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Source: World Health Organization (WHO)
10 February 2009




OVERVIEW


    This is the 4 February update on the situation of the health sector situation since the outbreak of hostilities in the Gaza Strip on 27 December 2008.

    o 4 Feb, UNDSS1 advised UN facilities in Gaza to remain closed and UN staff to remain at home while UNMAS2 teams neutralize unexploded ordinances.
    o Post-ceasefire assessments to evaluate immediate health needs and damage to health facilities are being finalized.
    o 122 health facilities assessed, about 48% found damaged or destroyed:
      - 15 hospitals and 41 PHC centers partially damaged;
      - 2 PHC centers destroyed;
      - 29 ambulances partially damaged or destroyed.
    o Immunization resumes with an attendance rate higher than average.
    o Electricity supplies improve at health facilities.

    International Humanitarian Law requires all medical personnel and facilities be protected at all times, even during armed conflict. Attacks on them are grave violations of International Humanitarian and Human Rights laws. Access to heath is a fundamental human right.






EMERGENCY STATUS
The emergency status declared by all MoH hospitals during the conflict was suspended on 22 January and all MoH facilities have resumed normal functionality.

CASUALTIES and AFFECTED
On 31 January, the MoH reported that 1380 Palestinian people had been killed3 since 27 December 2008, of whom 431 were children and 112 women. Approximately 5380 people were reported injured, including 1872 children and 800 women4. Injuries were often multiple traumas with head injuries, thorax and abdominal wounds. Among the casualties, 16 health staff were killed and 22 injured while on duty5.

UNRWA reported that 3 out of the 50 emergency shelters established to accommodate displaced people continue operating for 445 displaced people.

HEALTH PERSONNEL
Before 27 December 2008, 5469 health personnel were regularly reporting to duty at the different MoH health facilities. 514 health personnel were unable to report to duty during the crisis due to insecurity, according to the MoH Director of Hospitals. For this reason, 89 health personnel were redeployed from their hospitals to others near their place of residence. At MoH primary health care (PHC) level, around 1300 health personnel were reporting to work before 27 December. Most were unable to do so during the crisis but returned to duty with
regular working hours after the cease-fire.

DAMAGE TO HEALTH FACILITIES
15 of Gaza's 27 hospitals suffered damage, 9 MoH6 and 6 NGO hospitals, among them Al-Wafa rehabilitation hospital, which is Gaza's only rehabilitation hospital. Out of the surveyed PHC facilities, 41 PHC clinics were partially damaged and 2 destroyed: 28 MoH clinics, 7 UNRWA, and 8 NGO. (Annex I)

ELECTRICITY AND FUEL SUPPLY TO HEALTH CARE FACILITIES
Electricity supply improved during the last week of January. Around 4 hours per day of electricity outage in all the Gaza Strip.

PRIMARY HEALTH CARE FACILITES
Most health personnel are now reporting back to work. All services have fully resumed in the functioning centers, with some interruptions reported in laboratories and dental services during electricity outage hours at PHC centers that don’t have generators.

53 out of 557 MoH PHC centers are fully functioning and the other 2 are not as they were destroyed. The 1O PHC centers converted to emergency evacuation centers have returned to normal working hours. All UNRWA centers have resumed normal functioning.

There has been a significant increase observed in the attendance at PHC clinics for immunization services as compared to pre-27 December averages. UNRWA is providing catch-up immunization sessions at their immunization centers.

All MoH facilities have resumed regular working hours since the 18 January ceasefires. Trauma counseling activities are being provided to wounded patients and their families in addition to people living in the most affected areas. Other regular MoH services are functioning at community MoH centers and the psychiatric hospital.

The epidemiological surveillance system has resumed its activities, although with all pre-existing limitations, especially related to fragmentation of the system and lack of resources. Health education and promotion services have resumed at community and school levels, focusing on specific issues especially psychiatric disorders, post-traumatic stress disorders and hygienerelated issues.

The public health laboratory is collecting random water samples from the water networks, water wells and water treatment plant on a daily basis for microbiology testing to ensure water quality, especially in areas with destructed/damaged networks. But support is needed for transportation, fuel for generators, medical supplies, kits and reagents.

The environmental health department is coordinating with the public health laboratory for issues related to water quality. Due to a lack of resources, this department has not yet resumed insect and rodent control to disinfect areas close to sewage pools and areas that reported damage to the sewage networks.

REFERRALS ABROAD
Injured patients needing referral outside Gaza for specialized care were evacuated exclusively through the Rafah border crossing. The MoH reported that between 29 December and 22
January, 608 injured were evacuated through Rafah.


Table 1: Distribution of injured patients referred to the different hospitals during 29 Dec- 22 Jan



The Referral Abroad Department (RAD) and the Erez crossing was closed for much of the period and only 30 patients were able to exit during the crisis. 97 applications for permits were submitted between 1-21 January, 18 (18.6%) patients had their permits granted and the other 79 (81.4%) had their applications delayed.

Table 2: Patients evacuated through Erez Crossing




MEDICAL SUPPLIES
According to MoH/WHO operation room in Ramallah, 96% of the priority drugs at the central levels have been either delivered or committed and 81% of the priority disposables were either delivered or are in the pipeline.

At peripheral level, a full stock of pharmaceuticals is available at all MoH hospitals while some items are still in shortage at some PHC centers, especially in North Gaza, Khan Younis and the Middle Zone.

COORDINATION
WHO is undertaking a needs and health facilities assessment that is coordinated with Health Cluster partners. NGOs and doctors have also been asked to coordinate with WHO in Rafah and Jerusalem, as well as the MoH Operations Room in Ramallah, before deployment of health personnel into Gaza to ensure that the specialties being offered are needed by health services there.

WHO is coordinating the emergency health response through its Jerusalem, Gaza, Cairo and Geneva offices with the MoH in Ramallah and Health Cluster partners. A WHO Emergency Operational Plan has been launched for a range of urgent health interventions.



Notes
1 United Nations Department of safety and Security
2 United Nations Mine Action Service
3This number does not include those who have died due to lack of access to regular health care (including obstetric care and reatment for chronic diseases).
4Ministry of Health, Ramallah
5 Information collected by the Palestinian Health Information Center
6 There are 12 MoH Hospitals in Gaza, all MoH hospitals have been partially damaged, except Beit Hanun, Nasser and Gaza Psychiatric Hospitals, which remained unaffected
7 The 56 MoH PHC clinics reported up to now was a number taken from the last available assessment done by the MoH. From the assessment recently implemented it was discovered that, in two occasions, two clinics in north Gaza have been merged to form one PHC facility and one new clinic has been opened in Rafah. Accordingly the total number of the MoH PHC facilities is now 55.


CONTACTS
WHO West Bank and Gaza
Chiara Stefanini, Health and Human Rights Officer
Email: cst@who-health.org Tel.: + (972) (0) 2 540 0595 – Mobile: + (972) (0) 54 717 9024
WHO Regional Office for the Eastern Mediterranean
Altaf Musani, Regional Adviser
Emergency Preparedness and Humanitarian Action
Email: musania@emro.who.int Tel.: + (202) 26 76 50 25 – Mobile: + (201) 02 58 58 22
WHO Headquarters, Geneva
Paul Garwood, Communications Officer
Health Action in Crises
Email: garwoodp@who.int Tel.: +41227913462 - Mobile: +41794755546




ANNEX 1: 122 Surveyed health facilities with damage status: 27 December 2008-19 January 2009



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