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Source: World Health Organization (WHO)
12 January 2009


HEALTH SITUATION IN THE GAZA STRIP

11 January 2009

OVERVIEW

CASUALTIES
According to the Palestinian Ministry of Health (MoH) on 10 January, 883 people have been killed since 27 December, including at least 85 women and 284 children. At least 4057 Palestinians have been injured, including at least 1419 children and 596 women1. WHO has not been able to independently verify these details.

UNRWA reports that since 27 December, 21 555 people have been displaced by the conflict. UNRWA received a message that during evening of 10 January that a large mass of “smog” was covering an area in the eastern part of its Jabalia shelter. People complained of difficulties breathing, skin irritations, and laryngeal spasm. Two cases were referred by UNRWA team to hospital.

HOSPITAL FUNCTIONING

Damage to hospitals, primary health care centres, and ambulances
No damage to ambulances reported 11 January. The Palestinian Medical Relief Society (PMRS) reported two of its mobile clinics that were serving more than 42 Gaza communities have not been functioning since 28 December due to the insecurity.

Damage to hospitals:
Damage sustained by the Gaza European Hospital on 10 January has not yet been repaired.

Dorah and El Nasser Paediatrics hospitals are still functioning with major limitations due to damage sustained.

Damage to PHC centres:
MoH PHC centres: Shelling severely affected Sawarha clinic (Middle zone) during the night of 10 January. Artillery fire during the night of 9 January partially damaged the Sabha Al Harazin and Hala Al Shawa PHC centres. No details are currently available on the extent of damage.

Nearby shelling on 11 January forced the closure of three MoH PHC clinics: Shuhada’ Al Shate’ clinic (Gaza district); Khoza’a and Al Zana clinics (both Khan Younis).This brings the number of MoH PHC clinics closed to 27.

UNRWA centres: Limited damage occurred to UNRWA’s Rafah PHC centres during bombardment on 8 January.

UNRWA reopened two PHC centres. Three out of 18 remain closed: the Elshouka and Zaitoun centres were closed after IDF instructed people living in an adjacent building to evacuate prior to bombardment, while a centre in Beit Hanoun was closed due to being in a high risk area.

NGO centres: PMRS reported two of its 2 PHC centres in the north part of the governorate have been closed since 4 January due to being in high risk areas and staff cannot reach work. These centres are Um-Naser Health Care centre, which served the Bedouin Village and provided vaccinations; and Izbet Bait Hanon Health Care centre, which served Izbet Bait Hanon Village.

Electricity failure and fuel supply
All hospitals have four days fuel capacity for back-up generators after receiving fuel. All hospitals received an average of four-five hours of power supply.

On 11 January, UNRWA supplied generator fuel to four UNRWA PHC centres.

Bed capacity and occupancy rate
The Shifa hospital ICU remains overwhelmed. Some patients were evacuated but the ICU is functioning at almost full capacity, with more than 20 out of its total 30 beds occupied due to the low evacuation rate of patients through the Rafah Crossing. Shifa hospital continues to try and keep bed occupancy rate below 75% to allow space for urgent and emergency cases.

REFERRALS AND EVACUATIONS OUTSIDE GAZA
A total of 31 patients were evacuated 10 January through the Rafah Crossing and another 17, including three children, were evacuated on 11 January. The number of patients evacuated through Rafah since 27 December is 218, most for injuries and some for chronic conditions. Egyptian authorities declined an offer made by the Belgian government to support the medical evacuation to Brussels of injured children. Negotiations are being conducted between the Belgian embassy in Cairo and Egypt’s Ministry of Foreign Affairs.

The Palestinian Health Liaison Officer submitted until today 20 requests for evacuation of chronically ill patients through Erez crossing. Israeli authorities granted 5 positive answer but patient could not cross due to blockage of main road to the crossing and short notice. The Palestinian Referral Abroad Department remains closed.

MEDICAL SUPPLIES

Medical supplies resumed after UNRWA lifted its restriction on staff movements. Five trucks carrying medical equipment donated by the Italian Cooperation and other international organizations passed through Karem Shalom on 11 January. Medical equipment and five ambulances donated by several countries and international organizations were delivered through Rafah on 10 January.

On 11 January, UNRWA supplied drugs and vaccines to four UNRWA PHC centres in the Gaza Strip.

PRIMARY HEALTH CARE CENTRES
WHO remains concerned about public health and public sanitation in Gaza while waste management has not been assured and garbage is not collected in the Gaza Strip. The vaccination program is still dramatically interrupted, with some trials to operate some centres; this situation could result in outbreaks, a risk increased by Gaza's high population density and dire living conditions.

MoH PHC centres:
Of 58 PHC centres managed by the MoH, only 33 are functioning (with major interruptions) as of 11 January. The 1O PHC centres that have been converted into emergency evacuation centres continue to function. For the geographical distribution of functionality of the MoH PHC centres please see annex 1.

