'I can't bear my pain': Siege of Gaza taking terrible toll on people with disabilities

Nidal Hillis, 33, was waiting for his father to take him to the toilet. When Ashraf, 55, arrived from the mosque after praying, he lowered Nidal into his wheelchair and pushed him to the bathroom.

Since birth, Nidal has had paralysis in his left leg, where bed sores have spread recently. 

'All my neighbours hear me screaming in pain every single day'

- Nidal Hillis

His condition gradually worsened after he broke his patella 10 years ago following a fall from his wheelchair.

"Bed sores have spread in my leg. They cause unbearable pain. Gazan doctors will have nothing to do with me," said Nidal, while lying on a worn-out green sofa. "I can't bear my pain. All my neighbours hear me screaming in pain every single day."

So that Nidal can undergo knee replacement surgery at al-Makassed hospital in Jerusalem, he and his father have applied to the Palestinian General Authority of Civil Affairs five times since August 2021.

However, medical procedures have been delayed four times by Israel, as it does with almost half of Gazan patients, who experience delays and bans from access to the West Bank, Jerusalem or Israeli hospitals under security pretexts, although the Palestinian Authority covers all costs.

The measures are part of Israel's suffocating siege on the Gaza Strip, which is now in its 15th year.

The land, sea, and air blockade was imposed after Hamas won legislative elections in 2006. It has devastated social and economic life in the coastal enclave, and severe restrictions on the movement of people and goods have left two million Palestinians living in an open-air prison. 

According to a monthly report by the World Health Organisation in April, Israel approved only 57 percent of entry permits by patients from Gaza. International human rights groups and UN mechanisms have characterised the siege as unlawful, collective punishment.

"We get a message a day before the appointment from the Authority of Civil Affairs that says our application is under consideration - under security check - although I worked in Israel for more than a decade," said Ashraf, a father of seven, six of them unemployed.

'I can't afford his treatment. So I always give him painkillers to relieve his suffering'

- Ashraf Hillis

"The alternative is to go to Egypt, but I can't afford the expenses as I need at least $2,000. The worst thing is the 12-hour journey to Cairo and the three-day return journey to Gaza, due to Egyptian military operations in the Sinai Desert. How will my son bear that?"

The father, whose main source of income is welfare payments from the Ministry of Social Affairs, needs up to $100 for Nadal's treatment every month.

Recipients of welfare are supposed to receive 700 to 1,800 shekels ($201-$518) every three months. But they were paid only 400 shekels last week for the first time in more than a year due to a lack of funds flowing from the EU to the Palestinian Authority (PA).

Since it was established in 1993, the PA has relied heavily on foreign aid to pay its employees' salaries and pump cash into the economy.

However, in recent years, the US, UK, and EU had been using these donations to push the PA towards a political compromise with Israel.

The PA's 2021 budget deficit hit $1.26bn, while a "record low" $317m was received in foreign aid, the World Bank said in May.

"I can't afford his treatment, so I always give him painkillers to relieve his suffering," said Ashraf. 

Power outages

Fedaa al-Rifi, 33, has hemiplegia, a condition caused by brain damage that leads to paralysis on one side of the body, and ichthyosis vulgaris, a skin disorder. She needs an air-conditioner and an air mattress, but due to the daily electricity outages, which last from eight to 16 hours, and her family's financial situation, she cannot have them.

"We can't afford a conditioner, so I have a fan. But we don't have another electricity source. When it cuts out, I sweat and have to scratch my skin. Then my skin bleeds,"  Rifi said.

"During the outages, I sleep on the ground without a mattress. Despite being painful for my back, sleeping in such a way is better than bleeding due to the heat."

The electricity crisis badly affects people with disabilities, as it means there is no power for lifts, or for charging of electric wheelchair batteries and air mattresses, among other things. 

"My mobility scooter battery needs four hours to be fully charged. The problem is that I go to sleep early, the electricity returns at 10pm on three or four days a week, and it cuts off at 6am, before I wake up," Rifi said.

'Because I can't charge my scooter and therefore leave my home, I often have to cancel my appointments'

- Fedaa al-Rifi

"Because I can't charge my scooter and therefore leave my home, I often have to cancel my appointments."

