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Source: World Health Organization (WHO)
15 September 2002

Health Inforum News
Volume 1, No.12, 15 September 2002
______________________________________________________________________________________

Welcome to the twelfth edition of the Health Inforum Newsletter. In our ongoing efforts to provide useful information to the whole of the health community, we continue to welcome any comments or suggestions you might have to help us to improve this newsletter. Each Newsletter has had a particular theme. If your organization has an information need that you would like to address, please let us know and will do our best to accommodate your request.


MOH Appeals to lift the Siege on President Arafat Compound In Rammallah

Dr. Riyad Al-Za’noun the Minister of Health appeals to the international community, the UN agencies, the “WHO”, the “ICRC”, the Arab health ministers' council and human rights organizations to lift the Israeli siege on president Arafat in Ramallah. Dr. Zanoun warned of the deterioration of the health and environmental conditions inside the compound due to inadequate sanitation and water and lack of appropriate healthy environment, as well as the area of which is 400 square meters, where about 200 people are besieged including President Yaser Arafat.

Dr. Alza’noun was speaking in a press conference held in Gaza by the International Press Center of the State Information Service, following an Israeli invasion of the Shijaiya and Zaitoun neighborhoods, east of Gaza where 9 Palestinian civilians were reported killed and 21 others injured. He made clear that the Israeli’s denied access of Palestinian paramedics into the wounded and injured.

With regards to the Palestinian death toll during the past 24 months as a result of the Israeli offensive against the Occupied Territories, Alza’noun told reporters that it is 2520 martyrs including 511 children, while 39600 wounded.


Access is still the main obstacle facing the health community in the Palestinian territories; Closure and Curfews are every where. All health programs including vaccinations, women's health, child health, environmental health and preventive medicine are adversely affected, due to the inability to deliver services, medicines to hospitals and health centers, and for the environmental health isecticides and chlorine to water tanks, factors that will ultimately result in the spread of epidemics.

Last week, the Palestinian Ministry of Health appealed to the international community, UN agencies, WHO, the ICRC, the Arab health ministers' council and human rights organizations to pressurize the Israeli government to stop destruction of health foundations in Palestine, to allow ambulances and medical staff the right to free movement to evacuate the injured and transport patients to hospitals.

In Nablus, the health situation is very difficult. Dr. Munzer Sharif, the Deputy Minister of Health, has warned of the deteriorating health conditions in Nablus governorate that has been under Israeli curfews and strict siege for three months. During this
period movement has been impossible, with medical staff and health personnel
unable to reach their work places, whilst mortality has risen among chronic diseases patients and the threat of epidemics is present.

This issue of the newsletter will discuss access and its impacts on the health sector in the occupied Palestinian territories.

Why Access is a Problem?

Israel has dramatically tightened its restrictions on the free movement of Palestinian people, vehicles and goods since the second intifada (uprising) began in September 2000.

The Israeli army started their policy of restrictions in movements of the Palestinian population, with the isolation of rural and urban areas at district level, in addition to severe restriction of movements and closure between the different districts in West Bank and Gaza.

This type of curfew regime does not make any provisions for health services and vital service providers. Patients can’t arrive at health facilities and health personnel can’t reach their work.

According to the “OXFAM” study ”The Forgotten Villages in the West Bank”, closure denies village families access to basic services available in towns and cities. Health and water are now, for many households, either too expensive or simply not available. Increasingly families are forced to use dangerous or inappropriate alternatives – such as riding donkeys to hospital, or unplanned home births – or to simply do without. Scores of villages without water networks are facing severe water shortages, as water tankers either cannot access villages or people can no longer afford the price of tanked water.

Closure is creating a growing number of destitute families that are suffering from malnutrition, chronic health problems, welfare dependency, and psychological stress. As the main household managers, women are bearing the brunt of closure impact.

The health sector is severely affected by the closures regime. The absence of regular monitoring particularly in environmental health services is causing food and water born diseases, vector born diseases, in addition to other environmental health problems, including garbage, sewage vector, water, food, and animal (zoonotic diseases) control.

Vaccination program:

The vaccination program was also severely affected with delays of 3-4 months in many places in the West Bank and Gaza.

Curfew, closure, and strict siege, created a lot of problems and constrains to the vaccination program, concerning coverage, vaccine efficacy, vaccine preventable disease surveillance and monitoring and planning.

MOH can’t provide this service to Palestinian children without the help of international organizations and UN agencies. The assistance of the international community has provided transport, drivers and foreign staff consultants as MOH staff are not allowed to move on their own.

Access to health services:

Restrictions of access continue to prevent Palestinians requiring medical treatment from accessing health care services. Over 70 percent of the Palestinian population live in rural areas, which do not provide hospital services; closure therefore severely restricts the majority of the population from secondary and tertiary health care facilities.

The Palestinian Ministry of Health published recent data concerning the impacts of closures and curfews on patients since the 19 September 2000 until 1st September 2002.

