MONTHLY REPORT Referral of Patients from the Gaza Strip
December 2010
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occupied Palestinian territory
Summary for December 2010
Nearly one in four patients who applied to leave the Gaza Strip through Erez checkpoint for medical treatment were unable to attend their hospital appointment because they were delayed (21.2%) or denied (1.6%) permission to cross. Nearly half of all patients were referred for cardiovascular diseases, orthopedics, cancer, ophthalmology and neurosurgery.
Permit applications for patient referrals through Erez During December 2010, the Israeli District Liaison Office (DCL) processed 895 patient applications for permits to cross Erez checkpoint to access hospitals in East Jerusalem, the West Bank, Israel and Jordan (see Table 1 below). In comparison, 821 applications were processed in November and 976 in October.
Table 1: District Liaison Office decisions on permit requests to cross Erez (December 2010, disaggregated by age and sex) Age group
0-3 4 - 17 18 - 40 41 - 60 Over 60 Sub-total Total
Total
M F 74 63 87 78 148 82 130 89 71 73 510 385 895
Approved
M F 68 59 75 73 55 46 102 80 65 67 365 325 690
Denied
M 0 0 10 2 0 12
F 0 0 1 2 0 3 15
Delayed
M F 6 4 12 5 83 35 26 7 6 6 133 57 190
Out of which called in for GSS interview M F 0 0 0 0 12 4 4 0 0 0 16 4 20
Did not cross despite approval M 0 0 0 0 0 0
F 0 0 0 0 0 0 0
77.1% of all applications were approved in December, compared to 79.2% in November, 76.2% in October and 85% in September (see Figure 1 below). In December, 1.6% of all patients (12 men and 3 women) were denied permits to cross through Erez checkpoint. A further 21.2% (190 patients), including 27 children, had their application delayed. Delayed patients generally miss their hospital appointments. In most cases they have to seek new appointments and submit new applications for a permit to cross Erez checkpoint. 62.6% of delayed patients faced delays of more than a week. Of the 190 patients whose applications were delayed by the Israeli authorities, 20 (10.5%) were called for an interview with the Israeli Intelligence Services, known as General Security Services (GSS). 13 of these patients
Referral of Patients from the Gaza Strip, December 2010
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did not attend the interview; 2 patients were asked to submit a new application after the interview; 4 received approval; and 1 was denied. 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. Since the beginning of the year 2009 a total of 34 patients have died before being able to access the hospital they had been referred to.
Destinations and reasons for referral During December 2010, the Referral Abroad Department (RAD) of the Palestinian Ministry of Health (MoH) approved and issued 1,560 referral documents. RAD found that 435 referred patients were able to receive appropriate treatment within the Gaza Strip, in either NGO or private hospitals. The remaining 1,125 patients had to leave Gaza (see Figure 2 below) in order to be treated in hospitals in Egypt (47.7%), East Jerusalem (21.2%), Israel (18.8%), the West Bank (11%) and Jordan (1.3%). The main reasons for referrals in December continued to be for treatments not available in Gaza – for cardiovascular diseases (15.4%), orthopedic conditions, (9.2%), cancer (8.2%), eye diseases (7.3%) and 1 neurosurgical conditions (6.7%) . These health conditions accounted for 46.8% of all referrals from Gaza. Together they made up 58.1% of the total cost of referrals in December, which reached NIS 11.9 million. These figures are similar to those recorded in previous months. At the end of the year 2010, 140 drugs out of 480 on the essential drugs list were either completely out of stock or were down to less than one month’s supply. 9% were anti-cancer drugs and medicines to support cancer patients undergoing therapy. The effectiveness of cancer treatment depends to a large extent on the availability and consistent use of treatment protocol drugs. The non-availability of a single drug may lead to the suspension of a patient’s treatment and subsequent failure of the therapy. For more information on the state of cancer treatment in
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These figures include referrals to NGO and private hospitals inside Gaza. For technical reasons it is not currently possible to provide a separate breakdown for patients who have to leave the Gaza Strip.
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Gaza, please refer to Referral of Patients from the Gaza Strip, October 2010 (http://issuu.com/whoopt/docs/update_rad_october_2010).
