Referrals reflect needs and local capacity
The Ministry of Health (MoH) in Gaza referred 1,261 patients in July, 7% less than the monthly average of the first half of 2013 (1353). Most referrals were to hospitals in East Jerusalem (474-- 37.6%), followed by Israel (312--24.7%), NGO and private hospitals inside the Gaza Strip (167--13.2%), West Bank hospitals (165 –13%), Egypt (141 --11.2%), and Jordan (2—0.16%), following previous trends (Table 1).
Limited access to Egypt
Patients chose or were forced to delay their medical treatment in Cairo in view of the unstable situation and following restrictions on access to Egypt. Fewer than half the usual number of patients was referred to Egypt in July. The Rafah terminal was completely closed for 4 days for security reasons, in addition to 5 days for holiday and weekends. Rafah terminal authorities reported that after July 10, hours were restricted to only 10 am-2 pm, and only patients with official referral documents from the MoH-Ramallah were permitted to exit. In addition to the usual monthly average of 300 patients referred to Egypt by the MoH, estimates of private patients from Gaza who seek medical treatments every month in Egypt are between 1,000 (MoH-Gaza estimates) and 4,100 (Rafah terminal data). A total of 549 patients and companions were coordinated through Rafah in July, according to MoH EMS.
Only 2 referrals were made to Jordan, reflecting a June 2012 decision by most Jordanian hospitals to halt new MoH referrals due to outstanding PA debts (Chart 1). Referrals within Gaza to non-MoH facilities were for heart catheterization (64), lithotripsy (42), MRI (42), and (19) other services. Referrals for heart surgery increased again this month reflecting shortages of disposable materials needed for surgery. There was a significant gender gap in referrals in July: 57.65% male patients versus 42.35% female patients. 29.7% of all referrals were children aged 0-17 years and 18% were elderly over 60 years.