A/HRC/31/44 55. According to the General Authority for Civil Affairs of the State of Palestine, of the 173,835 applications that were received through West Bank district offices by patients and patient-companions during the first 11 months of 2015, 18 per cent were reportedly either delayed or denied. 56. WHO estimates that at least 1,500 patients travel from Gaza to the West Bank and Israel each month to receive specialized medical treatment. The approval rates dropped significantly during the last months of the reporting period, from around 80 per cent in the first eight months down to 69.85 per cent in October 2015. This represented the lowest approval rate since October 2009, with the exception of the period of escalation in 2014. As at 8 October 2015, the Ministry of Health in Gaza reported that 1,180 patients had been waiting for medical treatment outside of Gaza since the beginning of 2015. 57. Over the past three years, the number of applications for patient permits by Palestinians from Gaza nearly doubled, from around 1,000 per month in early 2013 to around 2,000 between May and September 2015.57 This increase occurred during a period in which patients’ access to medical care in Egypt through the Rafah crossing became increasingly restricted.58 58. Patients whose applications for medical permits for urgent and specialized care are rejected or delayed have no choice but to repeat the lengthy application process, or to accept less specialized and inadequate care. This delay can place patients, particularly those in need of urgent care, at serious risk of further damage to their health or even death. 59. For those who receive a permit to cross, Israeli security forces can unpredictably deny access to patients, or can detain patients for interrogation or arrest on a charge. 59 Four patients and their companions were thus arrested by Israeli security forces at Erez during the reporting period.60 Box 2 Case study: movement restrictions on patients from Gaza Medical patients in Gaza frequently experience denial or delay of care owing to the permit regime and the system of referrals. OHCHR monitored the case of Haytham Mohamad Ghazi Shurrab, aged 22, who fell ill during the escalation of hostilities in Gaza in 2014. Following several visits to hospitals in Gaza, Mr. Shurrab was referred to a health facility in Cairo, where he was diagnosed with cancer and began treatment. Mr. Shurrab returned to Gaza in January 2015. By April, it became clear that the treatment was not working. He received a permit to attend a hospital in Tel Aviv for a scan, returning to Gaza after one day. Following the results of the scan, his treatment was adjusted but had to be stopped in June 2015 owing to swelling in his abdomen. Mr. Shurrab was referred to Al-Naja hospital in Nablus but after two weeks he received a rejection letter indicating that the type of treatment he needed was not available there. 57 58 59 60 12 WHO, monthly report for September 2015. Available from www.emro.who.int. Ibid. WHO, “Report of a field assessment of health conditions in the Occupied Palestinian Territory”, April 2015. WHO, monthly reports covering the period November 2014-September 2015.