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Source: World Health Organization (WHO)
30 June 2004

Health Inforum News
Volume 3, No.49, June 2004
Welcome to the forty-ninth issue of the Health Inforum Newsletter.

Quote of the month
    A man's health can be judged by which he takes two at a time --
    pill or stairs. ~ Joan Welsh ~


Health News:

§ Measles Campaign….
§ Health situation in WB&GS could slide into collapse…
§ 57th World Health Assembly…
WHO - Rafah crises update report

Research/ Studies
Infant and Early Child Mortality among Palestine Refugees

The Radiotherapy Unit
Cancer Center of Augusta Victoria Hospital

The Italian Cooperation brings back the smile to a Palestinian Child’s family
Casualties & access incidents
120 Palestinians were killed, 808 injured and 58 incidents on ambulances during April


Measles Campaign
Ministry of Health and UNRWA, with technical and financial support from UNICEF, will carry out a national immunization campaign against measles. The campaign aiming at reaching more than 540,000 Palestinian children aged 9-59 months with one dose of measles as well as Vitamin A.

The WHO warned the health situation in the West Bank and Gaza has reached a critical point and could slide into collapse without further assistance.
Dr David Nabarro, the WHO's director for Health Action in Crisis, has recently returned from a fact-finding trip to the Palestinian territory. At the annual assembly in Geneva he said there were signs that the situation was becoming increasingly precarious. Malnutrition was rising and vaccination levels were falling, he said. People with diseases such as diabetes were not getting the treatment they require, he added. These are all indicators the WHO has observed in other crisis regions and they are frequently the precursors of a general collapse of the healthcare system.
Concern for children:
The Palestinian territory does benefit from generous medical aid and highly skilled doctors and nurses, but the increasing restrictions on movement caused by checkpoints and by the new security barrier mean that often medical supplies are not getting through. Patients cannot get to hospital and medical staff cannot get to work. The WHO is especially concerned for the health of very young children, the elderly and people with chronic diseases. These three groups account for almost 25% of the population. An international conference of donor countries will discuss aid to the West Bank and Gaza in Geneva at the start of June and health will be a top priority.
(Source: BBC news website (21 May 2004)

57th World Health Assembly
The 57th World Health Assembly passed a resolution on May 21, 2004, calling for the WHO Director General to send a team to the occupied Palestinian territory to assess the degradation of the health services resulting from the current crisis and from Israel's security barrier. The Assembly Expressed its concern at the deterioration of health conditions and the humanitarian crises resulting from military activities which caused severe restrictions on the movement of Palestinian people and goods, including restrictions on the movement to and from Palestinian territory, particularly of ambulances, health workers, the wounded and sick.
To read the full resolution please visit


Rafah Crises Update Report

v Public Health Situation in Tal Al-Sultan (25,000 inhabitants):
· The statistics of the MoH clinic show high increase of cases among children suffering from diarrhea and skin diseases (mainly chicken pox). The total number of children seen by GPs during the period between 22 and 31 of May (directly after releasing the curfew and closure) was 1363 cases. This number is almost double the number seen in the first two weeks of May (before the incursion) which was 848 cases.
· According to UNRWA (Dr. Yousef Musa, Rafah Meeting 3 June), the number of cases among children suffering from diarrhea in the last week of May increased to 48 cases while it was in the fist three weeks of May around 20 cases per week.
· The Sewage drainage pipes are destroyed and waste water runs on the streets. The Water authority and the municipality of Rafah reported that the USAID donated US$ 100,000 for immediate repair of the sewage system in Rafah.

v Tal Al-Sultan Clinic updates:
· The outside wall of Tal Al- Sultan clinic is still not reconstructed.
· The pharmacy is totally damaged and drugs are stored in a room originally used for equipment and old machines.
· The laboratory was also damaged where traces of bullets could be seen on the windows and walls.
· Vaccines are not stored at the clinic. The daily needs of vaccines are brought from the central Rafah clinic.
· As a result of Health Inforum appeal regarding Rafah crises, the ‘Friends of East Jerusalem’ hospitals organization agreed to fund an electricity generator and a Cell Blood Count Machine for Tal Al-Sultan clinic. The total fund will be about US$ 50,000.

