Two months ago, Aisha al-Loulou, a 5-year-old girl from Bureij refugee camp in the Gaza Strip, fell ill. She complained of severe headaches and was unable to keep down almost anything she ate. Her parents took her to the camp’s clinic, run by UNRWA, the United Nations’ refugee agency. The diagnosis there was that she had a problem in her abdomen; they gave her pain-killing medication but the pain and the vomiting continued. A few days later her parents took her back to the clinic. The doctors now said she was suffering from an infection of the jaw. Skeptical, her parents took her to a private doctor. He diagnosed a gastrointestinal ailment. The next diagnosis, at Shuhada al-Aqsa Hospital in Dir al-Balah, was that Aisha had a urinary infection. She received intravenous treatment, additional medications were prescribed, and she was sent home. But the little girl continued to suffer; she threw up all night long.

The next day, April 11, her parents took her back to the hospital, where she was to be held overnight. Tests were run but nothing definitive was detected. Her condition continued to deteriorate. That same afternoon she lost consciousness and lapsed into a coma. Her parents relate that she thrashed about and pulled her hair in her unconscious state. The hospital now suspected that she was suffering from meningitis and gave her medications accordingly. A CT scan turned up no special findings, the doctor said.

But then Aisha started to have convulsions in the evening. She was given Assival (Valium) to calm her down. The convulsions continued until 3 A.M. The physicians said there was nothing to worry about. No longer conscious, she was taken to Shifa, the central hospital in the Gaza Strip. Based on the CT scan taken earlier, the physicians at Shifa for the first time diagnosed a brain tumor. They also found excessive fluid on the brain and inserted a tube to drain it, after the child’s parents gave the go-ahead for the invasive procedure.

Aisha al-Loulou.

It was now Friday, April 12. In the afternoon, Aisha woke up and came back to life. She told her parents that the pain was gone. The family has a video clip showing her playing after the operation to insert the tube.

Aisha’s parents – her father, Wissam al-Loulou, 37, and her mother, Muna Awad, 27 – are relating all this from the closed balcony of their home in the Bureij refugee camp. The couple have three other small children. From time to time one of them – 4-year-old Ribka or Hasan, who’s 2 and a half – climbs onto the lap of their father or mother and curls up in their arms. Wissam is a graduate in management from the Islamic University of Gaza, but he’s currently unemployed. He was forced to shut down his small grocery store because there were no customers and in any case he needed the products to feed his own family. Since then the family’s only income has been the welfare allowances they receive from relief agencies.

The Gaza Strip is under siege. Muna’s face is veiled, only her bespectacled eyes are visible through the black covering. Wissam is wearing a light-colored galabiya. Our conversation is taking place via Skype: For the past 13 years Israeli authorities have prevented Israeli journalists from entering Gaza, other than those embedded with Israel Defense Forces units during invasions of the Strip.

To resume Aisha’s story: She was hospitalized for five days in Shifa’s neurosurgical department. Her parents were told that she needed to be moved urgently to Makassed Hospital in East Jerusalem for surgery to remove the tumor and then to receive chemotherapy that is not available in the Gaza Strip. Now it was necessary to deal with the bureaucracy of the Israeli occupation in order get Aisha to Jerusalem as quickly as possible. It was clear that her life was in danger. Her parents applied to the Ministry for Civil Affairs of the Palestinian Authority, which works with the Israeli Coordination and Liaison Administration. There, they were told that it would take five days to organize the authorization documents, two on the Palestinian side and three more days to get a reply from the Israeli side.

Open gallery view Muna Awad sites on Aisha's bed. Credit: Khaled Azaiza

Wissam says that he was told by the Palestinian office that because of his young age it would be very difficult to obtain an entry permit into Israel for him and that it would take Israel three weeks to run a security check. The situation was even more complicated for Aisha’s mother: Muna doesn’t have an ID card issued by the Israeli Population Registry, which is what counts in Gaza. She’s a Libyan-born Palestinian whose family originally hailed from Majdal, today’s Ashkelon, and she grew up in Egypt. She entered the Gaza Strip with a visitor’s permit and stayed on to live there without an ID card recognized by the Israeli government; she has only a Hamas-issued ID card, which is meaningless as far as Israel is concerned. The PA’s Ministry for Civil Affairs told Wissam that there was actually no chance that he or Muna would get permission to enter Israel. They asked for the names of other relatives who might be able to accompany Aisha during her ordeal.

Wissam suggested his mother, Aisha’s grandmother, 75-year-old Ribka. The Palestinian officials went back to the Israelis and were told that it would also take three weeks to run a security check on the grandmother. Maybe there’s someone else in the family, the Palestinian ministry asked. Wissam gave them the names of three of Aisha’s aunts, plus those of an uncle and the wife of an uncle. He submitted five requests and hoped that Israel would approve at least one. The grandmother and one of the aunts had received permission to pass through the Erez checkpoint between Gaza and Israel, on their way to Jordan half a year earlier. Another aunt recently received a laisser-passez to travel to the American consulate in Jerusalem, to arrange an entry visa for the United States.

At Makassed Hospital, surgery was scheduled for Aisha for April 16. Time was of the essence, her life dangled by a thread. No entry permit arrived from Israel: There was no way to send the child to East Jerusalem on the appointed day. Her hospitalization was rescheduled for April 17. Meanwhile the Ministry for Civil Affairs suggested to Wissam that he submit names of other people, strangers, not members of the family – maybe the security check would go more quickly for them. Desperate, the family asked people who happened to be at Shifa Hospital whether they would be prepared to escort their daughter to East Jerusalem for brain surgery and chemotherapy.

