Michael Omer-Man is the Director of Research for Israel-Palestine at DAWN.
It is easy to forget that long before the Israeli government cut off food supplies to Gaza, leading to famine, it had for nearly two decades imposed a brutal siege on the territory. In 2012, Gisha, an Israeli legal organization that advocates for freedom of movement for Palestinians in Gaza, uncovered an internal Israeli document calculating the minimum number of calories Palestinians in Gaza needed before facing malnutrition.
A 2010 Israeli military document listed the items it permitted and prohibited from entering Gaza. The seemingly arbitrary list of prohibited items included chocolate, potato chips, toys, newspapers, standard A4 paper, musical instruments and nearly all construction and industrial materials.
One of the few exceptions for most of that period was that Israel allowed a limited but significant number of Palestinians in Gaza to leave the besieged territory to seek medical treatment in Israel and the occupied West Bank, including East Jerusalem. This was critical as Israel barred medical devices, medicines and even specialist doctors from entering Gaza, severely limiting what treatments were available in the Palestinian territory.
After the Hamas attacks of Oct. 7, 2023, and the genocidal military campaign Israel launched in response, Israel shut off the flow of food, goods, electricity, fuel and water. It simultaneously destroyed civilian infrastructure, including the already fledgling health care system. Those restrictions, among other factors, led the International Court of Justice to open proceedings against Israel on the crime of genocide. Of particular concern has been Israel's targeting of medical facilities and personnel, reducing the health care system's capacity to a fraction of itself.
- Israel's decades-long policy of separating Gaza from the West Bank, "has been to tear apart Palestinian society, to separate people at every level — institutions, families, the economy," explains Tania Hary, executive director of Gisha. "Medical patients … relatively speaking, enjoyed greater access than others. They were the last link between Gaza and the West Bank. That has been severed completely now."
After Oct. 7, 2023, Israel imposed a complete ban on Palestinians in Gaza leaving for medical treatment at hospitals in the West Bank, including East Jerusalem, and Israel. According to the World Health Organization, some 18,500 Palestinians now require medical evacuation for treatment unavailable in Gaza. With Israel barring them from accessing hospitals in the West Bank, they have no viable way to receive treatment.
Over 18,000 patients in Gaza are in need of medical evacuation at the moment, according to the World Health Organization.
- Tania Hary
"That medical corridor — the 1,400 people a month — has been completely shut down," says Hary. "Opening up that medical corridor to East Jerusalem, the West Bank and Israel is vital for literally saving the lives of these patients."
Democracy in Exile spoke with Hary about the consequences of Israel shutting down the medical corridor for Palestinians in Gaza, how the system functioned before October 2023 and how it has changed since — including during the recent Iran war. The interview also explored the destruction of Gaza's domestic food production capacity, as well as the role foreign governments can play in pressuring Israel to end these practices and the broader genocide.
The interview took place on March 9, 2026 — 10 days into the U.S.-Israel war on Iran. The following has been edited for length and clarity.
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Michael Schaeffer Omer-Man: Let's talk about the situation before Oct. 7, 2023. Can you explain why people needed to leave for medical treatment, what was the process and what were their options?
Tania Hary: Even prior to Oct. 7, Gaza's health care system wasn't equipped to deal with the population's medical needs. That was for a variety of reasons, including restrictions Israel placed on the entry of equipment, the entry of specialists, the exit of medical staff for training and development and on the economic situation, which made it impossible for the health system to invest in development.
Israel recognized that it didn't allow this equipment in and thus certain treatments weren't available in the Strip, so it did allow some evacuation or exit of medical patients, mainly to East Jerusalem, the West Bank and some to Israel. It was very difficult to receive a permit — a whole bureaucratic cycle of getting various permissions internally in Gaza, getting coverage by the Palestinian Authority for the financial costs, a security exam by the Israeli authorities and hoping all of that took place before the appointment for treatment. If not, the whole process would start again.
Prior to Oct. 7, in that first part of the year, about 1,400 patients and their companions were leaving Gaza every month for treatment, mainly in East Jerusalem, [but also] some in the West Bank and in Israel. Approval rates varied over time but ranged somewhere between 80% and 90% in that period.
