Arab child’s sickbed is part of the battleground By Aron Heller | Associated Press, Wednesday, 18 Mar 2009

WADI FUQEEN, West Bank (AP) — Asil Manasra, a 6-year-old Palestinian girl, was in her eighth month of intensive treatment at an Israeli hospital for complications arising from a long bout of tuberculosis when she was abruptly forced to stop the visits.

A week after she was discharged, she died.

It’s impossible to know how much longer Asil might have lived, but her family is convinced she is the first victim of a Palestinian decision that has cut hundreds of people off from proper medical care and has led Israeli hospitals to turn away those in need.

It’s another painful byproduct of a conflict that recently exploded into a month of open warfare, and has left both sides on the defensive against charges they have left the weakest and most desperate to pay the price.

“I blame everyone. Should children die because of political decisions?” asked Asil’s father, Jamal Manasra. “How can you stop treatment? When a child is so sick that she is going to die, is there something more important than that?”

The family was forced to stop her treatments after the Palestinian government, angered by Israel’s fierce three-week offensive against Gaza militants, decided in January to stop paying Israeli hospitals to treat Palestinian patients. With no coverage, Asil’s parents could no longer afford to pay for her expensive tests, CT scans and medication.

For years, Palestinians and patients from the wider Arab world have regularly been referred to hospitals across Israel for diseases their own hospitals could not treat. Israel boasts an advanced medical system, and promotes its treatment of Palestinians and employment of Arab doctors as a small beacon of coexistence amid the Israeli-Palestinian conflict.

Fathi Abu Moughli, the Palestinian minister of health, abruptly halted the arrangement following Israel’s assault on Hamas militants in Gaza, which Palestinian officials say killed some 1,300 Palestinians and wounded thousands more.

Initially, Abu Moughli insisted the ruling was limited to those wounded in the war. He said more than 1,000 injured Gazans were transferred to Egypt, Saudi Arabia, Libya, Morocco and other Arab countries so that they would not have to be treated by the same country that harmed them.

But in an interview with The Associated Press, he acknowledged that the edict was far more comprehensive, aiming to cut costs, rid Palestinians of their need for Israeli medicine and deny the Jewish state a “propaganda” campaign that improves its world image while the cash-strapped Palestinian Authority foots the bill.

“We are trying to free our health system from dependence,” he said.

But Palestinian patients and their Israeli doctors say the measure is too drastic and now puts hundreds at risk. Strokes have gone untreated. Cancer patients in need of chemotherapy, radiotherapy and bone marrow transplants have had their treatments interrupted.

The Sheba Medical Center, near Tel Aviv, reported a drop of about 60 percent in referrals of Palestinian patients since the war ended Jan. 18. Jerusalem’s Hadassah Hospital said it received just a few dozen referrals in February, down from 1,600 a month on average last year.

Israeli hospitals have also come under criticism for refusing to accept the patients without the financial commitment of President Mahmoud Abbas’ Western-backed government. Many patients simply stopped coming, either lacking permits to cross Israeli roadblocks or fearful that they will be turned away by hospitals.

Physicians for Human Rights-Israel, along with three other rights groups, has criticized both sides. It has called on the Palestinian government to restore coverage for Palestinians until an alternative is found, and urged Israel to provide health care regardless of Palestinians’ financial means.

“The Palestinian Authority has the right to decide where it will refer its patients,” said Ran Yaron, from Physicians for Human Rights. “But it bears responsibility for those already referred … This political move cannot be on the backs of the patients.”

Mahmoud Manasra, 23, had his yearlong leukemia treatment at Hadassah halted last month. Now he fears he will face the same fate as Asil, a distant cousin.

“God knows how much I worry, my situation is getting worse,” he said in his home in Wadi Fuqeen, a West Bank village six miles from Hadassah. “We are waiting for mercy to come down from the sky.”

His mother Aaliya, 54, said if the Palestinian Authority wanted to cut its ties with Israel, it should leave sick people for last.

“My son is in danger – each day I die with him a hundred deaths,” she said.

Without the document that the PA once provided promising financial backing, Palestinian patients have stopped showing up at appointments or for regular treatment – though no patients have been physically pulled out of the wards.

“There are kids who simply disappeared in the middle of chemotherapy,” said Dr. Amos Toren, head of Sheba Medical Center’s Pediatric Hemato-Oncology Department. “As far as they are concerned, it’s a death sentence.”

“Our mission is that medicine is above borders and above politics. It is very dangerous and very sad that care could be withheld,” said Nancy Falchuk, the national president of Hadassah, the Women’s Zionist Organization of America, which founded and partially funds the Jerusalem hospital.

A Hadassah official said the hospital has treated some “special cases” at no cost, but cannot afford to give sweeping free medical services. “You can’t run a hospital if you treat everyone for free,” said the official, speaking on condition of anonymity because he was not permitted to discuss the policy publicly.

Abu Moughli, the health minister, said costs of Israeli hospitals are three to four times higher than in the West Bank. He insisted the Palestinian health system has greatly improved and can treat more diseases than ever before. Those it cannot are now referred to Egypt, Jordan and elsewhere.

The Palestinian Authority, whose budget is largely filled by international donations, says it is saving $17 million by stopping the transfers to Israeli hospitals.

Little Asil’s experience in Palestinian hospitals, however, was anything but positive.

Her father said she first became sick at six months after receiving a TB vaccination. For the following four years, he said, she was misdiagnosed by two Palestinian hospitals, getting liver and lung infections, suffering from severe stiffness and high fever.

“They lacked experience,” Manasra said, smoking a cigarette on the front porch of his home in Wadi Fuqeen. “If they knew what the problem was, she wouldn’t have gotten worse.”

Even with the Palestinian Authority covering 70 percent of Asil’s medical costs, Manasra still racked up over $50,000 in bills. He stopped working in construction to care for her and is now deep in debt.

Finally, after she turned 5, Asil got a referral to Hadassah, where Manasra said she was properly diagnosed, treated and medicated. But by then the disease had already spread to most of her body. Hadassah would not comment specifically about Asil’s case and did not permit the AP to interview her doctor.

When the Palestinian government cut off her payments in February, she had to stop going. She spent the last week of her life in a hospital in the West Bank town of Bethlehem, taking medication advised by a Hadassah doctor.

“If we wouldn’t have left Hadassah she would have been under supervision,” Manasra said. “There still would have been hope.”