Referral of Patients from the Gaza Strip, November 2010

Referral of Patients from the Gaza Strip, November 2010 1

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Permit applications for patient referrals through Erez

During November 2010, the Israeli District Liaison Office (DCL) processed 821 patient applications for

permits to cross Erez checkpoint to access hospitals in East Jerusalem, the West Bank, Israel and

Jordan (see Table 1 below). This compares to 976 processed applications in October and 626 in

September.

Table 1: District Liaison Office decisions on permit requests to cross Erez

(November 2010, disaggregated by age and sex)

Age group Total Approved Denied Delayed Did not

cross

despite

approval

Out of which

called in for

GSS interview

M F M F M F M F M F M F

0 - 3 79 60 77 57 0 0 2 3 0 0 0 0

4 - 17 100 67 91 60 0 0 9 7 0 0 0 0

18 - 40 118 84 46 53 8 4 64 27 8 2 0 0

41 - 60 137 71 107 62 4 0 26 9 2 1 0 0

Over 60 59 46 53 44 0 1 6 1 0 0 0 0

Sub-total 493 328 374 276 12 5 107 47 10 3 0 0

Total 821 650 17 154 13 0

79.2% of all applications were approved in November. In comparison, the approval rate for October

stood at 76.2%; however, in September it was substantially higher at 85.0% (see Figure 1 below).

In November, 2.1% of all patients (17 cases) had their application for referral through Erez checkpoint

denied. A further 18.8% (154 patients), including 21 children, had their application delayed.

Summary for November 2010

A 24-year-old man suffering from kidney failure and hepatitis C died while waiting

for referral. For three weeks, Israeli authorities did not reply to his request for an

urgent referral to a West Bank hospital.

One out of five patients who applied to cross Erez checkpoint for medical treatment could

not make it to their hospital appointment outside the Gaza Strip. Their application was

either delayed (18.8%) or denied (2.1%).

More than half of referred patients were transferred for the following health conditions:

cardiovascular diseases, oncology, orthopedics, ophthalmology and neurosurgery.

These treatments accounted for 60.3% of the total referral cost in November, which

reached NIS 11.9 million.

MONTHLY REPORT Referral of Patients from the Gaza Strip

November 2010

occupied Palestinian territory


Of the 154 patients whose applications were delayed by the Israeli authorities, 13 (1.6%) were called

for an interview with the Israeli Intelligence Services, known as General Security Services (GSS). Ten

of these patients did not attend the interview. One patient was asked to submit a new application after

the interview, one received approval to exit through Erez checkpoint, and one was denied.

93% of delayed patients faced delays of more than a week. 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. 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 November this was the case for a 24-year-old man (see “Death of Basil Lutfi Sadek” below). Since

the beginning of the year 2009 a total of 34 patients have died while waiting for permits.

Destinations and reasons for referral

During November 2010, the Referral Abroad Department (RAD) of the Palestinian Ministry of Health

(MoH) approved and issued 1,462 referral documents. RAD found that 453 patients were able to

receive appropriate treatment within the Gaza Strip, in either NGO or private hospitals.

The remaining 1,009 patients had to leave Gaza in order to be treated in hospitals in Egypt (42.5%),

East Jerusalem (24.4%), Israel (21.4%), the West Bank (10.7%) and Jordan (1.0%).

The main reasons for referrals in November were: cardiovascular i.e. heart diseases (17.5%), oncology

i.e. cancer (10.1%), orthopedics (9.1%), ophthalmology i.e. eye conditions (7.6%), and neurosurgery


(6.2%)1. These health conditions accounted for 50.3% of all referrals from Gaza; however, together

they made up 60.3% of the total cost of referrals in November, which reached NIS 11.9 million.

Erez and Rafah crossing data for November 2010

According to the Palestinian Liaison Officer at Erez, 638 patients crossed Erez checkpoint during

November 20102. 40 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 709 patients, including 48 via back-to-

back ambulances, in October.

Rafah border crossing was open for 23 days in November. It was closed for six days during the Muslim

holiday of Eid Al Adha and the two days of the last weekend. An estimated 500 patients crossed to

access Egyptian hospitals. This includes patients who were seeking medical treatment at their own

expense and, therefore, travelled without a RAD referral document.

Death of Basil Lutfi Sadek (24 years old)

Basil Lutfi Sadek, a 24-year-old man from Khan Younis, died on 22 November 2010 while waiting for a

referral to a hospital in the West Bank. He was suffering from kidney failure and his doctors referred

him to Al Mezzan Hospital in Hebron for a new AV fistula, a connection between an artery and a vein

which is required for dialysis.

1 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. 2 The discrepancy between the number of permits approved (650 for November 2010) and the number of patients who

crossed in this same month (638), is due to the fact that patients who have their permit approved at the end of one month might only cross the following month.


Basil Lutfi Sadek was diagnosed with kidney failure at the age of nine and shortly after started dialysis

to clean his blood. In 1998, when Basil was twelve years old, he received a kidney donated by his

mother. For four years Basil was able to live without dialysis. In 2002, his body rejected the kidney. At

the same time Basil received blood transfusions through which he contracted hepatitis C.

Gradually, Basil faced problems with dialysis: the AV fistulas were repeatedly infected or clogged,

which forced his doctors to create new ones. With each new AV fistula, the process became more

difficult. This is when Basil needed to be treated by specialists unavailable in Gaza.

