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West Bank hospitals included: St Joseph Hospital in East Jerusalem, MaqassadHospital in East Jerusalem, Najah Hospital in Nablus, a hospital in Hebron andrehabilitation centres in Ramallah and Beit Jallah. An unknown but small numberof patients were referred to Israeli hospitals in Tel Aviv, Tel Hashomer and Nazareth,apparently through personal contacts rather than formal arrangements.Compared to the 2008-2009 Gaza conflict, there was a marked difference in the ratioof referrals to total injuries. In that earlier conflict, approximately 5,000 injuries werereported, with more than 1,100 of these referred to external hospitals (a majority toEgypt and a smaller number to Israeli hospitals and to East Jerusalem). In the currentconflict, referrals made up a much lower proportion of the injured.According to Dr. Muhammad Al Kashef of the Palestinian Ministry of Health in Gaza,only 3000 of the most severely injured and in need of surgical procedures wereadmitted to health facilities in Gaza altogether. Since all referrals out from Gaza camethrough the Gaza hospitals, this figure, if accurate, could partly explain the gap in thenumber of referrals.Some of the gap can also be attributed to the political changes in Egypt and the policyof disengagement from Gaza that the current Egyptian government has taken. Thisdecision influenced other aspects of the referral process: a WHO official interviewedby the team said that at the Rafah Crossing into Egypt, even those few patientswho had been allowed to cross sometimes had to wait there in ambulances for over8 hours. 121 Some patients complained to the FFM teams of grudging treatment atEgyptian hospitals.Other explanations that limited outside referrals were related to the policies ofIsraeli authorities, who were strict regarding documentation and imposed stringentsecurity checks on those family members wishing to accompany the patients. Furtherexplanations include the lack of referrals by both Hamas authorities and the PalestinianAuthority to Israeli hospitals, a policy developed after the 2008-2009 war, and possiblythe wish of Hamas authorities to demonstrate independence and self-sufficiency, asentiment that was shared by officials with members of the first FFM team.5.3.2 Process of referral to external hospitalsIn order to be referred to an external hospital the local health authorities in Gazaand Shifa Hospital liaised with the Fatah-led Palestinian Authority in Ramallah, viaemployees of the Palestinian Authority’s Ministry of Health based in Gaza - MessrsRifaat Mohaisen and Fathi Abu Warda in Gaza. The referral process included bothmedical and financial approval, and security coordination of exit permits with theIsraeli authorities for transit via Erez Crossing. 122121Rafah Crossing into Egypt has been closed to all but humanitarian cases since Julyy 2013, for political reasons. Accordingto the Health Cluster report, the Palestinian side of Rafah terminal reported that 143 war casualties crossed to Egypt fortreatment during Julyy 2014 while 96 crossed during August for a total of 239.122All patients interviewed for this report exited via the Israeli Crossing; the mechanism for patients referred to Egypt via the59