Occupied Palestinian territory | News | Gaza: access to specialized medical treatment interrupted due to the internal political rift, July 2012

Gaza: access to specialized medical treatment interrupted due to the internal political rift, July 2012

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The referral of patients out of Gaza for specialised medical treatment was suspended for a nine-day period (between 17 and 25 July) following a disagreement between the health authorities in Ramallah and Gaza over the management of the Referral Abroad Department (RAD) in Gaza. The closure delayed the processing of applications and created hardship and confusion for several hundred Gaza patients who had been seeking support for medical care.

The RAD office in Gaza, which reports to the central RAD in the Palestinian Authority’s (PA) Minister of Health (MoH) in Ramallah, sends patients’ referral applications to its committee of medical specialists which recommend whether to refer a patient for treatment to a non-MoH facility within Gaza or to a hospital outside Gaza. The recommendation is then approved (or rejected) by the RAD director in Gaza and forwarded to the central RAD department in Ramallah for approval and financial cover.

Referrals have become a significant expense for the MoH, representing 40 per cent of the MoH annual budget, second only to salaries. The latest crisis began after the MoH in Ramallah decided to replace the Gaza director and the medical review committee with new personnel. The next day the Hamas-run Ministry of Health in Gaza closed the RAD office.

Over the course of the crisis, the Palestine Human Rights Center (PHRC) in Gaza intervened to facilitate the submission of urgent RAD applications directly to Ramallah. The PCHR submitted a total of 181 cases during the nine days, of which 163 cases received RAD approval for financial coverage, and ten critical cases for immediate transfer out of Gaza for urgent treatment. Following negotiations between the sides and local health leaders, facilitated by WHO in Gaza, the RAD office was reopened on 26 July. The dispute, compounded by an ongoing financial crisis affecting the PA, resulted in a substantial decrease in the total number of applications approved by the RAD, from a monthly average in 2012 of 1340 applications, to just 833 during July. (In a previous dispute in 2009, the RAD shut down for 33 consecutive days.)

The gaps in medical services in Gaza are a result of decades of neglect in the development of adequate health infrastructure, planning and services under occupation, and the more recent impact of the Israeli-imposed blockade of Gaza since 2007. The political rift between the Gaza and Ramallah authorities, and the financial crisis of the PA, has also resulted in shortages in the supply of drugs and medical disposables to Gaza, which in turn increases the demand for referrals, particularly for chemotherapy for oncology patients. MoH referrals of Gaza patients to Jordan and Israel have been recently declining as a result of the financial crisis of the PA, which forced it to reduce costs by reducing referrals to the most costly destinations. In July 2012, only two referrals were made to Jordan, compared to a 2012 average of 38 referrals per month.

Since January 1991, Israeli movement restrictions on Gaza residents, including medical patients, have made exit from the Gaza Strip dependent on individual permits. In the past 10 years, permits have been tightly restricted for even those needing to access hospitals in the West Bank, Jordan or Israel. According to WHO, permit approval rates have improved in recent years, from 80 per cent in 2010, 90 per cent in 2011 and currently 94 per cent, due in part to advocacy efforts. However, hundreds of patients are still denied and delayed access, and can be subjected to interrogation and arrest at Erez checkpoint.

You can access this text in OCHA Monthly Humanitarian Monitor, July 2012, page 6 and 7