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Source: World Health Organization (WHO)
1 June 2005

Health Inforum News
Volume 4, No.60, May-June, 2005
Welcome to the sixtieth issue of the Health Inforum Newsletter.
of the
    People are as happy as they make up their minds to be. ~Abe Lincoln~

Health News
• Major immunization MMR campaign completed in WB
• WHO and the Italian Cooperation host seminars for Palestinian Psychiatrists
• UNRWA’s Access to Barta’a enclave disrupted by IDF restrictions
• MERLIN will provide emergency support to the Primary Health Care in oPt

Disengagement and the Right to Health in Gaza – Humanitarian, Ethical and Economic Aspects

Upgrading Azoun Health Center to Emergency & Obstetrics Hospital

Casualties & access incidents
During May, there were 9 episodes of ambulance delay and 4 cases of denied access.


Major immunization “MMR” campaign completed in WB.
Between 5th to 31st of May, 2005, a major immunization campaign against measles, mumps and rubella (MMR) was launched in the West Bank. 650,000 persons aged 16 – 30 were vaccinated with a coverage rate of 95%.

Some concerns have arose for the number of immunized people presenting adverse events. The registered events have been the following: parotitis 5693, aseptic meningitis 398, rash 86, fever 98, neck swelling 17, transverse mielitis

The Ministry of Health requested technical advice to the World health Organization WHO. WHO consultants from CDC Atlanta informed that adverse events - mainly parotitis and aseptic meningitis - are common. WHO assessment concluded that while the number of parotitis as adverse event observed in Palestine is consistent with rates documented in literature, aseptic meningitis rate is higher than expected. However, as the campaign occurred during the mumps epidemics, a number of aseptic meningitis could have been caused by the disease itself, and not by the vaccine.

WHO and the Italian Cooperation host Seminars for Palestinian Psychiatrists
Dr. Benedetto Saraceno, Director of the Mental Health and Substance Abuse Department (MSD), WHO Geneva, visited Palestine from May 27th to June 1st in order to work directly with Palestinian psychiatrists. Seminars entitled "The Role of Psychiatry in a Modern Mental Health System" were held in Ramallah (May 28th and 29th) and in Gaza City (May 30th – 31st). All psychiatrists and trainee psychiatrists from the public mental health services attended (a total of approximately 50), and Dr. Saraceno facilitated all sessions the seminar.

This initiative was part of the on-going mental health projects that WHO and the Italian Cooperation are currently implementing in the oPt. These are long-term development projects which include a large human resources development component. Thus, these seminars were designed to complement the mental health training that has already occurred in the oPt, and to set the stage for future training initiatives.

Psychiatrists were exclusively targeted in this instance (as opposed to the multidisciplinary training that generally carried out) to create a forum in which to address, specifically, the psychiatrist's role within the community-based approach to mental health care.

At the end of the Ramallah event, a short Statement was drawn up by the participants, which reiterated the important recommendations already detailed in the mental health policy document which was developed in 2004. This Statement reads:

The participants in this Seminar, along with WHO, recommend that Mental Health Services should be able to address the complex needs of people with mental health problems. To achieve this, services (at all levels, namely: Hospital, Community and PHC) MUST adopt a bio-psychosocial approach to care, treatment and rehabilitation of individual service users and their families.

Therefore, services should provide Medical and Psychiatric treatment, Psychological Interventions and Social Support.

The mental health services should also establish partnerships with a variety of other organizations, in order to allow for holistic care of those seeking treatment, leading to better health and social inclusion.

These seminars will be followed up over the long-term with a variety of planned training initiatives, continuing to target the staff of the psychiatric hospitals and Community Mental Health Centers.

UNRWA’s Access to Barta’a enclave disrupted by IDF restrictions*
Since the building of the wall/fence, Barta’a, which is located to the west of Jenin, is a totally closed area with
access only through two gates, Barta’a and Shaked. Since October 2003, residents above 12 must have a permit to live inside and to enter and leave the enclave. Shaked gate is open between 7:00-7:15am and 12:15-12:30pm. UNRWA staff with West Bank identity cards are required a permit to cross Barta’a gate.

Since 1 October 2004, UNRWA’s staff members has often been denied access for lack of permits to be inside the enclave, or facing delays, abuses and intimidations at the gates on a number of occasions. UNRWA’s mobile teams and social workers, consisting of Palestinian staff members, regularly need an international escort by international OSO staff to go inside this area..

Children say that they are afraid to cross the Shaked gate because they fear soldiers and they are kept waiting
for hours at a time. Many parents are reluctant to allow their children to go to school.
* Source: UNRWA newsletter # 5, May–June 2005

MERLIN will provide emergency support to the Primary Health Care in oPt
Gaza- The Minister of Health, Dr. Thuhni Al Wahiedi has signed a Memo of Understanding with Dr. Prakash Nellepalli from Merlin for the Emergency Support of Primary Healthcare in West Bank and Gaza strip.

This project aims to empower the primary healthcare capacity at the MoH, in order to help the MoH to provide an exceptional customer service to the public, especially those who were directly affected by the Wall, closures and curfews.

The project will also work on the rehabilitation of the Jabalya Centre for Primary Healthcare and providing the medical equipments and furniture; in addition the project will build the capacity of the Primary Healthcare and the Empowerment of Community through Training for Health Promotion in Qalqilya and Tulkarem. The duration of this project is one year.

It is worth to mention that Ms. Caroline Miller the Chief Executive of Merlin is visited the oPt recently and she met with different health stakeholders.


