Between August 23 and 26, 38 persons were killed, 457 were injured, and four high commercial and residential tower blocks were destroyed. 30 clinics that had been damaged were closed as of August 27. This has hindered access for residents especially in outlying areas. Power cuts prevailed throughout Gaza for up to 18 hours or more daily, as lines from Israel were damaged again earlier in the week. However, more than 60% of the water network was reported to be again functioning.
The process of field assessment for damage and needs in each sector was delayed during the ceasefire breakdown but by August 27 began to be carried out by UN agencies, ministries, local governments and organizations.
Damage to health facilities has reduced the provision of health care. However, some damaged hospitals have managed to continue functioning, and three closed hospitals are providing services through alternative venues.
The 50-bed Al Wafa Medical Rehabilitation Hospital, which was totally destroyed on July 25, and patients temporarily evacuated to Al Sahaba hospital for 2 weeks, later relocated to the al Wafa Nursing Home in al Zahara with 40 beds set up for patients, the hospital director reported to WHO. Currently services include medical rehabilitation (physiotherapy, occupation therapy, psychosocial support, and nursing care); the new temporary location cannot support surgical services.
Beit Hanoun Hospital, the only MoH hospital located in the northern district, was closed from July 26 to August 18 due to insecurity and damage to the water and piped oxygen system, and to both of its buildings, including the wall of the administration building and female medical-surgical ward, broken equipment and furniture, and door and window damage. During the ceasefires, repairs were carried out to the damaged oxygen and water pipes and to some windows and doors sufficient for the hospital to partially open to accept patients for emergency room services only. Only one third of the staff are working and treating an average of 100 patients daily, without in-patient or out-patient services.
Balsam hospital, operated by the Palestinian medical military services for personnel and their families, located in Beit Lahiya in the northern district, was damaged and closed, but has moved some staff to the premises of the Patients' Friends Benevolent Society in Rimal where it is providing services to its patients.
The 120-bed pediatric hospital Al Nasser in Gaza reports 180% bed occupancy rate after the closure of the damaged Al Durra Pediatric Hospital
Zero stocks of essential drugs were reported by the Ministry of Health in Gaza at 27% (130 items) and medical disposables at 48% (431 items) in mid August. Although no change was seen in drug stocks, an improvement in disposable stocks was noted from 52% at zero stock at end July.
Primary health care
The early warning system for communicable disease did not detect any outbreak in communicable diseases that would be of public health concern, although the MoH is remaining vigilant in view of the reduced social determinants of health. The early warning system monitors 13 notifable communicable diseases: diarrheal disease, typhoid, mumps, scabies, impetigo, acute respiratory infections, polio (acute flaccid paralysis), meningitis ( aseptic, meningococcal,other bacterial meningitis), food poisoning, measles, infectious hepatitis, cholera and others.
The early warning system for communicable disease monitored a mild increase in watery diarrhoea mainly in Gaza city and in the north as well as a mild increase in viral meningitis in Gaza City, but the situation remains stable. Skin diseases (scabies, impetigo, lice) are still occurring. The MOH reports that the situation is under control and no cause for alarm at present. MOH continues to monitor the situation closely.
UNRWA reported that none of its disease monitoring thresholds for alerts or alarms had been exceeded. The surveillance system includes 97.3% of Palestinian refugees in Gaza, according to UNRWA. Consultatations in UNRWA clinics incidate the degree to which health provision depends on safe access: the number of patients utilizing clinics ranged from 24,000 in mid-July to 117,000 in the last week.
Palestinian Medical Relief Society teams providing home health care note that patients who had early discharge from hospital and whose injuries were managed at home have presented with complications such as wound infections. Follow up of these early discharge cases has been sometimes difficult due to the displacement of families.
The Palestinian Red Crescent Society is operating a field hospital consisting of tents and caravans in Rafah (the Emirati field hospital). The facility opened on August 9 with a small medical team of four physicians and support staff and received from 100 to 400 outpatients daily for emergencies and wound care.
Damage to health facilities and closures (see map in Annex)
Of 32 hospitals being monitored, a total of 17 reported damage ranging from from light to extensive since July 7. Six hospitals are closed, although 3 of these which had been damaged opened limited services and using different venues (detailed below). One NGO Hospital in Gaza City (Al Wafa Medical Rehabilitaion) was totally destroyed.
Of 97 clinics now being monitored by WHO for damage and closures, 50 reported damage and 30 are closed as of August 28, 13 more clinics than one week ago (See Annex.)
Eight of the 50 damaged clinics were totally destroyed. Five were Ministry of Health primary health clinics located in areas of great need and alternatives are urgently required for residents (Shajaiiyeh, Gaza city, Juhr al Deek, Khuza'a and Khan Younis). The Palestinian Red Crescent clinic, Khalil al Wazir health center in Gaza city, and the Hijazi clinic, operated by the Palestinian Medical Military Services (PMMS) in the northern district, were also totally destroyed.
According to data of the Ministry of Health, a total of 465 casualty patients exited Gaza from July 7 to August 24 for medical treatment in Palestinian hospitals in the West Bank and East Jerusalem, or to hospitals in the region or Europe, with the majority leaving Gaza in August. Another 50 patients are expected to be transferred to Turkey in the next week.
WHO Advocacy project issued the July monthly report on Gaza Referrals Abroad which highlighted the low numbers of patients who were referred during the violence in July. Only one third of the usual number of patients received referrals during the month (580 in July compared to 1,805 in June), due to the severe security restrictions on movement within Gaza, and Ministry of Health priorities during the emergency.
Of all patients needing access permits through Erez checkpoint in July, only 65.5% were approved; 70 were denied, including 14 children and 9 elderly persons, and 307 patients received no response to their applications prior to their medical appointments.
On August 27, Erez Crossing reportedly returned to its usual procedures of operations which had been in effect prior to June 13 for exit of patients and their companions.
Public Health Concerns
WHO and Health Cluster partners (MDM Spain, MAP UK, UNFPA, UNICEF) participated in the collection of general data for the OCHA-organized rapid assessment (MIRA) which was completed on August 19.
WHO with participation from Health Cluster partners in the field is leading the work of health teams for the more detailed assessment of the health sector to follow, focusing on infrastructure damage, reproductive health, general services (commmunicable disease, non communicable disease and key health indicators), drugs and supplies, and cross-cutting issues. A preliminary report is expected by early November.
WHO’s mental health program communicated to health partners a message concerning assessing mental health needs in order to avoid unnecessary or unuseful interventions in Gaza. The key points:
2) use standard mental health assessment tools,
3) consult with WHO and Health Cluster before conducting a survey.
WHO Advocacy issued its monthly report on Gaza referrals and access for July 2014. http://www.emro.who.int/countries/pse/index.html
A total of US$ 10.8 million in drugs and medical disposables have been received by the health sector in Gaza since July 7 to help meet the needs of this emergency, with more than half of the donations destined for Ministry of Health hospitals.