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Source: United Nations Population Fund (UNFPA)
17 January 2009




Life in the Gaza Strip six weeks after the armed conflict 27 Dec 2008–17 Jan 2009

Evidence from a household sample
survey – A summary


Fafo Institute for Applied
International Studies
Borggata 2B, P.O.Box 2947 Tøyen
N-0608 Oslo, Norway
Telephone +47 22 08 86 10
Fax +47 22 08 87 00
http://www.fafo.no






Introduction
This multi-topic household sample survey was implemented to collect data to document the living conditions in the Gaza Strip in the wake of Israel’s assault on 27 December and the ensuing armed conflict. It was thought that a fairly rapid assessment would benefit everyone concerned with post-war reconstruction and aid of various sorts.

Through interviews with more than 2,000 households, the survey covered issues such as displacement during the war and damages caused by it, people’s economic situation, needs and concerns, their health and psycho-social status.

The fieldwork was implemented from 3 to 12 March 2009, and face-to-face interviews were carried out at 132 fieldwork locations spanning the entire Gaza Strip.

The survey was funded by the Norwegian Government with additional contribution from the UNFPA. In addition to this summary of findings, major survey outputs will consist of an extensive list of tables posted at Fafo’s web page, and a report to be published jointly by the UNFPA and Fafo.

Displacement
Seven in ten households (71 %) stayed behind and remained in their dwellings during the entire Israeli attach, while three in ten households (29 %) left their homes and went to live elsewhere. The vast majority of the displaced, 28 % of all Gaza households, moved temporarily and returned home, while 1 % of all Gaza households had not gone back nearly two months after the cessation of hostilities.

The survey asked all those households that had moved from their homes during the war why they left. Allowing more than one answer, these are the results:

The majority of those who moved during the war went to live with close family (59 %) or more distant relatives (26 %). Others stayed with neighbours (2 %) and friends (3 %) or took refuge in private or collective places of residence owned by strangers (10 %). This figure includes those who sought refuge at schools.

7 % of those who abandoned their houses and apartments during the war reported that they were looted.

Physical destruction
The conditions of people’s current place of residence, i.e. the dwelling where the interviewed households resided at the time of the interview, were as follows:

Type of damages in affected dwellings:

The survey enquired what it would cost to repair the damages incurred and bring the dwelling back to its previous condition. These are the results:

Out of all households with dwellings in need of repair,

Among the latter, the lack of money (80 %) and building materials (65 %) were by far the most commonly stated reasons why people did not intend to repair their homes, at this time.

Those households that had already started to renovate their homes, or that said they had concrete plans for repair activities, were asked about how they would fund the expenses (more than one funding source allowed). The answers:

The survey attempted to collect information about the magnitude of the destructions resulting from the Israeli assault by posing questions not only about the residence of the interviewed household but also by including questions about the physical circumstances of people’s neighbourhoods (hara). Merely two out of five households (38 %) covered by the survey lived in neighbourhoods were residential houses were essentially unharmed. The households interviewed reported that their neighbourhoods contained:

Current services
As we have seen above, some households reported damages to water pipes, the sewage system, the electricity network, etc. due to the warfare. The survey also enquired about the status of some of these services at the time of the interview. Below are some results.

Except very few (1 %), people in Gaza rely on electricity to be delivered through the public grid. The day preceding the interview, people (those connected to the network) reported receiving 2 hours and 12 minutes of electricity, on average.

The survey examined the sorts of energy people had used for cooking the day preceding the interview. These are the findings (several sources could be mentioned):

Six in ten households informed the survey team that they were unable to keep the dwelling sufficiently warm at night.

With regard to water, one in four of Gaza’s households rely solely on delivery through the network. Another 62 % are connected to the water network, but combine this with additional sources of water. These other water sources are tanker trucks, reported by 11 % of all households, and private and public wells (5 and 4 % respectively). 2 % said they got water from other households, while 62 % reported that they supplemented water from these various sources with bottled water (small bottles of drinking water or larger quantities of water (typically 20 litres) bought at a nearby store).

72 % of all households reported a sufficient water supply.

We investigated for how long the interviewed households had received piped water the day preceding the interview. The results are as follows:

The sewage system was working appropriately in 87 % of the dwellings. In 6 % of the dwellings, there were problems while it was totally defunct in 7 % of all houses.

Domestic waste was collected from 88 % of the households the week preceding the interview.

Employment
The survey explored people’s connection to the labour market. Some results:

The employment rate of people with higher education is 2-4 times higher than for people with a different educational background. For example, nearly half of them (47 %) were employed in the week prior to the interview as compared with 11 % of those with basic schooling and 17 % of people with a certificate from secondary education.

Employer status before the 2007 blockade:

Things changed with the onset of the blockade. In relative terms, the significance of private sector jobs and self-employment dropped somewhat and employment with the Hamas government doubled. In December 2008, before the Israeli attack on Gaza, 12 % of the labour force was employed with the local authorities, and 42 % received their salaries from the PA. The Israeli labour market was out of reach.

