This is an update from 7 January on the health sector situation since Israel launched its military offensive in Gaza on 27 December.
· WHO is greatly concerned about the public health situation in the Gaza Strip: PHC services are severely restricted and all vaccinations have been interrupted since 27 December.
· All Gaza hospitals working on back-up generators since 3 January 3 - fifth consecutive day.
· Israel's military spokesperson confirmed a halt in hostilities to allow humanitarian aid from 1-4 pm local time 7 January.
· On 6 January, 18 patients evacuated through Rafah crossing and 22 awaiting evacuation today.
International Humanitarian Law requires all medical personnel and facilities be protected at all times, even during armed conflict. Attacks on them are grave violations of International Humanitarian and Human Rights laws.
On 6 January, 43 people were killed following an attack on an UNRWA school transformed into a refugee site for displaced people. 100 people were injured and evacuated. The total number of people killed in the Gaza Strip since 27 December is 680, 85 being women and 218 children. At least 2950 Palestinians have been injured including at least 1134 children and women. The Ministry of Health (MoH) (Gaza) issued a statement on 7 January stating that 160 people had been killed during 6 January, bringing to 269 the number of people killed since Israel's ground operation began 3 January. WHO has not been able to independently verify these numbers.
Primary health care centres – in focus
WHO is greatly concerned by the public health situation in Gaza and the potential impact of the total halt in vaccinations since 27 December, 2008. This could result in outbreaks of epidemics, a risk increased by Gaza's high population density and dire living conditions.
Of 56 PHC centres managed by the MoH, only 29 are functioning (with major interruptions). Those not functioning are located in risky areas. Gaza has five districts, the number of PHC centres open in each district is as follows: Rafah three out of four; Khanyounis 10 out of 11; Middle zones six out of 15; Gaza six out of 15; North Gaza four out of 11.
Although many staff who had been on strike since 30 August 2008 have returned to work, only 25-30% of staff are reporting to work. Most staff are either unable to get to work due to movement restrictions or have been redeployed to support hospital staff. The director of PHC reported that since 27 December, the use of PHC activities had declined by about 90%.
As a result:
· All 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.
· PHC laboratory services have been halted since military operations began due to lack of electricity, staff and laboratory re-agents.
· 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.
· 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.
· Dental care is not functioning due to lack of staff and electricity.
The director of PHC reported that many PHC centres have been damaged in the conflict and WHO is expecting additional information.
Fatalities and injuries among staff working for MoH PHC services since 27 December include:
· One general practitioner killed accompanying an ambulance.
· One nurse injured in the Middle Zone district
· One female pharmacist working at the Sourani community mental health centre was severely injured. She has been hospitalized at the ICU of Al-Quds PRCS hospital in a coma.
Damage to hospitals and ambulances
No damage to hospitals or ambulances was reported 7 January; three ambulances have been damaged and three mobile clinics destroyed since 27 December. Six medical personnel (including the above mentioned PHC general practitioner) have been killed. Fear of possible attacks on ambulances and medical personnel remains high.
There are 148 ambulances in the Gaza Strip. Of these, 19 include Intensive Care Units (ICUs), 92 are ordinary ambulances, and three are 4-wheel drives and 34 for transporting health personnel. Three mobile clinics remain operational.
Electricity failure and fuel supply
Mains electricity is expected to return late 7 January following today's arrival of 215 000 litres of fuel and repair of the Gaza power plant. Electricity had not resumed as of 4 pm 7 January.
Gaza City hospitals depend on back-up generators. UNRWA and ICRC are working to supply fuel to keep generators running. Hospitals warn that the generators are close to collapse from lack of spare parts and have limited fuel, even with services working at bare essentials.
The ICRC team of emergency surgeons and two Norwegian doctors are working at Shifa hospital.
Some health personnel are working 24-hour shifts to meet needs. Health personnel are having increasing difficulty reaching their place of work. The ICRC and the UN are coordinating with Israeli authorities to secure passage for health staff between zones, which can take 5-6 hours.
Bed capacity and occupancy rate
Stabilized patients are discharged as soon as possible to free space in hospitals and ICUs but evacuation to NGO-run hospitals remains essential. Shifa hospital is trying to keep bed occupancy below 75% so as to keep 25% of beds free for emergency cases. Non-governmental hospitals receiving patients include Ahli Arab Hospital, Al Quds Palestinian Red Crescent Society Hospital, Patients Friends Benevolent Hospital, and El Awda Hospital.
REFERRALS AND EVACUATIONS OUTSIDE GAZA
On 6 January, 18 patients were evacuated through the Rafah crossing for referral to hospitals in Egypt, Saudi Arabia and Libya. On 7 January, 22 patients were awaiting evacuation. So far 131 patients have been evacuated through Rafah, most for injuries and some for chronic conditions.
Two dead bodies were returned to Gaza through Erez crossing 7 January. The Palestinian Liaison Officer is awaiting answers on requests made for 12 patients seeking referral for cardiac and cancer care. The Palestinian Referral Abroad Department remains closed.
One truck facilitated by WHO passed through Karem Shalom 7 January carrying the consignment of medical aid donations provided by the Norwegian Government and WHO (50 surgical kits capable of treating 5000 people suffering trauma for 10 days and nine interagency emergency health kits, which provide medical supplies that can treat 90 000 patients for three months). Nine trucks carrying medical supplies are planned to enter 8 January.
On 5 January, the Palestinian MoH in Ramallah with WHO collaboration began activities at its emergency operations room to respond to the health crisis. The operations room will provide assessments of requirements (pharmaceuticals, consumables, equipments and spare parts), follow up on the response of international community and address referrals of injured and other patients.
WHO West Bank and Gaza
Ms. Chiara Stefanini
Health and Human Rights Officer
Tel.: + (972) (0)2 540 0595 – Mobile: + (972) (0)2 542326532
WHO Regional Office for the Eastern Mediterranean
Mr Altaf Musani
Emergency Preparedness and Humanitarian Action
Tel.: + (202) 26 76 50 25 – Mobile: + (201) 02 58 58 22
WHO Headquarters, Geneva
Health Action in Crises
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Old Nablus Road – Sheikh Jarrah POBox 54812 – Jerusalem 91547 Tel: +972 2 540 0595 Fax: + 972 2 581 0193 Email: firstname.lastname@example.org
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