Introduction
On 4 March 2002, Dr Khalil Suleiman, aged 58, was killed when an ambulance he was travelling in was hit by gunfire from members of the Israeli Defence Forces (IDF). Dr Khalil Suleiman was head of the Palestinian Red Crescent Society Emergency Medical Service (EMS) in Jenin in the West Bank. Also injured were four Red Crescent paramedics and a driver who were travelling in the ambulance. An injured girl was being transported in the ambulance at the time.
Four days later Dr Ahmad Nu'man Sabih al-Khoudari, the director of the small Yamama Hospital in al-Khadr, was shot dead as he drove to the al-Dheisheh refugee camp, on the fringes of Bethlehem. The doctor had received assurances from an Israeli official that his security would be respected.
Since 4 March a total of five health personnel have been killed and several others injured. These killings illustrate a blatant disregard for the provisions of the Geneva Conventions which Israel ratified in 1951.
According to the Palestine Red Crescent Society (PRCS), three Society ambulance staff have been killed and more than 130 injured since the beginning of the al-Aqsa intifada in September 2000. Since that time, more than 70 ambulances are reported to have been attacked by the army. PRCS medical staff are said to have treated more than 18,000 injured persons, and reported over 1,100 intifada- related Palestinian deaths(1). Other health personnel have provided medical care to the sick and wounded and have also been among the killed and wounded; some of these cases are detailed below.
Patients have also been killed or wounded while seeking medical care, sometimes suffering from delays imposed by Israeli soldiers staffing checkpoints through which Palestinians must pass en route to hospitals. Amnesty International is calling on the Israeli authorities to immediately cease all attacks on health personnel and ambulances and to remove all obstacles to Palestinians seeking prompt access to health care.
Attacks on health personnel
Over the past week, Palestinian ambulances and health personnel have been targeted by Israeli soldiers resulting in deaths and injuries to individual health workers and damage to Palestinian vehicles and health services.
As mentioned above, Dr Khalil Suleiman was killed on 4 March while travelling in an ambulance; four paramedics and a driver were wounded in the attack. Further killings of personnel travelling in ambulances occurred on 7 and 8 March.
On the evening of 7 March, ambulances had answered calls to attend to the injured in Tulkarem. Red Crescent officials were cited in press reports as having coordinated the ambulance travel with both the civil administration and the IDF. However two of the ambulances quickly came under IDF fire. A driver of one, Ibrahim As'ad, was killed when he got out of the ambulance and two staff with him, including paramedic Safiya Balbisi, were injured.
A second PRCS ambulance was hit resulting in injuries to the driver Ra'id Ghalib Yassin and crew member Mahmoud Hussein Bahjawi.
A third, UNRWA(2), ambulance entering Tulkarem was also attacked and Kamal Hamdan, an UNRWA staff member, was killed. A doctor also in the ambulance, Dr Adnan Karmash, and nurse Ansaf Tako'a were injured. Kamal Hamdan was the first UNRWA staff member to be killed since the intifada began in September 2000. He had been aiding an UNRWA medical team that was transporting a critically wounded camp resident to hospital. After being delayed 20 minutes by Israeli soldiers, the ambulance proceeded to the hospital though the wounded man died before arriving. Kamal Hamdan was shot during the ambulance's return to the camp. The vehicle was a clearly marked, well-lit UN ambulance that also had a UN flag mounted on it, according to UNRWA(3). It said that Kamal Hamdan, 40, had worked for the agency for the past 15 years. He leaves behind a wife and five children.
Another casualty in Tulkarem was Dr Nabhan Jallad, director of the PRCS Emergency Unit, who was shot in the leg by IDF soldiers while he was in the ambulance station.
In Gaza, health workers have also come under fire. Medics Sa'id Shalayil and Muhammad al-Hissa and a driver travelled by Red Crescent ambulance to evacuate the wounded during a pause in IDF shelling of Suaniyya north of Gaza City on 7 March. Sa'id Shalayil was killed after a resumption of firing and Muhammad al-Hissa was injured.
