‘Back-to-Back’ Procedure: Patients at Checkpoints

By Tamar Fleishman – The West Bank

The detainment of a person that is being transferred by an ambulance to one of the six Palestinian hospitals in East Jerusalem, until the completion of the bureaucratic procedures, falls under the euphemistic title of: "co-ordinations". These entail nothing more than the authorization of the secret services that grant the patient permission to pass through the checkpoint, but they are only the first step on the Via Dolorosa unfolding before the patient until he does (or does not) arrive at his destination.

Despite the fact that the patient’s rights act determines that in cases of medical emergency a person is entitled to receive urgent medical treatment without any preconditions or discriminations, in reality it would take time, in some incidents time that the patient doesn’t have, before he is granted passage. 

The mechanism of the occupation is organized so as to make the daily life of the occupied population harder, by rising demands from the individual to carry an innumerable amount of permits that enwrap his existence like layers of an onion. Layer on top of another layer and upon removing them all the naked truth is revealed- the operators of this complex mechanism aren’t the ones to come in contact with the people applying for permits. Those who give the verdict for better or for worse, are the invisibly present- the secret services, who are the only ones to decide if an ill or injured person will arrive at the hospital and receive the treatment he is entitled to by his right and not as some act of  kindness.

In the Name of Security

Security is a general code word which is used to prevent the patient from passing the checkpoint. The health coordinators inquire whether the person falls under the laconic category known as: "prevented". Meaning: anyone who had been defined by the GSS as "not clean" and whose entrance into Israel/Greater Jerusalem is strictly prohibited. This prevention requires no explanations. Ambiguity is an efficient tool for establishing authority and creating fear.

In an incident (not an unusual one) that demonstrates how wide is the spread of this arbitrariness, an ambulance from the occupied territories arrived at Qalandiya checkpoint, transferring for urgent treatment at Mokased hospital, a 73 years old heart patient in critical condition. The man, whose life was hanging by a thread, was between life and death and connected to a respiration machine. The ambulance driver had to stop at the entrance of the checkpoint where he phoned the health coordinator and was told that: "no co-ordinations had been preformed". I phoned as well, perhaps attempting to understand or perhaps to influence them, and the replay was: "who does he think he is… that he could just arrive at Qalandiya and pass through to Jerusalem?" This man, like many others- didn’t pass.


Once all the co-ordinations had been completed, and all the centers had already checked, assessed and affirmed that the patient is not a security threat, that he is "clean" and may cross through the checkpoint, the way is yet to be paved and open before him.

In 2005 an agreement for cooperation in urgent cases was signed between the Israeli Red Star of David and the Palestinian Red Crescent, according to which six Red Crescent ambulances would be permitted immediate passage to the Palestinian hospitals without the prior arrangement of any co-ordinations. Nonetheless, according the OCHA (the UN’s Office for the Coordination of Humanitarian Affairs), the agreement wasn’t honored and the passage of the patient, regardless of the urgency of his condition, is preformed only by using a procedure known as: "Back-to-Back". The meaning of this is that an ambulance from Jerusalem is sent for, it is then parked by the Palestinian one, the patient is shifted from one stretcher to the other, from one ambulance to the other, the blanket from the occupied territories is taken off his body and a blanket from Jerusalem takes its place, the eyes of unfamiliar soldiers and security guards follow and scan his body and unfamiliar hands rummage through his personal belongings.

Where occupation resides, rights vanish and among them is the right to privacy.

Escorting the Patient
According to the regulations of the occupation, only one person is allowed to escort the patient. A woman’s "dangerousness assessment" is lower than a man’s. That is why in most cases a woman (a mother or a wife) would receive a permit to escort the patient on his way to the hospital, while a man (a father or a husband) would be rejected. But this right as well, as limited as it already is, doesn’t obligate the authorities. The common argument is: "prevented", and it holds more power than the right for an escort and therefore annuls it. I was once present when a baby of seven months, sedated and on life support, was being transferred on her own. Her tiny body lied inside an intensive care unit and a doctor that was summoned was striving to keep her alive. "Where are the parents?" I asked the ambulance driver whom I knew. "They are prevented passage" he replied.

The High Court of Justice

The security mantra that the Israeli society worships, the mantra that causes it to blindly believe anything spokesmen say on behalf of security is also part of the considerations of the High Court of Justice that favors the argument of the military system over the fundamental rights of the Palestinians.

As a result, in April 2008 the HCJ dismissed a petition filed by the Physicians for Human Rights, regarding the regulations for the entrance of Palestinian ambulances into Jerusalem that necessitates the use of the "Back-to-Back" procedure, which in itself may only be preformed after the health coordinator at the civil administration grants her authorization. The court accepted the state’s argument that it fears the possibility that humanitarian gestures could be exploited for acts of terrorism.

Indeed, the judges didn’t ignore the state’s obligation in accordance to the international law, to allow every medical treatment that a patient requires for his recovery, but they fully accepted the position of the Israeli Security Forces regarding the danger that entails a direct passage of patients from the occupied territories to the hospitals in East Jerusalem, and understood the current state to be: "a balance between medical requirements and security requirements".

(Translated by Ruth Fleishman)

– As a member of Machsomwatch, once a week Tamar Fleishman heads out to document the checkpoints between Jerusalem and Ramallah. This documentation (reports, photos and videos) can be found on the organization’s site: www.machsomwatch.org. She is also a member of the Coalition of Women for Peace and volunteer in Breaking the Silence. She contributed this article to PalestineChronicle.com.

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