Every other day, Hisham Zughair must wake up at 4:00 a.m. to make his cancer treatment appointment at Jerusalem’s Hadassah Ein Kerem Hospital. The journey from his home in the East Jerusalem neighborhood of Kufr ‘Aqab to the hospital is roughly 15 miles. But it takes him four hours because of the heavily congested Israeli military checkpoint in Qalandiya village—the main artery of Palestinian traffic entering Jerusalem from the north.

Yet without any specialized medical services in Kufr ‘Aqab, Hisham, who was diagnosed with blood cancer in 2020, doesn’t have a choice but to travel an arduous distance for life-saving care.

Kufr ‘Aqab is one of several Palestinian neighborhoods located beyond the Israeli Separation Wall that was built over 20 years ago. While these neighborhoods fall within Jerusalem’s own unilaterally declared municipal boundaries, Israel stopped providing them with basic municipal services like waste management and healthcare some 15 years ago.

“We have no hospital and no ambulances. We have only one small hospital for pregnant women,” Abu Ashraf Zghayyar, head of the Northern Jerusalem neighborhood committee who lives in Kufr ‘Aqab, told Jerusalem Story.1

Kufr ‘Aqab and the Shu’fat refugee camp (also encompassing Ras Khamis, Ras Shihadeh, and Dahiyat al-Salam) are the largest Palestinian localities behind the wall but within the municipal boundaries (see Neighborhoods beyond the Wall).

In total, more than 150,000 Palestinian Jerusalemites are estimated to live behind the wall (see al-Jidar: An Instrument of Fragmentation), yet the number of medical facilities is severely lacking. Kufr ‘Aqab has three primary health clinics2 and only one infant health center that an Israeli health ministry franchisee, not the municipality, operates.3

In Shu’fat refugee camp, the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) ran one clinic in the camp where 13 staff members served nearly 19,000 patients. The health center was built in 1964 and provided rudimentary primary health care services, including reproductive health, oral health, infant and child care, immunizations, screening and medical check-ups, treatment of communicable and non-communicable diseases, and psychosocial counselling.4 However, UNRWA clinics only served residents who carry a refugee certificate. And beyond that, Israel closed all UNRWA facilities in 2025.5 The camp does not have a local trauma center, let alone a hospital. Therefore, all patients needing any more specialized or critical care must transit through the sole military checkpoint to reach the care they need elsewhere, whether in ‘Anata (2 km away) or East Jerusalem.

Given the lack of infant and maternal health centers in these neighborhoods, the Association for Civil Rights in Israel (ACRI), an Israeli human rights group, along with mothers from these areas, petitioned the Israeli Supreme Court in 2021 to establish at least infant and maternal health clinics in neighborhoods located beyond the wall. In 2022, Israel’s Ministry of Health and the Jerusalem Municipality committed to establishing two clinics in these neighborhoods. While one was established in Kufr ‘Aqab, the other clinic, planned for Shu’fat refugee camp, hasn’t been built yet, despite Supreme Court orders to do so.6

“There is no other place in the country where thousands of infants, toddlers, children, and mothers must pass through a checkpoint and undergo security screening in order to receive vaccinations and all the essential services vital to a child’s development, health, well-being, and future,” Tal Hassin, an ACRI lawyer who is working on this case, told Jerusalem Story.7

Even having some general health services isn’t enough in neighborhoods beyond the wall.

“People get little service [from the clinics], Abu Ashraf said. “So, when they need anything, the clinic gives them a [referral] to the hospital.”

When this happens, the patient must travel outside of the neighborhood and pass through a backlogged checkpoint to reach a hospital, given the lack of specialized medical care beyond the wall.

Yet passing through a checkpoint typically takes significant time and energy.

“Some days, I miss [treatment] because of the [army] raids and the closures where [the army] closes Qalandiya,” Hisham said.8

Even when Hisham navigates Qalandiya checkpoint, he often encounters difficulties. In one instance, he described how the soldiers at the checkpoint interrogated him and asked him to exit the car and open the trunk, which Hisham didn’t know how to do.