According to the International Committee of the Red Cross (ICRC), all the PRCS ambulances targeted in Jenin and Tulkarem (detailed above) were clearly marked with the Red Crescent emblem and the ICRC had cleared their missions with the Israeli authorities(4).
On 8 March another health professional travelling with the knowledge and agreement of the authorities was shot dead. Dr Ahmad al-Khoudari, Director of the Yamama Hospital in al-Khadr (Bethlehem), was killed at the entrance to al-Dheisheh refugee camp while attempting to visit Al-Hussain Hospital to obtain needed medical supplies. According to a report by the Palestinian Society for Law and Human Rights (LAW), the local ICRC representatives arranged with the Israeli District Coordination Office (DCO) to allow Dr al-Khoudari to leave his home for the Yamama Hospital, just a short distance away, and then to go to al-Hussain Hospital, al-Dheisheh.
Dr al-Khoudari was informed of the arrangement with the DCO and he was told by the Israeli commander by phone that he could move safely. Dr al-Khoudari then set off for al-Hussain Hospital to pick up medical supplies. He was allowed to cross the first Israeli military checkpoint, but Israeli forces at the entrance of al-Dheisheh refugee camp, close to the hospital, opened fire from a tank, killing Dr al-Khoudari instantly(5).
On 8 March, Physicians for Human Rights-Israel submitted a petition to the Israeli Supreme Court, against the commanders of Israeli forces in the West Bank and Gaza Strip. The petition sought an ''intermediary court order against these parties, in light of the Israeli forces' conduct against Palestinian ambulances and medical relief personnel on the 7th and 8th of March, 2002''.(6) PHR-Israel demanded that an urgent hearing be held immediately. The first hearing took place on 14 March. The judge asked for affidavits from PHR-Israel on the incidents listed in its application. The army was also asked to provide affidavits concerning the same incidents. The hearing was then postponed for 10 days without the judge issuing any temporary restraining order.
Attacks against health workers and medical establishments show little sign of ending. On 12 March, the Union of Palestinian Medical Relief Committees and Physicians for Human Rights-Israel issued a press release urging an end to military action in the Palestinian territories following a large-scale military incursion by IDF forces into Ramallah. According to the press release, the Ramallah Hospital and Ramallah PRCS Maternity Hospital were fired upon by Israeli troops. Soldiers fired upon two ambulances in Ramallah. Access by Palestinians to medical care is also being blocked by Israeli troops in Ramallah, according to the two organizations(7). The PRCS suspended ambulance movements on the evening of 12 March because of the risk posed by Israeli gunfire, resuming services on 13 March.
Disruption of health care services
The current attacks on health care workers and delays and blocks to the effective delivery of health care have to be seen in the context of ongoing impediments to access to health care in the Occupied Territories.
The 120 staffed Israeli checkpoints in the Occupied Territories regularly block the passage of ambulances or patients travelling by car to hospital. Doctors and other health professionals can also be blocked at such checkpoints. The impact of this is to deny Palestinian villagers access to health care either in their own village or at hospitals in the main cities. The human rights organization B'Tselem refers to 23 people having lost their lives due to delays at checkpoints(8).Other organizations have reported similar or even higher figures(9). The recent upsurge of violence following Israeli army incursions into Palestinian areas after 26 February will undoubtedly increase this figure. Already there are reports of seriously wounded Palestinians dying before Palestinian medical teams can gain access to them or before they can reach hospital. At present it is impossible to say to what extent delays of this kind contributed to their deaths.
In addition to staffed checkpoints there are other measures which impede or completely prevent passage of people or vehicles. These include trenches, ramps and other physical barriers and force individuals to walk or to leave a vehicle on one side of the barrier and walk to a second vehicle on the other side.
Within the last month, there have been several cases of attacks by soldiers on people driving to hospital for urgent care. On the morning of 24 February 2002, a 27-year-old pregnant woman, Shadia Khalid, suffered chest and back/shoulder injuries caused by fire from Israeli tanks on the Jerusalem to Nablus road. The car she was travelling in was not allowed to continue. An ambulance subsequently came and picked her up from the checkpoint.
