The Israeli Occupation Forces (IOF) practices a policy of deliberate medical negligence against Palestinian prisoners. It is estimated that the number of ill prisoners inside Israeli prisons and detention centres has reached more than 750 cases^[[1]] who suffer from various ailments including terminal or chronic illnesses. According to Addameer Prisoner Support and Human Rights Association statistics, 26 female prisoners suffer from multiple illnesses and health conditions including heart and thyroid diseases, diabetes, high blood pressure, and stomach, bones, eyes, and dental problems. Furthermore, seven female prisoners were injured due to the brutal and excessive use of force used against them during their arrest by the IOF. This policy of negligence caused the female prisoners to suffer even more after the injury as they were denied proper and adequate health care services.

The impact of such a policy does not spare prisoners even after their release. Many former prisoners die shortly after their release due to the deliberate medical negligence they were subjected to during their time in prison. Many of the illnesses that prisoners develop during their detention period are exacerbated due to not receiving proper treatment at the time.

The Israeli occupation authorities assiduously violate the right of Palestinian prisoners to proper health care guaranteed under many international conventions and covenants. Articles 76, 85, 91, and 92 of the Fourth Geneva Convention guarantee the right of prisoners to regular health check-ups and the provision of proper treatment for any illness they suffer. The articles also state that prisoners and detainees should be provided and have access to health clinics and specialised doctors to attend to the patients. The Israeli authorities avoid their responsibilities towards Palestinian prisoners under international conventions causing the health conditions of prisoners to deteriorate.

The Reality of Medical Negligence in Prisons

The harsh conditions weathered by Palestinian prisoners inside Israeli prisons and detention centres exacerbate the suffering of ill prisoners and worsen their health conditions. These conditions ultimately lead to more sick cases since most Israeli prisons do not provide an adequate and healthy living environment fit for human beings. Most of the detention centres are old and are not in line with international standards in terms of size and architecture, and rodents and insects have festered all over the place. Moreover, the Israeli Prison Service (IPS) has shirked all responsibility towards the individual and general needs of prisoners.

Many prisoners suffer from injuries they sustained during their first moments of arrest, interrogation or at the hands of the IPS special units. Without receiving the immediate medical care needed to stabilise their conditions, many of these prisoners fall victim to the IPS policy of deliberately stalling the implementation of the provision of specialised medical care. Mr. Faris Baroud was an ex-detainee who is the latest in a line of martyrs who lost their lives due to medical negligence in prison.

The Case of Prisoner Walid Sharaf

Mr. Walid Sharaf, who suffered from a skin condition before his detainment, was first arrested in August of 2017. After hours of being interrogated at al-Moscobiyeh Detention and Interrogation Centre in Jerusalem, he displayed symptoms affecting his urinary system. According to a statement he gave to Addameer's lawyer, he visited Ofer Prison Clinic multiple times where he was never tested and was only advised to drink water. Mr. Sharaf was released in April of 2018 without a diagnosis of the health condition, causing him pain in the kidneys and bladder.

Mr. Sharaf was arrested once again in June of 2018 under an administrative detention order and was sentenced to six months. The order against him was renewed for a month, and then five more months at the beginning of 2019. After his arrest, he revisited Ofer Prison Clinic seeking an answer to his symptoms but was not tested until the beginning of 2019. After undergoing medical tests, he was informed that he suffers from a liver condition without providing any further details. Consequently, after two days he was transferred to an Israeli hospital before starting his back and forth journey between hospitals where he was diagnosed with liver disease.

In a medical report requested by Physicians for Human Rights (PHR-I), a specialised internal medicine physician with a background in dermatology at Soroka University Medical Center reviewed the tests and paperwork of Mr. Sharaf to give his professional opinion on Mr. Sharaf's condition. The doctor concluded that Mr. Sharaf suffers from three health complications— the worst of which is his liver. He stated that there is a possibility that Mr. Sharaf's skin condition caused damage to his internal organs and also his liver complication. The doctor pointed out that he did not receive any documents or blood tests run by a specialised doctor and warned that Mr. Sharaf's skin condition requires constant monitoring since it might also affect the blood.

