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10 December 2000

10 December 2000

The conflict in the Palestinian Self Rule Areas is taking an increasing toll on health, says WHO's Special Technical
Assistance Programme Co-ordinator Dr Giuseppe Masala. Not only is the high level of injury and psychological trauma
straining medical services, but closure of borders and roads to, within and between self rule areas is undermining the
fledgling referral system, that had begun to develop throughout the territories under the hope of peace, constraining care
for those suffering from ill-health unrelated to the conflict.
To date about 300 people have lost their lives, most of them Palestinian boys and adolescents, and over 10,000 have been injured,
almost half severely. It is estimated that 15 per cent of these injuries will result in permanent disability.
Hospitals and health facilities have been overwhelmed by the sudden burden of patients, most of them in need of urgent medical or
surgical care. Medical vehicles have been directly affected by the upheavals; the Palestinian Red Crescent Society reports damage

to 41 ambulances while 32 Magen David Adom (the Israeli equivalent of the Red Cross) vehicles have been put out of action.
The ongoing military activities and the uprising on one hand and the closure of borders and roads to, between and within the
Palestinian Self Rule Areas (PSRA) on the other not only constrains social and economic activities but restricts the movement of
health personal and patients. Many health staff are not able to reach their normal place of work and many patients are unable to
access appropriate health facilities whether for normal preventative care or for emergency services.
Until September, the population had access to a health system that was developing in ways that foresaw peace and freedom of
movement. Now cities and territories which had developed a working referral system over recent times are cut off from each other
and from their rural areas.
The health system is also being indirectly affected by the economic losses suffered by the territories which, in just the first three

weeks of the clashes, are reported to have exceeded the total value of donor disbursements to the Palestinian Authorities in the first
half of the year [UNSCO, Oct. 2000].
At the same time, public services such as water, electricity, sanitation and communications have begun to deteriorate, both
increasing the risk of disease outbreaks and undermining the ability to maintain early warning surveillance activities. Internal
displacement within the PSRA islands is also likely to increase overcrowding and raise the incidence of air-borne and
hygiene-related diseases, while decreasing food security and its effect on nutritional status is another potential concern.
Action underway
·Assessments
Initial rapid assessment of the situation is ongoing. Funds allocated by WHO's Director General, Dr Gro Harlem Bruntland, will be
used to strengthen needs assessments in the Palestinian Self Rule Areas.
·Co-ordination
A Humanitarian Task Force for Emergency Needs, created under the auspices of the Ministry of Health and other Palestinian

Authority bodies and chaired by the UN Special Coordinator's Office (UNSCO), has been meeting once a week in Gaza to share
information about the incoming donations, constraints encountered, situation updates and possible common actions. Participants
include representatives of Palestinian Authority ministries, UN agencies (UNRWA, UNICEF, WHO, WFP), major bilateral donors
(such as EU, USAID, Japan, Norway, Italy, Belgium, Spain, Canada), national and international NGOs, and the Red Cross/Red
Crescent Societies. One of the aims is to produce a humanitarian strategy with defined short and longer term objectives.
Currently, the Taskforce is split in two field groups, one covering the West Bank and one the Gaza Strip. WHO chairs the health
component in each group. This coordination is vital in order to anticipate emerging health problems such as the recent Shigellosis
epidemic caused by the interruption of water chlorination, as well as co-ordinate action to shore up deteriorating access to health
services.
WHO has also prepared an appeal for US$7.5 million covering both immediate conflict-related needs, needs to combat the

increasing isolation of communities and the activities needed to prepare the health system for a potentially deepening crisis.
·Emergency Kits
Four emergency traumatological kits, funded by the Government of Italy, were shipped to Jerusalem from the OCHA/WHO/WFP
warehouse in Brindisi at the beginning of the crisis and have been delivered to the main Ministry of Health stocking centres.
Distribution to Ramallah, Beit Jahla and Jenin Hospitals in the West Bank took place timely to allow these centers to cope with
acute needs.
Funds allocated by WHO's Director General will be used to purchase specific supplies. In addition, an allocation from WHO's
Eastern Mediterranean Region (EMRO) is allowing for the purchase of additional emergency kits and supplies which have been
requested from the Ministry of Health.
Difficulties faced in the clearance from Ben Gurion (Tel Aviv) airport – both at customs and security-check levels – are exemplary of
the current situation in the Palestinian Self Rule Areas. Interagency coordination such as UNRWA (UN Relief and Works Agency for

the Palestine Refugees in the Near East) support in providing storing facilities and transport by UN trucks, and UNSCO (Office of
the UN Special Coordinator) communication with Israeli authorities, as well as WHO physical presence, helped eventually overcome
the difficulties.


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