GAZA - Palestinian high-school student Fida Hejji died of cancer waiting for Israeli permission to go to an Israeli hospital for treatment.
Hejji, 18, was promised an entry permit three times. Three days after she died last November, her family got a call to say the hospital had set the date for her admission.
One year after Israel's offensive on Hamas-ruled Gaza, U.N. agencies and the Association for International Development Agencies (AIDA), representing over 80 NGOs, on Wednesday highlighted the health impact of the continuing blockade there.
They again called on Israel to relax its tight control of the Gaza Strip's borders to allow in a sufficient supply of essential items and access to care not available in the enclave.
Max Gaylard, resident Humanitarian Coordinator for the Palestinian territories, said the blockade undermines the local health care system and puts lives at risk.
"It is causing on-going deterioration in the social, economic and environmental determinants of health," he said. "It is hampering the provision of medical supplies and the training of health staff and it is preventing patients with serious medical conditions getting timely specialized treatment..."
Israel generally permits supplies of drugs into Gaza but not always enough to prevent shortages. Certain medical equipment such as x-ray and electronic devices are difficult to bring in and clinical staff frequently lack equipment they need.
Israel says most requests by Gazan patients to cross its border for treatment are approved, and that there has been a 25 percent increase in approvals since 2008 -- data supported by World Health Organization findings issued by Gaylard's office.
"Not only are we doing our utmost to allow the people of Gaza every possible medical treatment, but we are doing this in a situation in which their own government is imposing a state of war and trying deliberately to harm Israelis, including those whose mission is to assist the very people of Gaza," said Yigal Palmor, a spokesman for Israel's Foreign Ministry.
"Not taking this into account is to do a great disservice to truth and the cause of caring for the health of Gaza residents."
Hejji had hoped to get life-saving treatment in Israel as other Gazans have done. The Egyptian border is also closed.
"In her (Hejji's) last days she used to ask when she could rest, and when all her pain would come to an end," said her mother Shadia. "I knew she was dying."
Israel captured Gaza from Egypt in a 1967 war. The ensuing occupation saw limited Palestinian scope for developing an autonomous health service. Israel left in 2005 but the result was far from the peaceful coexistence it might have hoped for.
Critics accuse Israel of applying collective punishment to Gaza's 1.5 million people, who are ruled by an elected Islamist government of the Hamas movement. Hamas refuses to recognize Israel and preaches armed struggle until its destruction.
Hamas remains in control despite the hammering Gaza took in the offensive Israel launched a year ago to stop the continuous firing of rockets and mortars aimed at southern Israeli towns.
Israel refuses to let them have materials that can be put to military use. It says the Palestinians are too ready to blame all ills on Israel, and should not be ungrateful for the medical aid Israeli doctors and hospitals provide.
The U.N. report said 1,103 patients sought permits for treatment in Israel in December 2009. Most succeeded but 21 percent were denied or delayed, as a result of which patients missed their hospital appointments and had to restart.
"Two patients died recently while awaiting referral - one in November and one in December," it said. In total, "27 patients have died while awaiting referral" in 2009.
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"Whenever I heard Israel had closed the crossings, I told myself I was going to die," said 67-year-old Mohammed Abdel-Al, who was undergoing dialysis this week. He said he had to wait four months for surgery in Israel to prepare for his dialysis.
The U.N. said Gaza's economy and environment were in a poor state, with inevitable consequences for health, and it noted that half the population are children.
"The humanitarian community is gravely concerned about the future of this generation whose health needs are not being met. The decline in infant mortality, which has occurred steadily over recent decades, has stalled in the last few years."
Israel's offensive damaged 15 of Gaza's 27 hospitals and 43 of its 110 primary health care facilities, the report said.
Some 1,400 Palestinians died in the bombing and shelling, and Israel lost 13 citizens in the Dec 27-Jan 18 conflict of 2009. Rocket and mortar fire into Israel from Gaza dropped off dramatically in 2009, but has never entirely ceased.
The damage cannot be fixed until Israel allows construction materials into Gaza, the report said. Meanwhile, doctors and nurses are cut off from learning the latest techniques abroad.
"The new surgical wing in Gaza's main Shifa hospital has remained unfinished since 2006," the report noted.
Nafeth Enaeem, head of Shifa's kidney department, said dialysis treatments had to be carefully rationed last year, which he said was the worst in terms of health conditions.
"Sometimes a cable for a machine took three months of coordination with the Israeli side to get into Gaza," he said.
(Additional reporting by Douglas Hamilton; editing by Douglas Hamilton and Samia Nakhoul)