Rafah border closure presents huge obstacle for Gaza patients seeking access to Egypt

Access to hospitals in Egypt can literally be a life and death issue for many Palestinians in the Gaza Strip. It is vital for patients who cannot be treated within Gaza and who have been denied or are ineligible for access to Israeli or West Bank health facilities through Erez, many of them patients requiring life-saving procedures.[1] In a WHO analysis of the 504 Ministry of Health (MoH) referrals to Egypt from January to April in 2015, the main reasons for referral were nuclear medicine (15 per cent), orthopaedic surgery (11 per cent), neurosurgery (nine per cent) and ophthalmic surgeries (nine per cent). However, only 42 patients were recorded as crossing the Rafah terminal during the first four months of 2015 compared with 12,594 Gaza patients recorded in the first quarter of 2013, prior to the restrictions introduced in July 2013.

The District Liaison Office (DLO) of the MoH reported that access for patients who do not have Israeli-issued ID cards has recently become extremely difficult. Many Gaza residents have strong ties with relatives in Egypt and often inter-marry. However, Israeli processing of family reunification applications between Gaza residents and non-Gaza spouses was halted several times since 1993, and stopped completely after the 2008/2009 hostilities. An estimated 35,000 people are awaiting ID cards which would allow them to travel out of Gaza.

Movement of goods through Rafah also declines

From January 2013 to June 2014, an average of 713 truckloads per month, primarily of construction materials intended for Qatari infrastructure projects and aid supplies, were allowed to cross through Rafah into Gaza. No truckloads entered Gaza via Rafah after 3 July for the remainder of 2014, and this trend has continued into 2015. Only 13 truckloads of aid supplies had entered by the end of April, although some aid has been redirected through the Israeli-controlled crossing.

Mohammed Madi

Mohammed Madi, 36 years of age, lived with his wife and four children in Rafah. He quit his job as a driver in spring 2014 when he became ill and started losing weight. Mohammed spent months going to a number of physicians before finally being diagnosed as suffering from Hodgkin’s lymphoma by a Shifa Hospital haematologist. He required chemotherapy, radiotherapy and a PET scan which are not available in Gaza. The Palestinian MoH referral department referred Mohammed for advanced treatment at an Israeli hospital. When Mohammed applied for a permit to travel out of Gaza, this was denied by the Israeli authorities on the grounds that he did not hold an Israeliissued ID card.

Mohammed had entered the Gaza Strip from Egypt in 2000 with an Israeli visitor’s permit, married and applied for family reunification which was never granted. The DLO advised Mohammed to change his referral destination to Egypt, but with Rafah crossing closed, the chances of travelling to Egypt were minimal. Mohammed appealed through the Palestinian Centre for Human Rights in Gaza but was informed that such a case could take several months and may only waste time.

Mohammed’s health deteriorated and he spent the last week of his life in Najjar Hospital in Rafah, unable to move, with his family still waiting for the border to open, until his death on 4 May.

Rafah Crossing

The Rafah crossing was established in 1982 after the Israeli withdrawal from the Egyptian Sinai Peninsula. The crossing was managed by the Israeli Crossings Authority until Israel completed its unilateral withdrawal from Gaza in September 2005. In November 2005, control of the crossing was transferred to the Palestinian Authority (PA), and the European Union Border Assistance Mission (EUBAM) was established to monitor the operation of the crossing as part of the US-brokered Agreement on Movement and Access (AMA) between Israel and the PA.

In June 2006, following the capture of the Israeli soldier Gilad Shalit, the Rafah crossing began to operate on an irregular basis. In June 2007 following the Hamas takeover of the Gaza Strip, EUBAM suspended operations at Rafah, although the crossing continued to open two or three days each month for scheduled, but irregular, openings to allow for the limited passage of specified Palestinian pedestrians (see chart). In June 2010 in the wake of the Israeli attack on the Gaza-bound flotilla, the Egyptian authorities re-opened the crossing on a more regular basis in both directions, and also permitted humanitarian aid to enter Gaza through the crossing. The number of Palestinians crossing increased steadily over the following three years, with almost 420,000 crossing in both directions in 2012, when Rafah was open for a total of 312 days. This trend continued into the first six months of 2013, when 40,000 crossed monthly (in both directions).

* This piece was submitted by WHO.