Referral of Patients from Gaza: Data and Commentary for 2010
Patients from Gaza Face Obstacles In Accessing Right to Health
The World Health Organization in the occupied Palestinian territories today published a 32-page report entitled Referral of Patients from Gaza about access to health care for patients from Gaza who are referred for medical treatment through the Israeli-controlled Erez checkpoint and the Egyptian-controlled Rafah crossing.
The majority of these referrals were for specialized diagnosis and treatment services for cardiovascular diseases, oncology, ophthalmology, orthopaedics or neurosurgery --- services which are not available in the Gaza Strip. The report examines the lack of development of these specialties in Gaza and the range of problems affecting the quality of patient care due to the blockade on Gaza. The public health system has deteriorated due to the restrictions on the movement of people and goods which are essential for training of health staff, import and maintenance of medical equipment, continuous professional education and construction and improvement of health facilities.
The report summarizes data from monthly reports published during 2010 by WHO oPt. 12,483 patients were referred by the Referral Abroad Department of the Palestinian Ministry of Health (MoH) for treatment or surgery to health facilities outside of the Gaza Strip. Of these, 7,640 patients required access through Erez checkpoint to hospitals in the West Bank including Jerusalem, Israel or Jordan. Almost half of the referrals were to the six Palestinian hospitals in East Jerusalem, the main referral hospitals for Palestinians for ophthalmic surgery, chemotherapy for cancer patients, and orthopaedic procedures. The remaining 4,843 (39%) patients were referred to facilities in Egypt, which require coordination with Egyptian authorities for access through the Rafah border crossing.
The Palestinian Liaison Office submitted 11,176 applications to the Israel Liaison Office for permits for patients to cross Erez for access to scheduled appointments for medical care in 2010. The overall approval rate of permit applications was 82%, highest for children (94%) and lowest for adults aged 18-40 (57%). A total of 646 patient applications for permits were denied in 2010 (6%). MoH referrals accounted for about 85% of the permit applications while the remaining 15% were for patients supported by NGOs or charities, or who were self-funded. 35% of applications were for medical care for children.
WHO identified a number of problems for Gaza patients who require access to medical care outside of Gaza. “Patients often suffer protracted delays in receiving permits to access medical services; can face interrogation by the Israeli security services as an application condition; experience difficulties during the arduous travel procedures to destination; and, in worst cases, can be denied access.”
The report indicated that 421 patients were called for questioning by the Israeli Security Services in 2010 after applying for a permit, 1,418 applications were not answered in time for patients to meet their medical appointments, and 646 patient applications for permits were refused, resulting in a denial of medical access. Critically ill patients traveling by ambulance must be transferred through back-to-back procedures at Erez checkpoint from Palestinian ambulances to Israeli ambulances for travel within Israel.
WHO emphasized that, “Patients waiting for health care require an efficient, timely, dignified and transparent process for applying for referrals and permits for themselves and their caretakers to exit from Erez checkpoint.”
Patient access through Rafah border crossing to Egypt checkpoint was also hindered in 2010, due to the irregular schedule of opening of Rafah checkpoint and its total closure for two months. However, in the last half of 2010, the percentage of patients referred through Rafah increased from 29% to 45% of MoH referrals, indicating its importance as a medical access route for Gaza patients.
WHO called on all parties concerned --- the Palestinian Authority in Ramallah and the de facto authorities in Gaza, as well as Israel and Egypt --- to fulfill their responsibilities to ensure that the Right to Health of patients is protected, including access for medical treatment, and that health services are efficiently managed and that the means is ensured for continued development, in the best interests of patients.