Table No. 1: Number of patient’s couldn’t access to health services
since 29 September 2000 until 1st September 2002

Children
Females
Males
Total
Patient fatalities at Israeli checkpoints
17
24
31
72
Deliveries at Israeli checkpoints due to siege conditions
45
Babies delivered and died at checkpoints and homes due to siege
27
Source: MOH


The Health Sector Bi-weekly Report, Number 2(19 August 02), published by John Hopkins University, Alquds University, MARAM and Care International/ ANERA, which funded by USAID, indicates that access to services is more affected in the West Bank than Gaza, likely due to greater restrictions of movement in the former. Of particular concern are dialysis patients, who if unable to access dialysis in a timely manner, could die.

The emergency's impact on access to health service facilities has significantly impacted health workers as well as patients. Staff in 46 (48.9%) of the 94 clinics surveyed reported having been unable to reach the facility where they work at least once during the previous two weeks. The overwhelming majority (45 out of 46 facilities, or 97.8%) indicated that the primary factor in their inability to reach work was curfews/ closures.

Forty of the 94 clinics surveyed since 31 May (43.6%) have had to suspend or cancel one or more services for more than one day in the two weeks prior to the survey interview. The proportion of clinics reporting such disruptions in services has remained steady, within a range of less than 5% from round to round. Primary care, prenatal care and emergency services in particular have been disrupted, followed by
Pharmaceutical services. All but 3 (92.5%) of the 40 facilities reporting having suspended services indicated that curfews/closures were a primary reason for suspension of services. At the time of the survey interviews, 17 facilities out of 40 (42.5%) had not yet resumed those services.

For more details, please refer to http://hart.itcoop-jer.org

World Health Organization recently reported (Situation Report, Occupied Palestinian Territories-July 2002), an alarming decline in the accessibility and affordability of medical services: · UNRWA reports decreases in access to preventive services, including a 52% decrease in women attending post-natal care (of the 90% of women attending pre-natal care pre-Intifada), and a 31% decrease in new acceptances on their family planning scheme;
· UNRWA reports from among its patients 58% increase in number of still births (particularly in the Jenin and Hebron areas);
· Hospitals report a decline in access to services, for example St Luke’s hospital in Nablus reports a 49% decline in general practice patients, a 73% decline in specialty services and a 53% decline in surgeries. The only ophthalmic hospital in the West Bank is in Jerusalem. Closure has therefore prevented West Bank inhabitants from accessing this specialized service;
· The Ministry of Health also reports a 60% decline in implementation of school health programs;

Risk to Health Professionals:

Assaults Against Ambulances And Medics since 29 September 2000 until 1st September 2002

Medical staff Fatalities
18
Injuries among ambulance drivers & medical staff
370
Assaults against ambulances
240
Injuries among ambulance drivers, rescue team members and doctors
370
Hindering and blocking ambulances
660
Ambulances destroyed
34
Assaults against hospitals and health facilities
215
Source: MOH, for more details please refer to www.moh3.com

Water, Environment and Natural Resources

Water resource damage is occurring through damage to environmental facilities, particularly sewage infrastructure, and due to restrictions imposed on proper waste disposal. Owing to the internal closures, outlying Palestinian villages are being denied access to drinking water. Many infrastructure projects supported by the international aid community to improve the Palestinian environment have been brought to a halt because of the closures.

The Emergency Environmental Health Project (USAID sponsored) indicated that 100% of water delivered by tanker in Nablus is below any acceptable standards for drinking water. MOH reported problems with contaminated water in the Balata and Askar camps due to the destruction of both the water network and sewage pipes.

In the last meeting of the “WHO” Emergency Meeting (11 September 02), it was reported that chlorine distribution was being hampered by the closures and curfews.

Outbreaks of Shigellosis were reported in the Nablus area due to water contamination arising from damaged sewage and water pipes infrastructure.

MOH can’t bring the water and food samples from different districts to check in the Central Laboratories in Ramallah without the help from international organizations.


Medical Supplies Distribution:

Due to the current curfews and the closures in the West Bank, Ministry of Health staff and trucks cannot gain access to local areas to reach their hospitals and clinics to supply them with the urgently needed medicines and supplies.

To ensure that these essential medical supplies reach the hospitals and clinics in the West Bank, International organizations and donor countries have had to step in and support the Ministry with International trucks and drivers.

Other news:

Help Needed for Chronic Individual Cases

Due to the current situation, many chronic cases and hospitals are calling Health Inforum asking if there is any organization that can offer support to these cases (most are children with congenital anomalies).

The increased number of these individual requests is due to:

§ Increased number of unemployed persons
§ High cost of medical treatment and medical examinations
§ The absence of special organizations dealing with specific diseases.
§ Certain cases not covered by the health insurance.

Health Inforum is raising this issue to assess if there is any organization working or interested in this field.

Please contact us: hart@undp.org

NGO PROFILE

Health Inforum will start to highlight in its Bi-weekly Newsletter one of the health stakeholders; for those who like to publish about their organization’s profile, please email a short background on the organization and its activities.


WEBSITE:

Health Inforum posts daily news and announcements concerning health issues on our website: Http://hart.itcoop-jer.org. We welcome your inputs, comments and suggestions.

FOR MORE INFORMATION

Please feel free to contact us for information at:
Health Inforum, c/o the Italian Cooperation
Sheik Jarrah, East Jerusalem

Tel: 02 532 7447 Fax: 02 532 2904
Email: hart@undp.org Http:// hart.itcoop-jer.org


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