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Source: World Health Organization (WHO)
1 January 2005

Health Inforum News
Volume 4, No.56, 1 January, 2005
Welcome to the fifty-sixth issue of the Health Inforum Newsletter.
Quote of the month
    Health is like money, we never have a true idea of its value
    until we lose it. ~ Josh Billings

Health News
• Palestine Human Development Report, 2004
• Bridges, an Israeli-Palestinian Public Health Magazine
• WHO Coordination in the oPt
• The Islamic Bank for Development allocated US$ 5 millions for health projects in Gaza Strip
• An In Vitro Fertilization department will be operated at the beginning of January 2005, in Gaza European Hospital

Health Situation Report on Khan Younis

Community Based Management Of Childhood Illness (CMCI)

Casualties & access incidents
During last December, 61 deaths (including 9 children) and 344 injuries (including 133 children) according to the Palestinian Ministry of Health.

While during the same period, there were 17 incident of delay of ambulances (for a total delay of 19hrs) and 9 cases were totally denied to access.


Palestine Human Development Report, 2004
On December 18, 2004, Birzeit University’s Development Studies Program (DSP) held the Launching Conference of the Human Development Report, Palestine 2004 (HDR) “Hope for the Future: Toward Empowering Palestinian Society through Investment in Social Capital”.
The HDR – Palestine, 2004 was prepared in cooperation with the Ministry of Planning (MoP) and with the support of the United Nations Development Program / Program of Assistance to the Palestinian People (UNDP/PAPP).

The report is made up of six chapters: the first chapter looks at various concepts within the context of the Palestinian experience such as empowerment, steadfastness and resistance, and hope for the future; the second chapter presents the progress and regression of the Palestinian society according to the identified human development indicators: education, population, health, economy and gender; the third and fourth chapter reflect the respective roles of the Palestinian National Authority and civil society organizations in building the society and empowering the Palestinian people; the fifth chapter looks at the role of funding agencies, concluding that the achievements are for the most part, short term and emphasizing the importance of a unified developmental vision for Palestine; the sixth and final chapter attempts to identify the framework needed for empowerment in Palestine to enable the development of the society and the attainment of self-determination and the development of a democratic Palestinian state.

Bridges, an Israeli-Palestinian Public Health Magazine
Bridges is a unique publication conceived of, written, edited, produced and managed jointly by Palestinian and Israeli academics and health professionals under the sponsorship of the World Health Organization.

The magazine embodies the WHO paradigm of "Health as a bridge for peace" - the integration of peace-building concerns, strategies and practices with health care – and represents an innovative approach to the planning and implementation of joint projects, sponsored by a professional and impartial body. The magazine covers public health topics of importance to both populations; seeks to analyze the impact of the conflict on the health and well being of both societies; and brings readers important information in relevant fields. To read Bridges Magazine

WHO Coordination in the oPt:
The Islamic Bank for Development allocated US$ 5 millions for health projects in Gaza Strip
During the annual meeting of the Islamic Bank for development (IBD) in Jordan between the 11th-13th of December, 2004, the IBD allocated $US 5 millions to construct new departments and improve some of the existing hospitals and primary health care facilities in Gaza Strip.

The fund will be spending as follows: US$ 1 million will be for the improvement of Shohada El Aqsa hospital in the mid zone to construct a surgery department, US$ 2 millions for Nasser hospital in Khan Younis to construct a new building with five stories for surgery, US$ 1 million to reconstruct the hospital for military services which is destructed by the IDF, US$ 1.3 million to construct stores for the ministry of health and the remaining US$ 750, 000 to buy 50 heamodialysis machines.

An In Vitro Fertilization department will be operated at the beginning of January 2005, in Gaza European Hospital
On the 27th of December, 2004, in a press release, the Palestinian minister of health, Dr. Jawad El Tibi, announced that at the beginning of January, 2005, an In Vitro Fertilization (IVF) department will be operated in Gaza European hospital.
Dr. Tibi said that some of the Ministry of Health hospitals will be improved and provided by advanced health services. Furthermore, a new five stories, funded by the Islamic bank, will be constructed in Nasser hospital in Khan Younis for the surgery department. Also an operational room funded by the Palestinian lobby in Egypt will be equipped in Nasser hospital.
Dr. Tibi continued that many doctors will be trained abroad on unavailable specialization to decrease the number of patients referred abroad for treatment.


