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Source: World Health Organization (WHO)
28 February 2013

Referral of Patients from the Gaza Strip

Referrals increased to Jerusalem
The total of 1,285 patients from Gaza were referred by the Ministry of Health (MoH) in February, a 13% increase over the monthly average in 2012 of 1,139. According to Gaza Referral Abroad Department (RAD) data, 466 (36.26%) were referred to hospitals in East Jerusalem, 262 (20.39%) to Egypt, 190 (14.79%) to Israel, 159 (12.37%) to West Bank hospitals, 1 (0.08%) to Jordan and 207 (16.11%) to NGO and private hospitals inside the Gaza Strip (Table 1). It was the highest monthly total for East Jerusalem in the last three years. Referrals fell slightly to Egypt because of medical coordination issues. Referrals to Israel were reduced as well. The 207 referrals to private and NGO facilities inside Gaza were higher than January. The rise was primarily due to reduced MoH capacity from malfunctioning equipment and lack of medical supplies for hearth catheterization. 126 referrals were for heart catheterization, 57 for lithotripsy and 24 for MRI. The gender gap in referrals persisted in February for all age groups: 55% of referrals were males and 45% were females. 25% of all referrals were children aged 0-17 years and 20% were elderly over 60 years. Hematology, heart surgery and neurosurgery represented the highest cost per case this month, while oncology referrals were the highest total cost and the most numerous (196 referrals) due to radiotherapy and complex chemotherapy treatment not being available in Gaza.

In February 2013, applications were submitted for 907 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. 836 (92.17%) received permits to access Erez and 2 (0.22%) were denied (Table 2). The two denied patients were a 3-year-old girl with an orthopedic condition referred to Makassed hospital in East Jerusalem and a 53-year-old woman who had an appointment with an endocrinologist in a Jordanian hospital.

69 patients (27 females and 42 males, 7.6% of the total applicants) did not receive a response and therefore lost their appointments in the hospitals, delaying their medical care; 17 of the delayed were children under 18 years, 4 were elderly over 60, 12 were patients with malignant diseases while 4 had congenital heart anomalies. Responses should be given with 10 days but 14 applicants did not receive a response after 2 weeks and 6 did not receive a response after 30 days. Of the 69 delayed patients, 17 were for scheduled appointments in Israeli hospitals and the rest were for West Bank hospitals including East Jerusalem.

17 patients (1.87% of the total applicants), one woman and 16 men were called for interrogation by Israeli General Security Services (GSS) as a condition to process their application. Only 2 were granted permits after interrogation while the rest received no response.

In February 89% of Israeli permit applicants were referrals financially covered by MoH. The remaining patients were covered by different sources (Table 3). The Palestinian General Authority for Civil Affairs registered 771 patients and 716 companions travelling through Erez checkpoint to Israel and oPt during February. 48 patients were transferred by ambulance through Erez; 15 were urgent cases and transferred during off-duty hours (Table 4).

According to the Emergency Medical Services of MoH in Gaza, their office coordinated the travel of 560 people to Egypt. 53 patients were transferred by ambulance with 74 companions. The remaining 433 were patients and their companions who travelled through Rafah terminal as regular passengers.

Drug Shortages in Gaza
The number of drug items at zero stock in the MoH Gaza Central Drug Store for the month of February 2013 was 142 (29.6%)out of 480 of the essential drug list and drug items at low stock (sufficient for less than 3 months) were 70. Regarding medical disposable items, 494 (54.8%) were at zero stock levels out of 902 items on the essential disposable list and those at low stock were 88.

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