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

 Referral of Patients from the Gaza Strip

 Ref: RAD 12 (Jan.21, 2013)

 Summary

 Referrals reflect fragile health care system

The total number of Gaza patients referred by the Ministry of Health (MoH) in December was 1,188, an increase from the previous month but below the monthly average in the first half of the year 2012 of 1,340. In the second half of the year the average number of referrals dropped to 937, due primarily to MoH budget limitations as a result of the financial crisis facing the Palestinian Authority.

According to the Gaza Referral Abroad Department (RAD) data, of the 1,188 MoH referrals, 374 (31.5%) were referred to hospitals in East Jerusalem, 344 (29%) to Egypt, 181 (15%) to Israel, 131 (11%) to West Bank hospitals, only 1 (0.08%) to Jordan and 157 (13%) to NGO and private hospitals inside the Gaza Strip (Table 1). The number of referrals inside Gaza to non-MoH facilities rose significantly in December compared with the previous 5 months because the lithotripsy machine for treating kidney stones in the European Gaza Hospital (EGH) was out of order. Referrals for MRI also increased, especially for children who require anesthesia during the test. The only MRI machine still functioning in MoH facilities, located in the EGH, lacks a monitor for children and is overloaded with cases.

Gaza referral data for December show a gender gap: 56% of referrals were males and 44% were females. 27% of all referrals were children aged 0-17 years and 18% were elderly over 60 years. 85% of all referrals were for admission as inpatients while 15% were to outpatient clinics. The total estimated cost for all referrals was NIS 11,392,762. Heart surgery, hematology and neurosurgery were the highest in cost per case. Nasser hospital in Cairo, Makassed hospital and Augusta Victoria hospital in East Jerusalem received the highest number of referrals respectively.

Health access: patient applications for Israeli-issued permits to cross Erez

In December 2012, applications were submitted for 894 patients to the Israeli District Liaison Office (DCL) for permits to cross Erez and access hospitals in the West Bank including East Jerusalem, in Israel or Jordan. Of the total, 820 patients (91.72%) received permits to cross Erez and 4 (0.45%) were denied (Table 2). The 4 denied patients were all men between 20 and 40 years old, and had been referred to Makassed hospital in East Jerusalem, 3 for orthopedic treatments and 1 for internal medicine. 70 patients (25 females and 45 males, 7.8% of the total applicants) did not receive a response and therefore lost their appointments in the hospitals: 16 had had appointments in Israeli hospitals and the rest in the West Bank including in East Jerusalem. Among the 70 patients, 5 were oncology patients, 9 were cardiac, and 12 were ophthalmic cases. 37 patients (4%) were called for interrogation by Israeli General Security Services (GSS) as a condition to process their application, representing an increase in GSS calls for patients compared to previous months.

In December, 88% of Israeli permit applicants were referrals financially covered by MoH. The rest were covered by different sources (Table 3).

The Palestinian General Authority for Civil Affairs registered 752 patients and 673 companions travelling through Erez checkpoint towards Israel during December. 51 patients were transferred by ambulance through Erez; 6 were urgent cases and transferred during off-duty hours. Since Palestinian ambulances are not permitted to leave Gaza, patients must be transferred from a Palestinian ambulance, and carried on a gurney to an Israeli-plated ambulance at Erez crossing 200 meters away (Table 4).

According to the Emergency Medical Services of MoH in Gaza, their office coordinated the travel of 743 people to Egypt. 70 patients were transferred by ambulance with 91 companions. The remaining 582 were patients and their companions who travelled through Rafah terminal as regular passengers.

Humanitarian assistance: patients transferred within the region

Tunisia: Four seriously injured patients from Gaza were transferred to Tunisia on December 7. The patients — two boys, aged 10 years and 14 years, and two young men, aged 18 — had sustained injuries in the recent 8-days of attacks on Gaza. The four patients were transferred through Rafah terminal to Al Arish airport where they were evacuated by a Tunisian aircraft to Tunis. They were accompanied by the Tunisian medical delegation that had been visiting Gaza after the ceasefire. The delegation coordinated the transfer with the MoH in Gaza through the Tunisian embassy in Cairo.

Turkey: Three Palestinian patients in Shifa Hospital in Gaza were referred to Atatürk Training and Research Hospital in Ankara, Turkey, on 4 December 2012. The patients and their companions were transferred to Turkey via al-Arish Airport in Egypt by ambulance aircraft provided by the Ministry of Health of the Republic of Turkey. The transfers between Rafah Border Gate and Al Arish Airport were coordinated by the embassies of Palestine and Turkey in Cairo. Two women, aged 34 and 48, and an 18-year-old young man were transferred; the latter two sustained injuries as a result of the attacks on Gaza in November.