Such practices by the IPS fall under their policy of deliberate medical negligence, as Mr.Sharaf was denied the proper medical testing needed to monitor his case and ensure his condition does not deteriorate. The doctor also mentioned that Mr. Sharaf suffers from bladder implications which cause a backlog of urine. He further explained that the added pressure could cause permanent damage to the kidneys if not reduced by using a catheter to drain the urine. The doctor asserted that the major issue Mr. Sharaf suffered from is advanced liver disease. After reviewing Mr. Sharaf's medical record, the doctor notes that he did not suffer from any problems in the liver in June 2018 (right before his first arrest). However, the tests he took a few months later in January 2019 indicate severe damage to the liver.

Mr. Sharaf was transferred to a hospital on 25 January 2019 after the deterioration of his health condition. According to the doctor's report, the IPS did not attempt to treat Mr. Sharaf's serious condition since he was admitted to the hospital. In the period between Mr. Sharaf's diagnosis on 6 January 2019, and his admittance to the hospital on 25 January 2019, the IPS did not take any action to treat Mr. Sharaf's grave condition. Moreover, he was heavily guarded and shackled to the bed during his stay at the hospital without receiving proper care to prevent his illness from worsening.

On 30 January 2019, Mr. Sharaf was discharged without a diagnosis of his condition. The doctor tracked the development of Mr. Sharaf's liver condition by comparing the results of his tests at the beginning of his arrest with the latest test he took on 3 February 2019. The doctor adds that Mr. Sharaf's condition necessitates a permanent stay in the hospital for regular monitoring. This action was not taken throughout his stay at the Ramleh Prison Clinic, which lacks the bare minimum of health care basics. Sharaf's condition poses a serious threat to his life since his liver could shut down at any moment. If that happens, he will need immediate medical intervention for a liver transplant. Such a procedure could only be provided in a specialised medical centre. The doctor assured that the IPS could not possibly monitor Mr. Sharaf's case at the Ramleh Prison Clinic, given their record of deliberate negligence.

The doctor's report explicitly details the deterioration of Mr. Sharaf's health condition due to the medical negligence of the IPS and their refusal to provide Palestinian prisoners with proper diagnosis and treatment.

At the court hearing to renew Mr. Sharaf's administrative detention order, his lawyer submitted a request to the military court to review Mr. Sharaf's medical record. After agreeing to review his record, Mr. Sharaf was released from prison only to begin a new journey of suffering caused by the deliberate medical negligence of the IPS.

The Case of Prisoner Laith Kanaan

Mr. Laith Kanaan was arrested on 30 January 2019, two days prior to his scheduled face and eye surgery to treat an injury he sustained during clashes with the IOF which cost him to lose vision in one eye. After his brutal arrest, Mr. Kanaan was immediately put under interrogation for two months with no consideration of his health condition which required special medical care. He was deprived of sleep for extended periods which led to the deterioration of his situation. He suffered from a searing pain in his injured eye that prevented him from sleeping.

At his first court hearing during the interrogation period, the IPS objected Addameer's request to provide the prison with Mr. Kanaan's special medication, the IPS argued that the prison nurse inspects all prisoners and provides adequate care. Later, in an appeal hearing, the lawyer reasserted that Kanaan suffers from a health condition that requires the change of the bandages on his eye twice a day, but he is only allowed to change it once. He also noted that the medical bandages brought by the prisoner when he had been arrested were about to run out, and thus new supplies would be needed soon. In another later hearing, the lawyer requested that the prison should provide Mr. Kanaan with medical bandages again. The judge issued an order for Mr. Kanaan to be examined by a doctor within 24 hours. Still, in the next hearing, Mr. Kanaan informed the military judge that he had not been tested, nor received the needed medical care.

Mr. Kanaan's case reaffirms the IPS' persistence to deny Palestinian prisoners the health care they need and further illustrates the practices that cause the conditions of prisoners to deteriorate, including the brutal interrogation under harsh conditions.

The Case of Israa Ja’abis

Ms. Israa Ja'abis, sentenced to 11 years in prison, is a female prisoner with the most challenging health condition among her peers. Ms. Ja'abis was arrested after her car caught on fire due to an electrical short at Z'ayyem military checkpoint. She suffers from third-degree burns on 50 percent of her body and has lost eight of her fingers. Ms. Ja'abis complains that despite the peculiar needs of her case, she is only offered painkillers. Her case warrants constant medical attention and treatment, including several surgical interventions to separate the attached parts of her limbs and to recover her remaining fingers. However, the IPS continues to deny Ms. Ja'abis access to any specialised medical care, causing her health state to worsen over time.