Bani Suhalia clinic (in Khanyounis District) and Shuhada’a Nusierat clinic (in Middle Zone District) have started to function as primary referral points for hospitals in their respective area.

The director of PHC reported that since 27 December, the use of PHC activities have dramatically declined. About 70% of chronically ill patients regularly attending PHC centres have interrupted their treatments and are no longer attending PHC centres.

On average, staff attendance is around 30% in all functioning PHC centers.

As a result:
· Most vaccination programmes (EPI and adult vaccinations) have been interrupted due to closure of clinics, unavailability of electricity or fuel at clinics equipped with generators, movement restrictions affecting distribution of vaccines and lack of staff. The vaccination program is now increasing its capacity to operate to 30-40% in most of areas around the Gaza Strip in coordination with UNRWA
· Antenatal Care (ANC) is not being provided due to lack of staff and electricity needed for ultrasound and other diagnostics. Women can't attend ANC due to conditions on the ground. Dental care is not functioning due to lack of staff and electricity. Antenatal and dental care are now being prepared to be partially functioning in the coming few days.
· PHC laboratory services have been halted since military operations began due to lack of electricity, staff and laboratory re-agents.
· Nutritional surveillance has stopped because the main centre is closed as it is located in a risky area.
· School health services are not functioning since schools are closed and staff not reporting to work.
· Preventive medicine is not functioning due to lack of staff.
· Epidemiology department is not functioning since no information is flowing from peripheral facilities, hospitals are overwhelmed with casualties, PHC centres are not fully functional and laboratories are not reporting.
· Occupational medicine is not functioning due to lack of staff.
· Health education and promotion activities have been suspended due to lack of staff.

UNRWA PHC centres:
During the limited break in hostilities on 11 January (13:00-17:00), outreach campaigns were carried out in two isolated areas (Beit Hanoun PHC centre and an emergency shelter). Food and medical care were provided for the two areas for the second time.

NGO PHC centres:
PMRS reports that Haeder Abed Shafi PHC centre in Jabalia (Al- Fahoura area) has been providing PHC services and functioning as an emergency centre (24 hours). PMRS reports that the staff at

the centre have observed a 250% increase in the attendance to this centre during the last four days.

COORDINATION
The Palestinian MoH in Ramallah with WHO collaboration continues its activities from the emergency operations room to respond to the health crisis.

CONTACTS
WHO West Bank and Gaza Ms. Chiara Stefanini
Health and Human Rights Officer Email: cst@who-health.org
Tel.: + (972) (0)2 540 0595 – Mobile: + (972) (0)2 55 717 9024

WHO Regional Office for the Eastern Mediterranean Mr 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
Tel.: +41 22791 3462 - Mobile: +41 794755546 Email: garwoodp@who.int




__________________________

1 The reason for the high increase in the death count is the identification of many bodies that were previously not identified or found under the rubble or in areas previously not accessible.


ANNEX 1: PHC functionality status:





































































District
Functioning PHC
clinics
Emergency PHC
clinics
Non-functioning PHC
clinics
North Gaza
• Shuhada’a Jabalia.
• Biet El Maqdis in
Biet Lahia
• Old Biet Lahia clinic
• Biet Hanoun clinic
• Shuhada’a Jabalia • Al Atatra
• Abu Shbak
• Al Shayma’a
• Izbet Biet Hanoun
• Jabalia Camp
• Biet Hanoun
• Al Atatra
Gaza
• Shuhada’a El Remal
• Shuhada’a El Daraj
• Al Huria
• Zayton
• Shiekh Radwan
Zayton

Shiekh Radwan

• Al-Surani
• Ata Habeeb
• Al Rahma
• Al Qubba
• Sabha Al Harazeen
• Al Salam
• Al Falah
• Hala Al Shawa
• Shuhada’a El Shate’
Middle zone
Nusierat old clinic
Shuhada’a Nusierat
Old buriej clinic
Dier El Balah
New Buriej clinic
West Nusierat
Mughazi
Hekr El Jame’
Zawada
Nusierat old clinic
Shuhada’a Nusierat
Nusierat old clinic

Shuhada’a Nusierat

Old buriej clinic

Dier El Balah

Wadi Al Salqa
Al Zahra
Al Mughraqa clinic
Johor El Diek clinic
AL Mussadar clinic
The medical institution
clinic
Sawarha clinic
Khayounis
Bany Suhalia clinic
Khaza’a clinic
Abasan Al Kabera clinic
Abasan Al Saghera
clinic
Joret AL Loot clinic
Khaldia AL agha clinic
Qarara clinic
Al Shuka clinic
Al Amal clinic
Fukhari clinic
Bany Suhalia clinic Shuhadaa Khanyounis
clinis
Rafah
Shuahada’a Rafah
center
Tal Al Sultan center
Shaboura clinic.
Shuahada’a Rafah center

Tal Al Sultan center

Al Shuka clinic


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