After the war, the relative significance of the Hamas government as an employer had increased even further as 13 % of the labour force now worked there. PA’s importance as an employer remained stable (41 %), while UNRWA at the time of the survey had 7 % of the labour force on its payroll. The significance of the NGO sector remained the same. A slightly smaller share had jobs in the private sector or were self-employed than before the war (19 and 18 %, respectively).

Household economy
When asked to identify the household’s most important source of income the past week, these are the results:

The desperate economic situation in Gaza continued to deteriorate with Israel’s armed attack. When compared with the situation six months earlier, this was, according to the interviewed households, the situation:
32 % of the households said they would be able to secure their basic needs the coming three months.

The survey posed the following hypothetical question: If your household had a sudden need for 1,000 NIS, would you be able to raise the money in a week (and if yes, how)? The answers are:

The majority that thought they would not manage to come up with 1,000 NIS if an unexpected need should arise were asked how long their circumstances had been so difficult. The answers:

The survey attempted to investigate how people’s dire strait in general, and the circumstances of the war specifically had affected their food intake. We asked if the interviewed household had experienced a list of conditions during the war due to the lack of money or food, etc. The results:

The survey further inquired from where the households received their most important food staples the week preceding the interview. The results:

Assistance
The survey examined the extent to which people in Gaza had received some sort of assistance during or after the recent hostilities, and in the near past:

Those households that received assistance during the war reported the following types of assistance:

The picture changed dramatically after the cessation of hostilities. As mentioned above, nearly four in five households (78 %) had received some sort of help after the war. The following list specifies the kind of assistance they had received (comparison with before the war in parenthesis):

As shown, food and cash aid had a wider outreach after the war than it had before Israel’s attack.

The interviewed households had received support from the following institutions after the war:

When asked to consider all kinds of help, including from relatives, the household might have received since the Israeli attack ended and to identify the most crucial provider, this becomes the picture:

Needs
The survey requested the households to identify their two most pressing needs at the time. With regards to the top priority, this is the list:

Other topics such as medical help, rental subsidies, electricity and so forth were mentioned by 1-3 % of the households.

The list for second priority is dominated by the same concerns but other issues received higher ‘votes’:

Summing up the four key household needs identified by the survey (by adding together the households’ first and second priorities), this becomes the picture:

Illness, injury & the use of health services during the war
As we saw above, in some neighbourhoods health facilities were destroyed during the war, and several households moved because they wanted to be closer to health services. In this section we describe people’s health and help-seeking behaviour during the war.

According to the survey, approximately one in ten (11 %) of Gaza’s population suffer from some sort of chronic health failure. Naturally, the prevalence of longstanding health problems increases with age and is twenty times more common among people aged 60 years and above than among children younger than ten (61 versus 3 %).

Reportedly, two in three chronically ill persons (66 %) were in need of medical care during Israel’s attack. Of those,

Reasons for receiving inadequate medical care or no care whatsoever (although such care in their opinion was required):

2-3 % of the people in Gaza suffered from acute illness during the war period, they were injured by the warfare, or they experienced severe distress and other psychological symptoms triggered by the war.

Individuals younger than 20, particularly those below 10 years of age, and individuals older than 60 suffered less injuries than other people. The young also were inflicted by acute (somatic) illness less often than other persons. However, according to the survey children and youth were more prone to have health problems caused by distress than others.

66 % of those who became abruptly ill or suffered from war injuries sought medical care. The survey explored the reasons why people did not receive medical examination or treatment following acute illness or injury, and these were the answers:

The vast majority of people with acute illness or injury were diagnosed and treated by a medical specialist (52 %) or general practitioner (35 %) while some people went straight to a pharmacist (10 %). A few saw a nurse only (2 %), or consulted a traditional healer (2 %), and a handful just consulted a non-professional relative.

The acutely ill went to a public hospital or clinic (45 and 11 %, respectively), they received care at a privately owned hospital or clinic (6 and 9 %, respectively), or they visited a health facility run by UNRWA (14 %). 6 % received consultation or treatment at home and 10 % saw the pharmacist at a pharmacy.

12 % of all married women aged 15-49 had been pregnant (or gave birth) during the three months before the interview. Broken down by age, these are the figures:

Place of delivery:

The youngest mothers (aged 15-24) more often than others gave birth at private facilities. Doctors supervised nine in ten deliveries (89 %) while midwives and nurses assisted 10 % of all deliveries. Having no professional support occurred rarely.

More than half of the pregnant women and those that had given birth recently (58 %) received pre- or post-natal care during the war. Four in ten of the women that did not receive such care wanted it but were prevented by the conditions of the war:

UNRWA facilities (37 %), public clinics (27 %), private clinics (15 %) and public hospitals (14 %) provided most of the pregnancy care.

