Occupied Palestinian territory | News | Press releases | 2011 | Referral patients vulnerable to delay, denial and conditions in accessing right to health

Referral patients vulnerable to delay, denial and conditions in accessing right to health

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"Patients often suffer protracted delays in receiving permits to access medical services; can face interrogation by the Israeli security services as an application condition; experience difficulties during the arduous travel procedures to destination; and, in worst cases, can be denied access. Patients waiting for health care require an efficient, timely, dignified and transparent process for applying for referrals and permits for themselves and their caretakers to exit from Erez checkpoint."

Referral of Gaza Patients: Commentary and Data 2010, WHO oPt (July 2011),


Barriers to access:

The Palestinian Authority Ministry of Health sponsors referral treatment for Palestinians for services that are not available in Gaza. Patient access to services, either in the oPt or in neighbouring countries, is a complicated process which is neither transparent nor timely, and presents barriers for Palestinian patients.

Permits required at Erez:

Patients are required to apply for Israeli-issued permits if they need to cross Erez checkpoint for treatment in the West Bank, East Jerusalem, Jordan or Israel. Patients needing multiple sessions of chemotherapy or radiation must apply for a new permit for each appointment. The Palestinian Liaison Office submitted 11,176 applications to the Israel Liaison Office for permits in 2010. MoH referrals accounted for 85% while 15% were for patients supported by NGOs or charities, or were self-funded.

63% of MoH outside referrals through Erez checkpoint are to Palestinian facilities within the oPt (West Bank and East Jerusalem).

Permits can be denied:

The overall approval rate of permit applications in 2010 was 82%, highest for children (94%) and lowest for

adults aged 18-40 (57%).18% of applications were denied or delayed: 646 permit applications were denied, and 1,418 applications were not answered in time for patients to meet their medical appointments.

Permits are conditioned:

One in 25 patients is called for questioning by Israeli security services as a condition for access though Erez checkpoint, after applying for a permit.

No direct access for ambulances:

Critically ill patients traveling by ambulance must be transferred at Erez checkpoint by being carried 100 meters from Palestinian ambulances to Israeli ambulances for travel through Israel. Ambulatory patients must travel by taxis at their own expense.

Delays for critically ill:

35 patients died before reaching referral hospital in 2009 (29) and 2010 (6).

Referrals reflect gaps in health care:

inadequate infrastructure

lack of professional training for staff

shortages in supply of medicines and disposables and fuel

delayed equipment maintenance due in part to the tight restrictions on


movement of people.

delayed equipment and good into and out of Gaza

Delays at Rafah:

In 2010, about 30% of patient referrals were to Nasser Institute Facility in Cairo, which requires coordination with Egyptian authorities to access through Rafah crossing. Patients faced long delays in access due to border closures and daily quotas on passenger exit. In the last half of 2010, the percentage of patients referred through Rafah increased from 29% to 45% of MoH referrals, indicating its importance as a medical access route for Gaza patients.

International law:

The Government of Israel is obligated under the International Covenant on Economic, Social and Cultural Rights, and General Comment 14 to respect the Right to Health, including to not deny or limit equal access to health services. WHO calls on all parties concerned, Israel and Egypt, as well as the Palestinian Authority in Ramallah and the de facto

authorities in Gaza, to fulfill their respective responsibilities to ensure that the Right to Health of patients is protected, including access for medical treatment, and that health services are efficiently managed and ensured the means for continued development, in the best interests of patients.

Health Facts Gaza

Fertility rate 5.4
Infant mortality 21.5
Anaemia among pregnant women 14.1% increase
Anaemia among infants 5.3% increase
Food insecurity 54%
Living in poverty 38%