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Source: World Health Organization (WHO)
30 April 2013





Summary

Reduced access: Israeli permit approval rate in April (82.9%) was lowest since January 2011 reflecting a dramatic increase in delays in responding to applications. No permit denials were issued in April for the first time in the last 5 years.
Patients delayed: 198 patients (17.1%; 78 F; 120 M) did not receive a response to their permit application and missed their hospital appointments.
Patients interrogated: 17 patients (5 F; 12 M) who had applied for permits to cross Erez checkpoint were requested to appear for Israeli security interviews.
Outside referrals: In April 285 patients were referred to Israel (34% more than March) and 3 patients to Jordan.
Referrals to non-MoH facilities inside Gaza: Fewer patients were referred to private and NGO facilities inside Gaza (193; 13.2%) and more to WB facilities (197; 13.5%) than during March.
Medical reasons for referrals: Most April 2013 referrals were for treatment in oncology (14%), heart catheterization (10%), nuclear medicine (8.5%), ophthalmology (8%), neurosurgery (7%), haematology (6%), orthopaedics (6%), paediatrics (6%), urology (5%) and heart surgery (4%).
Cost: The total estimated cost for Gaza referrals during April was NIS 10,648,269.


Increase in Referrals

A total of 1,463 patients from Gaza were referred by the Ministry of Health (MoH) in April, a 12.8% increase over the monthly average in 2013 of 1297, and also higher than averages in 2011 and 2012. According to Gaza Referral Abroad Department (RAD) data, 484 (33%) were referred to hospitals in East Jerusalem, 301 (20.6%) to Egypt, 285 (19.5%) to Israel, 197 (13.5%) to West Bank hospitals, 3 (0.2%) to Jordan and 193 (13.2%) to NGO and private hospitals inside the Gaza Strip (Table 1). Referrals to Egypt were consistent with the average of the last two years.

Referrals to Israeli hospitals (285) increased this month by 39% over the monthly average in 2013 (205), in contrast to a decrease in referrals to Israel since June 2012 due to the financial crisis of the Palestinian Authority. Most Jordanian hospitals stopped accepting referrals from the MoH since June 2012 because of outstanding debts of the PA but 3 referrals were given by the MoH this month. Referrals to West Bank hospitals have increased steadily in 2013 (Chart 1). Patient referrals to private and NGO facilities inside Gaza (193) decreased slightly; they have been primarily due to reduced MoH capacity from malfunctioning equipment and lack of medical supplies for heart catheterization. 104 referrals were for heart catheterization, 43 for lithotripsy and 43 for MRI, 2 for oncology and one for urology care. The gender gap in referrals persisted in April for all age groups: 57% of referrals were males and 43% were females. 25% of all referrals were children aged 0-17 years and 20% were elderly over 60 years.





Reduced health access: almost 1 in 6 patients receive no response to applications for Israeli-issued permits to cross Erez

In April 2013, applications were submitted for 1155 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. 957 patients (83%) received permits to access Erez and 198 patients (17%) received no response, although no patient was denied for the first time in 5 years (Table 2).




For the past two months there has been a significant decline in the permit approval rate and an increase in delayed responses (Chart 2). The approval rate decline is at the lowest point since January 2011. The average approval rate from January 2012 – February 2013 was 93% and delayed was 6.65%. A number of factors may be responsible for the drop, including new staff appointed in the Palestinian District coordination office, and a rise in the number of applications for permits. The slowdown may also be attributed to the effect of Jewish holidays during April which causes delays in permits approvals. WHO will continue to monitor the permit situation to ensure that patient access is not hindered.



In April 2013 there was a 51% increase in the total number of applications in comparison with April 2012, while the approval rate was 12% lower and the delayed was 13.2% higher in 2013. The average rate of delayed applications for January to April 2013 was 11.82% compared to 5.31% for the last year (Table 3).




17 patients (5 women and 12 men; 1.47% 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.

198 patients (78 females and 120 males; 17.14% of total applicants) did not receive a response and therefore lost their appointments in the hospitals, delaying their medical care; among them 55 children below 18 years, 76 females, and 37 patients suffering from cancer. Of the 198 delayed patients, 147 were destined for scheduled appointments in Palestinian hospitals in East Jerusalem and West Bank, 43 in Israeli hospitals and 4 in Jordan. Responses should be given within 10 days: 62 received no response after 2 weeks, and 43 were still waiting for a response after 4 weeks.

In April 91% of patients applying for Israeli permits were referrals financially covered by MoH. The remaining patients were covered by other sources (Table 4).




The Palestinian General Authority for Civil Affairs registered 888 patients and 841 companions travelling through Erez checkpoint to Israel, oPt or Jordan during April. The Emergency Medical Services of the MoH in Gaza coordinated the travel of 754 people to Egypt. 68 Patients were transferred by ambulances with 94 companions. The remaining 592 were patients and their companions who traveled through Rafah terminal as regular passengers.
(Table 5).


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