The Palestinian Authority is not an independent sovereign state and thus not an acceded party to the conventions of the International Narcotics Control Board ⁹ which therefore has no published figures for the consumption of narcotic drugs in the Palestinian Authority. The proportion of consumption via Israeli licence – and thus accounted for in Israeli returns - is not defined.^10,11

Other Middle East MECC ¹² member countries recorded the average defined daily dose consumption of morphine for statistical purposes (S-DDD)¹³ as follows: Cyprus 46, Egypt 2; Israel 253; Jordan 11; Turkey 7 (Table 2).

Table 2 Average daily consumption of defined daily doses (for statistical purposes) of morphine per million inhabitants, 2000-2002: the six MECC member countries in the Middle East region.

Source: International Narcotics Control Board Narcotic Drugs: Estimated World Requirements for 2004. Statistics for 2002. New York: United Nations, 2004.

A limited range of opioids is available for use in oncology units in the West Bank and Gaza Strip. Choice and availability of drugs and availability of the different drug dosages cannot be guaranteed. Oncologists report that the available range of drugs for pain at any stage of disease, in 2005, can include: morphine hydrochloride by injection 10 mg and 20 mg; MCR oral tablets - more commonly used than injectable morphine - (morphine sulphate as a controlled release system 10 mg and 30 mg); Dolestine (pethidine hydrochloride) by injection 50mg and 100mg; Percodan oral tablets (a combination drug containing oxycodone and aspirin) are widely used throughout Gaza and West Bank.^14,15 Opioids of choice when available at the end of life include injectable Fentanyl 2mg, 10mg (ampoules), and Pethidine 50mg (ampoules). The opioid antagonist Nalaxone is used if needed.¹⁶

Opioids are available to patients at the Augusta Victoria Hospital, East Jerusalem. However, availability for out patients is dependent on the authority of an Israeli licence holder and also is compromised by the ability of the patient to pay, as one of the oncologists explains:

The main problem that we have is the availability of pain medications, especially morphine. We are in a difficult situation, because here it’s a Palestinian hospital but it’s in Israeli territory, so we cannot get morphine, so I don’t have, let’s say, the authority to prescribe morphine. I can do it here inside the hospital, but if I want a patient to take morphine when he goes home, then officially I can’t do that, I have to wait for somebody with an Israeli license to come do a prescription. We do have somebody on the staff here who has an Israeli license, but he’s not available all the time. That’s not the only problem: another aspect is really most of our patients don’t have permits to go to West Jerusalem, and that’s where the pharmacy is. So even when we do get a prescription written, there are problems how to go and get it; and it’s kind of expensive because the average morphine prescription will cost a patient around probably 50 euros. Maybe that’s not expensive by your standards, but for our people here it’s really expensive. And of course there are restrictions, so sometimes people at the pharmacy will not give more than two weeks’ supplies, so the patient has to keep on going back and forth to pharmacy. So that’s a big problem for us.¹⁷