This is an update on the health sector situation since the Israeli air strikes started at 11.15 on 27 December 2008.
· While there are still some shortages of drugs and consumables at hospital-level, a significant volume of supplies have been delivered to Gaza over the last few days and further supplies are in the pipeline.
· Donors are asked to hold further in-kind contributions until it is possible to assess the remaining needs.
· Dorah and Gaza Paediatrics’ hospital have reported that the majority of the windows were broken by continuous shelling since 27 December.
UNOSAT: Situation map: Gaza crisis 31 December 2008
MINISTRY OF HEALTH RESPONSE TO THE CRISIS
All the MoH hospitals have declared a state of emergency, meaning that:
· Only urgent surgery is carried out; all elective surgery has been suspended:
· Closure of all out-patient clinics, except those dealing with urgent cases;
· All health personnel have to report to duty and all leave is cancelled;
· Emergency and operation rooms are fully equipped to serve casualties;
· All ambulances are on call;
· All internal pharmacies are functioning 24 hours;
· Some health personnel working at the PHC centres, mostly those with relevant specialties, are redeployed to hospitals.
As of 3 January, the Palestinian MoH reported 431 fatalities of which 74 are children and 26 women. The MoH also reported about 2240 injuries, including 650 children and 314 women. Most casualties have been received by MoH hospitals and treated as follows:
· Treatment on the spot and discharged;
· Initial treatment followed by internal referral to Shifa, Gaza European or Nasser hospitals*.
· Initial treatment and then external referral to hospitals outside Gaza through Rafah border crossing.
*The MoH hospitals in North Gaza refer casualties in need of specialized intervention to Shifa hospital. Yousif Najar hospital in Rafah refers cases to the Gaza European hospital in Khan Younis and Aqsa Martyrs hospital refers cases to Shifa or Nasser hospitals.
Since the beginning of the crisis, all health personnel have been working for one or two continuous 12-hour shifts. Staff who were on strike have returned to duty (including those who had been on strike since July 2007).
Intensive Care Units (ICUs) are still overstrained and capacity for neuro-, vascular, orthopaedic and open-heart surgery is lacking. The International committee of the Red Cross (ICRC) is bringing in a team of war surgeons to fill some of these gaps and more surgical teams are reported to be on their way.
Bed capacity and occupancy rate
The MoH has 1690 beds and its current strategy is to discharge cases as early as possible to be ready for new casualties. As a result, the bed occupancy rate is now under 50% at most MoH hospitals.
Electricity failure and fuel supply
All MoH hospitals are facing power cuts averaging 12 hours per day. The power cuts are distributed as follows: 12 hours in North Gaza, 20 hours in Gaza, 10 hours in the Mid zone, 12 hours in Khan Younis, and 4 hours in Rafah.
All MoH hospitals have at least one generator that functions during the electricity outage hours. MoH hospitals have on average 71% of fuel storage capacity, ranging between 33% in Dorah hospital and 94% in Beit Hanun hospital. UNRWA is working to provide hospitals with additional fuel.
Seven electricity generators for medical facilities have been sent in to the Gaza Strip since the crisis began and are in place as emergency back-up at the main hospitals and Central Drug Store.
At all MoH hospitals, 2–4 weeks of cooking gas is available, except for:
· Gaza European hospital has enough for 0 day;
· Dorah hospital has enough for 3 days;
· Beit Hanun hospital has enough for 4 days;
· Shifa hospital has enough for 10 days.
UNRWA is working to provide hospitals with cooking gas.
Since the crisis began, 10 ambulances have entered Gaza. All MoH ambulances are functioning and have more than 50% of their fuel capacities filled.
WFP is distributing food, mainly bread, to MoH hospitals. Distribution will be extended to reach NGO hospitals by 4 January.
Damage to hospitals
Dorah and the Gaza Paediatrics hospital have reported that most of their windows have were broken due to continuous shelling since 27 December. As a result, all in-patients have been placed in one ward in Gaza Paediatrics hospital. Plastic sheets have been placed over windows to maintain use of affected wards.
REFERRALS OUTSIDE GAZA
Referral of patients outside Gaza for specialist care is taking place almost exclusively through the Rafah border crossing, which has been opened to evacuate patients and import medical supplies. The MoH reported that since 29 December, 105 injured have been evacuated through Rafah.
The Referral Abroad Department has been closed since the crisis began. As a result, referral of other patients has been suspended. The Directorate of Coordination and Liaison is functioning and applying for permits for patients with referral documents issued before the crisis.
While there are still some shortages of drugs and consumables at hospital-level, a substantial volume of supplies has been delivered into Gaza during the last few days and further supplies are in the pipeline. WHO is working closely with the Palestinian MoH to coordinate deliveries but there is a risk that additional supplies could overwhelm the system and be in excess of requirements. Donors are therefore asked to hold further in-kind contributions until it is possible to assess the remaining needs.
Four trucks donated by ICRC, UNRWA and Islamic Relief and clearly marked with the logos of these entities are transporting drugs to fill up hospital stores. Supplies that were temporarily kept in small storage spaces throughout Gaza are being shifted to a new 1000m2 central warehouse for organization and inventory by a team of pharmacists. Once registration of newly arrived supplies is complete, a more accurate overview of needs can be obtained. The trucks are operating 24 hours a day and reaching all hospitals.
Thirty truckloads of drugs and medical supplies donated by Egypt, Qatar, Libya, Kuwait and Saudi Arabia have entered through Rafah since 27 December and been received by the MoH Gaza. In addition, more than 20 truckloads from Jordan and MoH Ramallah have entered through Karem Shalom. Blood units from Jordan have entered through Erez, so supplies are now at adequate levels to deal with the current level of casualties. On 4 January, donations from Greece, Turkey and WHO are expected to enter Gaza through Ben Gurion.
An emergency operational room has been set up by the PA Ministry of Health (Ramallah) in collaboration with WHO to follow up the health situation. The operation room will provide assessments of requirements (pharmaceuticals, consumables, equipments and spare parts), follow up on the response of the international community and address referrals of injured and other patients.
Situation report in PDF format [pdf 487kb]
Munia Abu El Hawa,
Tel.: 054 802 2753 (Ramallah).
Old Nablus Road – Sheikh Jarrah POBox 54812 – Jerusalem 91547 Tel: +972 2 540 0595 Fax: + 972 2 581 0193 Email: firstname.lastname@example.org
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