Health situation report on Khan Younis (16th-29th of December, 2004)

Khan Younis camp is located in the western part of the Khan Younis district that is located in the southern part of Gaza Strip. There is one UNRWA centre for primary health care located in the western part of the Khan Younis camp with 47,750 population. The centre serves all people residents in Khan Younis camp. The centre was not affected by the last two incursions on the Austrian quarter. For secondary health care, two Ministry of health (MoH) hospitals: Nasser hospital with 265 beds to the north of the Austrian quarter, Gaza European hospital with 277 beds located between Rafah and Khan Younis and Palestinian Red Crescent Society (Al Amal Hospital with 100 beds) in Khan Younis.

A joint mission of UN agencies (OCHA and WHO-HI) visited the Austrian quarter in Khan Younis camp and Nasser hospital on Wednesday, December 29, 2004 after the second Israeli military operation on Wednesday, December 22- 23 ,2004 in the area, where the first incursion was in the 16th – 18th of December, 2004. The objective of the visit was to assess the situation in the area and to identify any potential problems that may arise from the continuous incursions.

The movement inside the area was difficult since many roads were bulldozed and many buildings were demolished by the IDF and the situation was dangerous. The group moved around the quarter and stopped in a play ground which is located in the opposite side of an Israeli watching tower. Two minutes later the group was asked by the UN security office to leave the area as soon as possible, the group left the area and headed the second target, Nasser hospital where several departments were affected by the incursion.

The Director of Public Relations in Nasser hospital said that on the first incursion (December 16, 2004) the IDF asked all the residents of the Austrian quarter to leave their houses forcibly. Mubarak building in Nasser hospital and one UNRWA school in the area were used as a shelter for those people.
According to the same person, the IDF occupied some houses and sniped at any Palestinian moved in the area and in Nasser hospital.
The total number of casualties in the first incursion was 11 fatalities and 47 injuries. The ambulances were shot at during the evacuation of the casualties, two ambulances were Physically damaged and one ambulance driver was shot in his left leg. The total number of casualties in the second incursion was 3 fatalities and 11 injuries. The ambulances were shot at during the evacuation of the casualties, but no damage was reported.

The following departments were badly affected by the incursions:

Mubarak building: is a maternity hospital located in the southern part of Nasser hospital. The hospital provides neonatal intensive care, pediatric care and delivery services. The building is opposite to the Israeli watching tower.
During the second incursion, the eastern and western surrounding walls of the hospital were destructed by the IDF, the IDF tanks stationed inside the hospital from 11:30 pm of the 22nd of December to 5:30 am of the 23rd of December, 2004. The tanks were on the opposite side of the neonatal intensive care unit. The tanks were continuously shooting and firing shells while they were stationed inside the hospital, causing damage to all the neonatal intensive care unit windows. Also, the air compressor, which provides oxygen and compressed air, broke down. Six premature children were in the unit; one of them was incubated and supported by mechanical ventilation. The movement of the physicians was almost difficult inside the unit; however, they tried to do manual ventilation for the baby. The process continued for three hours until the air compressor was fixed. According to the Medical director of the unit, the manual ventilation was not enough to save the life of the baby, as a result, the baby died 12 hours later.

The Orthopaedic Department: the walls were full of holes as a result of the shooting bullets and most of the windows were broken. The rooms were almost empty, where patients were afraid to stay inside. The beds were scattered in the corridors which are safer than the rooms. The patients with severe conditions were in the hospital while other patients escaped from the hospital during the two incursions because of the continuous shooting at it. It was difficult to serve patients during the two incursions since movement was almost impossible inside the department especially when the IDF stationed inside the hospital.

Kidney department: eight patients and their escorts were in the department during the incursion. No patient was physically injured, however, their psychological status was affected as a result of the continuous shooting especially those who were under the haemodialysis during the incursion. Three escorts were injured.
The windows of the department were broken; the external walls were full of holes. One haemodialysis machine was broken down.
Laboratory: during the incursion the laboratory was not working, since movement was difficult inside the hospital, people from outside the hospital could not enter the hospital. Equipment used to defrost the platelet was broken down.
X- Ray room: one x-ray machine was directly damaged. The vibration of the explosions cased indirect slight damage to other x-ray machines.

