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Source: World Health Organization (WHO)
17 June 2013

Ref: RAD 5 (June 17, 2013)
Referral of Patients from the Gaza Strip
Reduced access: Israeli permit approval rate in May was 80.6%, the lowest since January 2011, reflecting a dramatic increase in delays in processing patients’ permit requests to exit Erez checkpoint. 900 of 1117 patients requesting permits were approved, one patient was denied and 216 patients (19.3%; 87 F; 129 M) received no response to their permit application and missed their hospital appointments.

Patients interrogated: 12 patients (5 F; 7 M) who had applied for permits to cross Erez checkpoint were requested to appear for Israeli security interviews.

Outside referrals: In May no MoH Gaza patients were sent to Jordan but referrals to Egypt increased.

Referrals to non-MoH facilities inside Gaza: Fewer patients were referred to private and NGO facilities inside Gaza (151; 10.7%) and to WB facilities (148; 10.5%) than during the previous three months.

Medical reasons for referrals: Most May 2013 referrals were for treatment in oncology 210 patients (15%), nuclear medicine 128 (9%), ophthalmology 118 (8%), orthopaedics 112 (8%), neurosurgery 94 (7%), haematology 92 (6.5%), paediatrics 88 (6%), heart catheterization 80 (6%), urology 67 (5%) and heart surgery 50 (3.5%).

Cost: The total estimated cost for Gaza referrals during May was NIS 9,289,441 (USD 2.56 million).

Referrals reflect needs and local capacity

The Ministry of Health (MoH) in Gaza referred 1,407 patients in May, a slight decrease compared to May 2012. Most referrals were to hospitals in East Jerusalem (484-- 34.4%), followed by Egypt (348 --24.7%), Israel (276 --19.6%), NGO and private hospitals inside the Gaza Strip (151; 10.7%), and West Bank hospitals (148 --10.5%) (Table 1).

No referrals were made to Jordan, reflecting a June 2012 decision by most Jordanian hospitals to halt MoH referrals due to outstanding PA debts (Chart 1). Patient referrals to private and NGO facilities inside Gaza (151) decreased in the last two months reflecting MoH recovered capacity for heart catheterization and lithotripsy after repair of medical equipment. However capacity is still sub-optimal; 70 referrals were for heart catheterization, 40 for MRI and 39 for lithotripsy, and 2 for intensive care.

The gender gap in referrals persisted in May for all age groups: 57% of referrals were males and 43% were females. 26% of all referrals were children aged 0-17 years and 17% were elderly over 60 years.

Nasser Hospital,

Chart 1: Trend of last 17 months of referrals of Gaza patients, January 2012 to May 2013

Reduced health access: permit approval rate declines 20%

In May 2013, only 900 of 1117 patients (80.57%) received permits to cross Erez to access hospitals in the West Bank including East Jerusalem, or in Israel. One patient, a 43-year-old man with lymphocytic leukemia was denied access to medical care in Augusta Victoria hospital in Jerusalem. Responses to applicants should be given within 10 days but 216 patients (19.3%) received no response to their application after 2-4 weeks and therefore lost their appointments in the hospitals delaying their medical care; 40% were females (Table 2). 58% were destined for scheduled appointments in East Jerusalem hospitals, 23% for Israeli hospitals and the rest (19%) were for hospitals in the West Bank.

12 patients (5 women and 7 men; 1.07% of total applicants) were called for interrogation by Israeli General Security Services (GSS) as a condition to process their application but none were granted a permit after interrogation.

The permit approval rate has decreased significantly since February with increasing delays (Chart 2), reaching the lowest point since January 2011. (The average approval rate from January 2012 to February 2013 was 93% and delayed was 6.65%.) A number of factors may be responsible for the recent drop, including staff changes in the Palestinian District coordination office, an increase in applications for permits, and length of security reviews. Applications in 2013 increased by 20% over the same 5-month period in 2012, and the rate of delays tripled (Table 3). Urgent cases are still processed within 24 hours. A meeting with the Israeli DLO to discuss the reasons for permit delays and measures to improve the situation was held at the beginning of June.

Chart 2: Permit application response from January-May 2013

In May 92.21% of referral patients applying for Israeli permits were financially covered by the Palestinian MoH, 4% were self-funded, and the remaining patients were funded by Physicians for Human Rights-Israel, Nour Ala-Al-Alam foundation, and Peres Center for Peace. MoH referrals do not cover transportation or companion costs and some items of patient care, for example, medicines not in hospital supply.

Gaza Crossings

Rafah terminal was closed for 9 days during May. In addition to 4 Fridays, it was closed for 5 days (May 17-21) by the Egyptian border police to protest the abduction of police in north Sinai who had been travelling to their workplace in Rafah terminal. The 7 policemen were abducted on May 16 and released on May 21. According to news reports on June 6, Egyptian authorities informed the Gaza de facto government that the number of passengers allowed through Rafah terminal will be increased from 700 to 1100 per day.

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