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Source: World Health Organization (WHO)
1 April 2003

Health Inforum News
Volume 2, No.24, 01 April 2003
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Welcome to the twenty-four edition of the Health Inforum Newsletter.

In our ongoing efforts to provide useful information to the whole of the health community, we continue to welcome any comments or suggestions you might have to help us improve this newsletter.

In this Issue:
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Dr. Sheibi attended the Arab Health Ministry’s Council

Dr. Ahmad Sheibi the minister of health and his deputy Dr. Munzer Sharif attended the Arab Health Ministry’s Council in Syria (March 28-March 31,03). The Palestinian delegation consists also of Dr. Majed Abu Ramadan, the Director General of International Cooperation, Dr. Azmi Al Jishi and Ghaida Fidda. Minister of Health gave in his speech comprehensive explanation on the health status in oPt and the violations against the health workers including ambulance cars and the medical teams.

The Arab Health Ministry’s Council discussed the request of Palestine to be a member in the World Health Organization, the coordination between the regional centers for genetic prevention and promoting the nursing role in Arab countries.

MoH: 101 Palestinians killed, including 26 children during March ? 2003

Palestinian Ministry of Health announced that (101) Palestinians were killed in the oPt including 26 children 648 Palestinians were injured in the period of first of March to 31st March 2003).

Significant improvements in health facilities' capacity to maintain service
delivery despite numerous constraints

Johns Hopkins University, Al Quds University, Maram Project and CARE International/ANERA published the health Sector Bi-Weekly Report # 9 recently. It is highlighting food security, water availability, and issues of health service access with emphasis on differences between Gaza and West Bank. The report mentioned that access to health services data refers to the last three months (the last six rounds of data collection, roughly November 2002-January 2003). Although data from this period reflects significant improvements in health facilities' capacity to maintain service delivery despite numerous constraints (as described below and in previous Health Sector Bi-weekly Reports), access to services by individual clients remains difficult:

The access to maternal child health care, diabetes and chemotherapy services continue to be the most difficult to access among our indicators (Table 1).

· The access to health care services is more much problematic in the West Bank compared to the Gaza Strip.
· The West Bank in general, and in particular the Northern West Bank has had the most difficulty in accessing emergency care, maternal child health care, and diabetes therapy from November 2002 through January 2003 (Graph 12).
· Reasons for not accessing emergency care and diabetic services were mainly curfew/checkpoints.

Table 1: Cumulative frequencies and percentages of households in which at least one member required specific health services and was unable to attain them in the two weeks prior to the survey.

Services
N*
%
Emergency care
Maternal child health care
Immunization
Dialysis treatment
Diabetic treatment
Chemotherapy
32/510
107/696
11/399
1/15
31/210
3/15
6.3
15.4
2.8
6.7
14.5
20
*Number of households with at least one member requiring health service but unable to access/total number of households with at least one member requiring services


Availability of specialized services at the facility level, based on cumulative data collected in 269 facilities since May of 2002, is shown in Graph 13 below. Although this is a representative sample, rather than an exhaustive one, clearly hemodialysis services are limited throughout the West Bank and Gaza Strip. Oncology services are available on a limited basis in the Southern West Bank and the Gaza Strip, and may not be available at all in the Northern and Central regions of the West Bank. Other services are more proportionately available in each region.

Facilities ability to maintain service delivery has improved tremendously since last summer, when many facilities in the West Bank reported having suspended services for two or more days during the reporting periods preceding the interviews. During the same three month period described above, although household members reported problems accessing needed specialized care, only 5 facilities (8.2%) of the 61 surveyed reported having had to suspend services, including 3 facilities in Tulkarem that suspended all services for 2-4 days for the Eid al Fitr holiday. The facilities that closed offer the following services:
· Primary care services including pediatric primary care, antenatal and postnatal care, labor and delivery services, and immunization services;
· Emergency medical services
· Hemodialysis
· Pharmacy services
· Counseling, health education, and physical and occupational therapy.

Although the circumstances for closure were not related to the on-going emergency, the facilities indicated that they are facing constraints to service delivery:
· All three of the Tulkarem facilities reported requesting emergency supplies of disposables, two requested supplies, and one requested pharmaceuticals;
· Curfews/closures and impassable roads were blamed for the disruptions in the Tulkarem facilities' referral services;
· One of the Tulkarem facilities reported disruptions in its supply of electricity

Earlier, in November, one facility in rural Nablus suspended pediatric primary care, ante- and postnatal care, and labor and delivery services for six days in November due to a staffing shortage resulting from curfews/closures. In December a clinic in rural Hebron suspended its pediatric primary care services (only) for 12 days due to shortages of staff and of operating funds. Both of these facilities also reported making emergency requests for additional medical supplies, disposables and pharmaceuticals during that time.

