The Ministry of Health (MoH) in Gaza referred 1,868 patients to outside hospitals in February, 33% higher than the monthly average for 2013. Referrals were lower this month to hospitals in East Jerusalem (29.18%; 545) and Israel (22.91%; 428). Referrals to non-MoH facilities in Gaza and to West Bank facilities were both higher than the previous month and double or more the monthly average for 2013 (Chart 1). Referrals to Egypt remained low, reflecting the unstable border and internal situation in Egypt prevalent since July 2013. In February 9.37% (175) of referrals were to Egypt. (Table l).
Limited access to Egypt
Of the 3,225 travellers who left Gaza through Rafah terminal in February, only 36 were patients (1%), the lowest monthly figure recorded in an 8-month downward trend of patients 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%).
Rafah terminal was closed for 25 days in February, allowing only 3 partial days for travelers under the criteria of humanitarian needs. During the closure days the terminal was open on 7 occasions, 4 times for pilgrims exiting with special coordination, and 3 times to allow pilgrims to return. 1,410 (44%) of the 3,225 travelers exiting during February were pilgrims. Since July 10, 2013, crossing hours have been restricted to 9 am to 2 pm. No medical delegates or medical aid passed through the terminal during February. Only one medical shipment, in November, has passed through Rafah since July 2013.
In February 2014, 1,289 (86.8%) of 1,485 patient applications to cross Erez were approved (Table 2). 50 patients were denied access through Erez to specialized hospitals in the West Bank including East Jerusalem, Israel and Jordan --20% more than the total denied in 2013 and the highest monthly number of patients denied since August 2010 when 87 patients were denied. The 50 patients (16 females; 34 males) denied in February, which included 7 children and 2 patients over 60 years, had been referred mainly for treatment in orthopedics, ophthalmology, urology, neurology, neurosurgery, internal medicine and nuclear medicine. 34 had appointments in East Jerusalem and West Bank hospitals, 13 in Israel and 3 in Jordan. 44 were funded by the MoH, and 6 were self -funded.
13 patients, including 2 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. To date, only one patient in February had been granted a permit following the interview.
Access through exit points
The Palestinian General Authority for Civil Affairs registered 1,165 patients and 1,454 companions travelling through Erez checkpoint to Israel, oPt or Jordan during February; 59 patients were transferred via back-to-back ambulances. The ambulance station at Rafah terminal reported that 36 patients and 30 companions were transferred by ambulance from the Palestinian side to the Egyptian side of the terminal during February (Table 4).
Israeli authorities at Erez cancelled passage for 70 patients and their companions who had been issued permits to cross on February 12, 2014, to access hospitals in Israel, East Jerusalem and the West Bank. The measure was apparently in protest of the Palestinian Ministry of Health's use of referral stationery printed with the address, "State of Palestine." The form has been in use for several months. Two private patients and 3 urgent cases transferred by ambulance were permitted to cross. After a compromise solution was found, 60 patients with appointments in hospitals in East Jerusalem and the West Bank were able to cross Erez with their companions on the following day. However, 10 patients scheduled for treatment in Israeli hospitals lost their appointments, and had to reschedule treatment and reapply for new permits.