Referral crisis: Processing of Ministry of Health (MoH) medical referrals for Gaza patients was suspended for 9 days, from July 17 to July 25, following a disagreement between Ramallah and Gaza over the management of the Referral Abroad Department (RAD) in Gaza. Closure delayed the processing of applications and created hardship and confusion for several hundred Gaza patients. Total referrals for July dropped to 833, a reduction of 38% from the 2012 monthly average of 1,340.
Detained: 2 patients called for interrogation were detained at Erez; 1 patient-companion, holding a valid Israeli-issued permit, was detained while exiting Erez.
Interrogated: At least 16 patients were called for Israeli interrogation (7 females; 9 males).
Denied: 5 patients (2 children) were denied permits to exit Erez crossing for medical treatment.
Delayed: 54 patients (17 females and 37 males) did not receive a response to their permit applications and missed their hospital appointments.
Permits required: The number of referred patients needing access through Erez was 520 (117 to Israel, 313 to Jerusalem, 2 to Jordan, and 88 to the West Bank). 237 patients referred to Egypt required special clearance at the border.
Medical reasons: Most July referrals were for: oncology (18%), cardiovascular (12%), ophthalmology (10%), pediatrics (8%), nuclear medicine (7%), hematology (6%), neurosurgery (6%), orthopedics (5%). The estimated cost for referrals was NIS 7,993,788 about $ 1,998,447.
The referral of patients out of Gaza for specialised medical treatment was suspended for a 9-day period in July following a disagreement between the health authorities in Ramallah and Gaza over the management of the Referral Abroad Department (RAD) in Gaza. The crisis began after the PA Minister of Health in Ramallah replaced the director and the medical review committee with new personnel. The next day the Gaza authorities closed the RAD office. The RAD office, which cooperates with Gaza authorities but reports directly to the RAD office in Ramallah, reopened on July 26 following negotiations through intermediaries, including WHO and a number of health leaders in Gaza. During the closure, the Palestine Human Rights Center (PHRC) in Gaza facilitated submission of urgent referral applications directly to Ramallah. MoH in Ramallah also received referrals direct from Gaza patients. The PCHR handled 181 cases during the 9 days, of which 163 cases received financial coverage, and 10 critical cases were transferred immediately out of Gaza for urgent treatment. Total referrals for July dropped to 833, a reduction of 38% from the 2012 monthly average of 1,342.
Reduced referrals to Jordan and Israel
MoH referrals of Gaza patients to Jordan and Israel were significantly reduced in July, reflecting the financial crisis of the Palestinian Authority as well as a policy begun in May of reducing referrals to the most costly destinations. (In May Jordan hospitals stopped admitting patients referred by the Ministry of Health because of the Palestinian Authority’s accrued debt for patient care over the past year.) MoH referrals to Israel in July 2012 were 117, less than the monthly average of 259 for January to May 2012. Only 2 MoH referrals were made to Jordan in July, compared to the previous monthly average of 38.
Most patients were referred during July for the following subspecialties: oncology (18%), cardiovascular (12%), ophthalmology (10%), pediatrics (8%), nuclear medicine (7%), hematology (6%), neurosurgery (6%), orthopedics (5%).
In July 2012, 764 patient applications were submitted to the Israeli District Liaison Office (DCL) for permits to cross Erez to access hospitals in the West Bank including East Jerusalem, or in Israel and Jordan compared with 784 in June. Almost 90% were MoH referrals (see Tables 2 and 3).
In July, 92.3% (705 patients) were approved permits; 5 patients (0.7%) were denied permits to cross Erez checkpoint, including two children (2: orthopedic treatment; 1: ENT, 1: ophthalmology and 1: urology).
54 patients, including 10 children, received no answer to their applications and missed their hospital appointment date (13 patients for ophthalmic treatment, 10 for oncology, 7 for diagnostic scans, 5 for orthopedic treatment, 4 for neurosurgery and the remaining for other specialties). 16 patients (7 females and 9 males) were called for interrogation by the Israeli General Security Services (GSS) after applying for a permit. Following their interrogation, 10 patients received no response from the GSS about their permit application, 2 were approved, one was denied and 3 were asked to resubmit their request.
Case 1. Detention of patient; Rawhi Fuad Hussein Gargaz, a 42-year-old patient referred to Makassed Hospital for orthopedic surgery, was detained at Erez crossing on July 15, 2012. According to the UNOHCHR, the patient’s brother was informed by the Israeli authorities that Rawhi was detained in Ashkelon prison. The patient was released after 19 days on August 2, 2012.
Case 2. Detention of companion; Ahmed Basheer Mahmoud Khella a 24-year-old patient-companion, received a permit to travel to Shneider Hospital on July 3, 2012 to replace his mother as companion by the bedside of his brother Belal, a lymphoma patient. On the day of Ahmed’s travel, he was detained by the Israeli authorities at Erez. The ICRC informed the family that Ahmed had been taken to Askhelon prison for interrogation. The patient was released after 16 days, on July 19, 2012.
Case 3. Detention of patient; Wael Kamil Mohammed Attaweel, a 40-year-old patient suffering from a prolapsed lumber disc, was referred to Makassed Hospital in East Jerusalem by the MoH. According to Wael’s wife, after Wael applied for a permit, the Israeli authorities called him twice for GSS interrogation, on July 4 and July 8, 2012. On the day of the second interrogation Israeli authorities called Wael’s wife to inform her that her husband had been arrested. According to UNOHCHR Wael was being held in Beer Sheva prison and as of August 22, was still being detained.