Medical Treatment

Israel

• Israel is taking part in the COVAX alliance.[1]

Treatment of populations lacking immigration status 

• The Head of the Medical Directorate in the Ministry of Health has instructed the general hospitals to provide any necessary response to persons lacking immigration status in Israel and persons from marginalised populations. She also noted that Magen David Adom should offer a response to this population as to any resident.[2]
   
• In a later correspondence the Head of the Medical Directorate in the Ministry of Health instructed the general hospitals and Magen David Adom that patients suspected of being infected or confirmed as infected must be admitted for treatment, even if the patient cannot pay and has no insurance. This instruction refers inter alia to infiltrators/asylum seekers and foreign/migrant workers.[3]
   
• On 24 December 2020 the Population and Immigration Authority stated based on information from the ministry of Health that foreign workers in the home-based caregiving sector who are insured by their employers are entitled to be vaccinated with their employers regardless of their national health insurance status. Furthermore, the ministry of health is intending to vaccinate all foreign workers in Israel regardless of their medical insurance.[4]
   
• On 30 December 2020 the Ministry of Health declared that persons present in Israel who are over 60 years old have been prioritised for vaccination similarly to Israeli nationals their age.[5]
   
• On 21 January 2021 the Director of the Section for Policy Planning in the Ministry of Health Dr. Shlomit Avni announced that the Committee on Vaccines and the Director-General of the ministry of health have confirmed a decision to vaccinate all status-less persons whose center of life is in Israel and qualify under the age prioritization schedule.[6]
   
• Asylum seekers: On 9 February the Municipality of Tel Aviv opened a vaccination center for asylum seekers and migrant workers age 16 and upwards at no cost. Over 20,000 persons have been vaccinated.[7]
   
• On 10 February 2021 the Ministry of Health decided that vaccines would be provided to persons lacking immigration status providing proof of being present in Israel half a year or longer, as well as to any person lacking immigration status over the age of 50.[8]

West Bank and Gaza

Health services in West Bank and Gaza - general

Legal obligations:

• On various occasions the GoI stated that.[9]

under the Interim Agreement, the responsibility and authorities in the health sphere with regard to the whole of the Palestinian population in Judea and Samaria and the Gaza Strip have been transferred to the Palestinian Authority. Accordingly, the responsibility for containing and addressing the spread of COVID-19 in these territories lies with the Palestinian Authority. Furthermore, in 2007 the Hamas took over the Gaza Strip through a military coup, and the medical response to residents of the Strip is provided also through the Gazan health authorities, that are subject to the Hamas terrorist organization. In this state of affairs, Israel acts in cooperation and coordination with the relevant Palestinian Authority organs and various actors in the international scene, to provide a plenteous and varied assistance for the Palestinian population’s combatting COVID-19. All this, far beyond Israel’s obligations under law.

The High Court of Justice noted that prima facie, the State of Israel acts in a variety of fashions, including far beyond the required in the circumstances.[10]

• Similarly, in February 2021 the GoI stated that ,under the Israeli-Palestinian Interim Agreement regarding the West Bank and Gaza Strip signed in September 1995, the responsibility and authorities in the health sphere with regard to the Palestinian population the Gaza Strip are in the hands of the Palestinian Authority, who bears the responsibility to respond to health needs of this population; the medical response to Gaza residents is given in practice by the Gaza health authorities, who are since 2007 subject to the Hamas regime’.[11]
   
• The GoI repeated its consistent view that international human rights treaties to which Israel is party do not apply outside its sovereign territory.[12]

Policy

• At the end of January 2021 Israel stated that it has ‘a vested interest in ensuring the vaccination of the population of the Palestinian Authority, while assuring the Palestinian Authority maintains its own fully functioning health system’.[13]
   
• Israel ‘remains committed to actively promoting and improving health standards globally and regionally by strengthening the close collaboration with all partners, including the Palestinians, to ensure adequate preparedness and response to the current pandemic’.[14]
   
