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UPDATE ON RAFAH CLOSURE Referral of Patients from the Gaza Strip

17 February 2011

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occupied Palestinian territory

SUMMARY: Two weeks after the closure of Rafah crossing  

Rafah border crossing with Egypt has remained closed as of 30 January 2011. No patients from the Gaza Strip have been able to travel to Egypt since that date. Prior to the closure, as many as 600 patients crossed through Rafah each month. The impact of the closure is felt most acutely by young men because they face problems obtaining Israeli-issued permits to cross through Erez. A young man accompanying his sick sister in an ambulance was arrested at Erez checkpoint on 15 February.

Rafah closed since the end of January On Sunday 30 January 2011, the Egyptian authorities announced that Rafah border crossing was to remain closed until further notice due to the political situation in Egypt. The crossing had been open on a daily basis since June 2010. In late November, the opening hours at Rafah were reduced to five days per week; the crossing being closed on weekends i.e. Fridays and Saturdays. Since June 2010, a substantial rise in the number of patients crossing from the Gaza Strip into Egypt had been recorded. In the last seven month of 2010, when Rafah was open, an average of 500 patients per month – roughly 45% of all referral patients – were referred to Egypt. The actual number of patients who travelled through Rafah was estimated to be higher - at over 600 per month - because some patients travelled at their own expense and were, thus, not recorded in the official referral figures. Rafah crossing is particularly important for young men between the ages of 18 and 40. Almost 60% of male patients in this age group requiring specialized medical treatment outside the Gaza Strip travelled to Egypt in the last seven months of 2010. This reflects the difficulties young men face in obtaining permits to cross Erez and access hospitals in East Jerusalem, the West Bank, Israel and Jordan. In 2010, half of all permit requests from 1 men aged 18-40 to cross Erez were denied or delayed by the Israeli authorities . They thus missed their hospital appointments.

Increased number of patients referred through Erez Since the closure of Rafah crossing, the Referral Abroad Department (RAD) of the Palestinian Ministry of Health (MoH) has started to redirect patients who were supposed to receive specialized treatment in Egypt to other destinations, mainly the West Bank and East Jerusalem. Between 1 and 15 February 2011, the Israeli District Liaison Office (DCL) processed 517 patient applications for permits to cross Erez checkpoint to access hospitals in East Jerusalem, the West Bank, Israel and Jordan (see Figure 1). The Israeli authorities approved 81% of these applications – a figure similar to the average number of approved permits in 2010. In comparison, 401 permit applications were processed in the first two weeks of January 2011, with an approval rate of 79%.

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Figures taken from an upcoming WHO report on the referral of patients from Gaza in 2010.

Referral of Patients from the Gaza Strip, Update on Rafah closure

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Figure 1: Permits and crossing data for Erez before and a er closure of Rafah on 30/01/2011 600 517 500 417

401

393

400 317

305

300

200

1st two weeks of January 2011 (when Rafah was open)

100

1st two weeks of February 2011 (Rafah crossing closed)

0 permits processed

permits approved

pa ents crossing

According to the Palestinian Liaison Officer at Erez, 393 patients crossed Erez checkpoint during the first half of February 2011. 25 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 305 patients, including 14 via back-to-back ambulances, in the first two weeks of January 2011.

Patient’s brother arrested at Erez crossing On 15 February 2011, Mohammed Zorob was arrested by Israeli authorities at Erez crossing. Mohammed was accompanying his sister Hanan Zorob to Rabin Beilinson Hospital in Israel. Hanan is suffering from leukemia (cancer of the blood) and was travelling in an intensive care unit ambulance. At Erez, Mohammed had to disembark the ambulance to go through the usual inspection process for Palestinian pedestrians. Despite having received a permit from the Israeli authorities as a companion to Hanan, Mohammed was interrogated by the Israeli General Security Services and thereafter detained. The reasons for his arrest and his whereabouts are unknown. Following the arrest of her brother, Hanan Zorob was transferred to Beilinson Hospital intensive care unit on her own. Her family was asked by the District Liaison Officer to arrange for another companion to join her. The fear of being detained at Erez crossing and the unpredictable permit process has lead many patients in the past months to ask for a referral to Egypt instead. With the prolonged closure of Rafah border, this option remains unavailable. For patients with severe medical conditions, the only alternative to passing through Erez is to make do with the limited treatment available in Gaza.

Referral of Patients from the Gaza Strip, Update on Rafah closure

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Update on Rafah Closure: Impact on Referral of Patients from the Gaza Strip -