In October 2009, Basil was referred for treatment to Al Makassed Hospital in East Jerusalem. He

missed his first hospital appointment because he was called by the Israeli GSS for an interview. After

the interview, his permit request was granted. He was allowed to pass through Erez checkpoint to travel

to Al Makassed Hospital twice in late November and again in December 2009.

Ten months later, new complications arose. This time, the RAD department referred Basil to Al Mezzan

Hospital in Hebron for an appointment on 18 October 2010. A first permit request transmitted to the

Israeli authorities went unanswered. A second urgent request was submitted on 2 November 2010.

Without an AV fistula, Basil could not undergo regular dialysis and had to reduce his sessions. It was

not until 22 November that the Israeli authorities gave the green light for him to cross Erez checkpoint.

In the meantime, Basil’s health condition deteriorated to the point where he was transferred to the

intensive care unit. The officials at the Palestinian MoH managed to secure an appointment at Al

Mezzan Hospital in Hebron, ambulance transportation and coordination for Basil for the very next day,

November 23.

Basil Lutfi Sadek died at 9pm on 22 November 2010, only hours before he was due to travel to the

specialist hospital.

Hepatitis B and C put additional strain on dialysis treatment for patients in Gaza

Since 2000, a rise in the number of hepatitis B and C cases (two forms of liver infection) has put

additional strain on dialysis treatment in Gaza. Shifa Hospital – Gaza’s biggest hospital – illustrates this

problem. 185 patients with kidney failure were undergoing dialysis in Shifa Hospital in November 2010.

Of these patients, 23 had the hepatitis C virus and an additional 10 had hepatitis B. To prevent

contamination of additional patients, Shifa Hospital has to split dialysis machines between three

separate groups: hepatitis B, hepatitis C and non-infected patients; and the machines cannot be

interchanged.

Lack of spare parts and difficulties with maintenance, as well as the highly unstable power supply,

continuously reduce the number of functioning machines. In late November, 8 machines out of a total of

38 were out of order. Scheduling patients – most of whom have to attend three 3-4 hour sessions per

week – is a constant challenge. Some patients have seen their sessions reduced or have had to go to

the hospital at irregular or late hours.


Annex 1: Historic data

District Liaison Office decisions on permit requests to cross Erez (total number and % per decision for given period)

Period Total Approved Denied Delayed

Out of which called in for

GSS interview3

Jan 2010 1081 845 24 212 85

78.2% 2.2% 19.6% 7.9%

Feb 2010 979 767 25 187 38

78.3% 2.6% 19.1% 3.9%

Mar 2010 1029 780 23 226 30

75.8% 2.2% 22.0% 2.9%

Apr 2010 1047 760 40 247 42

72.6% 3.8% 23.6% 4.0%

May 2010 1225 894 155 176 52

73.0% 12.7% 14.4% 4.2%

Jun 2010 1090 864 134 92 61

79.3% 12.3% 8.4% 5.6%

Jul 2010 947 789 95 63 31

83.3% 10.0% 6.7% 3.3%

Aug 2010 919 770 87 62 20

83.8% 9.5% 6.7% 2.2%

Sep 2010 626 532 14 80 15

85.0% 2.2% 12.8% 22.4%

Oct 2010 976 744 21 211 6

76.2% 2.2% 21.6% 0.6%

Nov 2010 821 650 17 154 13

79.2% 2.1% 18.8% 1.6%

Jan - Nov 2010 10740 8395 635 1710 393

78.2% 5.9% 15.9% 3.7%

2009 7514 5130 149 2235 636

68.3% 2.0% 29.7% 8.5%

3 The percentage rates for patients called for an interview with GSS are calculated from the total number of permit applications submitted.


Referrals out of Gaza by geographic location

(total numbers and % per destination for given period)

Period West Bank East Jerusalem

Egypt Jordan Israel

Jan 2010 125 327 172 11 189

15.2% 39.7% 20.9% 1.3% 22.9%

Feb 2010 148 327 167 21 168

17.8% 39.4% 20.1% 2.5% 20.2%

Mar 2010 87 364 204 10 205

10.0% 41.8% 23.4% 1.1% 23.6%

Apr 2010 97 299 280 7 183

11.2% 34.5% 32.3% 0.8% 21.1%

May 2010 176 342 209 9 230

18.2% 35.4% 21.6% 0.9% 23.8%

Jun 2010 125 301 443 10 186

11.7% 28.3% 41.6% 0.9% 17.5%

Jul 2010 140 253 470 14 203

13.0% 23.4% 43.5% 1.3% 18.8%

Aug 2010 129 323 388 11 257

11.6% 29.2% 35.0% 1.0% 23.2%

Sep 2010 99 212 414 8 206

10.5% 22.6% 44.1% 0.9% 21.9%

Oct 2010 114 285 496 24 189

10.3% 25.7% 44.8% 2.2% 17.1%

Nov 2010 108 246 429 10 216

10.7% 24.4% 42.5% 1.0% 21.4%

Jan - Nov 2010 1348 3279 3672 135 2232

12.6% 30.7% 34.4% 1.3% 20.9%

2009 1327 2453 3203 364 1158

15.6% 28.8% 37.7% 4.3% 13.6%

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Referral of Patients from the Gaza Strip, November 2010