Medical/Health

NEWS

• IRIN News Agency OPT: Signs of worsening malnutrition among children (reprinted by UNISPAL) (21 April 2009)
• Atlanta Journal-Constitution
  Israeli hospital hosts cancer-stricken Iranian boy, by Aron Heller, Associated Press (10 October 2008).
• Atlanta Journal-Constitution: Dozens of Gazans have died awaiting Israeli medical care, by Robert W. Gee (6 September 2008).
  … and this is since the truce with Israel. The article describes how patients are forced to spy for Israel in exchange for medical treatment, as per a report by Physicians for Human Rights-Israel.
• Chicago Tribune Hamas forces doctors to work as rival Fatah calls for strike, Gaza hospitals partly paralyzed,
  Washington Post Gaza hospitals strain under pressure of strikes,
  both article-versions by Ibrahim Barzak, Associated Press (4 September 2008) – union is Fatah, and strike is against Hamas policies.
• Washington Post
  Gaza strike deepens Palestinian rift: U.N. envoy, by Nidal al-Mughrabi, Reuters (2 September 2008) – describes the dispute between Hamas and a Fatah-led union in Gaza, and UN concerns this might have negative impact on medical services in Gaza.
• Washington Post: Gazans’ Access To Care Faulted, by Linda Gradstein (5 August 2008).
  This article describes in very diplomatic terms how Israel blackmails Gazans with medical needs to spy for Israel in exchange for medicine and treatment.
• Chicago Tribune,
  Gaza Palestinians to spy in exchange for treatment,
  Atlanta Journal-Constitution,
  Washington Post:
  Activists: Israel bullying ill Palestinians to spy:
  all 3 articles by Diaa Hadid, Associated Press (4 August 2008).
• Boston Globe
  Medical chaos, delays cost ill Gazans’ lives: UN agency cites border snarls, by Diaa Hadid, Associated Press (2 April 2008) – “Dozens of Gaza residents have died waiting for medical treatment because of delays in obtaining permits to enter Israel, combined with a crumbling health system in Gaza, the World Health Organization said yesterday”.

