The total number of Gaza patients referred by the Ministry of Health (MoH) in January was 1,216, an increase over the monthly average in the previous year of 1,139. According to the Gaza Referral Abroad Department (RAD) data, of these referrals, 425 (35%) were referred to hospitals in East Jerusalem, 296 (24%) to Egypt, 214 (17.5%) to Israel, 147 (12%) to West Bank hospitals, 1 (0.08%) to Jordan and 133 (11%) to NGO and private hospitals inside the Gaza Strip (Table 1). It was the highest monthly total for East Jerusalem in at least the last three years. Referrals fell slightly to Egypt because of medical coordination issues.
Gaza referral data for January showed a wide gender gap: 59% of referrals were males and 41% were females. 28% of all referrals were children aged 0-17 years and 17% were elderly over 60 years. The total estimated cost for all referrals was NIS 12,779,906, more than 10% higher than the previous month. Heart surgery, neurosurgery, and pediatrics were the highest cost per case for this month. Oncology referrals were the most common and the total cost was the highest: 200 referrals totaling NIS 2.1 million. Radiotherapy and complex chemotherapy treatment are not available in Gaza.
In January 2013, applications were submitted for 796 patients to the Israeli District Liaison Office (DCL) for permits to cross Erez and access hospitals in the West Bank including East Jerusalem, in Israel or Jordan. Of the total, 738 (92.7%) received permits to cross Erez and 2 (0.25%) were denied (Table 2). The 2 denied patients were a 33-year-old man with cancer who was approved later after submitting a detailed medical report and a 27-year-old woman with a kidney stone who is still denied. Both were referred to Al-Mizan hospital in Hebron.
56 patients (21 females and 35 males, 7% of the total applicants) did not receive a response and therefore lost their appointments in the hospitals; 9 of them were children under 18 years, 7 were over 60 years, and 11 were oncology- hematology patients. The waiting time for response should be in a maximum of 10 days but 9 applicants did not receive a response after 2 weeks and 12 did not receive a response after 30 days. Of the 56 delayed patients, 15 had had appointments in Israeli hospitals, 1 had an appointment in a Jordanian hospital and the rest in West Bank including in East Jerusalem.
In January 87% of patients applying for Israeli permits were referrals financially covered by MoH. The remaining patients were covered by different sources (Table 3).
According to the Emergency Medical Services of MoH in Gaza, their office coordinated the travel of 844 people to Egypt. 61 patients were transferred by ambulance with 79 companions. The remaining 704 were patients and their companions who travelled through Rafah terminal as regular passengers.
Man dies at Erez after ambulance transfer
A diabetic patient, 41 years old, infected with H1N1 virus and in critical condition, died in the security area inside Erez terminal minutes after he was placed in an Israeli ambulance. He had been enroute to Karmel Hospital in Haifa. Resuscitation efforts by both Palestinian and Israeli ambulance crews were unsuccessful.
Palestinian ambulances are not permitted to leave Gaza with patients; patients must be transferred from the Palestinian ambulance, and carried on a gurney to an Israeli-plated ambulance at Erez crossing some distance away.
The number of drug items at zero stock in Gaza central drug store for the month of January 2013 was 157 (32.7%) out of 480 on the essential drug list; low stock drug items sufficient for 1-3 months were 72. In addition, 471 (52.2%) medical disposable items were at zero level out of 902 on the medical disposables list in Gaza (expanded in 2012); 107 supply items were sufficient for 1-3 months.