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Minimizing Medical Referrals Abroad Jeopardizes Patients’ Lives

Ref: 53/2017

The Palestinian Center for Human Rights (PCHR) follows up with concern the latest updates of the External Medical Treatment Department in the Gaza Strip manifested in Ramallah’s Ministry of Health minimizing medical referrals abroad, without explaining reasons, for patients suffering from serious health problems that cannot be treated in the Gaza Strip hospitals. PCHR is concerned over the disastrous impacts inflicted on hundreds of patients who urgently need medical treatment or medical follow-up in hospitals in Israel and the West Bank, including occupied Jerusalem.


Based on PCHR’s constant follow-up of the external treatment file, Ramallah’s Ministry of Health minimized in April referrals abroad or the renewal of other referrals of hundreds of patients suffering from serious and chronic diseases without displaying the reasons behind this decision. In view of these updates, PCHR sent a letter to Dr. Jawad Awwad, the Health Minister in the National Unity Government, on 21 June 2017, expressing its concern over the delay of medical referrals for the Gaza Strip patients and demanding the Minister to send the financial coverage for those patients, especially for cancer and cardiac patients and children. However, PCHR received a response from Dr. Amira al-Hendi, Director General of the External Medical Treatment Department, through the Minister’s office on 03 July 2017 negating the Ministry’s suspension of medical referrals in the southern governorates (Gaza Strip), considering that as fake allegations.


Data collected by PCHR indicates there is a gradual decline in the number of medical referrals issued for the Gaza Strip patients, as the number reached 2,190 referrals in March, but declined to 1,756 in April at a rate of 19.8%. Moreover, the medical referrals decreased in May to 1,484 at a rate of 32.2%. The information collected by PCHR shows that the number of referrals in June did not exceed 500, which points out that they declined at a rate of over 75%. On the other hand, the External Medical Treatment Department adopted a new mechanism when dealing with serious cases, under which patients are referred upon the approval of the Department’s Director, as the “financial coverage is offered later and following the coordination needed”. On Thursday, 15 June 2017, this mechanism stopped upon the instructions given by Ramallah’s Ministry of Health to the External Medical Treatment Department in Gaza. The number of medical referrals approved by the Higher Medical Committee in the Gaza Strip since early June is over 2,500 referrals so far for patients suffering from serious diseases that have no treatment in Gaza. These patients are awaiting for the approval on the financial coverage for their treatment abroad. However, Ramallah’s External Medical Treatment Department issued only 400 referrals. This raises concerns on the delay of about a month and a half, in addition to the decline in the number of medical referrals despite the approval of the Higher Medical Committee in the Gaza Strip.

These measures deny dozens of patients who need urgent treatment the opportunity to receive medical treatment outside the Gaza Strip. They also result in a grave deterioration in the health sector and jeopardize the patients’ lives. A number of these patients were admitted to the intensive care unit in Gaza following their health status deterioration. Hundreds of patients have been expecting death in the Gaza Strip hospitals in light of the absence of any opportunity to receive treatment abroad.


PCHR is shocked as the West Bank hospitals has started rejecting hospital appointments for the Gaza Strip patients with medical referrals from the External Medical Treatment Department although these hospitals used to reserve a bed for the referred patient under the term “financial coverage offered later“.  The new measure taken hinders the Gaza Strip patients’ access to those hospitals and aggravates the health situation.


Denying patients their right to receive medical treatment abroad, in view of the absence of a proper alternative in Gaza, is a clear violation of the right to health ensured in the Palestinian Basic Law (PBL) amended in 2003 and the Public Health Law 20/2004 that stipulates in article (2-1), “With the coordination with the concerned institutions, the Ministry of Health must provide governmental preventive, diagnostic, curative, and rehabilitative health services ;and establish needed health institutions”. Denying patients the right to health is an obvious violation of the international human rights standards, including article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) to which Palestine acceded in 2014. This accession obliges Palestine to offer each individual the highest attainable standard of physical and mental health, including access to health services, medication and treatment.


PCHR emphasizes that each Palestinian civilian has the right to enjoy the highest attainable standard of mental and physical health according to the international human rights standards and PBL.  Thus, PCHR:


  • Calls upon the Palestinian President to intervene immediately to guarantee the protection of the Gaza Strip patients’ right to enjoy all health services, including referring them for treatment abroad and financially covering them.
  • Calls upon the Unity Government and Ministry of Health to consider the implications of reducing the number of patients referred for treatment abroad and its impact on patients’ life, demanding the Government to immediately work on issuing the medical referrals necessary for the Gaza patients, including the emergency cases.
  • Warns of the deterioration of health conditions of hundreds of patients, who suffer from serious diseases and cannot receive or complete their treatment in the Gaza Strip hospitals and also warns of the death of some patients in case these measures continued.
  • Calls for keeping away the health services from the political conflict and devoting all efforts to improve the health sector in general and take care of patients who suffer from serious diseases in particular.
  • Calls upon the international community to put pressure on the Israeli authorities, in its capacity as an occupying power, to assume its legal obligations towards the Gaza Strip residents in a way that guarantees their right to enjoy the most attainable standard of mental and physical health and right to travel and have secure access to the hospital abroad according to the international humanitarian law, particularly the 1949 Fourth Geneva Convention relative to the Protection of Civilian Persons in Time of War, and 1977 Protocols I and II additional to the 1949 Geneva Conventions.
  • Calls upon the international community to pressurize the Palestinian Authority not to undermine the basic rights of Palestinians residing in the Gaza Strip, particularly patients, and to fulfill its legal obligations as a State Party to the ICESCR after acceding to it in 2014, including its legal obligations towards the right to health.