The security fence is cutting off Palestinian access to quality medical care in Jerusalem, Physicians for Human Rights-Israel charged in a report issued Wednesday. There are some 600,000 Palestinians living within a 20-kilometer radius of Jerusalem's Old City, according to the report. For these people, east Jerusalem is not just a religious and commercial center but a place where they go when they need a doctor and, in particular, a specialist. The clinics in the West Bank are good enough for a flu shot or having a cast made, but Al Makassed Hospital, the largest and best-stocked Palestinian medical facility, is located on the Mount of Olives. So is Augusta Victoria Hospital, the only institution over the Green Line that provides radiation therapy for cancer patients, but according to the report may not be able to provide that service for much longer. The Jerusalem Envelope, a 90-kilometer section of the security fence under still construction, "has been having a very negative effect on both the hospitals and the patients," said Shabtai Gold, spokesman for Physicians for Human Rights. The report issued by Gold's group notes that the barrier effectively shuts out some east Jerusalem neighborhoods, such as Ras Hamis and a-Salaam, as well as nearby Palestinian villages of Abu-Dis and Eizariyah. Theoretically, patients living on the "wrong side" of the security fence may obtain travel permits from their local IDF District Coordination Office to travel into Jerusalem. However, critics say the process is fraught with red tape and permits are not exactly doled out. "A good percentage of patients get permits, but they have to come to Jerusalem alone," said Dr. Omar Abdul Shafi, director of the Old City's Austrian-Arab Community Clinic. "I know of patients who died [in their hospital beds] alone at night." The human rights group also contends that passing the improvised checkpoints and temporary gates set up along route of the barrier is a time-consuming affair for Palestinians who may be sick or suffering. Responding to this charge, security fence advocates say humanitarian organizations have themselves to blame. "We have been trying to get the cooperation of human rights groups in making improvements in the fence crossings for years," said Marc Luria, spokesman for Tafnit, the political movement that grew out of the now-defunct Security Fence for Israel group. "But the response we've gotten from these groups is 'We oppose the fence, so how can we improve the humanitarian aspect of the crossing points?'" Meanwhile, the hospitals in east Jerusalem are also hurting. According to the report, half as many Gaza and West Bank residents came to Jerusalem outpatient clinics in 2004 as did in 2003, a decline of some 170,000 patients. Even then, east Jerusalem hospitals lack enough personnel, such as West Bank janitors and technicians, to function properly. At his clinic, located not far from the Damascus Gate, Abdul Shafi tapped an X-ray machine which has yet to have its digital board installed. The West Bank technician who was supposed to fix the machine only had a two-week permit to work in Jerusalem, explained the surgeon. In the end, the X-ray man needed a month to finish the job, but the government instituted a closure on the territories before he could get his permit renewed. In response to difficulties such as these, the Palestinians have begun to upgrade medical facilities in Ramallah and elsewhere in the West Bank. It sounds like a solution, but noted Abdul Shafi, "Makassed and Augusta Victoria were not built overnight." For most Israelis, though, Palestinian complaints about the security fence fall on deaf ears. Etgar Azulai, 53, divorced father of two and resident of Modi'in, sees the barrier as a vital security measure - one that has been late in the taking. On February 22, 2004, a suicide bomber from a village near Bethlehem boarded the No.14 Bus in Jerusalem and blew it up, killing himself and eight other passengers. Azulai's 18-year-old son Lior was one of the dead. "We have to make sure that they [terrorists] do not get in," said Azulai. "This is a question of life and death, and every normal person prefers life."