Wassim, Aisha’s father, shows a picture on his phone of his daughter sent him after Aisha’s operation in Jerusalem. Mohammed Al-Hajjar

On 17 May, a 5-year-old child died from cancer in a hospital in Gaza.

She died with her family around her. But she didn’t know that.

In fact, she had spent most of the past month alone in hospitals in Jerusalem, separated from her parents and other relatives by the Israeli permit system that controls the movement of Palestinians in the occupied West Bank and Gaza.

Only when treatment failed and she was no longer conscious was she sent back to her family in Gaza.

Aisha Lulu of the Bureij Refugee Camp in Gaza had been diagnosed with brain cancer in April. She had been having headaches and vomiting attacks since March and doctors found a brain tumor on 7 April.

With no specialist doctors in Gaza and in view of her age, Aisha was granted a permit by the Israeli military authorities to allow her to attend al-Makassed, a Palestinian hospital in East Jerusalem in the occupied West Bank.

But neither of her parents were allowed to accompany her. In fact, not one of her relatives was cleared by the Israeli military to take the child to hospital.

“It is an hour-and-a-half drive from Gaza to Jerusalem,” said her mother, Muna, 27. “My heart broke every day my daughter was away.”

Muna was angry. She was angry at her child’s tumor. She was angry that there was nowhere near her that could treat her. And she was particularly angry at the Israeli military that let Aisha suffer alone.

“Why does Israel treat us like this? We are not affiliated to any political faction, we are just normal people.”

Relatives barred

Aisha’s funeral was held on the evening of the day she died.

Her father, Wissam, 37, held her in his arms, weeping. Muna collapsed. The whole neighborhood felt their pain.

Aisha had been treated in Jerusalem from 17 April until 13 May. By the time she died, Aisha had spent almost exactly a month away from her family.

No permits could be obtained. The parents tried. The family tried. Aisha’s uncles and aunts tried. Even her 75-year-old grandmother, Rifqa, applied for a permit from the Israeli military to accompany the child.

Wissam said he and his brother, Hussam called in as many contacts as they had in the Palestinian Authority to see if any of them could help pressure the Israeli side.

It was to no avail. Hussam even convinced a number of unrelated people to apply for a permit. Every attempt was rebuffed.

Eventually, however, Hussam found a friend of the family, Halima Edais, from Beach refugee camp in Gaza City, for whom a permit was obtained in order that she accompany Aisha.

On 17 April, the family put Aisha in car with Edais and watched her drive away.

“I was looking at her and crying,” remembered Wissam. “I couldn’t believe how cruel it was, to let a child that young go alone without her family.”

Muna told her crying child before she left that she would have to endure without her family for a while in order to come back and play with her three siblings again.

It didn’t help much. When Aisha arrived in Jerusalem, the first thing she did was call her family crying, her father said.

“She was among strangers. She was so distressed.”

Inhuman restrictions

Aisha’s is a tragic example of a common practice.

Israel’s military operates a permit regime to control the movement of Palestinians under occupation that is regularly in violation of international humanitarian law.

UN officials have singled out Israel’s permit system for Palestinians seeking medical attention for special opprobrium.

2017 saw the lowest rate of permits granted to Palestinians in Gaza since the World Health Organization began collecting such data in 2008. The organization reported that 54 patients from Gaza – most of whom had cancer – died as they waited for permits to be issued.

While the situation for patients has slightly eased since then, relatives and others also seeking permission to travel with a patient remain at the mercy of an Israeli system that not only has severe restrictions on the books, but which seems to be decided at the discretion of individuals.

Thus, according to Hussein Hamad, a researcher with the human rights organization Al Mezan, Israel might consider permits for men over the age of 45 and women over the age of 40.

But age is no guarantor. According to Hamad, the Israeli military authorities at the Erez checkpoint – which separates Gaza and Israel – have been denying permits on spurious grounds such as relatives’ alleged affiliations to political parties, in particular Hamas, over the past two years.

Those accompanying patients must be close relatives, parents or siblings, and may find that they become subject to Israeli questioning with a view to turning them into informants for Israel.

“The Israeli side procrastinates when responding to patients’ or their proposed companions’ applications,” said Hamad. “Aisha was among the unfortunate children who suffered both from her affliction and from the occupation. Her rights to life and medical treatment were violated, and the rights of her mother were violated when Muna wasn’t allowed to accompany her.”

Data from Al Mezan show that of more than 25,500 Palestinians from Gaza who applied for a permit to leave for medical reasons in 2018, some 15,800 were approved, just under 2,000 were refused while nearly 8,000 did not receive any decision.

According to Al Mezan data, the Israeli military apprehended one patient and four companions last year in violation of the Fourth Geneva Convention that prohibits the detention of any civilian except under “imperative” security reasons.

Nine people died in 2018 after being denied permits to leave Gaza and seek medical attention elsewhere, according to Al Mezan.

The last days

Aisha’s condition deteriorated after surgery on 20 April. Doctors told her parents that she was traumatized and didn’t want to talk or eat. They asked that the family send a relative for the girl’s comfort.

Again the family tried, this time through the PA. They sought that Aisha’s aunt Ghada be allowed to join her.

Again it was fruitless. They never even got a reply.

Aisha’s mother, Muna, sifts through her daughter’s books on a bed that still holds the child’s toys. “My heart broke every day my daughter was away.” Mohammed Al-Hajjar

Meanwhile, in Jerusalem, Aisha was sent from al-Makassed hospital, where she had surgery to the Augusta Victoria hospital in the hope that chemotherapy would help her. However, there, doctors decided against giving her chemotherapy because they felt it was a hopeless case.

As her condition deteriorated, doctors gave up. She was sent back to Gaza.

Aisha was admitted to al-Rantisi hospital on 13 May. Doctors informed the parents that there was nothing they could do.

Her father, Wissam, could hardly recognize her. She had lost weight. She was pale and very, very weak.

Muna said Aisha did not respond. Not to her. Not to anyone.

Aisha died four days after returning to Gaza. One day later the Israeli military released a statement denying it had prevented the family from leaving. Instead, the Israeli authorities claimed, the parents chose for Aisha to leave with a friend of the family rather than accompany her.

The statement also alleged that Aisha had returned to Gaza two weeks before she died, rather than four days.

The Electronic Intifada called al-Rantisi hospital, which confirmed that Aisha had been admitted on 13 May, as the family says.

Wassim dismisses the Israeli statement as an outright lie designed only for image purposes in the international media.

“Neither I nor her mother would leave our child alone to be treated somewhere far from us. This [statement] is a lie.”

“I sat beside her and prayed after she came back to Gaza,” Muna, her mother, said. “I can’t believe I was not allowed to be with her [for treatment]. I can’t believe how cruel.”

Amjad Ayman Yaghi is a journalist based in Gaza.