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Source: World Health Organization (WHO)
13 January 2012

Referrals from Gaza: Summary for December 2011
Destinations and Reasons for Referral for Medical Treatment

During December 2011, the Referral Abroad Department (RAD) of the Palestinian Ministry of Health (MoH) referred 1,206 patients to health facilities for specialized treatment not available in MoH facilities in Gaza: of these, 282 patients were referred for specialized treatment within the Gaza Strip (to NGO or private hospitals) and 924 patients were referred outside of Gaza to hospitals in East Jerusalem (35%), Egypt (27%), Israel (21%), the West Bank (12%) and Jordan (5%). Of these, 674 patients required access through Erez crossing and 250 through Rafah border crossing (see Table 1, below).

*Referrals are recorded according to month of scheduled hospital appointment. Source: MoH RAD Gaza.

Patients were referred during December mainly for treatment in the following subspecialties: cardiovascular (11%), oncology (10%), ophthalmology (8%), orthopedics (6%) and neurosurgery (6%). These cases represent almost 41% out of the total referrals and 52% of the total referral cost in December, which was NIS 10.5 million.

Permit Applications for Patient Referrals Through Erez

During December 2011, the Israeli District Liaison Office (DCL) processed 760 patient applications for permits to cross Erez to access hospitals in the West Bank including East Jerusalem, Israel and Jordan (see Table 2) compared with 711 last month and 864 in October. 87.7% of applications (667) were submitted and financially covered by the MoH, 4.8% (37) by Nour al Alam Foundation, 4% (31) were self-funded, 2.1% (16) by Physicians for Human Rights - Israel, 0.7% (6) by Peres Center for Peace, and the remaining by other charity organizations.

* Approvals are typically communicated to the patient only 24 hours in advance of their scheduled appointments.
** Permit applications for patient access through Erez can only be submitted within 10 days of hospital appointments. When there is no timely response from the Israeli Liaison Office, the applications are registered here as “delayed”, meaning that the Palestinian Liaison Office received no response to the permit application prior to the patient’s hospital appointment date. Some patients in this category may eventually receive permit approval, but after their hospital appointment has passed. They must then reschedule their appointment. Other patients in this category may eventually receive denials or may not receive any response.
*** These are requests for interrogation as communicated by Israeli authorities through the Palestinian Liaison Office. This may be underreported since Israeli authorities sometimes contact patients directly for interrogation.

In December, 95% (722 patients) of all applications for permits were approved, substantially higher than the 2010 average of 78%. Of the remaining 5% of all patients, 0.5% (4 cases) were denied permission to cross Erez checkpoint. Another 4.5% (34 patients, including 3 children) had their applications delayed beyond their hospital appointment. Of the 34 patients whose applications were delayed by the Israeli authorities, 25 were called for interrogation by the Israeli General Security Services (GSS) as a condition for receiving answer. Following their interrogation, 14 patients were still waiting for a GSS response, 6 were approved a permit, and one did not attend the interrogation.

Delays in processing applications can be critical for patients who are waiting for urgent medical treatment. In 2011, three patients died before receiving permits to travel through Erez crossing to access the hospitals they have been referred to.

Erez and Rafah Crossing Data for December 2011

Erez crossing was closed on Saturdays. According to the Palestinian Liaison Office at Erez, 697 patients crossed Erez checkpoint during December 2011, of which 47 needed to be transported by ambulance. Since Palestinian ambulances are not permitted to leave Gaza, patients must be transferred from a Palestinian ambulance, and carried on a stretcher to an Israeli ambulance at Erez checkpoint. This compares to 639 patients that exited Gaza in November, including 38 patients via back-to-back ambulance transfer at the checkpoint.

Rafah border crossing was open for humanitarian access for a total of 24 days in December 2011; it was closed on 5 Fridays and on 31 December due to Egyptian elections.The current waiting time for non urgent referrals through Rafah is less than a week. The total number of patients that crossed Rafah border during December was 396, including 64 by ambulances.

WHO publications are available at: Comments:

Referral of Patients from the Gaza Strip
December 2011
Ref: RAD 12 (January 13, 2012)
occupied Palestinian territory

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