Six names of volunteers the family didn’t know were submitted to the Palestinian ministry, which passed them on to Israel. After a quick check, the apparatus of the Israeli occupation chose the name of Halima al-Adess, 55, a resident of Shati refugee camp, who was an acquaintance of one of Aisha’s aunts. Neither Aisha nor her parents knew the woman who would be spending the coming fateful weeks with their little daughter, far, far away.

Open gallery view Muna Awad with her three children. Credit: Khaled Azaiza

That very day the parents and the escort traveled to the Erez crossing with Aisha. She and the woman who would be escorting her had to board a bus to take them from the Palestinian checkpoint to the Israeli checkpoint. The parents were forced to tear themselves away from their sick daughter. Aisha was fit for the journey physically, but emotionally was beside herself. She wouldn’t stop crying and refused to be taken from her parents. She shouted that she wanted to go home and would not go with a woman she didn’t know. Aisha had never before left the Gaza Strip.

Her mother tried to calm her. She told her that she had to go, it was all to cure her, so she wouldn’t have any more headaches, and that when she returned home they would buy her all the toys she wanted. Exhausted and still weeping, Aisha agreed to board the bus. Her mother accompanied her to her seat and got off the bus. She would never see the little girl conscious again.

After going through the crossing, the two traveled by taxi to Jerusalem. All the way, Aisha’s parents spoke to her by phone, trying to cheer her up. Still, Aisha cried for most of the trip. The operation, performed on April 21, took five hours. Aisha woke up the next day. The physicians said they had removed the tumor, but that the chemotherapy must be initiated quickly. They told her parents that their daughter’s psychological state was terrible, being cut off from them, and that this could affect her chances of recovery. It was imperative that at least one of them come to be by her side. A visitor to the hospital gave Aisha 20 shekels ($5.50), and she asked her parents by phone what to do with the money. They told her to keep it and that when she got home they would buy her toys. Thereafter, her condition worsened.

The parents’ faces are grim, at times they stare at the floor. Aisha’s mother is silent, her father tells the story. He recalls how a representative of an Israeli human rights NGO called them to ask for details and a copy of their IDs in an attempt to help. An Israeli relative who lives in Lod submitted a request to the Peres Center for Peace, in an effort to obtain an entry permit for one of the parents. The Palestinian Al Mezan Center for Human Rights also submitted a request for one of the parents to be allowed into Israel. Nothing came of any of those efforts. The days passed without a reply from the Israeli side. Aisha was alone with a woman she didn’t know.

Open gallery view Aisha al-Loulou.

The spokesperson for the Unit for the Coordination of Government Activities in the Territories told Haaretz this week: “Contrary to various reports, Israel permitted the entry of the girl Aisha a-Loulou for medical treatment in an East Jerusalem hospital, after her parents signed a declaration stating that they did not wish to go with her from the Gaza Strip and requested that she go with a friend of the family, who entered with her and stayed with her during the treatments. We wish to emphasize, in addition, that contrary to reports, Aisha a-Loulou passed away in the Gaza Strip, after returning to her home two weeks ago, at the conclusion of an operation that, unfortunately, was unsuccessful, at Makassed Hospital.

“We wish to emphasize that, in accordance with its policy, the Coordination and Liaison Administration requires parental escort for medical treatment of minors, based on the understanding that a child needs his parents at such moments. In this case, too, in accordance with CLA procedure, Aisha’s parents were required to transmit a document of declaration, according to which they were not interested in accompanying their daughter during the treatments for reasons of their own – and they requested that someone else escort her on their behalf.”

Wissam, Aisha’s father, told us this week: “The IDF killed my daughter. Israel killed her.”

She eventually was transferred to Augusta Victoria Hospital in East Jerusalem for chemotherapy. But there her condition started to deteriorate with frightening speed. Again, her parents were told that the fact that she was in strange surroundings, without them and without anyone she knew, was affecting her condition. Within two days she became paralyzed and also lost the power of speech. The family decided to try to obtain a permit again, to do everything to get to her. But the authorities told them that there was no chance. The hospital said that it would be best for the girl to return home as quickly as possible. She was no longer conscious. It was May 7.

Open gallery view Wissam al-Loulou. Credit: Khaled Azaiza

A private ambulance driver demanded 1,500 shekels ($415) to take Aisha from Jerusalem to the Erez checkpoint. The woman who was escorting Aisha didn’t have the money. She wrapped Aisha in a sheet from Augusta Victoria Hospital and laid her on the back seat of a taxi. These were Aisha’s last days. Her parents show the sheet that was wrapped around their unconscious daughter on the journey home. For the joint photograph appearing here they wrap themselves in the sheet, to which their daughter’s scent still clings, as though wrapping themselves in her body.

It proved impossible to get her onto a bus at Erez due to the delicacy and graveness of her situation; she was taken on a three-wheeled moped scooter. From the checkpoint her parents took her to Al-Rantisi, a pediatric hospital, which at first refused to admit her because of her condition and referred her to Shifa. At Shifa the parents were told that she must remain in Rantisi. In the end they took her home, to Bureij.

The next day they were compelled to return her to Rantisi. The physicians said there was no more that could be done. She spent seven days at the hospital, without the staff doing anything. Last Wednesday, May 15, at 6 A.M., the hospital phoned her parents to come immediately. They stayed with her the whole day, watching their daughter die. At 6 that evening, Aisha passed away, her parents by her side – at last.