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Source: World Health Organization (WHO)
11 November 2010

Summary For October 2010
Permit applications for patient referrals through Erez

During October 2010, the Israeli District Liaison Office (DCL) processed 976 patient applications for permits to cross Erez checkpoint to access hospitals in East Jerusalem, the West Bank, Israel, and Jordan (see Table 1 below). This is the highest number since June when 1,090 applications were processed.

76.2% of all applications were approved in October. This is the lowest rate since May 2010, and is substantially lower than September when the percentage stood at 85%. The rate of denied applications remains low at 2.2%.

On the other hand, the number of delayed cases was the third highest this year. 26.6% of all applications were delayed, which is almost double the September rate of 12.8% (see Figure 1 below).

Out of the 211 delayed patients, 6 (0.6%) were called for interview with the Israeli Intelligence Services, known as General Security Services (GSS).

Delayed patients generally miss their hospital appointments. In most cases they have to seek new appointments and submit new applications for a permit to cross Erez. Delays in processing applications can be critical for patients who are waiting for urgent medical treatment. Some may die while waiting for permission to access the medical facility they have been referred to.

This was the case in October for a two-year-old girl (see “Death of Nismah Najiy Abu Lasheen” below). Since the beginning of the year 2009 a total of 33 patients have died before being able to access the hospital they had been referred to.

Destinations and reasons for referral

During October 2010, the Referral Abroad Department (RAD) of the Palestinian Ministry of Health (MoH) approved and issued 1,728 referral documents. RAD found that 620 of these referred patients were able to receive appropriate medical treatment within the Gaza Strip, in either NGO or private hospitals.

The remaining 1,108 patients had to leave Gaza in order to be treated in hospitals in Egypt (44.8%), East Jerusalem (25.7%), Israel (17.1%), the West Bank (10.3%) and Jordan (2.2%). Referrals to Egypt have remained high ever since the Rafah border crossing was reopened in June 2010 (see Figure 2 below).

The main reasons for referrals were: cardiovascular i.e. heart diseases (22.2%), ophthalmology i.e. eye conditions (8.5%), oncology i.e. cancer (6.9%), orthopedics (6.4%) and neurosurgery (5.6%)1. These health conditions account for 49.6% of all referrals.

Erez and Rafah crossing data for October 2010

According to the Palestinian Liaison Officer at Erez, 709 patients crossed Erez during October 20102. 48 of these patients needed to be transported by ambulance. Because Palestinian ambulances are not permitted to leave Gaza, they were transferred from one ambulance to another (back-to-back). This compares to 519 patients, including 36 via back-to-back ambulances, in September.

Rafah border crossing remained open throughout October. An estimated 600 patients crossed to access Egyptian hospitals. This includes patients who were seeking medical treatment at their own expense and, therefore, travelled without a RAD referral document.

Death of Nismah Najiy Abu Lasheen (2 years old)

Nismah Najiy Abu Lasheen, born on 8 October 2008, died in Gaza of leukemia on 16 October 2010 while waiting for an urgent referral to a hospital in Israel.

In May 2010 Nismah was referred to Maqassed Hospital in East Jerusalem. The Israeli Authorities refused to allow her father to accompany her so her mother, who was heavily pregnant at the time, went with her instead. Doctors at Maqassed sent Nismah to Augusta Victoria Hospital - also in East Jerusalem - for further diagnosis and treatment. She was sent on from there to Eikhilov Hospital in Israel.

Nismah’s mother gave birth at Eikhilov Hospital. She returned to Gaza when Nismah’s father was able to obtain a permit and replace her at Nismah’s bedside. Once Nismah had undergone a round of treatment at Eikhilov Hospital she and her father returned home to Gaza.

On 7 July 2010, Nismah was referred to Rambam Hospital in Israel for emergency treatment. Her father accompanied her. When the treatment was completed, they returned to Gaza.

On 6 October, an urgent request was yet again submitted to the Israeli Authorities, this time for treatment at Ha-Emek Medical Centre in Afula, Israel. Nismah’s father was due to accompany her. However, no answer to the urgent request was received until 14 October, despite the efforts of the family and the District Liaison Office in Gaza to speed up the process of obtaining a permit. When the permit was finally approved Nismah’s condition had deteriorated to a point where her doctors advised her against travelling.

In the early hours of 16 October 2010, Nismah died.

Limited availability of cancer treatments in Gaza

Nismah’s case illustrates the limited medical treatment available in the Gaza Strip to treat cancer. Each month about 10% of referrals are patients suffering from cancer. Most have to leave Gaza to obtain the necessary treatment.

The health system in Gaza is unable to provide radiation therapy, one of the main methods used to treat cancer. Israel restricts importation of the necessary material to Gaza, some of which is radioactive. Drugs for chemotherapy, the other main cancer treatment, are often out of stock. They are very expensive and not part of the essential drugs list, therefore, they are not regularly provided by the MoH in Ramallah. Furthermore, Israeli restrictions on the movement of people out of Gaza curtail opportunities for medical staff to receive training in specialized fields such as oncology.

Augusta Victoria Hospital in East Jerusalem offers the most advanced care for cancer patients in occupied Palestinian territory. Access to East Jerusalem is, therefore, of utmost importance. Cancer patients referred outside of Gaza are also treated at hospitals in Israel and sometimes in Jordan.

Annex 1: Historic data

1 These figures include referrals to NGO and private hospitals inside Gaza because for technical reasons it is not currently possible to provide a separate breakdown for patients who have to leave the Gaza Strip.
2 The discrepancy between the number of permits approved (744 for October 2010) and the number of patients who crossed in this same month (709), is due to the fact that patients who have their permit approved at the end of one month might only cross the following month.
3 The percentage rates for patients called for an interview with GSS are calculated from the total number of permit applications submitted.

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