Beta-thalassaemia is a major health problem in the Gaza Strip, Palestine, where 293 patients are currently treated with transfusions and chelation. In September 2000, Palestine adopted a prevention programme of obligatory premarital testing for beta-thalassaemia before the issue of a marriage certificate. From April 2003 to May 2005, 21,825 blood samples from 19,712 couples were collected and analysed. Samples (n = 2251, 10.3%) with microcytosis (mean cell volume <80 fl) and/or hypochromasia (mean cell haemoglobin <26 pg) were considered as suspicious for beta-thalassaemia and subjected to serum ferritin and HbA(2) quantification. Of these samples, 25% were carriers for beta-thalassaemia while 32.4% were iron deficient. A diagnosis could not be established in 15.3% of the suspect samples. An increasing percentages of carrier couples did not go ahead with their marriage in the successive years of the programme, which was fitted to zero in the first year and reached 73.7% in the year 2005 (both partners were carriers in 19 couples, 14 decided to separate while five continued). Since implementation, there has been a reduction in the birth of children with beta-thalassaemia major. This study evaluated the 5-year experience of the Gaza Strip in implementing the obligatory premarital testing programme for beta-thalassaemia and recommends measures that could improve it.