The slow response of the Shin Bet security service to requests by Palestinians seeking to leave the Gaza Strip for medical care via the Erez crossing was the main reason that more than one third of such applicants missed their medical appointments between January and August 2009, according to a new report.

The conclusion was drawn by Physicians for Human Rights-Israel after analyzing data collected by the World Health Organization. Out of 3,758 requests submitted by patients during this period, 1,310 had to reschedule their appointments and reapply for an exit permit because they did not receive a permit in time. The Shin Bet rejected 77 requests.

PHR-Israel officials say that in the past Israeli authorities were relatively quick in issuing their responses. One result of the change, they say, is the amount of time it takes for patients whose exit applications are denied to begin the appeals process (which can go as high as Israel's High Court of Justice).

The Shin Bet is interviewing a greater number of applicants for such permits: in the eight-month period covered in the report, at least 325 Gazans were called in, with 47, 68 and 84 in June, July and August, respectively.

PHR-Israel says the Shin Bet often calls in applicants only shortly before or even after their medical appointments.

Issa Hamdan, 58, was diagnosed with a malignant brain tumor in March. Since then, surgery to remove the growth has been scheduled for seven different occasions, from April 27 to today, at an East Jerusalem hospital.

The April 27 surgery date was canceled due to a one-month suspension of trips by Gazans for medical care due to tension between the Ramallah and Gaza City Palestinian governments. The operation was postponed until June 28, but the Israeli authorities did not respond to Hamdan's request. Hamdan was given an August 1 surgery date, but was called in for a Shin Bet interview only on August 2. Hamdan's wife, Fadya, who is 50, says she brought him for the interview from their home in Rafah to Erez, where she had to push his wheelchair with difficulty before submitting their identity cards for inspection. Then, apparently when the Israeli officials realized that Hamdan was too sick to be interviewed, they were told to leave.

The operation has been rescheduled three more times since then - for August 3, September 13 and today - but each time no permit has been forthcoming.

In July, 735 requests for exit permits for medical care for submitted. Of these, 515 were approved in time, 17 were rejected and in 203 cases the response was delayed; in 51 cases, the permit was approved more than a month after the originally scheduled medical appointment.

In August, of 856 requests, 601 were approved in time, 11 were turned down and the response was delayed in 244 cases. In 163 cases, the permit was issued at least a week after the originally scheduled appointment.

The coordinator of government activities in the territories said in a statement, "Sometimes during the processing of applications by patients for exit permits delays are caused by various reasons, such as forged documents and the suspicion that humanitarian channels are being exploited for illegal stays in Israel and Judea and Samaria. Each request must be checked carefully in light of the complex security situation."

The Shin Bet said in part that its decisions are based on a careful balancing of security and medical needs.

It said that, "in many cases, the requests for exit permits are submitted only shortly before the medical appointment." It also said that Hamdan was twice scheduled for an interview at Erez but he did not show up or explain his absence, "and that is why the process was not completed."

Anonymous military sources said they were aware of about 300 cases in which Gazans permitted to leave the Strip for medical care during 2009 did not return to Gaza.