Adam was born in Jerusalem on a day of silence and separation. It was Yom Kippur, and the city was closed, roads were empty, and ambulances stood still. For Jewish Israelis, it was a holy day of reflection. For Palestinians like Adam’s family, it was a day when life-threatening emergencies were forced to wait.

Layla, nine months pregnant, went into labor that afternoon in her modest apartment in Kufr ‘Aqab, a Palestinian neighborhood within the Jerusalem Municipality boundaries that has been isolated for two decades beyond Israel’s Separation Wall (see Neighborhoods beyond the Wall). This meant they needed to pass through the massive Qalandiya checkpoint to reach the East Jerusalem hospital where she was supposed to give birth. Her husband, Sami, called everyone he knew for help.

Against all odds, and with the help of neighbors, they managed to get Layla to St. Joseph Hospital in Sheikh Jarrah—one of the few Palestinian-run medical institutions left in East Jerusalem. Adam was born not long after their arrival, surrounded by a team of doctors who could not believe Layla, Sami, and baby Adam’s good fortune.

Adam was tiny and sickly from the start. Within days, he was diagnosed with a severe milk allergy. He needed special formula—one not available in ordinary pharmacies, and certainly not cheap. It was a matter of life or death.

But another crisis was already unfolding. Despite being born in Jerusalem, and despite Sami holding permanent-resident status in Jerusalem, Adam was not entitled to his father’s residency and consequently to Israeli health care, simply because Layla held a PA ID card issued by the Palestinian Authority in the West Bank. Adam was thus not automatically granted his father’s status (see Born into a Never-Ending Bureaucracy: The Legal Status of Palestinian Jerusalemite Children).

As a result, Adam lacked legal status in the city of his birth. In the eyes of the Israeli National Insurance Institute (NII) and the Ministry of Interior, he lacked a recognized identity, much less any rights at all.

Israeli hospitals, including Hadassah and Shaare Zedek, turned the family away. “He’s not in the system,” they said. “He’s not eligible.”

Layla and Sami turned to Makassed Hospital, where countless Palestinian families go when Israeli institutions refuse them. There, they found care, but no coverage. The special formula Adam needed cost thousands of Israeli shekels per week. The family had no choice but to pay out of pocket.

Sami began the long, humiliating process of trying to register Adam for residency (see Precarious, Not Permanent: The Status Held by Palestinian Jerusalemites [Pt. 2]). Every week, he stood in line at the NII and the sole Ministry of Interior branch Palestinians are allowed to use in Wadi al-Joz holding a file of documents: proof of residence, utility and other bills, rent agreements—evidence that his son existed, that he lived, slept, and breathed in Jerusalem.

Each visit ended the same: “Come back next month. More documents. Still pending.” As of this writing, Layla and Sami continue to struggle to secure Adam legal residency status in his city of birth so they can apply for health and childcare benefits for which Sami qualifies as a resident of Jerusalem. Until then, Adam does not exist in Jerusalem.