Prison Clinics: Two-Fold Suffering

Prisoners who suffer from difficult health conditions spend their time at what is known as the Ramleh Prison' Clinic', where they are entirely subject to medical negligence. Sick prisoners are not offered proper treatment nor proper diagnosis. Painkillers, which exacerbate their health problems, are often provided. About 14-16 prisoners stay at the Ramleh Prison Clinic permanently where they suffer poor health and living conditions. Some of the prisoners suffer gunshot wounds, others are diagnosed with chronic diseases and malignant tumours, and others have physical disabilities that require the use of wheelchairs. One or two healthy prisoners stay at the facility to help the prisoners move around and to provide them with primary medical care and to perform first aid when needed. Such dereliction showcases how the IPS avoid its responsibilities and rely on other prisoners to attend to the needs of the ill ones. The clinic does not employ professional medical staff, so ill prisoners are often transferred to civilian hospitals for tests and examinations. Such measures are only taken after long delays.

The Ramleh Prison Clinic, like other prisons, does not meet the minimum standards of adequate human living. Aside from being old, its facilities, mainly the bathrooms and the forayard, are not equipped to accommodate prisoners who use wheelchairs. The cells also lack space for cooking. The clinic itself is not furnished with modern tools and medical equipment. The tools used are outdated and cannot be used to treat the cases living there.

Notably, Israeli prison clinics are understaffed and do lack full professional personnel to monitor cases and provide proper health care to those who need it the most. Periodic check-ups are often postponed and are difficult to schedule. Moreover, the Damon Prison for women lacks a full-time female gynaecologist. Despite the efforts of many human rights organisations and the demands for a full-time doctor to oversee routine check-ups at the clinic, the IPA still refuses even to allow a gynaecologist from outside the prison to examine the female prisoners.

International Humanitarian Law (IHL) guarantees the right of prisoners to be treated humanely and protected against violence as well as intimidation. Article 85 of the Fourth Geneva Convention states that "In no case shall permanent places of internment be situated in unhealthy areas or in districts the climate of which is injurious to the internees. In all cases where the district, in which a protected person is temporarily interned, is in an unhealthy area or has a climate which is harmful to his health, he shall be removed to a more suitable place of internment as rapidly as circumstances permit" and that "Internees shall have for their use, day and night, sanitary conveniences which conform to the rules of hygiene and are constantly maintained in a state of cleanliness".

In a similar vein, the Standard Minimum Rules for the Treatment of Prisoners guarantee the right of prisoners to proper health care that corresponds to their needs. As article 24 stands, "The provision of health care for prisoners is a State responsibility. Prisoners should enjoy the same standards of health care that are available in the community and should have access to necessary healthcare services free of charge without discrimination on the grounds of their legal status". Article 25 of the same convention states that "(i) Every prison shall have in place a healthcare service tasked with evaluating, promoting, protecting and improving the physical and mental health of prisoners, paying particular attention to prisoners with special healthcare needs or with health issues that hamper their rehabilitation; (ii) the healthcare service shall consist of an interdisciplinary team with sufficient qualified personnel acting in full clinical independence and shall encompass sufficient expertise in psychology and psychiatry. The services of a qualified dentist shall be available to every prisoner".

The Israeli occupation authorities' policies violate the minimum standards guaranteed under international conventions and covenants regarding the right of Palestinian prisoners to health care. Not only does the IPS deny prisoners treatment, but it also assiduously violates the rights of Palestinian prisoners by subjecting them to long and brutal hours of interrogation without considering their health conditions. Moreover, ill prisoners are transferred between hospitals and prisons in the Bosta, not in an ambulance or a comfortable vehicle. The long and harsh journey often worsens the condition of prisoners and pushes many of them to waive their right to treatment in hopes of escaping the hellish ride.

According to a testimony given by Mr. Abdullah Hmaideh, a former prisoner, to Addameer researchers on the latest assault on prisoners at the Naqab Prison, he stated that "even when escorting ill prisoners to the clinic, prison guards would stand in line and beat each prisoner that passes by them even when they were near the clinic. Many prisoners refused to leave the cells to go to the clinic based on previous encounters but are forced to leave, nonetheless".

