Referrals reflect needs and local capacity
The Ministry of Health (MoH) in Gaza referred 1,640 patients to outside hospitals in September, 22% higher than the monthly average in 2013 (1,345). 36.16% of referrals were to hospitals in East Jerusalem (593), followed by 24.09% to Israel (395). Referrals to Gaza (non-MoH) facilities and to East Jerusalem, Israel and West Bank hospitals are at the highest levels in recent years. Referrals to Egypt decreased significantly, from usual levels of 300 to 168 patients, reflecting the unstable border and internal situation in Egypt (Table 1). There was a significant gender gap in referrals in September: 57.4% male patients versus 42.6% female patients. 25% of all referrals were children aged 0-17 years and 18% were elderly over 60 years.
Referrals for oncology, hematology, ophthalmology, orthopedic surgery, heart surgery and catheterization in particular reflect the lack of capacity within the MoH due to shortages of drugs, specialists and equipment capacity in these areas.
Limited access to Egypt
The number of travelers using Rafah terminal dropped steadily in July and August; by September only 3,482 travelers left Gaza through Rafah terminal, including only 276 patients (7.9%), a fraction of the usual number (Chart 1). Rafah terminal was completely closed for 16 days in September (12 days for security reasons and 4 Fridays), and crossing hours have been restricted since July 10 from 10 am to 2 pm. An infant died shortly after birth to a Gaza woman who had been refused humanitarian access to Gaza after closing hours, September 27 (see http://www.emro.who.int/pse/palestine-infocus/palestinian-newborn-dies-at-rafah-border-october-2013.html ).
In September 2013, 1,182 of 1,303 patients (90.71%) received permits to cross Erez to access hospitals (Table 2). 5 men (for treatment in neurosurgery, nephrology, ophthalmology, orthopedics, and ENT) were denied health access. The rate of denials for September was 0.38% (5 patients) (Chart 3).
According to the Palestinian District Coordination office, 116 applications of patients (8.9%), including 23 children and 9 patients over the age of 60, received no response; 34.5% were females. Of those delayed, 50% had been destined for scheduled appointments in East Jerusalem hospitals, 23% in hospitals in the West Bank, and 25% in Israel and 2% in Jordan. The volume of applications has increased in 2013 compared to the same period in 2012 by 39%, and the approval rate has declined 6.5%. Applicants are 2.3 more likely to be delayed this year (Table 3).
7 patients, including 1 female, were called for security interviews by Israeli General Security Services (GSS) as a condition to process their application. None were granted a permit after interrogation.
Patient access at Gaza exits