Following a hearing session AMAN held on the role of the Palestinian Ministry of Health in treatment and medical referrals of the wounded and the patients from Gaza Strip
Unanimously agree on the need to declare an emergency in Gaza Strip and unify efforts to support the collapsing health sector in Gaza Strip
Ramallah-The Coalition for Accountability and Integrity-AMAN held a hearing session with the Ministry of Health (MOH), during which it hosted the Director General for External Treatment Doctor Mahdi Rashed. The hearing session addressed the role of MOH in external treatment and the process of medical referrals for of the wounded and sick in Gaza Strip”. Representatives of MOH, the Ministry of Social Development (MOSD), Ministry of Foreign Affairs and Expatriates (MOFA), the Prime Minister’s office/Executive reform office, physicians and hospital staff, directors of medical non-governmental organizations, representatives of the Independent Human Rights Commission/Gaza (ICHR) and different civil society organizations attended the session.
The session aimed to highlight the procedures and the criteria that MOH, (Department for External Treatment), adopts in its referrals of the wounded and sick from Gaza strip for treatment abroad, amid the ongoing genocidal war against Gaza, and the transparency and efficiency of those referrals amid the complications created by the vengeful Israeli policy against all the Palestinians. It also aimed to identify the main challenges and obstacles that impede MOHA efforts in this regard.
The hearing session started with a review of a paper on the health conditions in Palestine, with Wa’el Ba’alousha, the director of AMAN office in Gaza, in which he described the conditions of the health system in Gaza, targeted by the Israeli occupation and fully destroyed, with the aim of eliminating all possible forms of life in Gaza Strip. This created an additional burden on the health system and its ability to provide services to the wounded and sick. Moreover, the occupation practices that delay the security approvals to the wounded and sick and their companions, create a long waiting list, which threatens the lives of the wounded and sick. The paper also addressed the mechanism of coordinating travel among several parties, which causes inefficiency in external referrals, especially that the role of MOH is restricted to the first stage, to prepare the lists of names of the wounded and sick.
Challenges imposed on Gaza patients
The paper identified several obstacles, noting the small number of persons allowed leaving daily, amounting to 10 cases daily during December and January. Following several interventions and appeals, the daily number increased to reach between 35 and 40. The large numbers of cancer patients (around 10,000 cases) require treatment currently not available in Gaza hospitals, after the Rantisi and the Turkish hospitals went out of service, increasing the numbers of patients that require referrals. Furthermore, five kidney treatment centers went out of service, while two centers still operate in their full capacity, despite the lack of electricity and medications. The electronic system is largely dysfunctional and access to MOH data, because of the Israeli systemic destruction of MOH structural and logistic resources. This weakened its ability to follow up or to notify the wounded and sick of their date of departure because of the destruction of the telecommunications system, or because they stay in areas with restricted movement and require coordination with the occupation forces, who deny them the permit to move.
The need for an emergency plan for medical referrals
The MOH emergency plans do not include the assumption of having to operate under this level of mass destruction of the health system. Hence, the defect in addressing the external treatment file, amid the occupation’s practices that aim at fully destroying the health system. This created a main obstacle that impedes MOH ability and efficiency to provide health services to the wounded and sick, and destroyed MOH human and structural resources, including MOH centers and hospitals, which weakened its effectiveness in running this file. The destruction included the computer systems, which ran out of service. Destroying Al-Shifa Hospital dealt a heavy blow to MOH data system and weakened its ability to follow up and facilitate procedures of external referrals.
Difficulties in prioritization of external travel
MOH has taken a set of measures that enhance transparency of those measures particularly in relation to issuing internal instructions that determine the criteria for cases referred for treatment abroad, and regularly posting lists of names of wounded and sick persons on the social media. However, the inability of MOH to play a leading role in prioritizing cases, because of the many obstacles and challenges, opened the room for breaches.
Mechanism of referrals of patients in Gaza Strip before and during the Genocidal war
Dr. Mahdi Rashed, Director-General for External Treatment said that the mechanism for referrals in Gaza Strip before the genocidal war was similar to the mechanism adopted in the West Bank. All referrals were made through a computerized electronic system. Medical reports were uploaded onto it, and referred to specialized committees that decided on the medical files after studying. The committees' decisions were then electronically uploaded, denying the possibility of any referral without the relevant medical committees' reports. Rashed added that there are no communications between MOH in Ramallah and the employees responsible for service purchase in Gaza since the start of the genocidal war. This has cut the circle off, and there is no officially authorized body to provide MOH in Ramallah with the required information and reports. Regarding the pleas addressed to MOH, Rashed admitted that they receive pleas through the social media, but he firmly asserted that no referrals have been made based on pleas, but only after receiving the necessary official reports for their issuance.