v 1800 persons still live in schools:
· According to ICRC news release (2nd June), the number of persons still living in 3 UNRWA schools in Rafah is 1800.
· UNRWA provides people with food and basic needs. Temporary bathrooms and showers were established to improve the hygiene situation.
· UNRWA is also covering the medical needs and monitoring the health situation in these schools.
· People are still living in crowded rooms where about 40 persons live in a 16 M2 room.
· Many mothers reported that their children are suffering from diarrhea or skin diseases. Although a medical team is available in each school.
According to ICRC, there is cut off water in limited areas in Rafah. The ICRC has started to deliver urgently potable water to residents of the Block O, Hay Al Salam, Tal Al -Sultan and Al Brazil neighborhoods of Rafah. Over the next weeks, the ICRC will subsidize 14 mobile water tankers delivering 150.000 liters of water daily to over 38.000 Rafah residents whose access to water was cut off during the invasion.

Action points of Rafah Health District Group meeting (3 June 2004)
· Gaza Community Mental Health Program was suggested to be the focal organization for psycho-social intervention.
· The municipality of Rafah with the support of ICRC will be the focal institution for water.
· ICRC in coordination with Palestinian DCO will be the focal agency for access.
· Oxfam and UNICEF will be the focal organizations for health education.
· WHO is leading the coordination in health sector.

To read the full report on Rafah Crises, please visit


Infant and Early Child Mortality among Palestine Refugees

This study documents the level, trend, and patterns of infant and child mortality among Palestine Refugees in Jordan, Lebanon, Syria, the West Bank and Gaza Strip based on comparable data between two Agency-wide studies conducted in 1997 and 2003.

The objectives of the two studies, the baseline and the follow-up, were to estimate infant mortality rate (IMR) and child mortality rate (CMR) and assess the mortality pattern among Palestine refugees using UNRWA maternal and child health services in the five Fields of operation. In the two studies, some factors that might affect infant and child mortality rates such as; parity, mother’s age, mother’s education and sex of child/infant were studied. In addition, in the 2003 study, the causes of child and infant mortality were studied as well.

Data of the follow-up study was collected from March through October 2003. All primary health care facilities, in and outside camps, run by UNRWA in Jordan, Gaza, Lebanon, Syria and the West Bank participated in the study. The study included a total of 16,691 women with more than one child, who attended the Agency’s primary health care facilities to register their newborn babies.

The follow-up study has shown that infant and early childhood mortality rates per 1000 live births dropped markedly between 1997 and 2003. The largest drop in all mortality rates was in Lebanon field while in Syria; there was a mild drop in child and infant mortality rates and an increase in neonatal mortality. Agency-wide, there was a drop in early child mortality from 35 to 24.4 per 1000 live births with a drop of 30%. Infant mortality rate dropped from 32 to 22 deaths per 1000 live births, a drop of 31%. Likewise, neonatal mortality dropped from 21 to 15.3 deaths per 1000 live births with a drop of 27.1%. The main causes of infant mortality were almost the same in all Fields namely; prematurely/LBW, congenital malformations and respiratory causes. The main causes of child mortality were accidents, congenital malformations, including congenital heart diseases, and respiratory infections.

