JERUSALEM — Last month I took my wife to Al Makassed Islamic Charitable Hospital in East Jerusalem to have the head of the orthopedic ward, Dr. Rustom Nammari, examine her arm; she broke it this summer during a hike in Scotland. Since its establishment in 1968, this hospital has been the medical institution of choice for Palestinians in the West Bank.

Owned and funded by a not-for-profit foundation, over the past 25 years this state-of-the-art facility has graduated many of the specialists who staff the Palestinian Ministry of Health. Between 65 and 70 percent of Makassed’s patients are referred by the ministry, mostly for complicated conditions requiring endoscopic, spinal or open-heart surgery, none of which can be performed in other Palestinian hospitals.

Makassed has 250 beds and 750 employees, most of whom live in the West Bank. About 60 percent of its patients also come from there. There used to be far more, but in 1999 Israel tightened restrictions on Palestinians wishing to come to East Jerusalem from the West Bank. Since then Israel has used the checkpoints to limit not only Palestinians’ ability to move freely or get jobs in the city there but also their access to medical treatment.

Before the Oslo Accords of 1993 and 1995, the Israeli military fully controlled all aspects of Palestinians’ lives. Then with the transfer of civilian functions to the Palestinian Authority, the situation changed. Today the Israeli authorities’ mode of control rests on a permit system under which they alone determine who can enter Israel, including East Jerusalem, for work or care. Not infrequently Israel withholds such permits, depriving Palestinians of badly needed medical treatment.

As a result, Nammari typically spends two days a week at his clinic in Ramallah to treat those patients who cannot reach him at Makassed. He reserves another day, often a Friday — his day off — to travel to outlying villages in the West Bank and check on patients whose movement is even more restricted.

Special arrangements have been made for members of Makassed’s staff to leave their cars at checkpoints and travel to the hospital by bus. The 25-minute drive from Ramallah to Jerusalem takes them at least two hours.

But even such resourcefulness is not enough. The hospital hasn’t yet managed to work out how to secure access for patients and trainees from the Gaza Strip: very few of them have been allowed to use the hospital’s facilities since 1999.

The extent to which Israel invokes security concerns to restrict access to Makassed is maddening. Any patient in the West Bank who has a direct relative in an Israeli prison stands no chance of getting the permit needed to obtain treatment (or training) at Makassed or other hospitals in East Jerusalem. The Israeli security service, the Shabak, has placed thousands of young Palestinians on a blacklist, often without reference to any apparent security risk.

In a recent report “Invisible Prisoners: Don’t Know Why and There’s Nowhere to Turn,” the Israeli group Machsom Watch reveals that the Shabak had asked many of the blacklisted Palestinians to help it or else they would forever be denied a permit to go to a hospital or get a job in Israel.

How many Palestinians have been saved from being blackmailed into becoming collaborators by Nammari’s willingness to travel to treat those denied access to Makassed?