Forming a provisional committee under the department of external referrals in Gaza Strip
The referral department formed a provisional committee upon the decision of the Minister of Health, as mentioned in the paper, which shed the light on the positive decentralization resulting from some emergency factors in the face of the increasing demand from the numbers of the wounded and sick people in managing the referrals file. Rashed said that this committee consists of a coordinator (doctor), who acts as the service purchase employee, supported by a group of assistants (doctors) in different areas (north, center, south) to facilitate the reception and verification of cases. The patient approaches the authorized person, submits their documents, which are then forwarded to the coordinator, who in turn transfers them to the referral department in Ramallah. Establishing this committee reduced obstacles, but it is still not sufficient amid the increasing number of patients and the presence of patients from areas that are difficult to access in the current situation. Therefore, it is challenging to obtain confirmations regarding them, leading some patients to arrange to leave Gaza at their own expense, even though the vast majority of patients are listed on the official lists.
Ongoing efforts to develop a special system for the Palestinians stranded in Egypt
Regarding the Palestinians stranded in Egypt, whose number ranges between 100,000-120,000 citizens, and who may suffer from illnesses during their stay, Dr. Mahdi said that work is ongoing to develop a special system for them, which will come into effect soon. Through this system, stranded Palestinian patients in Egypt will be able to receive necessary treatment there by being referred to one of the seven hospitals (General Secretariat centers) contracted by MOH. Their files will be monitored after the activation of the roles of the service purchase employees displaced from Gaza to Egypt.
Israel deprives more than 36% of eligible wounded and sick persons from obtaining treatment outside Gaza
Rashed pointed out that MOH sends lists to coordinate the departure of approved cases from the Rafah crossing. However, the issue is that some names do not receive approval from the Israeli occupation. This was confirmed by AMAN paper, which discussed the Israeli violations of the International Humanitarian Law and the Geneva Convention concerning the protection of civilians and medical personnel. This has significantly affected the ability of healthcare providers such as the Palestinian Red Crescent (PRCS), the Red Cross, and other institutions to perform their roles in transporting the injured to safe locations where they can travel and receive appropriate treatment. This has led to the deprivation of more than 36% of deserving wounded and sick persons from receiving treatment outside Gaza. The paper emphasized the need for international and public pressure on the Israeli occupation to increase the effectiveness of external referrals, noting that MOH is unable to influence the prioritization of travel for more than 11,000 injured and around 10,000 patients due to the Israeli occupation's control over the lists of those leaving Gaza.
General comments
Abed Ghazal, of Bisan Center for Research and Development, said that the issue is to manage the collapse of the health system, amid the ongoing genocidal war. It is difficult to operate with the same procedures that MOH traditionally followed, which necessitates a national emergency plan to improve the response to risks.
Ismail Abu Ziadeh, from the Medical Relief Society, spoke about the importance of having a clear strategy and plan, especially after eight months of the ongoing war of extermination in Gaza. Ashraf Abu Hayya, from Al-Haq organization, attributed the obstacles we face to the Palestinian division, highlighting the role and responsibility of all parties in bridging the gap during the genocidal war, particularly in the healthcare sector.
Jihad Abu Ghosh, the Secretary-General of the Thalassemia Palestinian Friends Society, gave some shocking statistics concerning thalassemia patients, which raises questions about how the file of receiving treatment abroad is managed and monitored, to provide direct solutions within a comprehensive national plan. At the same time, she warned of the imminent danger facing blood disease patients in general and those with chronic genetic diseases. Many thalassemia patients have been martyred because they did not receive treatment, lack of medication, or not being monitored by hematologists.
Akram Al-Hafi, the Director-General at MOSD, said that the line ministries have been instructed to provide free health insurance to the patients, their companions and to the workers who are staying in the West Bank until the end of the current year.
Issam Aruri, the Director-General of Jerusalem Legal Aid and Human Rights Center, spoke about the need to restructure the referral system between Gaza and the West Bank and to support it with human resources. Moreover, there is a need to explore the "black box" related to the coordination of exit for wounded and the sick. Denying people treatment, leading to their deaths, constitutes a war crime. This could serve as the basis for a legal case to be pursued by human rights organizations, such as the national team at the War Crimes Court (International Criminal Court) or the South African team at the International Court of Justice, as additional evidence of the occupation's crime of genocide.
The need to declare a state of emergency in Gaza Strip
The participants unanimously agreed on the need for the government to declare a state of emergency in Gaza Strip, giving the healthcare sector the top priority in this state of emergency. This requires holding an urgent national meeting that brings together representatives of all the stakeholders of the healthcare sector (governmental, private, civil, and international). The goal is to give everyone the responsibility and unify the efforts comprehensively to support the targeted and collapsing healthcare sector in Gaza, located at the heart of the state of emergency.