Disengagement and the Right to Health in Gaza – Humanitarian, Ethical and Economic Aspects

PHR- Israel wrote:

Physicians for Human Rights– Israel The World Health Organization (WHO) held on June 7th at Tel-Aviv University a conference on “the Disengagement and the Right to Health in Gaza – Humanitarian, Ethical and Economic Aspects”.

The platform for the conference was the prevalent perception among the Israeli public that, after disengagement, the state of occupation in the Gaza Strip will end as will Israeli involvement in the lives of the residents of the area. No attention has been given to the outcome of dozens of patients, the chronically ill and those requiring treatment that is not available in Gaza Strip. If no systemic solution is found, a situation will be created in which many Palestinian patients will die. Physicians for Human Rights – Israel asserts the neglect of the Palestinian health system by Israel is manifested in dozens of examples and indexes.

Key professionals and interlocutors related to heath and to the disengagement plan discussed their positions on the situation and on what needs to be addressed:

Hadas Ziv, Executive Director of Physicians for Human Rights – Israel: Israel is committed to actively rehabilitate the medical infrastructure of the Gaza Strip. This is due to the legacy of occupation. Different parameters demonstrate that Israel has done little to bridge the gap between its own medical services and the Palestinian ones even during the years of complete and direct occupation. Further more we see a deterioration in the situation between 1988 and today.

Mr. Emanuele Giaufret, Head, Political and Economical Department, Delegation of the European Commission to the State of Israel: Israel should facilitate the coordination and rehabilitation in Gaza Strip but less than 70 days away from disengagement, many issues need to be addressed. “We [the EU] think that further impoverishment in Gaza is not in the best interest of Israel.” We need to create acceptable conditions for investment in Palestinian economy including security and rule of law in Gaza in order to create a viable economy and that is the responsibility of the PA. “We need to move Palestinian economy from a labor exporting economy to a goods exporting economy. We insist that Israel recognize the trade agreement between the EU and the PA.”

Dr. Ambrogio Manenti, Head, WHO Office in the West Bank and Gaza – Presented the dangers posed to the Gaza residents during disengagement: Patient access to care , health professional access to work place and the delivery of drugs and pharmaceuticals. “Disengagement should be the starting point and not an end point”

Prof. Hani Abdeen, Dean, Faculty of Medicine. Al-Quds University, Abu Dis – Prof. Abdeen gave a synopsis of medical education in Gaza, present and future. He presented data which showed a 36% drop in doctors and a 13% drop in nurses between 1998-2004 due to refusal to allow people to travel to study abroad and emigration. Since the Al-Aqsa Intifada, students from Nablus and Gaza campuses have been blocked off from reaching the medical school campus at Abu Dis. Gaza students have continued to be blocked off the Jerusalem campus. He identified Gaza’s health workforce needs as: postgraduate residency program; continuing medical education; accrediting or licensing opportunities; facilities such as labs, schools, hospitals and libraries.

Dr. Michael Dor, Director of General Medicine Division and Coordinator of Disengagement in the Israeli
Ministry of Health: Dr. Dor gave the shortest presentation of all the panelists drawing on anecdotes and presented no plan for disengagement. “We are breaking our heads to plan the disengagement as good as possible but we are dealing with Hamas on one hand and the crazy Jews on the other hand.” He promised that the Israeli Ministry of Health would give as much cooperation as they receive from the Palestinian end. Finally, he signed off saying he hoped to visit Abu Dis again in July or August and “let’s be in touch if any Palestinian medical staff have any problems gaining access.”


Project Title: Upgrading Azoun Health Center to Emergency & Obstetrics Hospital

Location: Azoun village / Qalqilia District.

Beneficiaries: Azoun village & its surrounding villages

Project Duration: 10 months.

Donor: Welfare Association Consortium

Starting Date: 25/10/2004.

Project Budget: $ 336.600.

Implementing Agency: Union of Health Care Committees (UHCC)

Expected time to use the New Building: January 2006

Project Objective:
To contribute to the improvement of women’s health care services in the region.

Immediate objectives:
Decrease diseases’ complications particularly those related to pregnancy and women’s health Decrease the mortality rate among pregnant women.
Increasing health services availability for women in the region to overcome problems of access created by Israeli siege.

Azoun Health Center is established in 2003 to serve the area of Azoun and another 20 neighboring villages due to the closures , the total population of the area is 45,000. Azoun lies between Salfeet, Tulkarem, Qalqilia and Nablus districts, so the access to Azoun from these villages is much easier than to the surrounding cities. The current health center provides primary health care with different specialties, and emergency for 24 hours.

Hospital services:
As planned the proposed hospital will have 15 beds for Maternity, gynecology and obstetrics surgery, there will two operation rooms, in addition to the current specialized clinics, the hospital will have also a diagnostic facility for breast and uterine cancer and a unit for prenatal and post natal care by next year.

Staff of the hospital:
The current staff of the Azoun Health Center will run mainly the hospital, but there will be need to recruit an anesthetist and some specialists.

Hospital needs:
Since Most the equipment are available in the current health center, some equipments are needed such as Portable incubators, heavy x-ray machine, Oxygen extractor and an elevator for the new building. The UHCC applied already for some donors to cover some of these needs.


During May 2005, there were 9 episodes of ambulance delay (for a total delay of 9 hrs). In 4 cases the access was totally denied, according to PRCS. The following diagram shows the total number of ambulance incidents by area, the time of delay and the episodes of denied access (D/A) at the checkpoints:

This diagram shows the variation from April 2004 – May 2005:

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