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Source: World Health Organization (WHO)
30 September 2013

Ref: RAD 9 (October 31, 2013)
Referral of Patients from the Gaza Strip


  • Outside referrals: September represented the highest month of Ministry of Health referrals of patients to outside facilities since January 2011, prompted by drug shortages and unavailability of specialists and equipment. As in recent months, referrals to Egypt dropped to 50% of usual levels; referrals remained negligible to Jordan. 49% of Gaza referrals were to hospitals within the occupied Palestinian territory (West Bank and East Jerusalem).
  • Access: 5 patients, all males between the ages of 18 and 60, were denied permits. 116 patients --- 40 females and 76 males (8.9% of total applicants) --- received no response to their applications, including 23 children, which delayed medical treatment. 90.7% of applicants received permits.
  • Patients interrogated: 7 patients (6 males; 1 female) who had applied for permits to cross Erez checkpoint were requested to appear for Israeli security interviews. None were granted a permit after interrogation.
  • Medical reasons for referrals: Most referrals were for treatment in the following specialties: oncology—226 patients (13.8%), urology--158 (9.6%), nuclear medicine--134 (8.2%), orthopedics--123 (7.5%), ophthalmology--109 (6.7%), pediatrics--98 (6%), heart catheterization--89 (5.4%), MRI--75 (4.6%), neurosurgery--75 (4.6%), haematology--68 (4.2%), and heart surgery--66 (4%).
  • Gender gap: There was a significant gender gap in referrals: 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. Cost: The total estimated cost for Gaza MoH referrals during September was NIS 10,646,503.

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 ).

According to Palestinian authorities at the terminal, no medical delegations or humanitarian aid entered Gaza from Egypt during September. Prior to restrictions imposed in July, a monthly average of 20,577 passengers travelled through the terminal to Egypt, including 4,177 Ministry of Health and private patients (20.3%) seeking health care abroad.

Access through Erez

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.

In September, 92% of referral patients applying for Israeli permits were financially covered by the Palestinian MoH, 4.8% were self-funded, and the remaining patients were funded by Peres Center for Peace, Nour Ala-Al-Alamfoundation, 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. Patients and companions face financial problems during their stay in hospitals for different reasons including long stay, and personal expenses.

Patient access at Gaza exits

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