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Source: World Health Organization (WHO)
1 December 2003

Health Inforum News
Volume 2, No.40, 01 December 2003

Welcome to the fortieth edition of the Health Inforum Newsletter.
In our ongoing efforts to provide useful information to the health community, we welcome any comments or suggestions you might have to help us to improve this newsletter. Please help us to distribute this update by forwarding it to your colleagues and friends. If you wish to subscribe, please send an email to

In this Issue:
· World Aids Day, 1 December 2003
· Ministry of Health AIDS/HIV Surveillance Report
· Press release for the Palestinian Minister of Health
· An American medical team performs open heart surgeries in Gaza
· Health Incidents at Checkpoints
· Project Overview, Emergency Medical Assistance Program II (EMAP II)


World AIDS Day, 1 December 2003

3 by 5 Initiative


World Aids Day, 1 December 2003

q Detailed "3 by 5" plan to rapidly expand access to AIDS treatment

1 December 2003 -- On World AIDS Day this year, WHO and UNAIDS unveil an action plan to reach the 3 by 5 target of providing antiretroviral treatment to three million people living with AIDS by the end of 2005. This is a vital step towards the ultimate goal of providing universal access to AIDS treatment to all those who need it.

q New HIV figures underscore urgent need for AIDS treatment.

Statistics released on 25 November 2003 by UNAIDS and WHO highlight the urgent need to improve access to AIDS treatment. "AIDS epidemic update 2003" is issued in advance of World AIDS Day on December 1, when WHO and UNAIDS will reveal details of the global strategy to help three million people get access to AIDS medicines by the end of 2005 - the "3 by 5" initiative. Three million people died of HIV/AIDS this year, making 2003 the most lethal year so far in the history of the epidemic.

For More information, please visit the WHO website

q Ministry of Health AIDS/HIV Surveillance Report

Country: Palestine Date of Report: 1/12/2003

Number of Cases of AIDS/HIV

Number of cases
AIDS Cases
HIV Carriers
New cases during 2003
Cumulative Total

Cumulative Number of AIDS Cases by Year
Up to 198688899091929394959697989900010203Total

Source of Information: Dr. As’ad Ramlawi, National AIDS Program Manager

Press release for the Palestinian Minister of Health

The Minister of health launched an appeal to the international community to take action in order to stop the Israeli attacks against the hospitals. This appeal was released after the attack on Khanyounis hospital on Thursday evening, 27 November 2003. The kidney dialysis department of the hospital was targeted and went into an intensive gunfire shooting which resulted in damaging of the glass barriers. The pharmacy and the water tanks of the hospital were also damaged by the gunfire. The Minister of Health Dr. Jawad Al-Tibi made an appeal to the Secretary General of the United Nations, the High Commissioner of Human Rights, the Director General of the WHO and the President of the ICRC, asking to put pressure on Israel in order to stop its attacks against health facilities, ambulances and health workers. Dr. Al-Tibi described the incident as a brutal violation of international laws. This incident is part of a series of episodes of aggressions and unjustified attacks against the health sector as a whole.

The Minister of Health mentioned in the press release the previous Israeli army attacks against hospitals and health workers. He stated that the Ministry of Health recorded 315 attacks against more than 60 health facilities.
Also, the Minister of Health condemned the killing of Palestinian people and referred to one of the latest incidents where the Israeli Army killed 3 persons of the same family of Al-Semeri. The minister described this act as a crime and a humanitarian tragedy where a whole family received the feast of Eid El-fitir with tears and morning instead of joy and peace.

An American medical team performs open heart surgeries in Gaza

The Palestinian Ministry of health received by the end of November an American medical team headed by Dr. Imad Tabry, a Palestinian-American cardiac surgeon, and theater nurses Mari Noel Weatherly and Rebekah Trittiope. Their mission will last for a 10-day performing heart surgery at the Shifa hospital for Palestinians suffering from heart problems. The team is treating mainly children, but also people too sick to travel elsewhere for treatment or locked into the Gaza Strip by Israeli travel restrictions. The medical mission is sponsored by the Palestine Children's Relief Fund, a charity based in Kent, Ohio, seeking to improve the quality of medical care in Gaza, the West Bank and elsewhere in the Middle East.

Dr. Tabry plans to perform 20-24 open heart surgeries including Coronary Artery Bypass Graft (CABG) and Cardiac Valves Repair operations. In a press conference held with the Minister of health Dr. Jawad Al-Tibi, Dr. Tabry stated that this visit aims to ease the suffering of Palestinians who are in need for such services. He added that he utilized a new surgical technique which should reduce the risk of complication. Each operation last for 3-4 hours and the rate of success reaches 99%. Dr. Tabry performed also a new valve repair technique (Pott procedure) in which a human valve is used. The donated valve was brought with the team from the USA.

Dr. Jawad Al-Tibi expressed his appreciation to the visiting team. He mentioned that the Ministry of Health will consider in its plans the training of staff focusing on specialized care, in order to reduce the transfer of patients abroad.
It is worth to mention that the only Open Heart Surgery Department in Gaza Strip was established in April 1999, since when 552 operations were done by American, Egyptian and local staff. These operations included repair of congenital heart problems (199), valve repair (122), CABG (144) and other types of heart operations (87).

