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Palestinians losing link to U.S. care
Sanctions against Hamas threaten to harm program for kids, entire medical system
Chronicle Foreign Service
Sunday, May 7, 2006
Jerusalem -- Four-year-old Sundras Badran sat still while Dr. Mahmoud Nashashibi, a Palestinian pediatric cardiologist, checked her heart on an echocardiogram at the El- Mokassed Hospital in East Jerusalem.
Sundras, a Palestinian girl from the West Bank village of Anata, was attending a clinic funded by the Palestine Children's Relief Fund, an Ohio-based charity that treats about 2,000 critically ill children in the Palestinian territories each year.
But even if Sundras needs cardiac surgery, the future of the children's charity program has been thrown into doubt by U.S. sanctions against the Hamas-led Palestinian Authority banning all contact with Palestinian hospitals and Ministry of Health employees.
Under new guidelines issued April 12 by the Treasury Department's Office of Foreign Asset Control, U.S. citizens and organizations must cease all transactions with the Palestinian government, its ministries and institutions operating under their control.
The Treasury directive noted that Hamas is classified as a terrorist entity, and it ordered U.S. citizens to conclude all contacts with the Palestinian Authority by Friday, unless specifically permitted to continue.
"U.S. persons are prohibited from engaging in transactions with the Palestinian Authority unless authorized, and may not transfer, pay, withdraw, export or otherwise deal in any assets in which the Palestinian Authority has an interest unless authorized," the document said.
The order does not apply to Palestinian President Mahmoud Abbas, of the Fatah party, or non-Hamas members of the Palestinian Legislative Council.
Steve Sosebee, founder and director of the children's charity, said the U.S. sanctions are so stringent that he is being forced to cancel life-saving missions by U.S. doctors.
"We bring volunteer surgeons from the U.S. to provide services in Palestinian public hospitals, including highly sophisticated operations like cardiac, plastic and reconstructive surgery not available locally due to the lack of specialists," said Sosebee, an Ohio native who first visited the West Bank as a student on a trip organized by the Arab American Anti- Discrimination League. Although he has no Palestinian background, he decided to form the charity to help people in the region.
The charity (www.pcrf.net) has an active Bay Area chapter, whose members help care for children brought here for treatment, finding doctors, helping with translations and raising money. Sosebee hopes to bring a young girl from Gaza to be treated by Raymond Rendon, a San Jose specialist in eye prosthetics, later this month. She lost an eye during an Israeli missile strike, when the car in which she was riding happened to be alongside one carrying Islamic Jihad militants.
Usually the charity sends doctors to Gaza and the West Bank, rather than flying patients elsewhere for treatment. Last month, for example, it brought Dr. Ziad Saba, a pediatric cardiologist from Oakland, to Beirut for a week to treat children living in Palestinian refugee camps in Lebanon.
Saba said he had already been to Jerusalem and Ramallah six times, but this was his first visit to Lebanon.
"I've gotten donations of equipment and gone to Jerusalem to do cases there for Palestinians who would not have access to that kind of care," he said. "We also train the local physicians there to do it by themselves. In the Palestinian territories, those patients are languishing. The majority would not have care. It's not an exaggeration to say that Steve and his organization are single-handedly providing cardiac care for most Palestinian children.
"It's great for me because they are really good people. I come from a Palestinian background, and I've always wanted to do something to help that's really black and white, with no politics involved," Saba said.
Sosebee said of the fund's approach, "It's better for the children not to leave their families, and taking family members along makes it very expensive. We get more bang for the buck bringing the doctors here, and we get the added benefit of local physicians working alongside them and learning from them."
The $500,000 or so that the charity raises annually pays for plane flights, accommodations and hospital services. Doctors donate their services, and some pay their own travel expenses. Some, including Saba, bring donated equipment with them. As a result, Sosebee said, the relief fund is able to provide medical services for far less than the $40 million to $50 million doctors and hospitals would normally charge for such services.
But for Sosebee's charity and patients like 4-year-old Sundras, the sanctions could be a deathblow.
