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Source: World Health Organization (WHO)
31 July 2002




OPT Situation Report Jul 2002

General situation

The humanitarian situation continues to deteriorate. Lack of access is still the main constraint faced by Palestinian people as well as by all service providers in the oPt, both international and Palestinian. The elaborate network of roadblocks and checkpoints continue to isolate villages from the main urban areas, thus hindering the rural population's access to vital services. Likewise, services providers' access to their beneficiaries remains severely hampered. The lifting of curfews remains sporadic and is not announced adequately in advance, thus significantly impacting on employment, health services and daily life of the population and making it impossible for humanitarian agencies to plan ahead (see graph at the end).

In a statement released early in July by the Association of International Development Agencies (AIDA) - the major international NGO coordination forum in the oPt - stated that they can no longer adequately fulfil their mandates due to excessive delays at military checkpoints, inconsistent refusal of access to their project sites and beneficiaries, and harassment and severe restrictions on the movements of local as well as international staff. The Ministry of Health (MoH) is still unable to deliver medical supplies without the help of internationals.

The ongoing crisis is worsening the generalized socio-economic hardship and impoverishment. The money shortage due to lack of work possibilities because of curfew and closure is severe; people are increasingly selling assets and relying on friends and family for economic support; household coping mechanisms such as credit networks allowing people to buy water and food are no longer sustainable. According to various assessments the unemployment rate is currently reaching up to 67 percent in the Gaza Strip and 48 percent in the West Bank1. Palestinian official sources further estimate that 66.5% of the Palestinian population currently lives below the poverty line (i.e. US $2 per person/day).

Preliminary findings of a UNICEF/ Palestinian Central Bureau of Statistics (PCBS) survey show that 63.8% of the surveyed households have faced difficulties in getting food supplies during the Intifada. Out of those, 85.2% of the households have reported siege as a cause of the difficulty, whereas 31.1% of the households have reported curfew as a cause of not getting food supplies. 56.0% of the households reported loss of family income as a cause of the difficulties they face in getting food to their households. Results also indicate that 61.9% of households were forced to borrow money in order to get food to their families, while 43.2% households were forced to use their savings or sell their valuables in order to buy food to their families and 32.1% households dependent mainly on food aid.

According to an ongoing Sentinel Surveillance System being conducted by CARE/USAID, more than half of the Palestinian population surveyed reported having to decrease food consumption; the primary reasons cited were lack of money (65 percent) and curfews (33 percent). Fifty-three percent of households said they had to borrow money to purchase food, with Bethlehem, North Gaza, Jericho and Gaza City containing the most households in this category. Roughly seventeen percent of households had to sell assets to buy food, with rates highest in Gaza City and Khan Younis. Thirty-two percent of all households reported buying less bread, potatoes, and rice, which are staples of the Palestinian diet.

As recently stated by Peter Hansen, commissioner general of UNRWA, "A consensus has emerged in the Middle East, among people of otherwise widely divergent views, on one point: something must be done for ordinary families in the West Bank and Gaza Strip. They face a crisis of such dimensions that it threatens everyone in the region." The American ambassador in Israel, Daniel Kurtzer, has called the situation in the territories "a humanitarian disaster,'' urging Israel to lift travel restrictions on Palestinians.

Health situation

Since March 2002 the collection and disposal of solid waste has been particularly problematic in the Gaza Strip. Similar difficulties have been and are being encountered by municipal services of the West Bank towns that remain under intermittent curfews since mid-June 2002. The Ministry of Health (MoH) is gravely concerned about reports by the USAID-sponsored Emergency Environmental Health Project indicating that 100 % of water delivered by tanker in the area of Nablus is below any acceptable standards for drinking water. MoH reports problems with contaminated water in the Balata and Askar camp due to the destruction of both the water network and sewage pipelines by IDF tanks in these localities, causing the sewage to flow into the water pipeline. Distribution of chlorine to clean the water is reportedly hampered by the closures and curfews making it severely difficult for MoH staff to reach out to the affected localities without help from international organizations. An outbreak of Shigellosis (over 600 cases) was reported to the MoH in that area in the past few weeks.

An emergency vaccination programme in the remote areas is currently being conducted by the MoH and coordinated by WHO's operations room. 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. MoH also reported on the dramatic impact of the lack of movement on the immunisation coverage and its mid-, long- term health implication. The Palestinian Ministry of Health reports that because of closures and curfews, its facilities operate at about 30% capacity.

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.

As half the Palestinian population has no medical insurance, many Palestinians are now unable to afford medical care. Recent findings in the public health sector reveal 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;
  • Over 19 percent (20.9 in the West Bank and 18.9 in the Gaza Strip) of Palestinian children under five suffer from anaemia2. The anaemia rates registered among non-pregnant Palestinian women of childbearing age average to 10.8 percent.