ONLINE REPORTS

• Physicians for Human Right - No Treatment in Gaza, No Security Risk, but Israel Prevents a Seriously ill Man from Getting Treatment (9 February 2010).
• World Health Organization - Gaza Health Fact Sheet (reprinted by UNISPAL) (20 January 2010).
• B’Tselem - “Testimony: Young girl dies in Gaza after waiting two months for a permit to enter Israel for treatment” (19 January 2010).
• Physicians for Human Rights - The World Medical Association refuses to hear evidence of WMA rule violations by Israeli doctors during its assault on Gaza (4 January 2010) – quote by Dr. Ruchama Marton – “At stake is the reputation of international medical ethical codes as a system that works”.
• Physicians for Human Rights - Medical Supply Shipment to Gaza 27.12.09 (3 January 2010).
• International Commitee of the Red Cross - Caring for civilians caught up in war – the story of an ambulanceman in Gaza (22 September 2009), quote – “Ashraf is an ambulanceman with the Palestine Red Crescent in Rafah, Gaza. He counts himself lucky to be able to help people and save lives, and is proud of what he does. But being an ambulanceman in Gaza is a risky job.”.
• The Lancet – Gazan patients targeted for interrogation, by Jan McGirk (30 May 2009) – quote, “A new report by Physicians for Human Rights-Israel has condemned Israel’s security service for interrogating Gazan patients travelling to hospitals outside the Gaza Strip.”.
• The Lancet – Health in the Occupied Palestinian Territory (4 March 2009) – quote, “This Series on the health status of 3·8 million people living in the occupied Palestinian territory details one of the most important flashpoints not only in Middle East politics, but for global security. The Lancet report examines aspects of the Palestinian health predicament: health services; maternal and child health; cardiovascular diseases; diabetes and cancer; health and human security; and the future of the healthcare system. The report has been written by a team of health scientists in the occupied Palestinian territory, together with international colleagues from WHO, associated UN agencies, and academic institutions in the USA, UK, Norway, and France.”.
• International Committee of the Red Cross - Gaza: from Qatar with a mission (27 January 2009), quote – “Shifa Hospital in Gaza City receives most of the critically injured patients from other Gaza hospitals. Said Abu Hasna and Samir Kazkaz are Qatari Red Crescent doctors returning from an ICRC mission at the hospital. Said discusses their experiences.”.
• International Committee of the Red Cross - Harald Veen Fresed goes through hell as a doctor at Shifa Hospital in Gaza, by Michel Bôle-Richard (16 January 2009) quote – “Article published in Le Monde on 16 January 2009. Harald Veen Fresed has just spent a week at Shifa Hospital in Gaza City. The Dutch physician, who specializes in abdominal surgery, is exhausted. He was sent to Gaza by the International Committee of the Red Cross (ICRC) and finds it difficult to disguise his feelings after what he calls “a real tragedy”. Although he is no stranger to war or distressing situations – especially African conflicts – he returned home profoundly disturbed by what he had seen.”.
• World Health Organization - Gaza Crisis January 2009: Initial Response Plan and Immediate Funding Need (8 January 2009).
• Physicians for Human Rights – GSS Interrogation and Extortion of Palestinian Patients at Erez Crossing, by Ran Yaron (August 2008).
• UN Office of Coordination of Human Rights Affairs – Israel – OPT: Critically ill patients from Gaza appeal to Israeli court, by (22 May 2008).
• UN Office of Coordination of Human Rights Affairs – Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan (21 May 2008).
• Amnesty International – Israeli interference with medical services
• World Health Organization - Health Conditions in the Occupied Palestinian Territory, including East Jerusalem, and in Occupied Syrian Golan (13 May 2008).
• UNICEF - Feedback on the Rapid Nutritional Assessment of Children 6-59 months in the Gaza Strip (as reprinted by IRIN News Service) (April 2008).
• World Bank - Reforming Prudently Under Pressure: Health Financing Reform and the Rationalization of Public Sector Health Expenditures (2008).
• International Committee of the Red Cross – Declining health services in the Palestinian territories: an ICRC report (15 November 2006) – Quote from website – “Since the beginning of 2006, the ICRC has repeatedly warned of the deterioration of the humanitarian situation in the Palestinian territories. An ICRC report issued today documents the tragic consequences that the interruption of essential health services has had on the Palestinian population. A key finding is that it is the poor, whose numbers are increasing because of the overall economic decline, who are predominantly affected by the current interruption of health services.
• World Health Organization - The Health Crisis in the Occupied Palestinian Territory: Strategy Paper (18 July 2006).
• World Health Organization - The West Bank and Gaza: Preventing a Humanitarian Health Crisis (2006).
• World Health Organization - West Bank and Gaza Strip: Health Sector Needs Assessment (2005?).
• World Health Organization (WHO) - Health Situation of Palestinian People Living in the Occupied Palestinian Territory, by Dr. Gro Harlem Brundtland, Director, WHO (27 September 2002).

The Gaza Strip has been the setting of a protracted political and socio-economic crisis. Recent events have resulted in a severe deterioration of the already precarious living conditions of the people in Gaza and have further eroded a weakened health system.

The closure of Gaza since mid-2007 and the last Israeli military strike between 27 December 2008 and 18 January 2009 have led to on-going deterioration in the social, economic and environmental determinants of health.

REFERRAL ABROAD OF PATIENTS WITH SERIOUS MEDICAL CONDITIONS FOR SPECIALIZED TREATMENT OUTSIDE GAZA

Many specialized treatments, for example for complex heart surgery and certain types of cancer, are not available in Gaza and patients are therefore referred for treatment to hospitals outside Gaza. But many patients have had their applications for exit permits denied or delayed by the Israeli Authorities and have missed their appointments. Some have died while waiting for referral.

1103 applications for permits for patients to cross Erez were submitted to the Israeli Authorities in December 2009. 21% had their applications denied or delayed as a result of which they missed their hospital appointments and had to restart the referral process.

Two patients died recently while awaiting referral – one in November and one in December. 27 patients have died while awaiting referral since the beginning of the year.

DEATH OF FIDAA TALAL HIJJY

Fidaa Talal Hijjy, 19 years old, was diagnosed with Hodgkin’s disease in 2007, and was treated at Shifa Hospital in Gaza. Her health deteriorated and she was told she needed a bone marrow transplant. This procedure is not available in Gaza. Her doctors referred her to Tel HaShomer Hospital in Israel on 20 August 2009 and she obtained a hospital appointment for 23 September 2009 for a transplant.

