they were pressured into becoming collaborators in exchange for treatment.
The consequences of Israeli's policy is most obviously visible in the desperate crush outside Dr Bassam al-Badri's office, where a crowd blocks the corridor and overwhelms his little room. On a good day there are a hundred people; on a bad day, the number doubles. There are women with breast cancer, men with broken legs, old men with eyes cloudy from cataracts.
Badri represents the only hope for treatment in Israel, Jordan or Egypt. 'It is always the same crowd,' he says. His job is to process medical referrals for the Palestinian health ministry. 'We do 700 to 800 referrals every month. But not all of them can go across. In December,' he says, digging through his papers, 'we had 669 patients accepted by the authorities inside Gaza for transfer. Of those 156 were refused by Israel. Another 132 are under evaluation.
'A half or a third of those coming to see me end up with no answer from the Israeli side, or they are told for some reason that they have to do their application again. It is a long procedure. It can take weeks to get to that point again.'
In Badri's office is Nariman Hamouda, a shy 28-year-old accompanied by her mother Kawkab. During the first intifada in the Eighties, Kawkab's sister was carrying Nariman and fell, badly damaging the child's elbow. Despite being treated in Israel, when she fell again last year the Israelis would not let Nariman in. Now she is applying once again.
'We don't know why they refused her,' said Badri. 'Sometimes there is a martyr in the family. Sometimes it is because her name sounds similar to someone else's name or because she has a relative who is wanted. Often there is no reasonable cause. No one who is here does not have a serious problem. All of them are poor.'
For those refused transit the only hope is PHR, which petitions the high court over pressing cases. But it is a process littered with obstructions. Shin Bet's evidence for refusing transit is heard without any representation of the petitioners' lawyers. Last month the three-judge bench first refused to hear any cases, and then insisted on hearing only cases of people who would die if they did not receive treatment 'today'.
'Since the declaration of Gaza as a hostile entity in September,' said Miri Weingarten of PHR, 'the situation has become much worse. The definition of what is an urgent humanitarian case has become extremely cynical.' But even those allowed through - like Abdul Kader Munzir, 19, shot in the stomach while going to help his aunt during an Israeli incursion - claim they have been confronted with inhuman treatment.
'The first time he was given permission to cross Erez,' said his father Munzir, 'Abdul and his mother were kept waiting from eight in the morning until five. Then they were told to go away again. His mother said: "We have to go across today. If we are not allowed to cross we'll have to wait another five months."'
Despite being kept at an Israeli hospital for 20 days, he was not treated. Instead he was sent back to Gaza and told to reapply. There are those who do not make it at all and die in the limbo of the referral system. Among them, say Gaza hospital sources, was two-year-old Said al-Ayidy, who died from a kidney infection on 19 February after being denied transfer to a hospital abroad.
© Guardian News and Media Limited 2008