Psycho-social situation
According to the survey, just about 1 % of the population suffered severe acute psychological distress caused by the war. The survey was not, however, designed to capture people’s psychological health or ill-health in detail. Nevertheless, it included a few questions to capture how the population in Gaza had been affected by the war. A considerable proportion reported symptoms of war-related distress several weeks after the withdrawal of Israeli troops and the bombardment came to a close.

For example, 13 % of the population suffered from sleeping problems the week preceding the interview and for the bulk of them (10 % of all individuals) the onset of the problem was during or after the war. Children aged 5-9 (especially girls) seems to have been somewhat more affected by this problem while youth aged 15-24 (particularly boys) are bothered slightly less than other age groups.

23 % of children aged 5-14 had a bed-wetting problem the past week:

Bed-wetting, particularly such problems that had started with the war, occurred more frequently in younger than older children, but bed-wetting caused by the war was even reported for 9 % of children in the 10-14 age group. These are the results by age for bed-wetting that started before versus during or after the armed conflict, respectively:

26 % of children had problems with their concentration during the seven days before the interview. For four in five children with concentration difficulties (i.e. 21 % of all children), the problem had arrived with the warfare. Concentration problems, which had arrived with the war, were most widespread with children aged 6 and 7 with a prevalence of 26 and 28 %, respectively). While concentration problems were found to be slightly more common in boys, there was no systematic gender difference concerning the spread of bed wetting.

The information presented in this section to his point is basically collected from proxy respondents (typically a mother or father about his or her children, and one adult about him or herself and other adults in the household). However, the survey also included a battery of questions meant to tap into people’s psychological wellbeing and that were posed directly to one randomly selected adult aged 18 and over in each household. The reference period was the past two weeks. The results are presented below:

These symptoms of psychological distress are as prevalent among youth aged 18-24 as in the rest of the population: 34 % reported frequent loss of appetite lately and as many had concentration difficulties. Further, 27 % of the youth reported nightmares, 35 % reported anger, signs of depression, and a deep sense of hopelessness.

9 % of the adults said that they were totally unable to carry out normal activities such as getting dressed, washing, carrying out household chores, go to work, etc. in at least seven out of the past 14 days. 47 % confirmed that they were fit to carry out ordinary, mundane activities every single day of the reference period (two weeks).

The survey asked the adults to identify their major worries and the intensity of their concerns. These are the results:

To sum up, it seems people in the Gaza Strip are most worried about the political and economic situation followed by security and employment, while health and family issues are of somewhat less, but still considerable, concern.

The survey asked the randomly selected adult individuals who they would see if they wanted to talk to someone about their worries. Multiple answers were allowed. These are the results:

Men were prone to go to friends more often than women (28 versus 16 %), while women more frequently than men said they would raise their worries with a family member (65 versus 52 %).

The survey also listed seven professionals/groups of people that could be of assistance to people with various concerns. Did the respondent believe the mentioned professional could be of any help to him or her with his/ her current worries? 24 % answered ‘no’ to all (groups of) professionals listed. Below we have ranked the (groups of) professionals according to the percentage of ‘yes’ answers they received:

One question examined whether there were certain activities that people would have liked to do ‘these days’ but for various reasons were unable to do. 21 % reported that there were no such activities. The following answers were given:

Finally, the survey presented a list of 10 topics and asked the respondent to rank them according to his or her degree of concern. If we add together the percentage of respondents that mentioned a topic as one of four concerns, the following becomes the list:

The survey and its sample
Fafo carried out the household sample survey in the Gaza Strip from 3 to 12 March 2009, some six to eight weeks after Israel’s assault on Gaza, which ended 17 January.

The interviews were implemented at 132 fieldwork points (clusters) selected for us by the Palestinian Central Bureau of Statistics (PCBS) from 15 strata, covering the entire Gaza Strip. The sample frame used by the PCBS is derived from the 1997 Census. Before drawing the random selection of households from the 132 clusters, we re-listed all households. This was necessary because of the considerable time lapse since the Census and the likely demographic changes since then due to population movement, new houses, and destroyed houses caused by Israeli bombings, particularly during the recent assault.

A total of 2112 households were randomly sampled. In each household one household member aged 18 years or older was randomly selected. The latter step of the sampling process relied on a so-called Kish table.1 Due to a variety of reasons such as non-existent and vacant dwellings, non-contact after two re-visits, mentally unstable respondents or respondents who were too old and weak or too sick to manage the interviews, or refusals (a total of 85) etc., the number of households and randomly selected adult individuals actually interviewed was considerably reduced. In one of the 132 fieldwork sites (clusters), all houses had been ruined by the war. Altogether 2020 households (95.5 % of the original sample) were visited. 1832 adult persons (equaling 90.5 % of the participating households) were interviewed face to face.

The survey interviewed approximately as many women as men, and the random selection process ensures that also other characteristics of those interviewed mirror the overall adult population in the Gaza Strip.


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1 Leslie Kish 1965, Survey sampling. New York: Wiley, page 399.


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