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Source: World Health Organization (WHO)
16 November 2011

Referrals from Gaza: Summary for October 2011
· 2% of patients who applied for a permit to cross Erez checkpoint were denied a permit. The Israeli response to 7% of patients (56 patients including 19 children) was delayed past the date of their hospital appointment.
· Shortages were reported for 25% of the items on the essential medications list and for 21% of the items on the essential medical disposables list.

Destinations and reasons for referral for medical treatment
During October 2011, the Referral Abroad Department (RAD) of the Palestinian Ministry of Health (MoH) referred 1,400 patients to health facilities for specialized treatment not available in MoH facilities in Gaza: of those, 373 patients were referred for specialized treatment that was within the Gaza Strip (in NGO or private hospitals) and 1,027 patients were referred outside of Gaza to hospitals in East Jerusalem (29%), Egypt (31%), Israel (21%), the West Bank (14%) and Jordan (5%). Of these, 712 patients required access through Erez crossing and 315 through Rafah border crossing.

The main reasons for 54% of all referrals, representing 60% (NIS 12.6 million) of the estimated cost, in October were: cardiovascular (19%), oncology (10%), urology (8%), ophthalmology (7%), orthopedics (5%) and neurosurgery (5%). In October 2011, RAD referred 146 patients for cardiovascular treatment to non-MoH facilities in Gaza compared to 25 during September (6.4% increase in referrals), as a result of the MoH cardiac catheterization machine being out of order during most of September and October.

Permit applications for patient referrals through Erez
During October 2011, the Israeli District Liaison Office (DCL) processed 864 patient applications for permits to cross Erez checkpoint to access hospitals in the West Bank including East Jerusalem, Israel and Jordan (see Table 2). This represents an increase from 822 applications in September 2011.

91% of applications (786) were submitted and financially covered by MoH, 3% (26) by Nour al Alam Foundation, 2% (17) by Peres Center for Peace, 2% (17) by other charity organizations, and the remaining 2% (16) by other or were self-funded.

[In October, 91% (790 patients) of all applications for permits were approved, substantially higher than the 2010 average of 78%. Of the remaining 9% of all patients, 2% (18 cases) were denied permission to cross Erez checkpoint. Another 7% (56 patients, including 19 children) had their applications delayed beyond their hospital appointment.1 Of the 56 patients whose applications were delayed by the Israeli authorities, 14 were called for interrogation by the Israeli General Security Services (GSS) as a condition for receiving answer. Following their interrogation, 5 were approved a permit, one was denied a permit and 7 patients were still waiting for a GSS response. (One did not attend the interrogation and was therefore not eligible to be issued a permit.)

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

Erez and Rafah crossing data for October 2011
Erez crossing was closed during weekends (Saturdays). According to the Palestinian Liaison Office at Erez, 724 patients crossed Erez checkpoint during October 2011, of which 50 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. The same number of patients exited Gaza in September (724) as in October; 44 patients required back-to-back ambulance transfer at the checkpoint.

Rafah border crossing was open for humanitarian access for a total of 25 days in October 2011; it was closed on 6 October and on weekends (Fridays). The current waiting time for non urgent referrals through Rafah is 3 weeks. An estimated 33 patients daily (total of 1000) were able to leave Gaza through Rafah for treatment in Egypt in October. This includes patients who were seeking medical treatment at their own expense and, therefore, traveled without a RAD financial cover, referral document.

Drugs and disposables October 2011
On 15 October 2011, the Central Drug Store in Gaza reported shortages of 120 (25%) essential drugs of the total 480 drugs on the essential list. In addition, 150 (21%) medical disposable items from the list of 700 essential items were out of stock in early October. The shortages of drugs and medical disposables remain at high levels although MoH in Gaza has requested drugs and disposables.

1 Of these 56 delayed patients 15 were referred for ophthalmic treatments, 13 for cardiology, 5 for oncology, 5 for neurosurgery and the remaining for 18 for other specialties.

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