The District Liaison Office submitted an application for Fidaa to cross Erez on the date of her appointment but the Israeli Authorities did not respond to her application and she lost her appointment with Tel HaShomer Hospital. She secured a new appointment for 20 October 2009 and a new application was submitted to cross Erez. She had no response from the Israeli Authorities. Her health condition deteriorated further. She was given a new appointment at Shneider Hospital in Israel for 9 November 2009 and submitted an urgent application to cross Erez. No response was received.

Fidaa died on 11 November 2009. The Israeli Authorities approved her request on 12 November 2009, three days after her hospital appointment and one day after her death.

PROVISION OF MEDICAL SUPPLIES – CENTRAL DRUG STORE

Supplies of drugs and disposables have generally been allowed into Gaza. However, there are often shortages on the ground mainly because of shortfalls in deliveries. The table below shows the drugs and disposables that are out of stock as a percentage of the essental list. The essential drugs list contains 480 items, and the medical disposables list is 700 items.

Delays of up to 2-3 months occur on the importation of certain types of medical equipment, such as x-ray machines and electronic devices. Clinical staff frequently lack the medical equipment they need. Medical devices are often broken, missing spare parts or out of date.

TRAINING OF HEALTH STAFF

- Health professionals in Gaza have been cut off from the outside world. Since 2000, very few doctors, nurses or technicians have been able to leave the Strip for training eg to update their clinical skills or to learn about new medical technology. This is severely undermining their ability to provide quality health care. An effective health care system cannot be sustained in isolation from the international community.

- During the health strike from end August to end December 2008, an estimated 1750 doctors, nurses and non-clinical staff from hospitals and health clinics went on strike and many of their jobs were filled by new people recruited by the de facto authority. Many of the staff who went on strike have not returned to their jobs

- In August 2008, two thirds of hospitals in Gaza had no maintenance staff. All Gaza hospitals . except the two in Rafah – now have engineers and technicians in post. But three quarters of technicians surveyed by WHO West Bank and Gaza in May 2009¹ had been in post for less than one year. Whilst half of the engineers had been trained in medical equipment maintenance, only one in four technicians had had any specific training.

- In medical schools and public health programs, curriculum development processes do not reach international standards.

GAZA’S ECONOMY IN COLLAPSE

Rising unemployment (41.5 percent of Gaza’s workforce in the first quarter of 2009²) and poverty (in May 2008, 70 percent of the families were living on an income of less than one dollar a day per person³) is likely to have long term adverse effects on the physical and mental health of the population.

WATER: OVER-EXTRACTION, SALINITY AND NITRATE LEVELS

The increasing salinity and high levels of nitrates in water supplies from the over-extraction of the ground water and the intrusion of salt water is a major concern for the safety of drinking water, particularly for children they are most vulnerable to high nitrate levels⁴. Salinity levels in water wells in most parts of the Gaza Strip are above the 250 mg/liter limit established by WHO, and nitrate concentrations exceed WHO guidelines of 50 mg/liter (up to 331 mg/l).

OPERATION “CAST LEAD” – IMPACT ON HEALTH FACILITIES AND STAFF

- 16 health workers killed and 25 injured on duty

• • • 15 of 27 Gaza’s hospitals
    • 43 of its 110 Primary Health Care services
    • 29 of its 148 ambulances

- Damaged health services infrastructure:

- The lack of building materials is affecting essential health facilities: the new surgical wing in Gazafs main Shifa hospital has remained unfinished since 2006. Hospitals and primary care facilities, damaged during operation eCast Leadf, have not been rebuilt because construction materials are not allowed into Gaza.

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¹ WHO. Gaza hospitals: medical devices maintenance. July 2009.
² OCHA, Special Focus August 2009, Locked in: The humanitarian Impact of two years of blockade on the Gaza Strip
³ OCHA, Special Focus August 2009, Locked in: The humanitarian Impact of two years of blockade on the Gaza Strip
⁴ UNEP report “Environmental Assessment of the Gaza Strip following the escalation of hostilities in December 2008 – January 2009”