As part of the Oslo Agreement, responsibility for the healthcare system in the oPt has officially been transferred from Israel to the Palestinian Ministry of Health. However, because Israel remains in control of many variables that directly impact upon the healthcare system, such as crossing checkpoints, import of medical equipment and medicine, and water resources, Israel effectively retains control over large parts of the Palestinian health system.245 Restriction to Access to Health Facilities Acquiring a medical permit to cross a checkpoint in order to leave the West Bank (not including Jerusalem) or the Gaza Strip is a long and complicated process, and even after Palestinians obtain a health permit, they still risk being denied by the Israeli military at the checkpoint.246 According to Rifat Muheisen, the Head of the Liaison Department of the Palestinian Ministry of Health, patients first need to obtain referral documents, financial coverage and an appointment from the hospital they want to visit. According to Muheisen, “if the patient is in a critical situation and needs immediate surgical intervention, then the coordination with the Israelis does not take more than two hours. But with the less critical cases, it takes from one week up to ten days, and sometimes even longer.”247 According to Muheisen, “the Israeli security checks affect many cases because it takes a long time, which makes the patients miss their appointments at hospitals. Thus, they need to get a new appointment at the hospital, getting worse at the same time. Even if all papers are presented at a checkpoint, the Israeli soldiers, who are not trained or experienced medical personal, have discretion to judge upon the medical necessity to actually allow the crossing of the checkpoint or not.”248 Each year, some 200,000 Palestinians apply for a medical permit to travel between Gaza, the West Bank and East Jerusalem to receive medical treatment or to accompany a close relative who is in need of medical attention. Of these people, around 40,000, representing 20 percent of all applicants, are denied.249 245 Physicians for Human Rights, “Divide & Conquer: Inequality in Health”, January 2015, pages 5-6. Available at: http://www.phr.org.il/uploaded/Divide%20and%20Conquer%20ENG%20REPORT%20 JAN%202015.pdf 246 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=1 247 BADIL’s interview with RifatMuheisen, Head of the Liaison Department of the Palestinian Ministry of Health, “Procedures for obtaining permits”, Ramallah, August 2015 248 Ibid. 249 Physicians for Human Rights, “Divide & Conquer: Inequality in Health”, January 2015, page 43. Available at: http://www.phr.org.il/uploaded/Divide%20and%20Conquer%20ENG%20REPORT%20 JAN%202015.pdf 66