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Source: World Health Organization (WHO)
31 March 2013





Summary

Patients denied access: Only one patient denied a permit in March.
Patients interrogated: 11 patients (4 F: 7 M) who applied for permits to cross Erez checkpoint were requested to appear for Israeli security interviews.
Patients delayed: 119 patients (52 F: 67 M) did not receive a response to their permit application and missed their hospital appointments.
Referrals within oPt: March represented the highest number of referrals (500) to East Jerusalem hospitals in the past three years.
Referrals to Jordan: In March there was only one referral to Jordan covered financially by the MoH.
Referrals to nonMoH facilities inside Gaza: There were 221 referrals to private and NGO facilities inside Gaza, an increase of 7% over the previous month.
Medical reasons for referrals: Most March 2013 referrals were for treatment in oncology (15%), heart catheterization (10%), nuclear medicine (8.5%), paediatrics (8%), ophthalmology (7%), urology (6%), orthopaedics (6%), haematology (6%), neurosurgery (6%) and heart surgery (4%).
The head of the coordination office in Gaza was replaced twice in less than a month.


Increase in Referrals to Jerusalem

A total of 1,391 patients from Gaza were referred by the Ministry of Health (MoH) in March, an increase of 11% over the average of 1250 for the first two months of 2013. According to Gaza Referral Abroad Department (RAD) data, 500 (36%) were referred to hospitals in East Jerusalem, 306 (22%) to Egypt, 212 (15%) to Israel, 151 (11%) to West Bank hospitals, one (0.07%) to Jordan and 221 (16%) to NGO and private hospitals inside the Gaza Strip (Table 1). The number of referrals to Egypt has been unstable since July 2012 due to coordination problems. Referrals to Israel have fallen since June last year due to the financial crisis in the Palestinian Authority. Jordanian hospitals have not accepted referrals from the oPt since June 2012 due to the high debt owed by the Palestinian Authority. These problems have increased the load on Palestinian hospitals in East Jerusalem, reaching a peak of 500 referrals, the highest monthly total in the last three years (Chart 1). A gradual rise in patient referrals to private and NGO facilities inside Gaza (221) was noted, mostly due to reduced MoH capacity from malfunctioning equipment and lack of medical supplies for heart catheterization. Of the 221 referrals, 117 were for heart catheterization, 71 for lithotripsy, 31 for MRI and two for intensive care. The gender gap in referrals persisted in March for all age groups: 57% of referrals were males and 43% were females, while 26% of all referrals were children aged 0‐17 years and 20% were elderly people aged over 60 years.





Health access: patient applications for Israeliissued permits to cross Erez

In March 2013, 882 applications were submitted 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: 762 (86.3%) received permits to access Erez, 119 (13.5%) were delayed and only one was denied, a female patient aged 23 with kidney disease who had an appointment in Makassed hospital (Table 2). In March there was a significant decline in the percentage of permit approval and delays almost doubled (Chart 2) and (Table 5). The average approval rate in the last 14 months was 93% and delayed patients made up 6.65%. The 7% decline in permit approval in March may be due to the replacement of the Palestinian health coordination officer in Gaza in the fourth week of March.





A total of 119 patients (52 females and 67 males, 13.5% of total applicants) did not receive a response and therefore lost their hospital appointments, delaying their medical care: among them 36 children below 18 years, 52 females, and 24 patients suffering from a malignant disease. Of the 119 patients who were delayed, 102 had appointments scheduled in Palestinian hospitals in East Jerusalem and the West Bank and the rest (17 patients) in Israeli hospitals. Responses should be received within 10 days, but 31 applicants had not received a response after two weeks and 7 had not received a response after 30 days. There were 11 patients, (1.25% of all applicants), 4 women and 7 men, who were called for interrogation by Israeli General Security Services (GSS) as a condition to process their application. Only one was granted a permit after interrogation while the rest received no response.

In March, 90% 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 747 patients and 714 companions travelling through Erez checkpoint to Israel and oPt during March. Also, 65 patients were transferred by ambulances through Erez during the same period (Table 4).





According to the Emergency Medical Services of MoH in Gaza, their office coordinated the travel of 677 people to Egypt: 63 patients were transferred by ambulance with 85 companions. The remaining 529 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 level in the MoH Gaza Central Drug Store in March 2013 was 150 (31.25%) out of 480 items in the essential drugs list. There were 73 drug items (15%) at low stock level (sufficient for less than 3 months). Of disposable medical items, 481 (53.3%) were at zero stock level out of 902 items on the essential disposable list and those at low stock were 104 (11.5%) (Table 6).



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