Health conditions in the Gaza Strip continue to worsen as the Israeli authorities tighten its restrictions under the closure and blockade, and the Palestinian government of national consensus in Ramallah pursues procedures that in effect compound the health crisis. Palestinian patients requiring urgent transfer to hospitals in the West Bank and Israel are among those worst impacted.

These restrictions constitute a major threat to the quality of healthcare in Gaza, especially in the context of a crippled economy and critical shortage of financial resources; the consistent lack of access to electricity and clean water; soaring levels of air and water pollution; widespread food-insecurity; and additional burdens resulting from the population-density and very high levels of unemployment and poverty. Some families are unable to afford basic foods required to maintain their health.

The electricity crisis has significantly added to the fragility of the healthcare system. Blackouts are often implemented for 20 consecutive hours, which hamper the delivery of basic services—among them sanitation and the delivery of drinkable water. Generators are mainly relied on to provide needed electricity, however, they produce enormous amounts of air pollution, including unsafe toxic gas.

The Ministry of Health in Gaza has warned of medicine stocks being at a critical low. Different sources report that in June 2017, 184 medicines were at zero-stock, which is a rise in shortage to 36% of medicines. 270 types of medical necessities, such as sterilizers, gauze, and basic equipment, were also at zero-stock, another rise in shortage to 32%. Another indicator of the health sector’s deterioration is understaffing, which is aggravated by the steps taken by the Palestinian government in Ramallah to force early retirement on 3,879 medical staff. This could include 942 doctors and 876 nurses who, with their knowledge and experience, have come to form the backbone of the healthcare system in Gaza. Their retirement warns of further deterioration in the quality and availability of health services.

In February, the Ministry of Health in Ramallah delayed the processing of referrals for patients who require urgent transfer to hospitals outside of the Gaza Strip.

• -- In February 2017, 1,900 requests were approved, which is a decrease of 14% from February 2016.
• -- In March 2017, 2,200 requests were approved, which is a decrease of 4% from March 2016.
• -- In April 2017, 1,750 requests were approved, which is a decrease of 8% from April 2016.
• -- In May 2017, 1,500 requests were approved, which is a decrease of 29% from May 2016.
• -- The drop was steeper in June 2017, when only 650 requests for referral were approved, which is a decrease of 64% from June 2016.
• -- In July 2017, 1,300 requests were approved, which is a decrease of 28% from July 2016.

Moreover, the restrictions implemented by the Israeli authorities on access to hospitals outside of Gaza continued to increase. In the first half of 2017, the Israel authorities rejected 20% more requests for permits from patients who need to access hospitals than in the previous three years. In the first half of 2017, Al Mezan documented deaths of nine patients—among them four women and three children—while awaiting approval of their requests for referral. The detention of four patients and accompanying family members traveling to reach hospitals outside of Gaza was also reported in the same period.

These restrictions are unlawful and contradict international law norms that oblige duty bearers to maintain adequate standards of health, and in particular require that Israel, the occupying power, allow the passage of health supplies and equipment into the occupied territory.

Al Mezan calls on the Palestinian authorities to prevent political disputes from affecting access to basic rights and services. Al Mezan reminds the Palestinian government of national consensus of the urgent need to cease and retract all procedures that inflame the humanitarian crisis in the Gaza Strip, and of the importance of providing immediate support to the health sector.

Al Mezan calls on the international community to immediately take serious steps to stop the occupying power’s violations of international humanitarian law and human rights law, and calls on concerned agencies, NGOs and international bodies to mobilize support for patients in the Gaza Strip whose lives are threatened by the current crisis.