Access to health for 1.7 million Palestinians in Gaza, 70% of whom are refugees, is dependent on a complex interrelation of social and political determinants, in which many parties, including foreign governments, play a role.
The impact of occupation accumulates on the health and well-being of the growing population, and more recent changes alter the context: the total closure and isolation of Gaza since 2007, the political split in the Palestinian Authority, and regional political changes which have reduced coping mechanisms. Other constraints are frequent periods of political crises, vulnerability to military attacks and unstable supply systems, arbitrary restrictions on movement of people and goods entering/exiting Gaza from Israel and Egypt, and weak public sector and aid dependency.
Humanitarian needs are different in Gaza than in other crisis situations and responses should focus on both short-term and long-term interventions by all duty-bearers to eliminate barriers to health, especially relating to access.
Patient access to quality health care in Gaza
The health care system in Gaza has limited capacity to fully meet the needs of the 1.7 million population due to poor underlying determinants of health such as closed borders, economic sanctions and periodic outbreaks of violence which hinder health system functioning. Health-specific determinants such as lack of quality and quantity of resources, attitudes, knowledge and skills also affect health care. The shortage of essential medicines has been a chronic problem for the PA and Gaza Ministry of Health that seriously affects the quality of life for patients. All of these deficiencies force an increase in referrals to outside hospitals, at high cost to the Palestinian Authority:
Patients from Gaza and the West Bank are referred outside their region by the MoH or private physicians for treatment not available locally.
In Gaza, patients must submit a permit application at least 10 days in advance of their hospital appointment to allow for Israeli processing. Documents are reviewed first by the health coordinator but final decisions are made by security officials. Permits can be denied for reasons of security, without explanation; decisions are often delayed. In 2013, 40 patients were denied and 1,616 were delayed travel through Erez crossing to access hospitals in East Jerusalem, Israel, the West Bank and Jordan past the time of their scheduled appointment. If a patient loses an appointment they must begin the application process again. Delays interrupt the continuity of medical care and can result in deterioration of patient health.
Companions (mandatory for children) must also apply for permits. A parent accompanying a child is sometimes denied a permit, and often both parents, and the family must arrange for a substitute, a process which delays the child’s treatment.
Rafah border crossing has been subject to openings and closing depending on the political situation and policy changes by both Egypt and Israel during that period. Since July 2013, when Egypt closed the border except for ‘exceptional humanitarian need’, the number of patients dropped 95%, from 4,125 per month to 305 per month. Patients had been about 20% of all travellers but their priority dropped with the closure to only 5% of travellers. In early 2014, less than 50 patients per month have been able to cross on the few days the border is open. In April only 7 patients could cross.
The closure has also halted medical missions and supply of donated medicines to the MoH via Rafah; only one shipment from Egypt was received over the past 10 months.