MSO: What is the situation today?
TH: Over 18,000 patients in Gaza are in need of medical evacuation at the moment, according to the World Health Organization. They need treatments that were never available inside Gaza for chronic conditions, but also for complex injuries from airstrikes and attacks on the Strip, and people who need long-term rehabilitation for those complex injuries. The health care system in Gaza is simply not equipped to deal with those kinds of injuries.
At the moment, there is no possibility for evacuation. The crossings have been closed for the movement of people since the attack on Iran began on Feb. 28. But just prior to that, Rafah crossing reopened in early February for the exit of medical patients to Egypt. Fewer than 50 patients per day were coming out with their companions. With around 50 people leaving per day, it would take more than a year to evacuate everyone. But Rafah isn't open, and
Israel has completely banned evacuations to East Jerusalem, the West Bank and Israel since October 2023. [Israel partially reopened the Rafah crossing with further limitations on medical evacuations on March 19, after this interview was conducted]
That medical corridor — the 1,400 people a month — has been completely shut down, other than one case where Gisha was successful in helping a cancer patient who got to the West Bank after a successful court petition. Opening up that medical corridor to East Jerusalem, the West Bank and Israel is vital for saving the lives of these patients and improving the quality of life for so many others.
MSO: Specifically on the cancer patients who require ongoing and repeated treatments — I'm assuming that simply because of the geographic proximity that it was preferable to get treatment in East Jerusalem, the West Bank and Israeli hospitals prior to Oct. 7. Are those types of treatments even available to folks who are leaving to third countries through Egypt?
TH: When people evacuate to third countries through Egypt, they're leaving without any sense of when they can come back. Rafah recently reopened for the return of patients and other people who had been stuck in Egypt, but you have thousands of other patients who've been in the UAE, across Europe and in other countries, and they have no idea when they'll be able to return.
They would leave with companions, but in all cases, they're leaving family members behind, including children and spouses. People are forfeiting their family lives, forfeiting their homes and access to treatment which isn't available to them otherwise. In a way, it's been a form of forced transfer — people leaving and having no idea if or when they'll be able to return.
MSO: Setting aside the question of access to Israeli hospitals, does Israel give a justification for its refusal to open a medical corridor to East Jerusalem and the West Bank?
TH: Israel's position has been that its complete ban on access to hospitals in East Jerusalem and the West Bank is for broad security reasons. They are not willing to perform individual security screenings as they did before; they just say there is a complete ban on access. So far, we have landed on some judges who have been willing to look at that. In the case of the cancer patient who we helped, the judge said, "I'm not going to look at the overall ban, but I believe that Israel needs to look at exceptions and look at these issues on a case-by-case basis." We had another judge, who, in the case of a five-year-old boy, refused to further examine the facts. So, it really depends on which judge you land.
We are also involved in a principled legal proceeding via the Israeli Supreme Court in a petition led by our partners, Physicians for Human Rights – Israel, which is seeking to open the medical corridor, not just for individual patients, but to overturn the ban completely.
MSO: And the closure of the medical corridor is a policy decision at this point?
TH: It's a complete policy decision, a blanket ban that's preventing all patients from exiting Gaza to the West Bank and East Jerusalem for medical treatment.
MSO: Of course, the ban on medical patients is only one part of a far older Israeli policy of creating and enforcing separation between Gaza and the rest of Palestine and the occupied Palestinian territory. How does that manifest and what effects has it had?
TH: Israel says it is enforcing what it refers to openly as the "separation policy." It says that it does not allow movement between the territory as a means of fragmenting the Palestinian population. It has cited what it calls both security and political motivations, related to what it calls the transfer of terrorist infrastructure. But the effect has been to tear apart Palestinian society, to separate people at every level — institutions, families, the economy. Everything has been fragmented. And unfortunately, after Oct. 7, that split is now complete.
Medical patients were one of the groups that, relatively speaking, enjoyed greater access than others. They were, in a way, the last link between Gaza and the West Bank. That has been severed completely now.
