A/HRC/9/26 page 17 Special Rapporteur has described the many ways in which the primary obligation to protect the right to physical and mental health has been severely undermined by the economic situation and the blockade of Gaza (see A/HRC/7/17). 54. The situation in Beit Hanoun before and after the shelling has had a significant detrimental impact on the access of victims and survivors to adequate health care. Before the shelling, the health-care infrastructure of the town had already been overwhelmed during the Autumn Clouds incursion. The director of Beit Hanoun hospital told the mission that they had used all their reserves by 8 November; these included physical reserves of strength of medical staff after the demands caused by the severe injuries presented during Autumn Clouds, as well as of essential supplies, such as blood. 55. In the immediate aftermath of the shelling, access to and the availability of health services appropriate to the levels and type of injury was limited by the continued shelling, which impeded ambulances and medical teams from getting to the scene. Subsequently, there were delays in evacuating severely wounded people to hospitals in Israel and Egypt. Despite the promise by the Israeli Prime Minister and the Defense Minister of urgent humanitarian assistance and immediate medical care,19 the mission was told that it was not until late in the afternoon of 8 November that evacuations were made, and even then with the significant restrictions described above. 56. The fact that the mission was not able to visit Beit Hanoun until May 2008 allowed its members to witness the long-term health consequences of the shelling. The obligation under the Covenant to respect the right to physical and mental health requires States to refrain from interfering directly or indirectly with the enjoyment of the right to health. Survivors told of the various ways in which Israeli authorities had failed to comply with this obligation, for example by refusing permission to return to hospitals in Israel and Egypt for follow-up treatment that had been prescribed by doctors. Testimonies included the following: “Once a month, I have to go to Israel to follow treatment. I spend a month getting my permit. Since the siege I can’t go for follow-up.” Another survivor could not return to Egypt to have shrapnel removed from wounds, nor could a woman whose foot had been blown off during the shelling return to Egypt to receive a prosthetic foot. As one survivor noted, “there were two attacks, the military attack on 8 November and the second a bureaucratic one”. The mayor reported that there was no physiotherapy facility available in the town, and plans with the Catholic Church to build a psychiatric counselling centre had been stalled because of the blockade. The mission was able to witness the effects of the blockade on Al-Shifa hospital, Gaza’s largest medical facility. 57. The survivors do not suffer from physical injury alone; there are also significant mental health problems. In the words of one survivor, “I am physically healed but am having problems dealing with it.”38 The number of children with mental health issues is also increasing. The mission was told by survivors of traumatized children who were afraid to sleep because of the bombs, who had reverted to bed wetting, who ask for their dead parents and who do not want to live in Beit Hanoun. The Committee on Economic, Social and Cultural Rights stated that States parties are obliged to fulfil (provide) a specific right contained in the Covenant when individuals 38 In his report (A/HRC/7/17), the Special Rapporteur also argues that the use of sonic booms is among the means through which the Israeli military exerts control over the Gaza Strip.