The following day, Israeli soldiers fired on a family trying to reach hospital. Maysoun al-Ha'iq, 20 years old, who was pregnant, was travelling with her husband, Muhammad, and her father-in-law, Abdullah Daoud, aged 60. Israeli soldiers gave them permission to leave their place of residence, Zeita, but as the car carrying the family approached the military roadblock outside Nablus, soldiers in tanks fired on them, killing Muhammad al-Ha'iq and critically injuring his father. Maysoun al-Ha'iq was also injured, but gave birth to a daughter after her arrival in hospital.
Even when not shot at, the delays and obstacles imposed on Palestinians can result in grave problems. On 9 March 2002 Rana Adel Hamad, aged 18, from Qur village near Tulkarem in the West Bank, went into labour. However, attempts to get to hospital were impeded by Israeli checkpoints and restrictions and she was unable to reach obstetric help in Tulkarem. She subsequently saw a midwife in a neighbouring town and gave birth to a baby which was unable to survive. The mother's condition gave cause for concern and her family made another attempt to reach hospital. They again faced obstacles and after one hour's delay arrived at the hospital. However, Rana Adel Hamad died. Amnesty International does not yet have information about the cause of her death.
On 27 February 2002, a 32 year old pregnant woman, Samar Hamdoun, was travelling by taxi to Nablus with her husband, Iyad, and other family members from Beit Furiq, southeast of Nablus. She had started having contractions that morning and her doctor had recommended that she travel to hospital. They were ordered back into the village by an IDF soldier at the checkpoint just outside the village. They then circled around by back roads to approach and enter Nablus from the northwest, transforming a ten minute journey into one lasting hours. En route Samar Hamdoun lost consciousness. On arrival at the Rafidia hospital at 13.00 hours the doctors found that the baby had died in utero.(10)
Physicians for Human Rights-Israel (PHR-IL)(11) has recorded a number of examples of delays imposed on people seeking access to hospital care in Nablus and problems caused to villagers requiring medical visits from Nablus-based health workers (increasingly due to transport problems faced by villagers).
Similar delays and refusal of passage to people seeking access to hospitals and clinics continue to occur elsewhere in the Occupied Territories, though the current upsurge in military activity has significantly aggravated an already serious problem.
Reaction by international organizations
The International Committee of the Red Cross (ICRC) issued a joint press release with the Palestine Red Crescent Society on 4 March 2002 following the killing of Dr Khalil Suleiman(12). The ICRC issued a further press release on 8 March to express its condemnation of recent attacks on PRCS and UN health personnel and to call on the Israeli authorities ''to take immediate steps to protect medical personnel and to conduct a full inquiry into the latest events''. The ICRC added that under international humanitarian law, ''collecting and caring for the wounded is an obligation, and facilitating access for and ensuring the safety of medical personnel and ambulances is a basic duty of all forces and individuals involved in fighting. Deliberate attacks on medical personnel, vehicles and infrastructure constitute a grave breach of the Geneva Conventions and are strictly prohibited.''(13)
On 8 March, Amnesty International noted that over the previous ten days, ''at least 130 Palestinians have been killed. At least 18 wounded Palestinians have reportedly died because of denial of access to medical services. In the same period, at least 33 Israelis have been killed, including 17 civilians''. The organization noted the deaths of several health workers and attacks on ambulances and called on the international community to ''act immediately to save Palestinian and Israeli lives by insisting on an international presence in Israel's Occupied Territories''.(14)
The International Federation of Health and Human Rights Organizations (IFHRHO), in an open letter written on 8 March 2002, reiterated that ''medical services, premises and transports are protected under International Law, and should be respected and protected. The Geneva Conventions, as well as International Human Rights Law and internationally accepted professional codes of conduct, such as declarations of the World Medical Association, are clear about the immunity and neutrality of medical services and transports.'' It called for protests at the violation of medical neutrality and called for support from Israeli colleagues ''to do all they can to secure medical neutrality and immunity for Palestinian medical services and transports.''(15)
Human Rights Watch, on 9 March, called on the Israeli government ''to instruct soldiers to immediately refrain from attacking medical personnel in the West Bank and Gaza''. It noted the attacks on ambulances and killing and wounding of medical staff. Human Rights Watch said that deliberate attacks on medical personnel, vehicles and infrastructure constituted a grave breach of the Geneva Conventions and called for investigations into all incidents of firing on emergency medical personnel(16).