MSO: Could you give a little bit of political history on the relationship between Gaza and Israel and Gaza and the West Bank prior to Israel's imposition of the permit regime in the 1990s and before and since the disengagement [Israel's 2005 withdrawal of settlers and military forces from Gaza] and then the siege [the blockade imposed by Israel restricting movement of people and goods] in 2006-07?
TH: After Israel's 1967 occupation of Gaza and the West Bank, there was what can be referred to as a logic of integration. It wasn't an integration based on any kind of equality; it was more about exploitation of resources, of labor, of land. Laborers were able to travel outside of the occupied territory into Israel, and some movement was possible between Gaza and the West Bank. Palestinians were not allowed to stay overnight, but they were able to visit family and cross the territory.
Gradually, in the late 1980s and early 1990s, the logic of integration was replaced by a logic of separation: of splitting apart the territory, keeping people in their cantons and managing each territory with its own logic of bureaucracy. We've seen that gradually become more and more extreme, where residents of Gaza and residents of the West Bank are treated completely differently — as if they're alien to one another.
You can see that in the case of the five-year-old boy I mentioned. He's already in the West Bank. Actually, he needs to get into Israel for treatment, but he's registered in the Israeli-controlled Palestinian population registry as a resident of Gaza. Because of what's written in his ID card, Israel doesn't allow him to get a permit like a child who is a West Bank resident would.
Medical patients were one of the groups that, relatively speaking, enjoyed greater access than others. They were, in a way, the last link between Gaza and the West Bank. That has been severed completely now.
- Tania Hary
MSO: What about humanitarian goods — food and medicine? What was the situation prior to Oct. 7? How reliant was Gaza — and the Gaza economy — on Israel for imports, for exports? Was that a system that worked at all for anybody in Gaza before Oct. 7?
TH: Prior to Oct. 7, most of the goods that were coming into the Strip were coming in via Israeli territory. You did have some goods entering via Egypt — mainly consumer products. International humanitarian organizations were exclusively bringing goods in through Israeli-controlled territory. And you had goods coming in both for the private sector and for aid organizations. The vast, vast majority was coming in for the private sector. Aid organizations were sourcing some products on the private market inside of Gaza, but they weren't doing the logistics of bringing the items in.
In many cases, only something like 10% of goods were coming in directly for the agencies themselves. So, the private sector played an important role in supplying goods on the market, and of course, they were also involved in bringing goods out of Gaza as a way of supporting manufacturing and industries in the Strip.
There too, Israel's policy changed over time. After 2007 [when Hamas took control of Gaza and Israel imposed a blockade], Israel completely shut the borders for the exit of goods, and then only later started opening things up for certain kinds of products. But all of it was very limited, very circumscribed and came after a period of years where nothing was coming out. When things opened back up, they opened up really slowly, but the exit of goods was really vital for the development of agriculture and industry. The more that you allow, the more the economy inside of Gaza can develop and the more it can provide jobs for people.
On the eve of Oct. 7, in many ways we were seeing more goods exiting Gaza than we had seen before. On the other hand, it was really just a fraction of what the real capacity of the market would have been. It was creating jobs, but not enough. Unemployment was always hovering around 40%. Now, of course, the situation is much worse.
MSO: For much of the world, the past two and a half years in Gaza have been defined by starvation — a lack of adequate food. We tend to put it all under the umbrella of humanitarian aid. To what extent was food being produced and manufactured in Gaza prior to the war? And I ask that knowing that Israel has destroyed everything and created a no-man's land along Gaza's eastern border where most of the agricultural land was. How much of that local food production disappeared overnight?
TH: Food production inside of Gaza has been an important source of jobs and of food security over the years. Gaza had a thriving agricultural sector prior to 2007. It had factories for the production of food. After Oct. 7, Israel started bombing agricultural fields, destroying wells, greenhouses and factories.
The fishing sector, which provided a source of protein to the population, also came under attack. Israel completely destroyed Gaza's main fishing port, and other smaller fishing ports were completely destroyed, with boats sunk. The ability of Gaza's producers to produce food for the population was eliminated at the same time that Israel was putting these very severe restrictions on food aid coming in.
We see this as a calculated choice. It wasn't by chance. This was a systematic attack on the ability to have food — a policy of starvation, a policy of using aid and starvation as a weapon of war.
