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MONTHLY REPORT Referral Abroad of Patients from the Gaza Strip

February 2010

West Bank and Gaza

• Summary -

A 62 year old patient died before he could access the hospital he had been referred to for urgent medical treatment.

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979 applications for permits for patients to cross Erez were submitted to the Israeli Authorities in February 2010. 22% of these applications were denied or delayed, as a result of which patients missed their hospital appointments and had to restart the referral process.

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Rafah border was closed to patients during the whole of February 2010. Patients with appointments in Egyptian hospitals were forced to miss these appointments.

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For the last two months, referrals for oncology treatment have been higher than in previous months. This reflects the shortage of oncology medication in Gaza.

• Referral Abroad Department Between 1 and 28 February 2010, the Referral Abroad Department (RAD) approved and issued 1105 referral documents, compared with 1107 in January and 1224 in December 2009. The breakdown of referrals by main disease or health condition, as reported by the District Liaison Office - Gaza, is as follows: 16% cardiovascular disease, 13% - oncology, 15% - ophthalmology, 10% - orthopaedics, and 9% - neurosurgery. For the second consecutive month there was a higher proportion of oncology referrals than in previous months. This increase is due to the ongoing shortage of cancer drugs in Gaza. Referrals by destination were as follows: 15% to Israeli hospitals, 43% to the West Bank and East Jerusalem, 15% to Egypt, 2% to Jordan, and the remainder to NGOs hospitals within Gaza. The District Liaison Office for Erez crossing processed 979 applications for permits for patients to cross Erez for hospital appointments during February, compared to 1081 in January. Of the 979 applications processed, 78% were approved, 3% (25 cases) were denied and 19% delayed. These figures are very similar to figures from the previous four months. Age Group in years 0–3 4 - 18 19 – 40 41 – 60 Over 60 Total

Total M 54 150 177 158 65 604

F 44 76 90 106 59 375

Approved

Denied

Delayed

M 50 131 91 118 61 451

M 0 0 17 5

M 4 19 69 35 4 131

F 38 68 64 92 54 316

22

F 0 0 2 1 0 3

F 6 8 24 13 5 56

Of those delayed, number sent for GSS interview M F 0 0 0 1 18 9 8 2 0 0 26 12

Grand Total 979

767

25

187

38

Table showing the results of District Liaison Office processing of patient applications to cross Erez, disaggregated by age and sex, for February 2010.

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Table showing patient applications to cross Erez by numbers approved, denied and delayed since January 2008.

Of the 187 patients whose applications were delayed by the Israeli Authorities, 38 were called for interview with the Israeli General Security Services (GSS). The proportion of applicants referred for interview in February with the GSS was 4% compared to 8% in January and 4% in December. Six of those referred to the GSS did not attend the interview; 24 were asked to submit new applications; 6 were given permission to cross after the interview; and two were denied permission. Of the 187 patients whose applications were delayed, the majority faced delays of more than eight days (69%). 98% of applications were processed within 30 days. The delayed patients missed their appointments. As a result, they have to obtain new hospital appointments and submit new applications for permits to cross Erez. Delays in processing applications can be critical for patients who are waiting for urgent medical treatment. Some may die while waiting for permission to access the medical facility they have been referred to. In February 2010 one patient died before being able to access the hospital he had been referred to (See case study below). To date, 30 patients have died while awaiting referral since the beginning of 2009. The strict closure of the Gaza Strip has impoverished and restricted medical services in Gaza. This increases the need to refer patients for treatment outside Gaza. The process of obtaining a referral document is not easy, and when a patient manages to obtain it, he or she then has to wait for a hospital appointment to come through, before applying to the Israeli Authorities for permission to leave Gaza. According to the Liaison Officer at Erez, 720 patients crossed Erez in February, including 42 patients who crossed via back to back ambulances. This compares to 748, including 43 via back to back ambulances, in January and 858 including 52 via back to back ambulances in December. Rafah border crossing was closed to patients for the whole of February, so patients were unable to cross for medical treatment in Egypt.

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Case Study Death of Farouq Khaleel Kanoon Farouq K. Kanoon , 62 years old, suffered from a cardiac disease known as mitral valve stenosis that requires urgent surgery. He managed to obtain a referral document and an appointment at Nablus Hospital on 8 February 2010. The District Liaison Office, responsible for coordinating Mr. Kanoon's exit through Erez Crossing, tried to obtain an urgent permit for him from 1400 hours on 8 February. The Israeli response came through at 2100 hours. Mr. Kanoon died at 0300 on 9 February 2010 as his family were arranging for his transfer from Erez via ambulance.

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Referral Abroad of Patients from the Gaza Strip, February 2010