Monthly Report: Health Access - Barriers for patients in the occupied Palestinian territory, August 2020

Situation Report
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6,593 referrals issued to access health facilities outside the Palestinian MoH
949 Gaza
5,570 West Bank

192 Gaza patients exited through Beit Hanoun/Erez for healthcare
155 Gaza patient companions exited through Beit Hanoun/Erez

No comprehensive data available for West Bank patient and companion permit applications following suspension to functioning of Civil Affairs Office; 889 permits approved for patients to access Augusta Victoria Hospital

3 Gaza patients called for security interrogation

Part 1 Referrals

August Referrals by the Ministry of Health

In August, the Palestinian Ministry of Health (MoH) issued 6,593 referrals to non-MoH facilities. A greater proportion of referrals were for patients from the West Bank in the context of continued restrictions on movement during the COVID-19 pandemic and obstacles to the coordination of permits. West Bank referrals comprised 84% (5,570) of all MoH referrals (the West Bank population comprises approximately 60% of the population in the oPt), including 846 for patients from Jerusalem, with Gaza referrals accounting for 14% (949). Meanwhile, two referrals were for Palestinian patients in Jordan and the origin of 72 referrals was not reported.

After an almost 40% reduction in West Bank referrals from March to April 2020, by June 2020 West Bank referrals had recovered to the pre-COVID-19 level. In August, there were 5,570 referrals compared to a monthly average of 5,133 referrals for the first quarter of 2020. By contrast, in the Gaza Strip the substantial 58% reduction in the monthly number of referrals from March to April 2020 has persisted. The number of referrals from the Gaza Strip in August (949) represents a 62% reduction in referrals compared to the monthly average for the first quarter of 2020 (2,481). Movement restrictions and the end to permits coordination, which has disproportionately affected the Gaza Strip, may be contributing factors to the inequity in referrals issued by the MoH.

The proportion of all Palestinian MoH referrals destined for hospitals within the West Bank, outside East Jerusalem, increased from 40% in the first quarter of 2020 – prior to the COVID-19 outbreak in the oPt – to 53% in August. Referrals within the Gaza Strip increased from 7% to 9%. Referrals to East Jerusalem hospitals have decreased from 41% to 33%; to Israeli hospitals from 5% to 4%; and to Egypt from 6% to 1%. Referrals to Jordan comprised 0.3% of the total in August. The top needed specialties for referrals were oncology (23%); urology (12%); nephrology (12%); cardiac catheterization (8%); cardiology (6%); ophthalmology (5%); and radiotherapy (5%).

Referrals for patients under 18 years of age comprised 19% (1,250) of the total, while 30% (1,968) were for those aged 60 years or older. Referrals for female patients comprised 46% of the total.