To read the full summary, please visit


Radiotherapy Unit Project/ Augusta Victoria Hospital
Project Description:

Location:Cancer Center of Augusta Victoria Hospital/Jerusalem
Over all aim:Provision of comprehensive quality medical service to cancer patients
Beneficiaries:Cancer patients in the West Bank, Palestinian ministry of health will transfer cancer cases to Augusta Victoria instead of transferring them to other countries.
Duration:Ongoing project, will start work by the end of August 2004
Budget:US$ 4.5 million
Donor:Arab Countries and the German government
Diagnostic Support Center is needed for the project

The Cancer Center needs very specialized diagnostic procedures to determine the most effective protocol, currently it is available only in Israel, and Augusta Victoria hospital is expending a large amount on these external testing. The feasibility requires establishment of a specialized diagnostic center, this will include anatomical and clinical pathology, where the cost of this center is around US$ 900,000.

It is worth to mention that Augusta Victoria Hospital, is working in Jerusalem since 54 years ago, the majority of its clients (70%) are the Palestinians refugees.

The hospital started few years ago to concentrate on specialized medical services, it offers services for pediatric and adult dialysis, Ear Nose and Throat (ENT), Endoscopy, Geriatrics and since three years ago the hospital established the Chemotherapy Unit for the cancer patients, the hospital offers also surgical Oncology and pediatric hematology -oncology.

In order to overcome the access problems from the West Bank to Jerusalem, the Hospital initiated a program called “Patient Transport”, the aim of this program is to assure the right of patients to access specialized health care. Currently, all pediatric dialysis patients are transported to and from the hospital.


The Italian Cooperation brings back the smile to a Palestinian Child’s family

After a long struggle with a congenital heart malformation and a heart-breaking search for survival, one-year old Palestinian boy Adel Khaled Ibrahim was reborn in a Milano hospital.

Adel came back with his mother from Italy after having performed a successful heart surgery by a team supervised by professor Friggiola at San Domato Hospital in Italy. Adel had a congenital heart malformation which disabled him from having a normal life. He is a native of the northern West Bank town of Tammoun, near Jenin. He was delivered in a caesarean operation at the Rafidya Hospital in Nablus, where doctors detected his birth malformation, his skin was all in blue he couldn’t breathe easily, they moved him to the intensive care unit for 15 days and then he was delivered home.

Adel’s parents has two more brothers 4 years and 3 years, his mother explained the hard time that Adel, herself and the whole family had during this year, she said that Adel was getting sick every time he gets out of home, and it used to take him weeks before he recovered again. His parents made big efforts to help Adel to overcome his sickness by taking him to doctors and specialists who tried to diagnose what he has, but his problem was very complicated in a way that even the cardiologist couldn’t diagnose.

God answered her prayers, as she expressed, with the Italian Cooperation, through whom she was able to diagnose what is Adel’s problem, what should be done to save his life, and finally to send him to Italy for treatment. “I can’t express the happiness that I have now, I feel that Adel was born again because he is active, he smiles, actually plays, and started to live a normal life after a period of suffering”. The grateful mother added “I couldn’t find words to express my appreciation for the Italian Cooperation for bringing back the smile to our family, during the last year we didn’t have a normal life, we couldn’t even sleep at night we were very disheartened and stressed all the time”.

Amongst the health projects of the Italian Cooperation is the program where either specialist medical teams come in a mission to Palestine to conduct surgical operations for patients with heart diseases or patients are sent to specialist hospitals in Italy for medical treatment or operations abroad. Adel was one of the patients sent to Italy for treatment within the joint project between AISPO and the Italian Cooperation. The MOH is in process of preparing a list of patients to be sent to Italy for serious operations before the end of this year.


According to Palestinian Ministry of Health statistics, the total number of deaths & causalities from 28/04/2004 to 27/05/2004 were the following:

Total number of deaths: 120
In Gaza Strip: 92
In West Bank 28
Total number of casualities: 808
In Gaza Strip: 467
In West Bank: 341

While during the period 1 – 28 May 2004, there were 58 incident (62hrs) reported on ambulances delay of access, and 24 cases were totally denied to access.


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Health Inforum, c/o WHO, Gaza office, Al-Bayed building, Al-Halbi Str. Tel: 08-2822033, Fax: 02-2845409
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