Nashashibi, an East Jerusalem physician whose clinic helps identify candidates for treatment by visiting surgeons, said not just his own patients would be affected by the U.S.-led sanctions.
"If this goes on more than a couple of weeks, the health care system will collapse in Palestine," he said. "The health care issue should be viewed differently from the political question of Hamas."
At the government hospital in Ramallah, the work of the children's charity is well-known and deeply appreciated.
"For the last five years, Steve has sent two or three teams every year to carry out pediatric surgery," said Dr. Husni Atari, the hospital director. "They come and deal with 25 to 30 cases in a week. We only have one cardiac surgeon here, so we do not have enough time to perform pediatric surgery."
"Steve should be exempt from these sanctions," he said. "The American government should not stop doctors coming from the U.S. to perform surgery on critically ill patients. This has nothing to do with terrorism."
Atari said the sanctions not only would end the Palestine Children's Relief Fund program here, but also threaten to shut down the entire Palestinian health system.
He said Ramallah Hospital -- the main referral hospital for all of the West Bank -- is running out of medicines, sterile dressings and other disposable items. Western donors had helped pay for salaries, medicine and equipment, but now those funds have stopped. None of the 346 doctors, nurses and ancillary staff has received salaries since February.
They are not alone. The Palestinian Authority government is bankrupt and has been unable to pay March or April salaries to its 167,000 civil servants, affecting about one-quarter of the 4 million population.
Palestinian Finance Minister Omar Abdel Razek told parliament last month that the new government was saddled with debts of $1.3 billion from the previous Fatah administration, had no cash reserves and was rapidly running out of credit with the banks. He said the financial crisis has been caused by massive overspending by the previous government and the decision of Israel, the European Union and other donor states to cut off tax transfers and financial support as long as Hamas is in control.
Israel suspended about $950 million in payments of customs and taxes, which it is supposed to transfer each year to the Palestinian Authority for goods and services conducted through Israel. The EU suspended about $600 million in annual direct budgetary assistance.
For hospital director Husni Atari, that means disaster is just around the corner: "So far, the sanctions have had no effect. The doctors and other staff are still coming to work, even though they have not been paid. Soon they will have no money to get to the hospital. When I look at my storage cupboards, I see things are in danger of collapse. If this goes on, we will have to close."
Atari said he has worked at the hospital since 1974. His salary at that time was paid by the Israeli occupation forces. In 1994, the hospital was transferred to Palestinian control, and he was paid by the Palestinian Authority. Now, Hamas is in charge. He said it makes no difference.
"I worked under the Israeli occupation, under Fatah and now under Hamas," Atari said. "I am a physician. I don't care who is the government paying my salary or the running costs of the hospital. We don't discriminate between patients. We treat anyone, regardless of their religion or nationality. I don't feel it is right that our patients are being discriminated against because of the political view of the government. We have become the victims of politics."
At the Palestinian Ministry of Health, the outlook is bleak. Dr. Anan Masri, a pediatric cardiologist who has been deputy minister of health for the past 18 months under both Fatah and Hamas governments, said supplies were running so low, he had immediate fears for the lives of 800 dialysis patients.
"We are in a life-threatening situation. We are trying to make those patients survive," said Masri. "Dialysis requires special solutions to clean the blood, and we need 3,000 units per month. We are almost at zero point. If a patient misses two sessions, they will die. Unless we get new supplies within one week, we are definitely going to start losing patients."
He said the Ministry of Health was allocated 7 percent of the budget by the last government, and needed $4.5 million every month just to cover operating costs, plus salaries for 12,500 civil servants, including the medical staff. He said new appointments had been frozen and retirees were not being replaced.
"The Americans say they are not cutting humanitarian aid, but the Ministry of Health provides health care for more than 80 percent of the population," Masri said. "I am sure the American people are not well aware about the Palestinian situation. We have an emergency here. It is like a war -- but even worse, because the people do not understand why the situation is so bad when it seems to them like an ordinary day."
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