Erez and Rafah crossing data for December 2010 According to the Palestinian Liaison Officer at Erez, 669 patients crossed Erez checkpoint during December 2 2010 . 41 of these patients needed to be transported by ambulance. Because Palestinian ambulances are not permitted to leave Gaza, the patients were transferred from one ambulance to another (back-to-back) at Erez checkpoint. This compares to 638 patients, including 40 via back-to-back ambulances, in November 2010. Rafah border crossing was open throughout December except for the weekends (Friday and Saturday). An estimated 600 patients crossed to access Egyptian hospitals. This includes patients who were seeking medical treatment at their own expense and, therefore, traveled without a RAD referral document.
Further information Back issues of this report and other WHO publications are available at: http://issuu.com/who-opt/docs To subscribe, for questions and inquiries, please write to: rad-report@who-health.org
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The discrepancy between the number of permits approved (690 for December 2010) and the number of patients who crossed in this same month (669), is due to the fact that patients who have their permit approved at the end of one month might only cross the following month.
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Annex 1: Historic data
District Liaison Office decisions on permit requests to cross Erez (total number and % per decision for given period) Period
Jan 2010 Feb 2010 Mar 2010 Apr 2010 May 2010 Jun 2010 Jul 2010 Aug 2010 Sep 2010 Oct 2010 Nov 2010 Dec 2010 2010 2009
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Total
1081 979 1029 1047 1225 1090 947 919 626 976 821 895 11635 7514
Approved
845 78.2% 767 78.3% 780 75.8% 760 72.6% 894 73.0% 864 79.3% 789 83.3% 770 83.8% 532 85.0% 744 76.2% 650 79.2% 690 77.1% 9085 78.1% 5130 68.3%
Denied
24 2.2% 25 2.6% 23 2.2% 40 3.8% 155 12.7% 134 12.3% 95 10.0% 87 9.5% 14 2.2% 21 2.2% 17 2.1% 15 1.7% 650 5.6% 149 2.0%
Delayed
212 19.6% 187 19.1% 226 22.0% 247 23.6% 176 14.4% 92 8.4% 63 6.7% 62 6.7% 80 12.8% 211 21.6% 154 18.8% 190 21.2% 1900 16.3% 2235 29.7%
Out of which called in for 3 GSS interview 85 7.9% 38 3.9% 30 2.9% 42 4.0% 52 4.2% 61 5.6% 31 3.3% 20 2.2% 15 22.4% 6 0.6% 13 1.6% 20 2.2% 413 3.5% 636 8.5%
The percentage rates for patients called for an interview with GSS are calculated from the total number of permit applications submitted.
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Referrals out of Gaza by geographic location (total numbers and % per destination for given period) Period Jan 2010 Feb 2010 Mar 2010 Apr 2010 May 2010 Jun 2010 Jul 2010 Aug 2010 Sep 2010 Oct 2010 Nov 2010 Dec 2010 2010 2009
West Bank
East Jerusalem
Egypt
Jordan
Israel
125 15.2% 148 17.8% 87 10.0% 97 11.2% 176 18.2% 125 11.7% 140 13.0% 129 11.6% 99 10.5% 114
327 39.7% 327 39.4% 364 41.8% 299 34.5% 342 35.4% 301 28.3% 253 23.4% 323 29.2% 212 22.6% 285
172 20.9% 167 20.1% 204 23.4% 280 32.3% 209 21.6% 443 41.6% 470 43.5% 388 35.0% 414 44.1% 496
11 1.3% 21 2.5% 10 1.1% 7 0.8% 9 0.9% 10 0.9% 14 1.3% 11 1.0% 8 0.9% 24
189 22.9% 168 20.2% 205 23.6% 183 21.1% 230 23.8% 186 17.5% 203 18.8% 257 23.2% 206 21.9% 189
10.3%
25.7%
44.8%
2.2%
17.1%
108
246
429
10
216
10.7%
24.4%
42.5%
1.0%
21.4%
124
238
537
15
211
11.0%
21.2%
47.7%
1.3%
18.8%
1472 12.5% 1327 15.6%
3517 29.8% 2453 28.8%
4209 35.7% 3203 37.7%
150 1.3% 364 4.3%
2443 20.7% 1158 13.6%
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