• ‘Given the daily contact between the two populations, the epidemiological position of the ministry of health is that the territory of the State of Israel and the Palestinian Authority is one unit from an epidemiological perspective, given the size and geopolitical composition of the territory. Accordingly, from a narrow epidemiological perspective the areas of the Palestinian Authority in Judea and Samaria should be regarded as one territory with the State of Israel. Therefore, the position of the ministry of health is that Israel sees value and health benefit in the Palestinian Authority coping successfully with the pandemic and accordingly also in the Palestinian population in Judea and Samaria being for the most part vaccinated. Since the crossing over between Israel and the Gaza Strip are limited, the risk of infection from the Gaza Strip territory into Israel is lower, but still exists.[15]

West Bank

General:

• Efforts undertaken by the GoI to assist in curbing the spread of COVID-19 with regard to the Palestinian Authority/West Bank include calling on the international community to support the United Nations 90-day programme and direct international aid so that the Palestinian Authority can be better equipped to manage the COVID-19 crisis; Joint consultations and deliberations between expert-level officials from Israel, UN and PA; Training and guidance of Palestinian medical teams, and delivery of medical supplies to the Palestinian Authority.[16]
   
• Israel maintains continuous contact with Palestinian authorities to consider assistance with combatting COVID-19, and requests as for vaccines and other forms of assistance are considered in light of relevant considerations.[17]

Provision of medical supplies from Israel and third parties to the West Bank:

• Israel has transferred to the Palestinian health ministry 1950 testing kits and 2400 nasal swabs. In addition, international donations including from the WHO have been transferred to the Palestinian Authority including emergency room beds, respirators and auxiliary equipment, testing kits and swabs, medication and perishable medical supplies.[18]

Vaccination of Palestinians employed in Israel and in Israeli settlements: 

• On 10 February 2021 the Ministry of Health decided that vaccines would be not be provided to Palestinians employed in Israel, whether holding a work permit or otherwise.[19]
   
• On 8 March 2021 the ministry of health and the military authorities began a vaccination campaign at various crossings and Israeli industrial areas across the West Bank, for Palestinian employees who hold a valid work permit in Israel or in the Israeli settlements in the West Bank.[20] Over the course of the following two weeks, every employee who wishes to do so will be able to be vaccinated at one of the vaccination stations in the crossings, in coordination with their employer and the relevant government authorities.[21] By 29 April 2021, over 104,000 Palestinians holding employment licenses had received the second doze of the vaccines and some 3000 others received a first doze.[22]
   
• Some 4000 Palestinian have been vaccinated under Israeli frameworks (medical teams, teachers and persons insured under national health insurance).[23]

Provision of vaccines from Israel to the West Bank:

• Following a request of the Palestinian Authority, in January 2021 Israel provided, as a humanitarian gesture, vaccines for 100 medical personnel over 60 years old who are treating COVID-19 patients in the West Bank (2 batches of 100 doses). Subsequently, the Israeli authorities transferred 5000 vaccine doses to medical teams in the Palestinian Authority.[24]
   
• On 23 February 2021 the Office of the Prime Minister stated that ‘[d]ue to the accumulation of a limited quantity to unused vaccines, it has been decided to assist Palestinian Authority medical teams and several of the countries that contacted Israel with a symbolic quantity of vaccines’.[25]
   
• On 18 June 2021 the GoI announced that Israel and the Palestinian Authority have reached agreement on a barter of vaccine dozes, according to which Israel will transfer to the Palestinian Authority about a million dozes that are about to expire, in exchange for Pfizer’s next shipment to the Palestinian Authority, due in September-October 2021.[26]

Transfer of vaccines from third parties to the West Bank:

• Under the Interim Agreement, importation of pharmaceuticals to the West Bank are subject to the regulatory framework applicable in Israel. Requests for importation of pharmaceuticals (through COGAT and the taxation authority to the ministry of health) are generally approved from the medical regulatory aspect very quickly. Vaccine donations are exempted from the regular approval procedure and are approved immediately.[27] The medical regulatory framework does not hinder the Palestinian Authority from purchasing vaccines that have not been approved for importation for use within Israel.[28]
   
• According to COGAT, over the months of February and March 2021, 223,140 vaccination dozes were transferred to the Palestinian Authority through WHO under COVAX, from China, from the Serum Institute India and from Russia.[29] In late May and early June 2021, 218,560 additional dozes were transferred from COVAX, UNICEF, WHO and Qatar. Additional requests for transfer of vaccines are under review and in the absence of security obstacles the tendency is to approve them.[30]
   