Within Israel, the Occupied Territories and the Palestinian Authority, a number of human rights organizations have actively protested against the attacks on ambulances and health personnel and on the prevention of the wounded or sick getting access to medical care as a result of action by the Israeli Defence Forces. They have published reports, issued press releases, demonstrated peacefully and taken court action to protect Palestinian civilians and medical services (see text above for examples).
Applicable international standards
Israel signed the Geneva Conventions of 12 August 1949 on 8 December 1949 and ratified them on 6 July 1951. The Fourth Geneva Convention specifies standards which should be observed with respect to the protection of civilian persons in time of war.
The following articles have a particular relevance to the current situation:
Article 2
The Convention shall also apply to all cases of partial or total occupation of the territory of a High Contracting Party, even if the said occupation meets with no armed resistance.
Article 16
The wounded and sick, as well as the infirm, and expectant mothers, shall be the object of particular protection and respect.
Article 18
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.
Article 20
Persons regularly and solely engaged in the operation and administration of civilian hospitals, including the personnel engaged in the search for, removal and transporting of and caring for wounded and sick civilians, the infirm and maternity cases shall be respected and protected.(17)
The provisions of the Fourth Geneva Convention have been persistently breached by the Israeli forces.
In meetings with the Israeli authorities in November 2001, the Director General of the ICRC called for greater respect for international humanitarian law - particularly the Fourth Geneva Convention - and put particular emphasis on the ''humanitarian consequences of the illegal presence of Israeli settlements in the occupied territories, on the right of families to visit their relatives in prison, the devastating effect of the prolonged closures on the population's mobility and the problems this engenders, the question of access for ambulances to the wounded and sick, and the effect on the Palestinian economy in general.''(18) The ICRC press release of 8 March (see note 12 above) emphasised concerns about the security of health personnel and vehicles.
However, Israel has stated that it does not regard the Geneva Conventions as applying de jure to the West Bank and Gaza Strip. In a statement made before the Committee against Torture in November 2001 in Geneva, the Israeli delegation also argued that the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment did not apply to the Occupied Territories because they were governed by the Geneva Conventions. The United Nations has consistently stated that both international human rights and humanitarian law apply.
Amnesty International has frequently expressed its concern that Israel has committed grave breaches of international human rights and humanitarian law. Since the beginning of the intifada more than 1000 Palestinians have been killed by Israeli security forces. Most were unlawfully killed; they included at least 200 children and more than 60 Palestinians who were extrajudicially executed. Palestinian detainees frequently suffer torture or other ill treatment under interrogation. Collective punishments against Palestinians include closures of towns and villages, demolition of more than 600 Palestinian homes and prolonged curfews(19).
Of the standards applicable to doctors, the World Medical Association's Regulations in Time of Armed Conflict (most recently revised in 1983) makes clear that doctors have the same ethical obligations in time of armed conflict as in time of peace. Paragraph 4 states:
''In emergencies, the physician must always give the required care impartially and without consideration of sex, race, nationality, religion, political affiliation or any other similar criterion. Such medical assistance must be continued for as long as necessary and practicable.''(20)
Conclusion
The problems faced by Palestinians in gaining access to health care since the beginning of the al-Aqsa intifada have worsened in recent weeks as violence has escalated. AI is calling for the Israeli authorities to implement and observe international human rights and humanitarian law and, in particular, to ensure that patients seeking medical care are not attacked; that ambulances and other vehicles attending the sick and wounded are not attacked; that medical personnel engaged solely in collecting and caring for the sick and wounded are not attacked; that hospitals, clinic and emergency first aid posts are not attacked; and that Israeli checkpoint staff are provided with clear instructions on their obligations to ensure that Palestinian health services are not impeded.
Israeli Assault on Gaza By Numbers in 30 Days
Date posted: August 09, 2014
By Safa Agency
