Occupied Palestinian territory | News | Continuing restrictions on Rafah crossing impede Gazans’ access to health, July 2013

Continuing restrictions on Rafah crossing impede Gazans’ access to health, July 2013

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Following unrest in Egypt and a deteriorating security situation in the Sinai Peninsula, the Egyptian authorities tightened controls on the border area with Gaza. On 5 July, the Egyptian authorities closed the Rafah passenger crossing entirely, leaving thousands of Palestinians stranded on both the Egyptian and Gaza side of the border. The crossing partially re-opened on 10 July and has since remained operational for four hours per day, six days per week, compared to the previous standard of nine hours per day, seven days per week. Only foreign nationals, authorized Palestinians holding dual nationality and a limited number of Palestinians referred officially for medical treatment abroad were allowed to cross. The average number of people passing per day in July was 540, less than 30 per cent of the approximately 1,860 who crossed daily in June. The crossing remains the primary exit and entry point to the Gaza Strip for Palestinians, due to the long-standing restrictions imposed by Israel on pedestrian movement via the Erez Crossing.

The partial closure restricted travel abroad for hundreds of Gaza patients. In July, only patients who held official referral documents from the Palestinian Ministry of Health Referral Abroad Department (MoH-Ramallah) guaranteeing financial coverage were able to exit Gaza through the Rafah Crossing. In the first four weeks of July, a total of 131 patients, of whom 22 were children up to 17 years old, were referred by the MoH to Egypt, less than half the usual number. However, no compensatory increases were noted in referrals through Erez checkpoint to the West Bank and Israel, or to non-Ministry facilities within Gaza in July, suggesting that patients chose to delay medical treatment, rather than seek to obtain a permit to exit through Erez to alternative hospitals. Patients aged 18-40 years, especially males, are most often required to submit to Israeli security interviews as part of the application process for permits to exit via Erez. Companions must also apply for permits, and may likewise be called for interviews.

Since 2010, the Palestinian Ministry of Health has depended on Egypt to treat 22 per  cent of its outside referrals from Gaza, second only to East Jerusalem hospitals, where 26  per cent of Gaza referral patients are sent. Twenty per cent are referred to non-Ministry facilities in Gaza, 16 per cent to Israel, and 10 per cent to other health centres in the West  Bank. Previously, six per cent had been referred to Jordan, but that ended in 2012 due to the accrued Palestinian Authority (PA) debt. The number of Gaza patients seeking self funded care in Egypt may be equal to the number of MoH referrals per month, but can only be estimated, as these cases are not registered as medical cases at the border.

Also this month, the Ministry of Health in Gaza began restricting X-rays and limiting certain drugs to emergency use only, due to low supplies and the unreliable flow of medical supplies via the Rafah Crossing. Twenty-five per cent of its drug supplies are normally received from, or through, Egypt via this crossing. Two principal Egyptian donors, the Arab Physicians Union and the Physicians Syndicate, are expected to halt donations to Gaza in view of current urgent needs in Egypt. These groups have played a crucial role as a source for rapid supply of critical items, such as dialysis solutions, common chemotherapy drugs, Factor VIII for haemophilia, immunosuppressants for kidney transplant patients and treatments for other chronic blood disease conditions. Any sustained gap in the supply of these items would have immediate negative impact  on patients. The Human Appeal International (United Arab Emirates) and Qatar Red Crescent also provide donations to the MoH in Gaza via Rafah, but according to the MoH, only one drug shipment has been received via that route since 30 June, from an Italian NGO.

At the end of July, 27 per cent (128 items) of essential medicines were at zero stock in the Central Drug Store in Gaza and 16 per cent (78 items) were at low stock (between 1-3 months’ supply). Medical disposables were also at critical levels, with 53 per cent (476 items) at zero stock and eight per cent (73 items) at low stock. The ability of the MoH in the West Bank to resupply Gaza is also hindered by a similar level of drug shortages in its Central Drug Store, due to the Palestinian Authority budget shortfall. Thirty per cent of medical donations and supplies are transferred to the MoH in Gaza from the West Bank, via the Kerem Shalom crossing; WHO, ICRC and UNICEF provided supplies of medicines and medical consumables requested by the MoH Gaza as top priority items during June and July. Erez checkpoint is sometimes used for supplies of vaccines through WHO coordination.

You can access this text in OCHA Humanitarian Bulletin, July 2013, Page 2