Referral of Patients from the Gaza Strip, September 2010

Referral of Patients from the Gaza Strip, September 2010 1

Permit applications for patient referrals through Erez

During September 2010, the Israeli District Liaison Office (DCL) processed 626 patient applications for permits to

cross Erez checkpoint to access hospitals in East Jerusalem, the West Bank, Israel and Jordan (see Table 1

below). The number of applications processed in September was approximately one third lower than in

the preceding three months: 919 applications were processed in August, 947 in July and 1,090 in June. The

reason for this decrease is the numerous Israeli holidays in September: besides the regular four Saturdays,

Erez crossing was closed for an additional eight days.

Table 1: District Liaison Office decisions on permit requests to cross Erez (September 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 40 49 37 48 0 0 3 1 0 0 0 0

4 – 17 82 62 73 55 0 1 9 6 0 0 0 0

18 – 40 81 75 47 53 6 3 28 19 7 7 0 0

41 – 60 82 70 73 64 2 2 7 4 1 0 0 0

Over 60 46 39 44 38 0 0 2 1 0 0 0 0

Sub-total 331 295 274 258 8 6 49 31 8 7 0 0

Total 626 532 14 80 15 0

The proportion of applications that were approved remained high at 85% (532 applications). This is the

highest rate since the beginning of 2008. Approval rates have been over 80% for three consecutive months – in

the third quarter of 2010 83.9% of all applications were approved compared to 76.1% in the first half of the year.

Summary for September 2010

The number of patient applications for permits to cross Erez which were processed,

as well as the number of patients who crossed the checkpoint, decreased

substantially in September 2010. Erez remained closed for 12 days, due to Israeli

holidays.

Referrals to Egypt have remained high since the opening of the Rafah border crossing

in June. Whereas referrals to Egypt have roughly doubled, those to East Jerusalem

have declined substantially.

Cardiovascular diseases, oncology, ophthalmology, orthopedics and neurosurgery

are the main causes for referrals, accounting for almost half of all cases.

MONTHLY REPORT Referral of Patients from the Gaza Strip

September 2010

occupied Palestinian territory


September saw the highest proportion of cases delayed in the last four months (see Figure 1 below) –

probably a result of the limited working hours at the Erez DCL during the holidays. 12.8% of applicants did not

receive an answer from the Israeli DCL in time for their hospital appointment and, therefore, missed it. On the

other hand, only 2.2% of applications (14 cases, including one child) were denied, the lowest rate since March

2010.

Of the 80 patients whose applications were delayed by the Israeli Authorities, 15 (2.4% of all applicants) were

called for an interview with the Israeli Intelligence Services, known as General Security Services (see Table 1

above). This is slightly more than in August (2.2%) and less than in July (3.3%). Of the 15 patients called for

interview, 6 did not attend, 6 were asked to submit new applications and 3 were given permission to cross after

the interview.

57.5% of delayed patients faced delays for 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.

Delays in processing applications can be critical for patients who are waiting for urgent medical treatment. Since

the beginning of 2009 32 patients have died before being able to access the hospital they were referred

to.

Destinations and reasons for referral

In September 2010 the Referral Abroad Department (RAD) of the Palestinian Ministry of Health (MoH) approved

and issued 1,248 referral documents, compared with an average of 1,368 in the previous three months.

For 309 of these 1,248 patients RAD found appropriate medical treatment within the Gaza Strip, in either NGO or

private hospitals. The remaining 939 patients had to leave Gaza to be treated in hospitals in Egypt (44.1%),

East Jerusalem (22.6%), Israel (21.9%), the West Bank (10.5%) or Jordan (0.9%).

The trend towards a substantially higher proportion of patients being referred to Egypt has continued since

June 2010, when the border crossing at Rafah opened on a daily basis – following the Gaza flotilla incident on 31

May. Whereas between January and May 2010 23.7% of patients referred to hospitals outside Gaza went to


Egypt, in the wake of the flotilla incident Egypt’s share of referrals has risen to 40.9%. In contrast, East Jerusalem

hospitals have registered the sharpest decline in the share of patients referred from Gaza, falling from an average

of 38.1% in the first five months of the year to a 26% average since June (see Figure 2 below).

The main causes for referrals were cardiovascular diseases (17.8%), oncology (9.2%), ophthalmology (8.5%),

orthopedics (7.6%) and neurosurgery (5.8%)1. These health conditions account for an accumulated 48.9% of total

referrals, very much similar to the last five months.

Erez and Rafah crossing data for September 2010

According to the Palestinian Liaison Officer at Erez, 519 patients crossed the checkpoint during September 20102;

36 were patients who were transferred from one ambulance to another (back-to-back). This compares to 729

patients, including 43 via back-to-back ambulances, in August.

For the fourth month in a row, the Rafah border crossing was open throughout the month of September. An

estimated 550 patients crossed the border to access Egyptian hospitals. This includes patients who were seeking

medical treatment at their own expense and, therefore, travelled without a RAD referral document.

1 These figures include referrals to NGO and private hospitals inside Gaza because 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 (532 for September 2010) and the number of patients who crossed in this same

month (519), 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 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%

Jan-Sep 2010 8943 7001 597 1345 374

78.3% 6.7% 15.0%% 4.2%

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%

Jan - Sep 2010 1126 2748 2747 101 1827

13.2% 32.1% 32.1% 1.2% 21.4%

2009 1327 2453 3203 364 1158

15.6% 28.8% 37.7% 4.3% 13.6%

Documents

Referral of Patients from the Gaza Strip, September 2010