The population of the Gaza Strip suffers continuous problems in attaining its right to health, especially patients who are have to deal with  complex medical conditions and serious illnesses that cannot be treated in local hospitals- e.
g.
cancer treatment, cardiology, and brain.
These patients are being deprived access to specialized hospital care outside Gaza, which threatens their lives and has already been the cause of death of tens of patients over the last two years.
On one hand, the Israeli Government continues to impose a siege on the Gaza Strip, which has led to major violations of the right to receive health care as the closure policies include forbidding the entry of many medicines and medical supplies and to prevent patients' access to medical care outside Gaza.
This lack of medical materials has contributed to the increase in the number of patients that need to seek treatment outside Gaza.
  In addition to the siege, the internal Palestinian political divide has negatively impacted the ability of these patients to access specialized medical services outside the Gaza Strip.
The internal conflict has produced a bureaucratic process that all patients seeking referrals must go through.
It is incredibly time-consuming, and sometimes takes months from the patient’s application, to the arrival of a decision and financial coverage: two prerequisites for patients to start the application for coordination to leave Gaza.
The process has become further stalled by the decision of the Minister of Health of the Ramallah Government, Dr.
Fathi Abu Moghli on 18 January2009 to stop all referrals for treatment in Israeli hospitals.
This decision was adopted without taking into account individual cases in which patients had been previously receiving treatment in Israeli hospitals and will face serious consequences if they do not return to continue their treatment or for checkups.
This decision also ignores the fact that Israel has an obligation as the occupying power to provide healthcare for Palestinians who cannot access the necessary services at local hospitals, and to ensure the proper functioning of medical facilities as well as the continuous supply of medical materials, in accordance with international law principles.
  The situation further escalated after the Gaza Government’s Ministry of Health (MoH) assumed control of the Department of Referrals Abroad (DRA) on Sunday, 22 March 2009.
Dr.
Bassam Albadri, an employee of MoH in Ramallah who is in charge of the DRA received an order from the Minister of Health in Gaza, Dr.
Basim Naim, to vacate his office in the MoH and to hand over the work of his office to the MoH in Gaza.
In addition he was ordered to provide the stamps that are used to validate referral forms for treatment abroad.
Al-Badri refused to hand over the stamps initially; however, under pressure from the MoH in Gaza he handed them and the staff members in his department vacated their offices.
This development was a clear sign of halting all efforts to coordinate healthcare for Gazan patients in Israel or the West Bank.
In practice, patients cannot be referred to Israel owing to the decision of Ramallah Government to halt such referrals.
Moreover, patients cannot access hospitals in the West Bank since the Gaza MoH decision to interfere and prevent the Ramallah government from carrying out its efforts to coordinate the travel of patients through Erez crossing, because the Israeli Government refuses to coordinate with the Hamas-led Gaza Government and any of its bodies.
Israel only will coordinate with the Ramallah government, including on the issue of referrals.
                The patients, suffering serious illnesses, pain and psychological conditions, have no control over their lives and have to accept getting sicker and potentially dying, while the two governments focus on exchanging accusations over the lack of equality and transparency in each other’s processes of decided who requires a referral for treatment abroad.
  The Gaza government justified its takeover of the DRA with claims that the Ramallah Government’s MoH staff in the DRA was using double standards when granting referrals, basing their decisions on cronyism and family connections, instead of medical need.
In return, the Ramallah Government leveled the same accusations at the Gaza Government, claiming that it is trying to process referrals for people who do not require treatment abroad.
Similar accusations have been voiced by the Egyptian Government, which coordinates with both governments to arrange the exit of patients via Rafah Crossing.
  Patients suffering serious illnesses, who had already started receiving treatment in Israeli hospitals prior to the Ramallah Government's decision to prohibit referrals to Israel and need to return to Israel to receive further treatment, can no longer use their old referrals.
The same applies to patients who were receiving treatment in hospitals and specialized clinics in the West Bank, because the liaison officers from the MoH in Ramallah Government have been prevented from carryout out their work and coordination, after the Gaza Government ordered them to cease their coordination work.
In reaction to this development, the staff members of the DRA also received a decision from the Ministry of Civil Affairs in the Ramallah Government preventing them from processing the coordination of the patients the Gaza Strip.
  Regarding referrals for treatment in hospitals in Arab countries and elsewhere abroad through Rafah Crossing, the patients have become entangled in the same political conflict; often patients with referrals from the MoH in Ramallah trying to cross into Egypt from Gaza are denied passageway by Hamas staff at the Palestinian side of the Crossing under the pretext that their referrals are not valid and must be issued from the MoH of the Gaza Government.
The patients then need to restart the entire process including getting all of the medical signatures needed, as well as new permission from the MoH in Gaza.
According to Al Mezan’s sources, patients use the Gazan MoH’s referral form simply to pass through the Palestinian side which is controlled by the Gaza Government's security, and once on the Egyptian side they use the referral from Ramallah.
According to a number of patients, the Egyptian hospitals accept the Ramallah issued referrals for recognition of financial coverage of medical expenses.
There is a further problem facing residents who receive their salary from the government in Ramallah.
Each month a sum is directly deducted from their salary to pay for government health insurance, however the MoH in Gaza does not recognize this insurance and forces them to pay a second insurance fee to Department of Insurance in Gaza.
This adds an additional financial burden on these people.
  Al Mezan has received many complaints from patients who have been deprived access to hospitals and clinics abroad.
Al Mezan Center for Human Rights supports the continued and intensified efforts to resolve the problems facing the Gazan population and affirms its support of other Palestinian and international organizations working towards this goal.
It renews its demand for an immediate solution to this particular problem of referrals, which is now seriously threatening the lives of a significant segment of the population whose health conditions cannot be treated in Gaza.
It is adding to their suffering while ignoring the fact that they are citizens possessing equal rights and are entitled to be treated as such, without any discrimination, in accordance with the Palestinian Basic Law, which emphasizes respect for human rights, including the right to enjoy the highest attainable level of health, including access to health services necessary to preserve life.
  It should also be remembered that health care is a basic human right enshrined in the Universal Declaration of Human Rights in Article 25 and the International Covenant on Economic, Social and Cultural Rights Article 12, which emphasizes the right to enjoy the highest attainable standard of physical and mental health.


Accordingly, Al Mezan calls for the government in Gaza and the government in Ramallah to uphold their legal obligations and assess the seriousness of the situation and the disastrous effects this power struggle is having on the lives of patients within the Gaza Strip.
It calls for quick action and compromise to resolve all the obstacles preventing Gazan patients from seeking treatment abroad.
It also calls for the governments to consider developing mechanisms that would help overcome the obstacles that patients face, as well as providing support for them not only for humanitarian reasons but also because ensuring the health and safety of the Palestinian population is one of the key duties the government has to its citizens.
Ends