As reported also that the ambulance station, water storage tanks, the generator, phone lines, were totally destructed. The movement inside the hospital was only by the ambulance.

UNRWA press release (20 December 2004),indicated that UNRWA urgently opened one of its schools in the Khan Younis refugee camp to provide temporary accommodation to 127 families (600 persons) who were forced to flee their homes following the IDF incursion in Khan Younis on Friday, 17 December 2004. The IDF two-day offensive on Khan Younis resulted in demolishing of 43 shelters accommodating 51 refugee families (303 persons). Three more shelters housing three refugee families (25 persons) were partially destroyed.

UNRWA press release added that the new demolitions in Khan Younis bring the number of homes demolished in the Gaza Strip alone since the beginning of the uprising (Intifada) to 2,957 shelters, rendering homeless over 28,000 Palestinians. Of them, 2,487 shelters - 84 percent of the total – accommodated refugee families.


Project Title: Community Based Management Of Childhood Illness (CMCI).

Location: Beit Dajan, Beit Furik nd Huwara in the Northern West Bank, Dura and Kahil in the southern West bank and Al Mowasi Rafah and Khan Younis in Gaza Strip.

Project duration:12months.
Donor: European Commission for Humanitarian Aid Office (ECHO)
Starting Date: first of December, 2004
Project Budget: EUR 400,000
Implementing agency: Save the Children Federation (SCF/US)

SCF is an active partner in promoting the module of integrated management of childhood illnesses (IMCI) at the health care facility level and it is the leading implementing agency for its community component which includes messages related to the management and prevention of childhood illnesses as well as proper care seeking practices.

This project is designed to respond to deteriorating child health indicators in remote and marginalized Palestinian communities by increasing the community’s ability to manage childhood illness through appropriate home-based intervention and timely care seeking behaviours and by increasing capacities of community-based health personnel in well-baby protocols.

SCF has tested the community IMCI (CIMCI) approach in several Palestinian communities through the previous USAID funded project, with clear positive impact. Therefore, this proposed project will form a scaling up of this experience and would expand the coverage of the methodology to include new isolated clusters.

The proposed locations are isolated and have been subjected to long term closures and movement restrictions. While in some locations there are limited health services targeting children aged 0-5 years, the proposed project will improve the quality of existing facility care, introduce the innovative CIMCI methodology and will focus on the most prevalent childhood illnesses in Palestine: respiratory infections, diarrhea, malnutrition, and vaccination.

To improve the community based management of the most prevalent childhood illness in six clusters throughout Palestine.

The project will reach 34,000 children between the ages of 0 -5 living in the northern, southern area of the West Bank and the southern area of Gaza Strip. The project has two components, facility based and community based components.
Facility Based Component: Within the health facility the implementation of this component will be through: Community Based Component: this component will be implemented through a comprehensive, well structured Behavior Change and Communication (BCC) program. This program will start with a formative study to identify key practices related to prevention and home management and timely care- seeking practices related to diseases.
The component will build on SCF experience in community mobilization and an extensive network of volunteers which is essential to support dissemination of massages through peer-to-peer education and to support the sustainability of the community level component, also materials will be developed for this component.

According to the Palestinian Health Information Center (MOH), during the month of December 2004 the total number of deaths and injuries reported in the West Bank and Gaza Strip was 61 deaths (including 9 children) and 344 injuries (Including 133 children).
During the same period, there were 17 episodes of ambulance delay (for a total delay of 19 hrs). In 9 cases the access was totally denied –according to PRCS, in addition to 2 delivery incidents for 2 pregnant women in the ambulances that were transferring them to give birth in the hospital in Nablus and Gaza. (source: PRCS weekly press release 1 Dec & 28 Dec, 2004).
The following diagram shows by area the total number of ambulance incidents, the time of ambulance delay and the episodes of denied access (D/A) at the checkpoints:

This diagram shows the variation of incidents from April – December, 2004


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