In the summer of 2007, Israel instated a new procedure regarding residents of the Gaza Strip wishing to exit Gaza in order to receive medical treatment. According to the procedure, authorization some of these requests are authorized only if the resident first undergoes a questioning by the Israeli Security Agency (ISA). In a response by the Prime Minister's Office to a letter from Physicians for Human Rights (PHR) on 22 May 2008, the purpose of the questioning was described as "evaluating the degree of danger posed by the applicant." However, testimonies given to human rights organizations in Israel indicate otherwise. The organizations have documented cases in which the ISA has exploited the questionings to exert inappropriate pressure on ill persons, with the aim of forcing them to collaborate with the Agency and give information to agents, as a prerequisite for receiving a permit to exit Gaza for medical treatment. As the questionings take place in Erez Checkpoint, the ISA has even used them, in some cases, as a means to arrest persons and take them to interrogation within Israel .

As part of a petition relating to several individuals filed to the Israeli High Court of Justice by PHR on 8 November 2007, the organization requested that the ISA be forbidden to condition exiting Gaza on giving information and collaborating. After solutions were found for most of the patients for whom the petition was filed, the justices chose to refrain from the addressing the phenomenon itself.

According to data collected by PHR, from January to August 2008, of 3,760 patients who submitted requests for exit permits from the Gaza Strip, 325 were questioned by the ISA and 1,310 had to cancel the medical appointments set for them and re-submit their requests.

'Abd al-Karim al-'Atal, a resident of Jabalya, in the Gaza Strip, was arrested and interrogated by the ISA in September 2009. His description of the events clearly demonstrates the ISA's wrongful use of this procedure.

Al-'Atal, 18, is losing his sight. According to a testimony he gave to B'Tselem, physicians told him he needed a cornea transplant, and that it could not be done in Gaza . In July 2009, the physicians referred him to St. John Eye Hospital , in East Jerusalem.

According to al-'Atal, he requested the liaison office in the Gaza Strip to coordinate his entry into Israel for treatment. Following the request, he received a call from the ISA summoning him for a meeting at Erez Checkpoint.

On the morning of 6 September 2009, he arrived at the checkpoint, and after undergoing a security check, he was taken to a waiting room. A few minutes later, two Hebrew-speaking men searched him, cuffed his hands behind his back, blindfolded him, and took him to another room.

Al-'Atal related that he was questioned for several hours, during which he was asked about the physician who had referred him to treatment in Israel, about his uncle, who is residing in Egypt, and about family members. The interrogator accused him of having forged the medical documents and threatened to arrest him for forgery. The interrogator also accused him and his brothers of being commanders in the Hamas military wing, and warned him that, given these suspicions, it would be very difficult for him to enter Israel unless he aided the ISA and spied on his relatives for the Agency. According to al-'Atal, at the end of the questioning, the interrogator told him he was being detained. He was taken by jeep to the detention center in Ashkelon , where he was examined by a physician and then placed in isolation, as he described:

"I was standing there. They removed the blindfold, took off the cuffs, and told me to enter a cell that looked about 130cm X 130cm large. The walls were black and very rough, so I couldn't lean on them with my back or straighten my legs. There was a yellow light bulb. Next to the cell was a toilet hole which stank and had lots of insects around it."

Later, he states, he was taken to court, were the judge ordered that he be detained for ten days. Al-'Atal was then taken to interrogation, which he described in his testimony:

"He handed me a piece of paper. The prison's laws and instructions were written on it. I was so tired and exhausted, I could barely read it. Also, I couldn't see well. I handed it back to him. He said they wanted to bring me a copy printed in Braille. I replied that, if it is Allah's will, I'll be able to read Braille one day. Then he ordered me to sit on a small chair that was fixed to the floor, bound my hands, behind me, to the chair, and told me to put my legs next to each other. This is a very tiring and exhausting position. Then he accused me of all kinds of things. He put his face right in front of mine and said I'm a terrorist and know where weapons are stored, and that I'm in contact with my uncle Mansur Shalail, and with Salem Thabet and Amir a-Sharif, of the al-Aqsa Brigades. He shouted in my face, and saliva spattered from his mouth. When he stopped talking, I told him I didn't know anything. He said I did, and that they'd hold me 180 days, and that I'd talk at some point. I told him I was ill and couldn't see, and to do those things, I had to have better sight. He continued until three in the morning."

In the days that followed, al-'Atal states that he was repeatedly interrogated while tied in painful positions and held in freezing cold under an air-conditioner. At some stage, he was connected to a device that policemen told him was a polygraph machine. As the ten-day period of detention was coming to an end, he was taken to a room with persons who were presented as detainees, but were apparently men who were planted there to encourage him to talk. They, too, tried to extract information from him.

The next day, he was taken back to court, where his detention was extended again, this time for eight days. He was taken back to interrogation. Four days later, he was taken to Erez Checkpoint and released. No legal measures were taken against him.

As yet, Al-'Atal has not received a permit to enter Israel to obtain medical treatment, and he is liable to lose his sight.