· Sporadic ceasefires affect daily conditions and health access in Gaza
· Killed and injured (MoH, as of 19:00 August 20):
Prior to the renewed violence, the temporary ceasefires during the past week had allowed some improvement in the humanitarian situation, most importantly by increasing personal safety and security, but also by allowing for movement for families to resupply with essentials, return to damaged homes, recover household possessions and access health services. Two hospitals that had closed due to extensive damage reopened on an emergency basis and received patients using alternative facilities. The assessment process of damage and needs in each sector began to be carried out by UN agencies, ministries, local governments and organizations.
The Ministry of Health has established a task force with the International Medical Corps to review recommendations on needs for foreign medical teams into Gaza to support health service provision. MoHis reviewing its previous appeal (for specialists in vascular, neuro, plastic and orthopedic surgeries and in management of burns and infections) following the increase in referrals to outside hospitals for specialized treatment.
The MoH Central Drug Store issued a report on drug stocks in July which indicated that 130 drug items of 481 (27%) and 472 medical disposables are at zero stock (52%), similar to the same period in 2013, demonstrating that the high consumption for the increased number of inpatients may be offset by incoming donations.
Primary health care
Since the enhancing of disease surveillance on 13 communicable diseases through the early warning system, analysis of disease notifications from UNRWA clinics shows an increase in cases of diarrhea (bloody, watery < 5 years, watery > 5 years), but not yet at the level of outbreaks. Caes of viral meningitis have also increased, but not to levels of public health concern. Existing protective factors in outbreak prevention include effective vaccination coverage in Gaza and improved health and hygiene behaviour. UNRWA reports that it is continuing to give priority to water and sanitation activities, as well as disease surveillance with daily data collection.
The ceasefires allowed several NGOs to conduct clean-up and repairs in clinics that were lightly damaged so that they could be safely reopened to receive patients.
Damage to health facilities and closures
15 out of 32 hospitals have been damaged since July 7, and 6 are closed. One of the closed hospitals, al Wafa Hospital, which had been totally destroyed, opened a facility nearby to treat patients. Beit Hanoun Hospital, which was extensively damaged, opened to accept emergency patients since it is the only MoH hospital serving the northern sector.
Out of 97 clinics now being monitored for damage and closures, 45 reported damage and 17 are closed. (See Annex 1)
Referrals of casualties are being coordinated by the Ministry of Health with receiving hospitals and sponsoring governments, especially Turkey and Germany, and for access with Egyptian authorities at Rafah, and with Israeli authorities at Erez checkpoint. Out of the 185 casualty cases coordinated for travel through Erez checkpoint to the West Bank and East Jerusalem hospitals, 4 patients were denied permits.
Four patients traveled to Egypt for transfer to hospitals in Germany and Turkey, with the support of those governments. According to the Ministry of Health, more patients will be referred abroad, 40 to Germany and up to 150 for treatment in Turkey. While the delay from security clearance procedures at Erez checkpoint has been greatly reduced, it still requires 20 minutes per patients traveling by ambulance, which limits the number that can be processed during Israeli checkpoint working hours (20 hours per day).
In a preliminary analysis of 167 referrals, 70% were males and 30% females, and 29% were children aged 0 to 17. Most of the injuries were due to multiple trauma and crush injuries involving complex vascular, neurological and bone damage, and required specialized care to reduce the risk of complications such as renal failure, amputations, infected wounds and permanent nerve damage and disability.
*Excluding 3 Gaza patients transferred to Turkey from West Bank hospitals and 3 patients who travelled via Egypt.
Public health concerns
— Water-borne diseases as a result of overcrowded shelters for displaced persons, reduced functioning of water and sanitation systems due to damage and loss of electricity.
— Complications in casualty patients developing following initial treatment of injuries and discharge from hospitals.
— With 238,000 displaced persons taking shelter in 81 UNRWA schools, half of whom having no homes to return to, there is risk of decline in population physical and mental health status from prolongation of emergency period without improvements in social determinants of health.
Health needs, priorities and gaps
— Support specialized medical teams in reconstruction and rehabilitation of casualty patients.
— Continued vigilance of health situation among displaced families in shelters.
— Health access for people in outlying areas where clinics may be closed.
— Repair and rehabilitaiton of damaged health facilities.
— Maintain critical supplies of fuel, medicines and medical disposables in hospitals sufficient for emergency preparations.
The Interagency Standing Committee endorsed the reactivation of the Health Cluster in view of the ongoing humanitarian emergency in Gaza and challenges to the health system. The reactivation was requested by WHO in order to better coordinate health responses in the UN Cluster system through multi-clusters and multi-agencies approaches. The Health Cluster was deactivated in 2012 but health coordination had been continuing through WHO leadership with Health and Nutrition Sector partners. The initial meeting of the Health Cluster was held in Ramallah and Gaza WHO offices on August 18, and will continue on a weekly basis until further notice.
WHO and Health Cluster partners (MDM Spain, MAP UK, UNFPA, UNICEF) participated in the collection of data for the OCHA-organized rapid assessment (MIRA) which was completed on August 19. Tools are being developed and data collectors are being trained for a more detailed assessment of the health sector to follow. A preliminary report is expected by early November.
19 Health Cluster partners have detailed more than 150 activities which are ongoing or fully implemented since July 7 in response to the humanitarian emergency in Gaza. The support was implemented directly by the health partner or provided to the MoH or to smaller NGO health providers, and it targeted hospitals, clinics, shelters or communities. Activites ranged from operating mobile clinics, providing specialist medical teams, procuring drugs, assistive devices, fuel, hygiene kits, emergency staff for drug warehouses, psychosocial support services, nutritional support for children, meals for hospitals, primary health services, postoperative care for patients who were discharged, community-based rehabilitation, repair of damage to health facilities, and advocacy for the right to health, including access.
A total of US$ 10.8 million in drugs and medical disposables have been received by the health sector in Gaza since July 7 to help meet the needs of this emergency,
WHO West Bank and Gaza Country Office
Contact: Dr. Mahmoud Daher