Five years ago Ramallah native M. married Ayman, an Israeli ID card holder. Together with their child, they live in the east Jerusalem neighborhood of Shuafat, near Pisgat Ze'ev and Neveh Ya'acov, but the Interior Ministry hasn't granted M. residency status. Instead, she relies on her Palestinian documents and a "tasrih" - permission to live in Jerusalem legally. But no ID means no social security and no right to health care services. Nonetheless, every month money is deducted from her salary (she works at a local pharmacy) for health coverage, even though in practice she would have to pay out of pocket for medical treatment. "Thank God my husband is a doctor, so if something happens he can take care of me, but I know many other people who are just stuck," M. says. "There is no solution for them. They can't get help here and they also can't go to Ramallah, as they might never be able to enter Jerusalem again." There are thousands of families such as M.'s in east Jerusalem, says Ibrahim Habib of Physicians for Human Rights. According to a report prepared by him at the end of 2005, "In many east Jerusalem families, one of the spouses is a resident of Israel and the other lacks residency status. Palestinians who are married to residents of east Jerusalem, and have not yet received status, suffer due to construction of the barrier, especially those who requested family unification from the Interior Ministry and whose request was denied. Theirs is the opposite difficulty: Exiting Jerusalem. Many of the spouses live with their Jerusalemite families without any permit, and every run-in with the police or Border Police may result in their deportation to the West Bank." For many of these families, the only available solution is going to a hospital in east Jerusalem. There are nine hospitals in the eastern part of the city.Two are relatively large: Al Makassed, the only Palestinian teaching hospital with 220 beds, and Augusta Victoria with 100 beds, three maternity hospitals and one geriatric hospital. Most of the hospitals were established during the 1950s or '60s and still reside in their original buildings. They are supported by donations from the US, the European Union and Arab countries, and provide medical services to populations of both east Jerusalem and the West Bank. But Habib says that due to political circumstances in the area, these hospitals are unlikely to survive much longer. "East Jerusalem has by far the largest and the best medical facilities in the West Bank," says Mahmoud Elayan, the administrative director of the Red Crescent Society Hospital. Although there are hospitals in Ramallah, Nablus and Jenin, their services don't compare to that of Makassed or Augusta Victoria, which are required to adhere to Israeli standards. Elayan says that while there are many reasons why there aren't any decent hospitals in the PA-controlled territories, a lack of money isn't one of them."The main problem is corruption and lack of organizational thinking," he claims. As a result, many West Bank Palestinians come to Jerusalem for medical treatment. "Patients who are entitled to medical insurance come to our hospitals in the eastern part of the town because they don't feel foreign here. The food, the customs, the language - it is all familiar," says Elayan. "As for those who do not have insurance, they come because our services are significantly cheaper. The cost of delivery in our hospital is NIS 1,500, whereas if they go to Hadassah or Shaare Zedek, they will pay NIS 6,500. And in most of the cases they don't pay at all if they can't, or get a significant reduction or discount." According to Elayan, approximately 30 percent of the patients at the 30-bed Red Crescent Society Hospital, most of whom are from east Jerusalem, do not have insurance. The hospital staff, though, is mainly from the West Bank, since salaries there aren't as competitive. It's not easy to cross an international border every single day on your way to work, says Elayan, who blames the situation on those who, during the intifada years, used ambulances and pregnant women to smuggle weapons and explosives into Israel. "They spoiled everything. Because of them the security measures became so tight," he says. "But now Israelis also have to cut us some slack. The situation has changed. If we want to trust each other, each side has to change. I understand that there need to be security measures, but they should be more reasonable." In a bid to ease some of these restraints, Physicians for Human Rights petitioned the High Court of Justice recently to allow very ill or injured Palestinians from the West Bank easier access to hospitals in east Jerusalem. The petition's requests included: permission for Palestinian ambulances carrying patients in severe condition to go through the security barrier checkpoints and east Jerusalem to the hospitals; and canceling the requirement that Palestinian patients be transferred to an Israeli ambulance at checkpoints, which can often cause delays and aggravation of injuries. For the time being the security measures remain tight, and for those residing beyond the security barrier it has been increasingly difficult to cross into Jerusalem. Many east Jerusalem neighborhoods, such as A-Ram, Azariya and Kafr Akab, do not have a hospital close to home and their residents are stuck between the municipal line and the West Bank. "The solution offered by Israeli authorities is to build a hospital beyond the separation barrier, so that there will be no need to cross the checkpoint at all," says Elayan. In 2004 Augusta Victoria opened a branch in Ramallah in an attempt to provide greater access to medical services . And Al-Quds University recently received funding to open a new teaching hospital at Abu Dis, so that students will be able to practice without having to cross the checkpoint. "The people of Abu Dis will have easy access to the hospital on the one hand. On the other hand, after this hospital opens, the Makassed Hospital will shut down, since most of the patients will go to the Abu Dis branch," says Elayan. The Red Crescent Society Hospital also received an offer from the Israeli authorities to change addresses - from the Mount of Olives to the Kalandiya refugee camp, beyond the security barrier. "The board of the hospital refused this offer. We regard east Jerusalem to be part of the West Bank and we won't be driven outside the city," says Elayan. But for M. and the thousands of other Palestinians who live in east Jerusalem with spouses who are residents of the city, the threat of local hospitals closing is more personal than political, as they are afraid they will run out of options. "We can't go to Israeli hospitals, as they are too expensive. At the same time we also can't go to Ramallah, so that we will not be caught by Border Police. And God only knows how long it will take until we will receive an Israeli ID card and get our medical insurance," says M.

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