PRCS Health Incidents at Checkpoints (November 17-28, 2003)

OrganizationDateAmbul-anceMobile clinicDistrictCheckpointDelay (hours)Access denied
Palestine Red Crescent Society17/11/03XNablusZattara 5.00X
16/11/2003XQalqilya Habla-Gate0.50X
20/11/2003XQalqilyaHebla Gate0.50
18/11/2003XHebron Container3.00
27/11/2003XJeninRefugee CampX
27/11/2003XJerichoAl-Nwa’ma checkpoint1.00X

Emergency Medical Assistance Program II (EMAP II): Project Overview

In its continuous efforts to share and exchange Information, Health Inforum will highlight on Bi-monthly basis one of the main ongoing Health projects in the oPt.

Health Inforum will publish an overview on the project and will clarify any related information by asking the implementing agency about any queries.

Many thanks for Dr. David Silver David Silver, Health Sector Coordinator, CARE West Bank Gaza for providing Health Inforum with this valuable information.

EMAP II is a Follow-On Program to the Emergency Medical Assistance Program (EMAP), which was launched in October 2001 and ended on September 30, 2003. Funded by USAID and implemented by Care International, EMAP II will run for 18 months, from October 1, 2003 until March 31, 2005.

The aim of EMAP II is to ensure continuation of essential support services to the Palestinian health care system, in order to mitigate the impact of the Palestinian-Israeli conflict on the health and well being of Palestinians.

In this context, EMAP II consists of the same broad categories of intervention as the original EMAP:

(1) Continued procurement support to the MOH and selected primary health care NGOs, in terms of essential medicines, medical disposables, and medical equipment;
(2) Operational support to Palestinian NGOs through sub-grants (primarily in rehabilitative care);
(3) Emergency health care training of Palestinian health professionals; and
(4) Health information gathering through surveillance.

Within these same broad categories, EMAP II includes new adjunct activities, which are based on lessons learned under the original EMAP. These new activities include:
-Provision of technical assistance to the MOH in improving assessment of medical needs and inventory management;
-Provision of technical assistance to selected NGOs in improving rational use of drugs;
-Provision of training and technical assistance in both organizational and technical capacity building to NGOs selected for sub-grants;
-Development of 3 model regional emergency centers to introduce best practice emergency care guidelines and emergency department management skills;
-Establishment of a sustainable mechanism for continuing medical education, certification and accounting (professional standards of care); and
-Provision of technical assistance in surveillance to strengthen the MOH health information system.

The aim of these adjunct activities is essentially to ensure greater sustainability of the program’s outcomes and to maximize the program’s impact on actual health care practices. By doing so, EMAP II is moving beyond responding to ad hoc emergency needs, and even beyond sustaining the Palestinian health care sector through the crisis situation (as was the case under EMAP I), towards supporting the transition to a more autonomous and functional Palestinian health care system in the long term. As such, EMAP II can be considered a transitional support program, rather than purely an emergency support program.

The beneficiaries, throughout the 16 governorates of the West Bank and Gaza, include:
• Palestinians in need of health care (basic health care as well as emergency care)
• MOH in West Bank and Gaza, including Central Stores, primary health care department, health information department, etc;
• Approximately 10 rehabilitative care centers and NGOs providing health care on an emergency basis;
• Approximately 60 selected NGO primary health care clinics;
• Approximately 650 doctors and nurses working in emergency departments.

Through its support to the NGO sector, EMAP II can be estimated to reach approximately 130,000 Palestinians on a monthly basis. It is more difficult to estimate the number of Palestinian patients EMAP II reaches through its support to the public health sector. The MOH is generally estimated to serve two-thirds of the population.

Health Inforum asked Dr. Silver more about this project.

1. Will EMAPII provide the same types of medical kits and the same types of medicines to NGOs health facilities than did EMAPI?
The medical kits and medicines will be largely the same. However, we are currently reviewing the pharmaceutical list to ensure that what we are providing supports to a rational drug use strategy. I anticipate that several medications will be removed and others will be added.

Regarding pharmaceutical procurement for the MOH, we would like to prioritize medicines that the MOH would utilize in their primary health care (PHC) clinics, and omit the drugs that are for hospital use alone. This choice falls more in line with EMAP II's goal of addressing the more emergent health care needs facing the Palestinian people. Our reasoning here is that although the MOH still faces shortages in its hospitals, greater needs are faced by the rural health clinics which remain cantonized and isolated. As a result, patients continue to depend more on local health clinics for medications because of their ongoing difficulty with access to hospitals.

2. Are the health facilities that will be targeted by EMAPII the same that were targeted by EMAPI?

We are working on a revision of the previously selected NGO clinics to review the suitability of continuing with each of them, i.e., if they still meet the selection criteria. We anticipate de-selecting about 10 NGO clinics that have currently reduced their needs for procurement support. Since we have the capacity in the field and in the budget to support at least 60 NGO clinics, we would like to consider adding at least another 10 clinics from the NGOs who will soon be completing EMATT funding application. Our criteria will include, among other things, those clinics demonstrating the greatest needs and who are also willing to accept USAID support.

3. What about health information gathering through surveillance, foreseen in EMAPII? During EMAPI, there was a Bi-weekly Health Sector Report: will you use in EMAPII the same methodology and tools for surveillance?

The Bi-weekly Health Sector Reports under EMAPI will be completed for data collected up until September 30, and then discontinued. It has served its use, and will be replaced by efforts to strengthen the MoH’s current system in such a way as to capture, analyze, disseminate, and act upon critical public health information. Emphasis will be placed on improving the quality of data collection and analysis in order to provide information that guides programming, policy decisions, and humanitarian interventions.

EMAP II will continue to maintain ongoing food security and nutritional surveillance (FSANS) by completing phases two and three of the FSANS study, the former in October 2003 and the latter February 2004. This will permit the observation of seasonal trends in food security and consumption with rapid analysis and reporting to stakeholders.


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