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Source: World Health Organization (WHO)
1 October 2004

Health Inforum News
Volume 3, No.53, 1 October, 2004
Welcome to the fifty-third issue of the Health Inforum Newsletter.
Quote of the month
    A healthy body is the guest-chamberof the soul; a sick, its prison.
    ~ Francis Bacon ~

Health News
• Infrastructure damage in the invaded areas in Gaza Strip
• MSF unable to reach its patients within the Gaza Strip
• In Rafah, a donkey cart used to transport a severely injured child Mental health/August 04
• Vitamin A Deficiency among Palestinian children
Effect of the crisis on health care in North Gaza Strip
Research Studies
• Milk for Preschoolers Program (MFP)
Casualties & access incidents
During last September, 111deaths and 874 injuries according to the Palestinian Ministry of Health. While during the same period, there were 42 incident of delay for ambulances (46hrs delays) and 12 cases were totally denied to access.


Infrastructure damage in the invaded areas in Gaza Strip
The Ministry of Health (MoH) reported that during the IDF incursion on the 28th of September, there has been non stop destruction of the electricity, water and sewage infrastructure in some of the invaded areas. As a consequence, there has been a water and power shortage in this areas. Also, water have been contaminated by sewage. As a result of the power cut, in one of the PHC clinics there has been a break in the cold chain and the immunization program had to be suspended.

MSF unable to reach its patients within the Gaza Strip
Since September 28, 2004, and the onset of the "Operation Days of Penitence" in Gaza, MSF medical teams have not been authorized to reach the majority of their patients in the southern and central areas of the strip. Despite repeated daily requests to the Israeli authorities, no clearance has been given by Israeli army to MSF to allow medical teams to reach the people in need.

For more information

In Rafah, a donkey cart used to transport a severely injured child
In mid of September, 2004 an 11-year old girl was severely injured when the IDF fired a rocket at his house in Yebna camp in Rafah, according to the MoH. The patient was hospitalized in the Gaza European Hospital and had a permission from the Israeli side to be treated in a hospital in Israel. In September 25, 2004, the coastal road was closed by the IDF, and the patient was not allowed to pass. The patient was transported by a donkey cart through the sandy road on the beach. The monitor and the oxygen tube were hocked up to the patient on the donkey cart. After 1 km, from Gaza city an ambulance transported the patient to Erez checkpoint, were access to Israel was denied.

Vitamin A Deficiency among Palestinian children
22% of Palestinian children aged 12-59 months suffer from vitamin A deficiency, according to a recently published survey conducted by MARAM and funded by the United States Agency for International Development (USAID). A further 53.9% of the children in the West Bank and Gaza had vitamin A levels indicating borderline deficiency. Results showed a higher prevalence of vitamin A deficiency in Gaza Strip (26.5%) compared to the West Bank (18.9%). The World Health Organization (WHO) deems a vitamin A deficiency prevalence rate of over 20% to be “severe,” constituting a public health problem that requires immediate action.

The prevalence of vitamin A deficiency was determined by testing retinol levels in blood plasma samples collected from 1, 127 children living in the West Bank and Gaza Strip. “Such a high level of vitamin A deficiency often goes hand in hand with anemia and other micronutrient deficiencies, and can contribute to the outbreak and spread of some childhood illnesses such as measles,” said Dr. Umaiyeh Khammash, Chief of Party for MARAM.

MARAM prepared the survey sampling in coordination with the Ministry of Health, with technical advice from the Micronutrients Operational Strategies & Technologies (MOST) Project, and the Jordan University of Science and Technology.

For the full report:


Effect of the crisis on health care in North Gaza Strip

WHO/HI Situation Report, September 28 - October 12, 2004
A massive military operation in Northern Gaza Strip (about 210.000 people) lasted for more than two weeks. No major health crisis have developed in the area. The local health services have been coping reasonably well despite the increased burden represented by the high number of casualties.

Drugs and medical supply have been sufficient in the majority of PHC health facilities and in the two hospitals. However, the central drug store of the MoH was quickly running out of emergency and surgical drugs and supply, and a list of urgent needs had been circulated through WHO. Care International, through EMAP II, quickly responded to fill the needs.

In the health services in the area, staff have been redeployed, to compensate the lack of access to usual working place of several health workers. This has been especially the case in Beit Hanoun clinics, where the total number of staff increased (from 66 to 78) despite the fact that 27 staff of UNRWA Beith Hanoun clinic were not able to reach the clinic.

Among the health staff of Kamal Adwan hospital, consisting of 68 doctors, and 72 nurses, 10 doctors and 6 nurses have not been able to reach the hospital in the last two weeks due to the presence of Israeli forces around their homes. These staff members have been replaced by local volunteers – eight doctors and 10 nurses. In addition, an orthopedic surgeon has been redeployed by the MoH to Kamal Adwan from Gaza Shifa hospital.

The period of working hours of PHC services have been extended, especially in Beith Hanoun and in Jabalia camp where the cumulative number of working hours among all centers almost doubled. This reorganization appeared to be appropriate and effective to compensate for the reduction of available staff in some centers, to cope with the increased burden of diseases, and to guarantee a response to emergency/first aid care.

