Referral of patients from the Gaza Strip – WHO monthly report (June 2012)

During June 2012, the Referral Abroad Department (RAD) of the Palestinian Ministry of Health (MoH) referred 1,336 patients (733 males and 603 females; 54% and 45%, respectively) to health facilities for specialized treatment not available in MoH facilities in Gaza. 21.7% (290 patients) were referred to NGO or private facilities within the Gaza Strip and 78.3% (1,046 patients) were referred outside of Gaza to hospitals in East Jerusalem (40.2%), Egypt (31.4%), Israel (16.5%), the West Bank (11.5%) and Jordan (0.5%). 736 of these patients required Israeli-issued permits to access through Erez crossing, while 328 required an Israeli-issued ID and Egyptian approval to enter Egypt through Rafah border crossing (see Table 1, below).

According to the Director of Gaza RAD, Jordanian hospitals have limited admissions of recent MoH referrals since early May 2012, due to the failure of PA to cover costs of treatment for Palestinian patients referred over the last few years: only 5 MoH referrals were made during June, compared to a monthly average of 38 in 2012.

Patients were referred during June primarily for treatment in the following subspecialties: cardiovascular (20%), oncology (16%), ophthalmology (8%), nuclear medicine (7%), orthopedics (6%), hematology (4%), and neurosurgery (4%). These cases represented 65.5% of total referrals, and 72.7% of estimated total cost of referrals in June of NIS 13 million ($ 3.3 million). A total of 218 patients were referred for either cardiac surgery (82) or cardiac catheterization (136), which represented almost one third (27.2%) of the total referral cost in June 2012; cases were referred to hospitals in the oPt (192 cases), Israel (18) Egypt (7) and Jordan (1).

Permit applications for patient referrals through Erez

In June 2012, 784 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, Israel and Jordan (see Table 2) compared with 883 in May, 764 in April and 768 in March 2012.

During this month 91% of applications (715) were for patient referrals submitted and financially covered by the MoH, 3.1% (25) were self-funded, 2% (16) by Physicians for Human Rights – Israel, 1.5% (12) by Nour ala al Alam Foundation, 0.6% (5) by Peres Peace Center and the remaining 1% (9) cases by other funds.

Throughout June, 93.5% (733 patients) of all patient applications for permits were approved, higher than the 2011 average approval rate of 89.7%. Three patients (0.4%) were denied permits to cross Erez checkpoint (2 males for orthopedic treatment, and one female for gynecologic treatment); 2 of the denied patients (1 male and  1 female) were in the 18-40 years age group, and the third was a male patient in the 41-60 years age group.

6.1% (48 patients, including 9 children) receive no answer to their applications before their hospital appointment date; 14 patients were waiting for ophthalmic treatment, 7 for orthopedic, 8 for cardiac, 6 for oncology, 4 for neurosurgery and the remaining for other specialties. 15 patients (4 females and 11 males) were called for interrogation by the Israeli General Security Services (GSS) as a condition of their permit application.

Following their interrogation, 10 patients received no response from the GSS about their permit application, 3 were approved, one was asked to resubmit the request, and one was asked to change their companion.

Delays in Medical Treatment

Delays in processing applications and non response to applications can be critical for patients who are waiting for urgent medical treatment. In 2011, WHO documented three cases of patients who died while waiting to receive permits to travel through Erez crossing to access their referral treatment, but this figure is considered underreported due to the lack of systematic follow up of the health status of patients denied health access.

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