According to the procedural rules, the Israeli District Civil Liaison Offices need a medical opinion before they can refuse or grant a medical permit. In practice, the State does not provide medical opinions, whilst so-called security considerations typically outweigh medical needs of the applicants.250 Moreover, on those occasions when Israel provides explanations for denial or for prolonged delays in the processing of applications, such explanations are often inconsistent in their stated logic, leading to further uncertainty as to how health permits may be acquired.251 Health Permits for Residents of the Gaza Strip252 “I live with my family in Gaza City and I have three children. My eldest son,Yahya, who is six years old, was born with a kidney disease that needs to be treated in a continuous manner. Unfortunately, we cannot always find the required medications and treatment in Gaza, so we have to leave Gaza on a regular basis. We had to travel to Egypt, to Jerusalem or to Ramallah to get the required treatment. Whilst traveling, I have to leave my two younger daughters alone with their grandmother. It is hard for me to leave them, especially since they are still very young. Sometimes I feel guilty because I don’t look after my two daughters properly; because I have to spend much time with Yahya in the hospitals. This time, Israel refused to issue me a permit to go with Yahya to the hospital in the West Bank. How will he be able to go alone? In a normal situation, the trip from our home to the hospital in Jerusalem should not take more than one to one and a half hours, but unfortunately we do not live in a normal situation. Otherwise I could go to Jerusalem to be with Yahya and go back to Gaza every day to be with my daughters. This could be possible if these checkpoints, restrictions and the permit system were not here. After they rejected my application to go with my son, we were advised by our doctor to do an urgent surgery in Gaza. After the successful surgery, we had to do an urgent kidney dialysis. We did it seven times within two months in Gaza because the lines used in the dialysis were of a very low quality. In the end, the doctors advised us to do it outside Gaza because the medical equipment there would be better. We followed the procedures of the new medical referral from the Gaza Strip to the West Bank. It took longer than you can imagine. It was supposed to be an urgent referral because my son was doing the kidney dialysis but his body wasn’t responding to the treatment. The amount of toxins in his body was too high. The permit should have been 250 Machsom Watch and Physicians for Human Rights, “The Bureaucracy of Occupation: the District Civil Liaison Offices”, 2004, page 31. Available at: http://www.ochaopt.org/documents/opt_prot_ machsomwatch_bureaucracy_occupation_200.pdf 251 Claude de Ville de Goyet et al., “Report of a Field Assessment of Health Conditions in the Occupied Palestinian Territory (oPt)”, World Health Organization, 2015, page 9. Available at: http://applications. emro.who.int/docs/Cons_Rep_2015_EN_16311.pdf?ua=1 252 BADIL’s interview with Rana al-Atrash, mother of a child suffering from a kidney disease living in the Gaza Strip, “Health Permits for Residents of the Gaza Strip”, the Gaza Strip, August 2015 67