For more information refer to Health Inforum Web Portal: www.healthinforum.org

PRCS Health Incidents Report (March 15-26, 2003)

Nablus, 26 March 2003 (02:15): An ambulance arrived at Madema Village, in response to a call about an injured person in the area. The medical team found two men who claimed to have been beaten by Israeli soldiers and were visibly bruised. The Howarra checkpoint was closed with barbed wire. After a half an hour, the team called for another ambulance to come from the other side of the checkpoint to transfer the patients. At this point some soldiers appeared, searched the ambulance, and told them to go back. They refused to allow the patients to be transferred to another ambulance, and told the crew to cancel the call for the second ambulance. Access was denied, and the patients were returned to their homes.
Nablus, 24 March 2003 (15:00): An ambulance, carrying a newborn with respiratory problems, was detained for 45 minutes at the Qusin checkpoint.
Nablus, 24 March 2003 (12:30): Israeli soldiers at the Qusin checkpoint detained an ambulance for 20 minutes and then told the ambulance crew to use the Howwara checkpoint instead. The ambulance was carrying patients from Tel Village to Nablus. After being turned back from the Qusin checkpoint, the ambulance was detained at the Howwara checkpoint for 45 minutes. The ambulance was eventually allowed to pass.
Nablus, 22 March 2003 (02:30): At the Howwara checkpoint, Israeli soldiers denied passage to an ambulance carrying a woman who was in labor. They made the ambulance wait at the checkpoint for one hour, before sending the ambulance back. The ambulance crew took the woman back to her home and called a midwife.
Jenin, March 23, 2003 (14:00): An ambulance parked at the front of the Jenin Governmental Hospital, and the ambulance crew went inside to the second floor to pick up a patient for transport. When the crew reached the second floor, they heard a sound like that of the megaphones used by the Israeli Army. Looking through a window, they witnessed an Israeli tank ramming the ambulance from the back. The tank pushed the ambulance forward, until the front of the ambulance struck the wall of the hospital. The tank had apparently been chasing children who were throwing stones.
Jenin, 22 March 2003 (18:10): During curfew, an ambulance transported a patient from Yabed Village to Dr. Khalil Suleiman Hospital. At the gate to the village, Israeli Army jeeps stopped the ambulance. Despite the urgency demanded by the patient’s condition, the soldiers detained the ambulance from 18:10 to 19:15 and verbally abused the ambulance crew. Eventually they were allowed to pass.
Qalqiliya, 28 March 2003 (10:00): Israeli Soldiers at the Al-Kasserat checkpoint detained an ambulance for one half hour, saying that the driver was wanted. The ambulance was transporting a patient from Qalqiliya to Nablus. The soldiers eventually allowed the ambulance to continue to Nablus, but made the driver go back to Qalqiliya with another ambulance for security reasons.
Qalqiliya, 27 March 2003 (12:00): An ambulance, transporting a patient to Nablus, was detained at the DCO checkpoint for 20 minutes.
Bethlehem, 27 March 2003 (15:40): Soldiers at the Kontinar checkpoint detained an ambulance for 45 minutes. The ambulance was transporting a cancer patient from Hussein Hospital in Bethlehem to Al-Nazeriyeh. After coordination with the ICRC, the ambulance was allowed to pass.
Bethlehem, 22 March 2003 (16:35): Israeli soldiers at the Gilo checkpoint detained an ambulance that was going to pick up a heart surgery patient at Al-Maqassed Hospital in Jerusalem. The soldiers at the checkpoint said that no Palestine Red Crescent Society (PRCS) ambulance could pass through the Al-Ghars area, and that the medical team would need to coordinate with an Israeli ambulance service to transfer the patient. After one and a half an hour and the coordination with the ICRC, the ambulance was allowed to pass. Upon arriving in Jerusalem, the ambulance was stopped again by an Israeli Army jeep and detained for 15 minutes.

Hebron, March 21, 2003 (19:02): An ambulance responded to a call about a woman who had suffered a serious head injury in Al-Arub camp. Israeli soldiers stopped the ambulance at the checkpoint at the entrance to the camp. The soldiers told the driver to turn off the engine of the vehicle and to give them the keys. Then they searched the ambulance and the Emergency Medical Technicians (EMTs). They made the crew members stand in front of the ambulance with their hands raised and legs apart; to get the crew members to stand with their legs apart, the soldiers hit the legs of the EMTs. The patient’s family attempted to approach the ambulance, but was ordered back by the soldiers. After 23 minutes, the soldiers permitted the ambulance crew to continue to respond to the emergency call. The woman’s condition had worsened over the span of 23 minutes.