Access to PHC centers seems to have been roughly maintained, according to the number of visits to PHC centers. Only in Beith Hanoun, despite the availability of PHC services, the number of visits to the centers decreased from an average of 710 visits/day, to 500 visits/day.

The type of services provided by the PHC clinics does not seem to be significantly affected by the incursion. However, in one clinic in Beit Hanoun, the immunization activities have been suspended by a break in the cold chain. Several episodes of patients with chronic diseases running out of drugs and not able to reach the clinics have been reported by PRCS and by the clinics themselves.

Systematic data on communicable diseases have been collected only by few clinics. However, according to the majority of PHC clinic Directors, the number of detected cases of the main communicable diseases (diarrhea, respiratory infections, measles, meningitis, hepatitis/jaundice) have not increased during the crisis.

The two referral hospitals for the Northern area coped reasonably well with the additional demand for emergency care, in terms of availability of health personnel and medical supply. Both hospitals adopted a preparedness referral policy of providing first aid and stabilization measures to the injured patients and then transferring them to Shifa hospital in Gaza city. Patients seeking non-urgent referral care were directed on to primary health care clinics, as a strategy to rationalize the resources. Access to referral hospitals from Beit Hanoun has been difficult during the crisis.

For the full report:


Project Title: Milk For Preschoolers Program (MFP).
Location: The five districts of Gaza Strip.
Project duration: 11months.
Donors: Jerusalem Fund, Washington DC; Latte per I Bambini Palestinisi, Rome; Movimiento por la Paz, el Desarme, y la Libertad, Madrid; National Arab-American medical association, US Omen San Fransisco; World Food Program.
Starting Date: 5th September 2004
Project Budget: US$ 1,000,000
Implementing agency: American Near East Refugee Aid (ANERA); Islamic Relief UK; Japan International Volunteer Centre; Tetra Pak Food for development Office, Al- Safa Dairy; Sinokrot Food Company; Al-Quds University; Ard El-Insan Benevolent Association; Educational Development Association.

According to a study conducted by Johns Hopkins University, CARE and ANERA in 2003, 12.7% of children screened in Gaza suffered from chronic malnutrition and 3.9% from acute malnutrition. Of additional concern is the high rate of anemia, 44% in both the West Bank and Gaza.

According to a June 2004 World Bank study, the Palestinian recession is among the worst in modern history. Nearly a half of Palestinians now live below the poverty line (US $2 per person per day). The percentage for Gaza is above 50%. The livelihoods of Palestinian farmers, fishermen and unskilled workers have been severely disrupted by closures and curfews, preventing them from supplying food and earning income.

To respond to the crisis, in February 2003 ANERA initiated the “Milk for Preschoolers” Program - an innovative project to supply milk and high energy biscuits to 830 children in preschools in needy communities of the Gaza Strip. In September 2003, with support from Islamic Relief, UK and other donors, the program was expanded to include over 2,300 children in 26 preschools throughout the Gaza Strip.

To date, the project has expanded and will reach 10,000 children in preschools in areas of the Gaza Strip that are needy in the 2004/2005 school year.

• To supply milk and high energy biscuits, to children in preschools in needy communities of the Gaza Strip.
• To raise the nutritional awareness of children, their mothers, and preschool teachers.

The program will reach 10,000 children in 100 schools in the five districts of Gaza strip in 2004/2005 school year.

Milk from Al Safa Dairy will be fortified with vitamins and minerals. Technical support and financial assistant will be provided by Tetra Pak Food for development Office to help Al- Safa Dairy create a new fortified milk product for the MFP. Also, fortified wafers from Sinokrot Food Company will be provided.

Home visits by the MFP coordinator and school visits by AEI team will be carried out so as to provide health education to the teachers and mothers on proper nutrition and on the supervision of children as a part of the improvement of the nutritional status. Interactive lessons will be organized by the Educational Development Association.

Nutritional Assessments will be conducted to track the nutritional levels of the children benefiting from the program.


According to the Palestinian Health Information Center (MOH), during the month of September 2004 the total number of deaths and injuries reported in the West Bank and Gaza Strip was 111 deaths and 874 injuries, (including 29 deaths and 249 injured of children)
During the same period, there were 42 incidents of delay for ambulances (46hrs delays) and in 12 cases were totally denied access –according to PRCS.
The following diagram shows the number of incidents according to areas and delay or denied access (D/A) on checkpoints:

The above diagram shows:
• In Gaza strip, (Gaza city & Jabaliya) the ambulances are experiencing the majority of difficulties in movement where an average of 2:30hr delay per incident besides the totally denial of access.
• As well in Jenin area, ambulances faced a big number of incidents (15) out of 42, which is relatively high comparing other areas.

• The diagram shows that more than 1/4 of the incidents are represented by fully denial of access.

• In September, there is an increase in the incidents reported which is ranked as the second after May incidents, due to the invasion of Gaza Strip.

• There is no stability in the situation, since it goes up and down, but relatively in an increase of tension and incidents.


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