The poverty rate in Gaza is 53 percent, and the medicine Rifi needs, which costs up to $200 a month, is too expensive for her father, Mohammed, 56, to afford.

"All her body is supposed to be covered with creams three times daily, especially when the electricity outages cause her to start sweating," said Mohammed, an electrical technician and a father of 10.

"Sometimes, we can't find her medicine in Gaza, so we have to buy the alternatives, which are not effective. But she doesn't suffer from the lack of medicine as much as she does from the electricity outages."

Soaring price of spare parts

Human Rights Watch issued a report in 2020 that said a decade of Israeli restrictions have "robbed people with disabilities in Gaza of their freedom of movement, as well as access to the devices, electricity and technology they need to communicate or leave their homes".

Mohammed Amrin, 33, a father of three, has cerebral palsy and completely depends on his mobility scooter.

Due to the siege, the price of spare parts for scooters and electric wheelchairs has soared.

"My scooter has been out of order for more than a year, and I can't afford the 1,500 shekels [$432] it would cost to repair it. So, I have to walk on my crutches for 50 minutes every day to find a cheap ride," said Amrin, who has a diploma in accounting he has never been able to use. 

"I have a stand at a street market and work from 9am to 10pm for around 25 shekels [$7.20] a day. The taxi fares cost me eight shekels daily. If the price of spare parts ever became affordable again, I would repair my wheelchair and save the eight shekels for my family."

Some local civil society groups grant people with disabilities a new electric wheelchair every two or three years, depending on funds. The NGOs include the National Society for Rehabilitation, Balsam for Social Rehabilitation, Society of Physically Handicapped People, and others.

Most of them are run by Gazans but funded by regional and international organisations and countries.

"I received mine, which is out of order, in 2018. When I asked if I could get a new one, the society told me there were no funds," said Amrin.  

Deteriorating situation

Three percent of the 2.17 million Palestinians in Gaza have disabilities, according to the Palestinian Central Bureau of Statistics. 

The quality of spare parts for electric wheelchairs and mobility scooters is poor. They are not always available, and their prices are high, said Ali al-Hindi, the owner of a workshop for electric wheelchairs.

"The motherboard price is 1,500 shekels ($432) compared to 600 shekels in 2012. The average price of a charger is 800 shekels ($231), up from $100 in 2012. I tried to import second-hand electric wheelchairs and mobility scooters last year from Israel, which banned me from doing so. The prices have tripled and quadrupled because of the siege," Hindi said.

"Ten years ago, I used to carry out two or three projects a month for local societies to maintain electric wheelchairs and scooters. Now, I do one every two or three months." 

Due to the deteriorating situation, donors tend to fund relief rather than developmental projects, said Jamal al-Rozi, director of the National Society for Rehabilitation. 

A relief project provides humanitarian aid to needy people during and after a crisis. In contrast, development projects aim to generate a source of income for people with disabilities in the long term through various small economic projects.

'There must be an intervention by the international community to break the siege of Gaza and to allow the entry of all medical equipment to people with disabilities'

- Salah Abdel-Aty, human rights expert

"Besides the lack of spare parts and the catastrophic effects of the electricity outages on people with disabilities, foreign funds have been dramatically decreased. The fund my society has received recently is 60 percent less than before the siege," he said.

"Unfortunately, we were forced last year to terminate a long-term project for 2,000 Gazans with disabilities due to lack of funds".

According to the Fourth Geneva Convention, denying disabled people access to hospitals in the West Bank and banning medical equipment could constitute war crimes, said Salah Abdel-Aty, a human rights expert and director of the International Commission to Support Palestinian People’s Rights.

"There must be an intervention by the international community to break the siege of Gaza and to allow the entry of all medical equipment and devices to people with disabilities," Abdel-Aty said.

Nidal has a new appointment on 8 August at al-Makassed hospital.

"I appeal to all people to help me receive my treatment," he said.

"Doctors warned me that if I don't have my leg treated, I will get gangrene and might have to have my leg amputated. Please, I don't want this."