Yatta, 21 March 2003 (12:00): An ambulance that was transferring a pregnant woman from Al-Itimad Hospital to Alia Hospital was forced to wait at Zayf gate for 35 minutes. Eventually an Israeli Army jeep came, the soldiers searched the ambulance, and they allowed the ambulance to pass.
Nablus, 20 March 2003 (12:30): Israeli soldiers at the Al-Kasarat checkpoint stopped an ambulance in transit between Nablus and Sabastiya. The ambulance was carrying patients from the Al-Watani and Rafidiya Hospitals. After 45 minutes, and after a coordination with the International Committee of the Red Cross (ICRC), the ambulance was allowed to pass. At the Shafi Shamron checkpoint, the same ambulance was stopped again. The Israeli soldiers at the checkpoint verbally abused the ambulance crew before allowing the ambulance to pass. After dropping the patients off, the ambulance was stopped again at the Shafi Shamron checkpoint. The soldiers again verbally assaulted the crew, and detained them for half an hour.
Nablus, 17 March 2003 (13:30): An ambulance left Rafidiya hospital transporting patients to Sebastiya. At Qusin checkpoint, Israeli soldiers made the ambulance wait for one hour and 15 minutes, before even beginning to check the ambulance. The soldiers obliged the patients to leave the ambulance, and questioned the EMTs about the patient’s conditions. A soldier verbally abused the driver, alleged that the ambulance was being used as a taxi, and insisted that the amputee, man with a back problem, kidney patient, and epileptic man who were riding in the ambulance were not patients. The soldier told the driver that he had the right to say whatever he wanted, whenever he wanted, and that he was ready to shoot the driver to get rid of him. He yelled at the driver to take the rest of the crew and patients and leave, and threatened to shoot and kill the driver if he ever saw the driver at the checkpoint again. The ambulance was forced to turn back.
Nablus, 15 March 2003 (08:00): At the Shafi Shamron checkpoint, Israeli soldiers stopped an ambulance that was going to pick up a patient in Sabastiya. The ambulance was detained for one and a half an hours. The ambulance crew coordinated with the ICRC, and was eventually allowed to pass.
Ramallah, 15 March 2003 (18:50): Israeli soldiers stopped an ambulance at Deir Sharaf intersection, as it was transporting patients from Ramallah to Tulkarem. The soldiers made the ambulance crew strip off their upper clothes, and took the crew members IDs. The soldiers left without giving the IDs back to the ambulance crew, telling them to wait where they were. In half an hour the soldiers returned, gave back the IDs, and allowed the ambulance to continue on its way.
Jericho, 18 March 2003 (09:35): At the Al-Zayim checkpoint, an ambulance carrying an unconscious cancer patient was stopped by Israeli soldiers. The patient was going to the Augusta Victoria Hospital in Jerusalem. The soldiers searched the ambulance for 20 minutes, and then forced the ambulance to turn back to Jericho, denying it permission to pass, saying that it had no permit to go to Jerusalem.
Jericho, 15 March 2003 (09:00): At the Al-Zayim checkpoint, Israeli soldiers stopped an ambulance that was transporting patients from Jericho to Jerusalem. The ambulance was detained for one hour, and was ultimately refused passage, despite the fact that one of the passengers was in bad condition and was going for an operation. The reason given for this denial was that the ambulance had no permit to go to Jerusalem.
Bethlehem, 15 March 2003 (17:45): An ambulance carrying a patient from Bethlehem to the ophthalmic hospital in Jerusalem was stopped at the Gilo checkpoint. The Israeli soldiers ordered the ambulance crew to turn around. The ambulance crew called the ambulance station to coordinate with the ICRC. The soldiers told the ambulance crew to either coordinate with an Israeli ambulance company, or go back to Bethlehem. After one and a half hours, the ambulance was allowed to pass.

For more information visit www.palestinercs.org

USAID Participates in Food Aid Roundtable

The United Nations Relief and Works Agency (UNRWA) recently sponsored a major roundtable on emergency food assistance to the Palestinian people. A representative from USAID's Health and Humanitarian Assistance program participated, delivering a paper entitled "Malnutrition: Diagnosis and Appropriate Responses." Many of the facts included in the presentation were disturbing. For example, over half of the Palestinian children living in the West Bank and Gaza suffer from inadequate caloric and vitamin A intake. Four out of five Palestinian children have inadequate iron and zinc intake, deficiencies which cause anemia.

The presentation also outlined an emergency nutritional strategy for the Palestinian Territories, the culmination of a six-month coordinated effort between USAID's MARAM project, the Palestinian Ministry of Health and other international donors. The strategy addressed the causes of wasting, stunting, anemia and micronutrient deficiencies, particularly in children and pregnant women.

A series of aid interventions were proposed, with the goal of advancing a genuine, and long-term, positive impact on the nutritional status of Palestinians living in the West Bank and Gaza. Proposed interventions included: vitamin and mineral supplementation for children and pregnant women; support for breast-feeding; introduction of iron-fortification food policies; and enhanced coordination with water professionals, since malnourished children and adults are at increased risk of contracting diarrheal diseases.

For more Information, please visit our website: www.healthinforum.org

Newly Published Reports on the Ministry of Health website (March 2003)

· Two Years of Intifada, Closures and Palestinian Economic Crisis- An Assessment -World Bank, March 2003.
· FAFO - Institute for Applied International Studies (25 Feb. 2003), ): Coping with Conflict, two years of the Intifada.
· PCHR - Palestinian Centre for Human Rights (January 2003):

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