Summary for July 2010
- Out of a total of 947 patient applications for permits to cross Erez the Israeli authorities denied or delayed 16.7%.
- At 10% the number of patients whose permit applications were denied remains high for the third consecutive month. This is in contrast to the 2.3% of applications that were denied in the first quarter of 2010.
- The Rafah border crossing has remained open since the beginning of June 2010, which has led to a much higher number of patients being referred to Egypt than before.
- Cardiovascular diseases, oncology, ophthalmology, neurosurgery and orthopedics remain the major reasons for referral, accounting for almost half of all referred cases.
Permit applications for patient referrals through Erez In July 2010, the Israeli District Liaison Office processed a total of 947 patient applications for permits to cross Erez (see Table 1), compared to 1,090 in June and 1,225 in May. 83.3% of all applications were approved – the highest rate in the last two years (see Figure 1). Moreover, the average approval rate in the first seven months of 2010 was substantially higher than the annual average for 2009: 77% compared to 68.3%.
On the other hand, 10% of patients (95 cases), including one child, were denied a permit to cross Erez in July 2010. This figure adds to the trend recorded in the preceding two months (12.7% in May and 12.3% in June) towards a significantly higher denial rate than in the first quarter of 2010 (2.3%) or compared to the yearly average for 2009 (2.0%) (see Figure 1). WHO has made a request to the Israeli authorities for an explanation for this trend and is currently awaiting a response.
6.7% of patient permit applications (63 cases) were delayed in July 2010, 11.1% of which were on behalf of children. Although the number of denied requests has increased, as reported above, the percentage of delayed applications has decreased significantly in the last three months (see Figure 1); in the first quarter of 2010 the delayed rate stood at 20.2%.
31 of the 63 patients who had their application delayed in July were called for an interview with the General Security Services (GSS), part of the Israeli intelligence services: 15 patients could not or chose not to attend the interview and, as such, were not granted a permit to cross Erez; 7 were asked to submit new applications; 5 were given permission to cross after the interview; and 4 had their applications denied.
Almost half of patients whose applications were delayed (46%) faced a waiting time of more than eight days past their original hospital appointment. 93.6% of all applications were processed within 30 days, a rate which has remained roughly stable over the preceding two months. Delayed patients will have to seek new hospital appointments and resubmit their applications for a permit to cross Erez.
Delays in processing applications can be critical for patients in need of urgent medical treatment: Since the beginning of 2009, 32 patients have died before being able to access the hospital they were referred to.
Destinations and Reasons for Referral
During July 2010, the Referral Abroad Department (RAD) of the Palestinian Ministry of Health (MoH) approved and issued 1,357 referral documents. 34.6% of these were for referrals to Egypt, which was for the second month in a row the destination to which the highest number of patients was referred. 28.9% of patients were referred to hospitals in the West Bank and East Jerusalem, 15% to Israel, 1% to Jordan and the remainder to hospitals run by NGOs within Gaza.
The border with Egypt has remained open throughout July, as it was during the entire month of June. Compared to the preceding period, when Rafah was only open intermittently and at short notice, a clear shift in referral destinations can be identified (see Figure 2). The percentage of patients referred to Egypt has doubled, whereas referrals to other destinations, in particular to East Jerusalem, have declined. According to the director of RAD in Gaza, many patients ask to be referred to Egypt in order to avoid the denials and delays that are frequent when requests are made to the Israeli authorities for permits to cross Erez to reach hospitals in East Jerusalem, West Bank and Israel.
In July 2010, the main reasons for referrals to hospitals outside Gaza were cardiovascular diseases (12%), ophthalmology (11.5%), oncology (9.6%), neurosurgery (7.7%) and orthopedics (7.6%). These health conditions accounted for 48.4% of all referrals, a figure very similar to the preceding three months.
Erez and Rafah Crossing Data for July 2010
According to the Erez Liaison Officer, 737 patients crossed in July 1, including 45 who were transported with back-to-back ambulances. This compares to 865 patients in June (45 using back-to-back ambulances) and 863 in May 2010 (31 using back-to-back ambulances). As reported above, Rafah border has remained open throughout the month of July, excluding Fridays. An estimated 560 patients have managed to cross the border to access Egyptian hospitals.
Annex 1: Historic data
Endnotes
1 The discrepancy between the number of permits approved (947 for July 2010) and the number of patients who crossed in this same month (737), is due to the fact that patients who have their permit approved at the end of one month might only cross the following month.
2 The percentage rates for patients called for an interview with GSS are calculated from the total number of permit applications submitted.
Document Sources: World Health Organization (WHO)
Subject: Access and movement, Assistance, Gaza Strip, Health, Humanitarian relief
Publication Date: 31/07/2010