    Two different nutritional surveys have in the past few days released their preliminary findings. A UNICEF/PCBS study indicates (compared with available statistics for the period of summer 2000
    3) an increase of 22.6% in the number of children suffering from moderate stunting; an increase of 36.0% in the number of children suffering from moderate underweight; and an increase of 50.0% in the number of children suffering from moderate wasting. More than one third of households are not able to access health services (36.4%). When asked about the main causes of not accessing health care facilities, 79.1% of households indicated closure and Israeli measures, 37.2% of households reporting difficulties have sited curfew as a major cause for not accessing services and 76.5% reported lack of resources.

    A Nutritional Assessment by USAID/CARE shows an increase in the number of malnourished children with 9.3 percent of children under 5 suffering from acute malnutrition and 13.2 percent from chronic malnutrition. The preliminary rates are particularly high in Gaza with the survey showing 13.2 percent of children suffering from acute malnutrition, putting them on par with children in countries such as Nigeria and Chad. Other early findings from the same study show that the rate of anaemia in Palestinian children under 5 has reached 19.7 percent (20.9 percent in the West Bank and 18.9 percent in Gaza), while anaemia rates of non-pregnant Palestinian women of childbearing age are 10.8 percent (9.5 percent in the West Bank and 12 percent in Gaza). A market survey reveals shortages of high protein foods such as fish, chicken, and dairy products amongst wholesalers and retailers in the West Bank and Gaza Strip. Fifty-two percent of wholesalers and 48.3 percent of retailers reported a shortage of infant formula. Survey respondents indicated that shortages in Gaza were primarily due to border closures that seal the Gaza Strip off from Egypt, Israel and the West Bank. In the West Bank, survey respondents said food shortages were caused by a combination of road closures, checkpoints, curfews and military conflict.

    WHO activities in the oPt

    In the context of the current emergency WHO continues to be involved in a number of initiatives:

  • The emergency operations room for the health sector (HART, now renamed Health Inforum) is continuing to strengthen coordination in support of the Palestinian health authorities and service providers by collecting and sharing up-to-date information about the humanitarian health situation and the emergency response. Health Inforum is now setting up a Discussion Board to stimulate open dialogue and debate around health issues in the Palestinian territories. It is a way to allow as many people as possible to share in discussions about important issues.
  • Emergency Coordination meetings, chaired by WHO, are taking place in Ramallah at the Public Health Laboratory every two weeks, curfews permitting, to share information and problems encountered among organizations involved in the emergency health response.
  • Over 100,000$ worth of rodenticides and pesticides for the emergency environmental health programme are currently being delivered to the MoH. These are for controlling diseases like leishmaniasis, West Nile fever, foot and mouth disease and diseases induced by rodents and flies which are becoming increasingly likely in the present situation in which garbage disposal services are completely disrupted.
  • Coordination work is continuing within the established structure of the Health Sector Working Group where WHO acts as the Secretariat. A Health Sector Working Group meeting took place in Gaza on 10 July. The Ministry of Health (MoH) outlined its new strategy of decentralisation, in response to the curfew regime in the main West Bank cities.
  • WHO is actively involved in the preparation of the incoming Health Sector Review promoted by the European Commission. MOH, Palestinian NGOs and local stakeholders are being contacted to establish a Steering Committee which will guide the activities of the HSR and support the team of experts carrying out the exercise.
  • A household/health facility survey is being planned together with the PCBS. Its inception is expected within the next few days.
  • A Mental Health technical assistance programme to the Ministry of Health, whose start had been kept on hold for sometime, is now being revived and five Palestinian professional are in the process to travel to Trieste, Italy, for a six-month training programme.

    Conclusions

    The situation in the oPt is characterized by a progressive disrespect by the occupying power of humanitarian laws. Humiliation and harassment especially at the checkpoints add to the suffering and frustration of Palestinian civilians. The current regime of reoccupation, inter-temporary curfews, and movement restrictions imposed on the population, to national and international service providers constitute the single largest cause of the growing health as well as humanitarian emergency. This situation is expected to last in the short-to-medium term leading to a rapid deterioration as a result of consistently diminishing amount of services provided to the population and strangulation of the private sector.

    The Israeli Defence Force have announced their intention to ease the restrictions earlier imposed on international relief operators, as they rely on international relief community to ensure continuity of basic services that otherwise are impossible to deliver. However, a massive humanitarian aid package unconditionally delivered to the great majority of Palestinians as long as humanitarian needs persists is not a recommendable choice. Gradual substitution of the functions of the Palestinian service providers will create additional disincentives for the local economy undermining the very notion of a future State. The international community should reflect on the best strategy to deliver humanitarian assistance under the present circumstances.

    Jerusalem, 10 August,

    Angelo Stefanini
    WHO Health Coordinator



    Graph 1 Curfew Hours by district, June-August 2002

    (Source: Palestinian Red Crescent Society website)




    Footnotes:

    1 PCBS (Palestinian Central Bureau of Statistics).

    2 CARE/USAID, PCBS/UNICEF.

    3 PCBS: 2.5% of children with moderate underweight and 1.4% with moderate wasting in 2000


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