The Ministry of Health (MoH) in Gaza referred 1,848 patients to outside hospitals in January, 32% higher than the monthly average for 2013 and 22% higher than the previous month. 30.19% of referrals were to hospitals in East Jerusalem (558) and 25.16% to Israel (465). Referrals to Gaza non-MoH facilities were 18.7% (347), 68% higher than the monthly average for 2013 (Chart 1). Referrals to West Bank were 53% higher than the average for 2013. Referrals to Egypt remained lower than usual; the average number of referrals in the first half of 2013 was 300, but fell to half that (150) in the second half of the year, reflecting the unstable border and internal situation in Egypt. In January 10.7% (198) of referrals were to Egypt. (Table 1)
Of the 2,335 travellers who left Gaza through Rafah terminal in January, only 88 were patients (3.77%), continuing a 7-month trend of patients discouraged from using that route (Chart 2). From January to June 2013, Rafah terminal data had reported a monthly average of 20,577 passengers to Egypt, 20% (4,146) of which were Ministry of Health and private patients seeking health care abroad. In the second half of 2013, the average monthly number of travelers dropped by 75% (to 5,251) and monthly average of patients to 305 (6%).
Access through Erez
In January 2014, 1,350 (87.78%) of 1,538 patient applications were granted permits to cross Erez to access hospitals in the West Bank, including East Jerusalem, or in Israel or Jordan (Table 2). 37 patients, were denied access through Erez to specialized hospitals in the West Bank including East Jerusalem, Israel and Jordan. This is the highest number of patients denied in one month since August 2010 when 87 patients were denied. Of those patients denied, 31 were funded by the MoH, 2 by Physicians for Human Rights-Israel and the rest (4) were self-funded. Among them 3 children and 2 patients over 60 years (10 females; 27 males), with appointments mainly for treatment in orthopedics, nuclear medicine, neurosurgery, ophthalmology, urology, and neurology.
Thirty-three patients, including four females, were called for security interviews by the Israeli General Security Services (GSS) as a condition to process their application. The average monthly number of patients called for GSS in 2013 was 15. This is the highest number of patients called for interrogation in one month since June 2010. To date, only two patients in January had been granted a permit following the interview.
In January 2014, 90.38% of patients applying for Israeli permits were referrals from the Palestinian MoH, 6.44% were self-funded, and the remaining patients were funded by Nour Al-Alam foundation, Physicians for Human Rights-Israel and the Peres Center for Peace. MoH referrals do not cover transportation or companion costs and some items of patient care such as medicines not in the regular hospital supply. Patients and companions often face financial problems during long stays in hospitals due to these uncovered costs.
The Palestinian General Authority for Civil Affairs registered 1,232 patients and 1,183 companions travelling through Erez checkpoint to Israel, oPt or Jordan during January; 71 patients were transferred via back-to-back ambulances. The ambulance station at Rafah terminal reported that 88 patients and 82 companions were transferred by ambulance from the Palestinian side to the Egyptian side of the terminal during January (Table 4).
Two Arrests at Erez crossing
Preferring not to wait for uncertain Israeli approval, the patient and his family decided to change his destination to Egypt. It took 10 days to obtain a passport and travel to Egypt where he was admitted to the International Eye Hospital in Cairo. Yousef underwent surgery twice, in March and August, but his vision did not improve. The RAD referred him for treatment to Ramallah and on January 5, 2014, Yousef and his family were informed that Yousef had permission to cross Erez the next day. Yousef, accompanied by his mother, went to Erez but Yousef was arrested at the Israeli checkpoint by two Israeli plain-clothed security men. The mother was told that Yousef would be released in one or two hours and waited. At 5 p.m. the family was informed that Yousef had been detained for interrogation and that could be one or two days. He was detained in Ashkelon prison and was prohibited from meeting with his lawyer. The ICRC contacted the family and provided them information about Yousef that he is in good situation and he received a medical check in the prison. On February 5, 2014, Yousef was released from Israeli detention and sent back to Gaza without obtaining the treatment he needs. His vision is very poor and he requires assistance from others for simple activities. He is still seeking health care outside of Gaza.
Mahmoud Abu Shammas, 34 years old, from Deir Al-Ballah, was arrested on January 16, 2014 by Israeli security forces at Erez Crossing. He was on his way to Assuta hospital in Tel Aviv upon the hospital's request to sign a consent form for his father's treatment who was hospitalized in their facility.
The father, Salem Abu Shammas, 70 years old, had undergone open heart surgery in a Nablus hospital, in November 25, 2013 but his medical situation deteriorated gradually after surgery. He developed a hospital- acquired pneumonia and bilateral pleural effusion. He was referred to Assuta hospital in Tel Aviv in December 16, 2013, upon the family's request. The family paid NIS 80,000 to secure a bed in the hospital for the father; he was accompanied by a nephew. Salem improved slowly in Assuta in the first two weeks, then his situation deteriorated again. The hospital said a first-degree relative was required 'to sign papers', which Mahmoud agreed to do and applied for a permit to travel to the hospital. On January 15, 2014, he received a phone call from the Palestinian coordination office official saying that a permit had been issued for him to cross Erez, and on the following day he travelled to Erez, whereupon he was arrested at the terminal. He was detained in Ashkelon prison. A lawyer succeeded to visit Mahmoud once and reported that he was under interrogation. The family reported that Salem's situation deteriorated dramatically after hearing that his son had been arrested. The father died on January 19, 2014, 3 days after Mahmoud's arrest at Erez. Mahmoud was released on February 18, after 32 days of detention.