The Independent Commission for Human Rights - ICHR 29 1.1.4.1 Deterioration of the health system in the Gaza Strip The blockade on the Gaza Strip, closure of crossing points, and ban on travel for medical treatment have deprived patients from accessing hospitals outside Gaza, further deteriorating their health condition. The Israeli occupying authorities rejected or stalled the approval of 36 percent of patient applications, resulting in precarious health conditions of many Gazans due to disease complications and delayed treatment. Consequently, four patients, including two children, referred for medical treatment outside Gaza died. Patient referrals to hospitals outside the Gaza Strip saw a remarkable reduction of 30.4 percent. This was concurrent with a decline in underlying determinants of health among the Gaza population as well as shortage of medicines and medical consumables. Towards the end of 2021, 209 essential drugs were at zero stock level, representing a 45 percent deficit in the list of medicines. Compounded by insufficient human resources, a total of 164 medical disposables were at zero stock, marking a deficit of 19 percent. Shortfalls were acute in medicines for cardiac catheterisation and open heart surgeries on one hand, and primary healthcare on the other, recording a deficit of 39 and 55 percent respectively. Maternal and child health registered a shortage of 57 percent. There was a deficit of 42 percent in medicines for cancer patients, whose complete treatment relies on a special protocol comprising several complementary drugs. On the other hand, demand for mental health services increased by 15 percent. Compared to 78,662 in 2020, visits to mental health facilities rose to 90,887 in 2021.25 Due to Israeli bombardment during the Israeli military aggression on the Gaza Strip, at least 24 health facilities sustained severe damage, including 11 MoH structures (five hospitals and six health centres) and 13 private health facilities.26 Health facilities were also targeted during the Israeli military aggression, posing a threat to medical staff operations and ability to provide health services and care to patients and wounded citizens. The Israeli offensive impeded access for ambulances and medics’ ability to evacuate casualties. It disrupted MoH efforts to provide healthcare to COVID-19 patients. Following the spread of the Delta variant of COVID-19, the MoH decided to place returnees from India, Bangladesh, and other countries in quarantine. Damaged roads around the Ash-Shifa’ Medical Complex disrupted the movement of ambulances.27 The attack on medical centres and their surrounding areas left some out of operation or reduced health service delivery to the Gaza population. A case in point was the MoH central laboratory. The bombing of a neighbouring building resulted in a breakdown in service delivery and lab testing, including COVID-19 tests. The MoH efforts to contain and respond to COVID-19 was negatively impacted by the displacement of thousands of citizens from their homes, overcrowded shelters, inadequate social distancing, and lack of preventive health measures.28 1.1.4.2 Closure of crossing points and travel ban on patients to receive treatment outside Gaza The Israeli occupying authorities continued to impose a travel ban on patients with medical referrals for treatment at hospitals outside the Gaza Strip, including in the West Bank, occupied Jerusalem, and inside the Green Line. Israel also prevented civilians injured during the aggression from travelling abroad to receive medical attention, putting their lives at risk and further deteriorating their 25 26 27 28 Al Mezan Centre for Human Rights, The Reality of Economic, Social and Cultural Rights in the Gaza Strip, 2021: Summary Report, available at: https://www.mezan.org/uploads/files/1645614968663.pdf. Palestinian Centre for Human Rights (PCHR). The health situation during the military aggression on the Gaza Strip in May 2021, Gaza, May 2021. PCHR, The health situation during the military aggression on the Gaza Strip in May 2021, Gaza, May 2021. MoH, Update on the COVID-19 pandemic, https://www.moh.gov.ps/portal/en/. Twenty Seventh Annual Report 2021