• According to COGAT, in late May and early June 2021 Israel provided 145,300 dozes purchased by the Palestinian Authority.[31]

Movement of COVID-19 patients from Israel to the West Bank 

• Israel coordinated with the Palestinian Authority the transfer of Palestinians suspected or confirmed as carrying COVID-19 patients from Israel to the West Bank, and provided the Palestinian Authority with names of Palestinians entering Israel so that they can be isolated and monitored once they have entered the West Bank.[32]

Gaza

General:

• Efforts undertaken by the GoI to assist in curbing the spread of COVID-19 include delivery of testing and protection kits to the Gaza Strip, and willingness to assist in laboratory testing; and maintaining commercial crossings into Gaza open for the transfer of goods and assistance.[33]

Transfer of medical supplies to Gaza:

Legal obligations: 

• ‘Israel recognises that the international law of armed conflict applies to the conflict between Israel and Hamas in Gaza. According to these laws, Israel is obligated to allow neutral third parties to transfer equipment and vital medical response to the civilian population in Gaza, including life-saving vaccines, subject to security considerations’.[34]

Practice: 

• ‘Israel facilitates transfer of provisions and assistance to Gaza, subject to security considerations and technical arrangements’.[35] Israel allows entry of medical teams subject to a security check.[36]
   
• With regard to dual-use items that under the law require export permit in order to be transferred to Gaza, some relaxations have been approved in light of changing circumstances and concrete needs.[37] Vaccines against Covid-19 are not regarded as dual-use items.[38]
   
• Numerous and varied additional measures, have been taken relating to addressing COVID-19 in Gaza that cannot be divulged due to a danger of harming Israel’s foreign relations’.[39]

Provision of vaccines from Israel to Gaza:

• As of 10 May 2021, Israel did not intend to provide vaccines to Gaza.[40]

Transfer of vaccines from the Palestinian Authority and third parties to Gaza:

• ‘The prime minister has confirmed that the Palestinian Authority should not be prevented from transferring vaccines to Gaza, provided that those are not funded by Israel or emanating from Israeli stocks’.[41]
   
• ‘Should a request be made by neutral third parties, or by the Palestinian Authority who has the authorities under the Interim Agreement in this context, Israel is obligated under the laws of war in light of the armed conflict between Israel and Hamas and other terrorist groups in Gaza, to allow entry of the said vaccines into Gaza, subject to security considerations’.[42]
   
• On 4 February 2021 the Palestinian Authority received a shipment of Sputnik vaccines (anticipated at 5,000 according to earlier reports) by donation from the Government of Russia. On the same day the Palestinian Authority requested to transfer 1,000 doses to Gaza. The request was approved by the Israeli authorities and the vaccines were transferred.[43] Over the course of February and March 2021, 60,000 vaccine dozes were provided to Gaza through the border with Egypt, and 11,700 vaccine dozes were provided by the WHO under COVAX through Israel.[44] Over the months of April, May and June, 74,200 dozes were received in Gaza from UNICEF, COVAX and WHO, as well as 30,000 from the United Arab Emirates, provided through Rafah Crossing (with Egypt). Requests for additional transfers of vaccine dozes and diluters have been received, some have already been approved by the ministry of health.[45]

Entry of COVID-19 patients from Gaza to Israel or passage through Israel to the West Bank: 

• In accordance with the general policy regarding entry for medical treatment of Gaza residents into Israel, or through Israel to the West Bank, entry is allowed for life-saving treatment or that without which the quality of life is dramatically harmed, if such treatment is unavailable in Gaza. Requests for such entry are channelled through the Civil Palestinian Committee to the Gaza Liaison office and are considered in light of the policy, of specific security considerations, and political considerations.[46]
   
• In February 2021 the GoI noted that requests of COVID-19 patients from Gaza to enter medical treatment in Israel or the West Bank are refused since they do not qualify under the policy approved by the Supreme Court. Furthermore it stated that ccording to the information available to it, medical treatment for COVID-19 is fully available in Gaza and requests are therefore refused.[47]