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Source: World Health Organization (WHO)
30 June 2013

Ref: RAD 6 (July 24, 2013)
Referral of Patients from the Gaza Strip

Access: The approval rate for Israeli permits in June was 84.55%, higher than May but 8% lower than 2012; 985 of 1165 patients requesting permits were approved; 180 patients (15.45%; 71 F; 109 M) received no response and missed their hospital appointments.
Patients interrogated: 17 patients (3 F; 14 M) who had applied for permits to cross Erez checkpoint were requested to appear for Israeli security interviews. None received a permit after interrogation.
Outside referrals: June had the highest number of referrals to Israel in 2013 (313), in part due to the lack of available beds in East Jerusalem hospitals preventing new admissions from Gaza at this time.
Medical reasons for referrals: Most June 2013 referrals were for treatment in oncology/196 patients (14.5%), nuclear medicine/118 (8.7%), ophthalmology/115 (8.5%), orthopaedics/114 (8.4%), urology/94 (6.9%), paediatrics/87 (6.4%), neurosurgery/69 (5%), heart catheterization/68 (5%), haematology/64 (4.7%), MRI/55 (4%) and heart surgery -37 (2.7%).
Cost: The total estimated cost for Gaza MoH referrals during June was NIS 8,786,434 (USD 2.7 million).

Referrals reflect needs and local capacity

The Ministry of Health (MoH) in Gaza referred 1,357 patients in June, a slight decrease compared to the last 3 months. Most referrals were to hospitals in East Jerusalem (411-- 30.3%), followed by Israel (313 --23.1%), Egypt (291 --21.4%), NGO and private hospitals inside the Gaza Strip (172--12.7%), West Bank hospitals (169 –12.5%), and Jordan (1—0.07%) (Table 1).

Only one referral was made to Jordan, reflecting a June 2012 decision by most Jordanian hospitals to halt new MoH referrals due to outstanding PA debts. Referrals to East Jerusalem hospitals declined after a peak of 500 patients in March due to lack of available beds (Chart 1). Referrals within Gaza were for lithotripsy (60), heart catheterization (46), MRI (45), and (21) other services. Referrals for heart surgery decreased significantly in the last two months due to a second hospital in the Gaza Strip with capacity to perform operations, the European hospital, in addition to Shifa. The gender gap in referrals was reduced in June: 52.5% of referrals were males and 47.5% were females. 30% of all referrals were children aged 0-17 years and 17% were elderly over 60 years.

Reduced health access:

In June 2013, 985 of 1165 patients (84.55%) received permits to cross Erez to access hospitals in the West Bank including East Jerusalem, Israel or Jordan (Table 2). 180 patients (15.45%) did not receive a response to their applications and therefore lost their appointments in the hospitals, delaying their medical care. Of those delayed, 54% were destined for scheduled appointments in East Jerusalem hospitals, 23% in Israeli hospitals and 23% in hospitals in the West Bank. 39.4% were females. Responses from Israeli authorities should be given to applicants within 10 days. After two weeks, 159 patients (13.65%) were still waiting for a response to their permit request.

17 patients (3 women and 14 men; 1.46% of total applicants) were called for interrogation by Israeli General Security Services (GSS) as a condition to process their application. None were granted a permit after interrogation.

The permit approval rate increased 4% over the previous month after decreasing since February. The rate of delays also decreased by 4% (Chart 2). (The average approval rate from January 2012 to February 2013 was 93% and delayed was 6.65%.)

Compared to the same 6-month period in 2012, applications in 2013 have increased by 24%, while the approval rate declined by 8%, and the rate of delays tripled (Table 3).

In June 90.56% of referral patients applying for Israeli permits were financially covered by the Palestinian MoH, 5.24% were self-funded, and the remaining patients were funded by Nour Ala-Al-Alam foundation, Peres Center for Peace, and Physicians for Human Rights-Israel. MoH referrals do not cover transportation or companion costs and some items of patient care, for example, medicines not in hospital supply.

Patient access at Gaza exit points


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