“The whole situation, how the soldiers deal with us, even if we are patients, even if I have a card that says I’m sick or handicapped, is a very cruel and aggressive way to deal with people on a daily basis,” Hisham said. “It’s always unpleasant to pass through [the checkpoint]. And if we’re stopped and checked, it depends on the mood of the soldier. If they are nasty, it can be a very difficult situation.”

Amid all these obstacles, Hisham isn’t able to attend every appointment.

“I try to skip some or cancel some [appointments], because it’s very, very difficult to get through,” he told Jerusalem Story. “I try to go to the ones that are higher priority.”

Arriving at medical appointments is challenging because of the checkpoint, but the wall also exacerbates emergencies.

Israeli ambulances are not legally allowed to enter neighborhoods beyond the wall; rather, they must wait at the checkpoint on the Jerusalem side. This means patients and their families must arrange their own transportation to leave the neighborhood through the checkpoint to meet the waiting  Israeli ambulance. Paramedics then must transfer the patient from one vehicle to the next—risking the patient’s life, especially in cases when time is of the essence and/or even the slightest physical jostling can be life threatening.

“To order an ambulance and get through [the checkpoint] took an hour and a half,” Hisham said, recalling an emergency he experienced. “As a cancer patient to move from point A to point B, it’s very difficult to even find [Palestinian] ambulances that will coordinate with Israeli hospitals.”

Despite residing on the other side of the wall, most of Kufr ‘Aqab’s residents are permanent residents of Israel, so they receive healthcare through Israeli medical funds and can only access Palestinian services in West Bank areas if they pay from their own pockets.

Given how long passing a checkpoint takes, ACRI filed an appeal to the Jerusalem Envelope Border Police on June 17, 2025, to allow seriously ill patients from Kufr ‘Aqab—like Hisham—to use the less-congested al-Jib checkpoint instead of the Qalandiya, Jaba, and Hizma checkpoints. The state responded on December 11, 2025, saying that seriously ill patients in need of frequent treatment in Jerusalem can email humanitarian requests to the Civil Administration, the Israeli military body governing the West Bank, which will respond within 21 working days.9

“That does not provide a real solution for the petitioners and other seriously ill patients residing in Kufr ‘Aqab,” ACRI wrote in their response to the state. “[This] indicates the attitude of the respondents towards them: indifference, disrespect, arrogance, and imperviousness. This is despite the fact that these are very sick people, some with incurable diseases, and even though they are permanent residents and Israeli citizens— their constitutional rights to health and life are violated.”10

While Hisham has applied for such a humanitarian request, he has yet to receive a response.

As Kufr ‘Aqab struggles with the lack of healthcare, residents are taking matters into their own hands.

Abu Ashraf is currently working with a Palestinian engineer and a doctor from Kufr ‘Aqab to transform a vacated building in Kufr ‘Aqab into an X-ray facility.

“We want to build a hospital in the area and start with X-rays. After that, we will put in [a facility for] kidney dialysis, and after that, we’ll have an emergency room with ambulances,” he said.

The team is applying for building permissions with the Israeli Ministry of Health and Jerusalem Municipality and seeking foreign funding. Yet it remains unclear if Kufr ‘Aqab will receive approval to renovate the building into a medical facility, given the Jerusalem Municipality’s pattern of denying building permits to Kufr ‘Aqab. More than 95 percent of buildings in Kufr ‘Aqab are considered illegal by Israel, because they were built without a permit, since the municipality didn’t grant permission.11

In the meantime, without an appropriate healthcare provider in Kufr ‘Aqab, Hisham must keep traveling across the wall for treatment for the foreseeable future.

“Although I am a legal resident who lives in Kufr ‘Aqab, where I pay taxes, I still need access to medical care,” Hisham said.