Medical Negligence of Prisoners on a Hunger Strike

Israeli occupation authorities continue to violate the right of Palestinian prisoners to protest and strike to attain their just demands by denying them proper health care to repress any opposition. The IPS pressures prisoners on a hunger strike to end their strikes by refusing to provide them with the needed medical support even when prisoners reach a critical stage. As documented by Addameer, the IPS intimidates prisoners into breaking their strike by means of isolation. According to the testimonies given by many prisoners to Addameer's lawyers, prisoners who go on strike are kept bound and shackled by their hands and legs even when they leave the cells. The prisoners are held in unsanitary and harsh conditions, and when their health fails, they are transferred to hospitals by Bostato further their suffering. At the hospital, prisoners are bound to their hospital beds by the hands even though they can barely move at that point.

The policy of retaliation and medical negligence against striking prisoners led the IPS to reject the request of prisoner Husam ar-Ruzza, who has recently broken his hunger strike, to have a stomach x-ray, as he reported to Addameer's lawyer. On the 23^rdday of his hunger strike, he threatened to stop drinking water in protest of this medical negligence if his demand for an x-ray was not met. Another prisoner, Auda al-Hrub, who went on a strike on 2 April 2019, told Addameer's lawyer after a visit at the Ramleh Prison Clinic that he stopped drinking water to protest the administration's refusal to transfer him to a civilian hospital. He stated that the Ramleh Prison Clinic is not a clinic but another set of prison cells that is not adequate for the needs of a prisoner going on a hunger strike. He repeatedly demanded that the IPS transfer him to a civilian hospital because of his health condition. He could barely stand up and use the bathroom. He needs special health care that is not provided at the Ramleh Prison Clinic.

The IPS uses the health condition of hunger-striking prisoners against them as a tactic to force them to break their strike. In the 2017 hunger strike, prisoner Muhammad Abu Sakha reported, "prisoners on their 38^thday of the hunger strike had to deal with repeated cases of fainting that the prison guards stalled to move into the clinic. It is a deliberate tactic used to sway the prisoners into breaking their strike. When a prisoner has fainted and is lying down on the ground, prison guards start to bargain with the prisoner to break their strike in exchange for receiving medical aid".

The IPS deprives hunger-striking prisoners of their right to consult with medical professionals from outside the prison to ascertain the reality of their health condition. Such was the case of former prisoner Bilal Kayed during his hunger strike in 2016. Kayed affirmed that he had not been allowed to meet with an independent doctor. The fact that pushed a human rights organisation to file a petition to the Israeli High Court regarding the issue.

The Martyrs of the Prisoners' Movement

The systematic and deliberate policy adopted by the IPS against Palestinian prisoners is not a recent development. Faris Baroud is the last in a line of prisoners who have fell martyrs due to this policy. Up until 2019, the number of martyrs from the Prisoners' Movement has reached 218. They were subjected to all kinds of torture, brutality, and deliberate medical negligence. Seventy-eight of them were victims of wilful killing, seven of them were directly shot inside Israeli prisons and detention centres; 60 of them died due to medical negligence, and 73 due to torture. 

Not only doesthe IPS torment Palestinian prisoners with medical negligence, but it also withholds the bodies of martyred prisoners refusing to return the bodies to their families. Israeli authorities have been withholding the body of martyr 'Aziz Owaisat, who was severely beaten and neglected causing him to die of a heart attack, since May 2018. The Palestinian doctor who participated in the autopsy of the martyr's body confirmed that he was suffering from several heart problems and confirmed the livid bruises were littering the martyr's bodies. The pain endured by the martyr after the beating combined with medical negligence led to the death of 'Owaisat whose body has yet to be returned to his family.

Moreover, Israeli authorities have been still holding the body of the martyr Faris Baroud since his death in February 2019. Baroud, who was sentenced to life in 1991, was subjected to numerous violations along with his fellow prisoners. He was held in solitary confinement for over 17 years starting in 1995 until 2012 when the Prisoners' Movement went on a hunger strike. One of the Movement's key demands was to put an end to solitary confinement, and the success of the strike ensured Baroud's escape from his single cell. During these 17 years, he suffered inhumane and harsh conditions that led to the deterioration of his health condition. The martyr spoke to Addameer on numerous occasions regarding his poor health in solitary confinement and the lack of medical care he was given. Deliberate medical negligence led to the death of Baroud, and yet Israeli authorities refuse to return his body to his family for proper burial.

In its unremitting adoption of the policy of deliberate medical negligence and as more prisoners fall martyrs due to this policy, the Israeli occupation continues to violate all international conventions and covenants that grant prisoners the right to health care and the protection against torture, brutality and ill-treatment. Nonetheless, it continues to evade its responsibilities as an occupying power to ensure the safety and health of prisoners under its watch as mandated by international conventions.