Since the [October 2025 Israel-Hamas] ceasefire — which is hard to call a ceasefire given how many people have been killed since and the ongoing attacks — people are trying to restore some of these industries. But the vast destruction that's taken place and the enforcement of the Yellow Line [an informal term for a military control line between Hamas and Israel-controlled territory] splitting Gaza into two, has blocked people from going back to their lands, which, like you said, are close to the border areas — close to the fence with Israel. These lands are simply inaccessible to the population.
MSO: Has Israel allowed any fishing to take place since the ceasefire or at all during the past two and a half years?
TH: Israel still completely bans access to the sea for fishermen. We do know that people are risking their lives going out as far as they can. In some cases, they are even using improvised floating devices. We've even seen refrigerator doors being used as rafts in the absence of real fishing equipment. They're being shot at — sometimes killed — by the Israeli Navy, which is patrolling Gaza's waters. Israel is not allowing access to the sea.
MSO: Over the past few years, but really going back much further, there's been a real battle of narratives about what the actual barriers to humanitarian access have been in Gaza. In your experience and your analysis, what is the biggest misconception about humanitarian access, and what are the biggest barriers today?
TH: The biggest misconception about humanitarian access is the idea that Israel is just enforcing restrictions to prevent diversion of aid by Hamas. A large portion of the international community, unfortunately, has perceived the problem to be about [stopping] the diversion of aid, when really it's been a deliberate policy of deprivation. Really, it's just a decision to starve the population.
On the other side of that, we have also seen information at times that absolutely nothing is being allowed in, or that no delivery of aid is possible. That has been true during certain periods, but not throughout. Israel has tried to keep pressure on the population by promoting deprivation but at the same time is trying to keep international criticism at bay by managing starvation.
I feel like there's something even more sinister in trying to get people to look away — trying to get people not to pay attention — because they are not able to follow all the details. How many people have the capacity for the sort of nuance of what's allowed, what's not allowed and when, alongside how this affects the population, and the interplay between local food production and supply of humanitarian aid and issues related to distribution?
So, Israel has also played this game of saying that there's enough food inside of the Strip. If you do the math, that could be true, but it assumes equal distribution [throughout Gaza], which will never take place in a situation of scarcity and war.
MSO: Let's drill down on distribution. The most recent United Nations Coordinator of Humanitarian Affairs (OCHA) report states that, out of 25 humanitarian missions that the U.N. coordinated, only 11 were facilitated, three were denied, three were canceled by the organizers and three were approved but faced impediments or were partially or fully accomplished. What's the difference between coordination and facilitation, and what does distribution actually entail? What does the U.N. or other humanitarian organizations look — or need — to get from Israel to facilitate the distribution or movement of aid within Gaza?
TH: At the moment, the Yellow Line splitting Gaza in two means that humanitarians need coordination in order to physically reach the crossing points to pick up the aid and deliver it inside of the Gaza Strip.
MSO: All internally within Gaza?
TH: All internally inside of Gaza. They come to a holding point, which is on the edge of the Yellow Line, and they radio in: "We're here, can we have permission to approach the crossing point?" They need that permission. If they don't get it, they can be shot at, which we've seen multiple times. Even sometimes when they do have the coordination, they're still shot at. A fuel tanker was shot at a few days ago.
When the Israeli military was present throughout the Strip, they needed coordination to go from Point A to Point B internally — completely within Gaza. So, the coordination that they need is anywhere they could come into contact with Israeli forces. Israeli forces are in more than 50% of the territory — Gaza is split in half.
MSO: You were just in Washington, D.C. What's your number one ask to policymakers outside of Israel-Palestine right now?
TH: We're asking that the medical corridor be reopened between Gaza and the West Bank, including East Jerusalem, as well as to Israel. Of course, there are a million things that I would want to happen tomorrow if I could convince policymakers, but this is one that should be doable. It should be low-hanging fruit.
These were people who were coming out for treatment before. There is a system for conducting security assessments, and it's a vital humanitarian need. Nobody can argue with the fact that innocent civilians, children and people need access to medical care, and that it's simply not available in Gaza right now. So, that is one of the main policy requests that we're making at the moment.
