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World Health Organization (WHO)
1 February 2005
Health Inforum News
Volume 4, No.57, 1 February, 2005
Welcome to the fifty-seventh issue of the Health Inforum Newsletter
Quote of the month
If you have health, you probably will be happy, and if you have health and happiness,
you have all the wealth you need, even if it is not all you want.
• Food and Nutrition National Council
• Response to Mumps Outbreak in the West Bank
• Nutrition Advisor to Support Ministry of Health Nutrition Department
• Upgrading Ibn-Sina's Nursing College Library
• Mobile clinics to improve access in areas affected by the wall
• Construction of a new Primary Health Care centre in Beit Hanun
• Al Hiwar Magazine by the Primary Health Care Department
• Protocols on Emergency Medical Services (EMS)
• Physicians for Human Rights-Israel “on the Day after Disengagement”
• Medical treatment abroad for Gaza residents: closures and access
Casualties & access incidents
During last January, 55 deaths (including 24 children) and 192 injuries (including 77 children) according to the Palestinian Ministry of Health.
While during the same period, there were 14 incident of delay of ambulances (for a total delay of 11hrs) and 4 cases were totally denied to access.
Food and Nutrition National Council
On the 6th of January, 2005 a Food and Nutrition National Council has been formally established by the Ministry of Health (MoH). Preparatory work has been done through two workshops and a meeting with the Palestinian Minister of Health, where the rational for the establishment of the Council has been discussed and agreed by the members.
The Council includes members from the Ministries of Health, Agriculture, National Economy, Social Affairs, Education, and from universities and research centers. The Nutrition Department in the MoH will operate as a secretariat of the Council. The Council will meet regularly every two months or with ad hoc meetings in case of emergency.
Response to Mumps Outbreak in the West Bank
In order to respond to a mumps outbreak in the West Bank, a meeting was organized by the MoH and the World Health Organization (WHO) on January 12, 2005, with the participation of the main providers and interested organizations. During the meeting, the following information related to the outbreak have been presented:
The MoH has a routine vaccination programme against Mumps, Measles and Rubella (MMR vaccine) since 1988, using Orabi strain vaccine. The coverage rate has always been around 95%.
In Askar and Balata refugee camps, a mumps outbreak developed in April 2003. During the summer it stopped and then it started again in September 2004.
Most of the reported cases are from Northern West Bank and mainly from Nablus governorate (250,000) with an average frequency of 10 cases/day per Governorate, mainly in Nablus, Tulkarem and Jenin.
From the beginning of the outbreak until December 31,2004, the number of reported cases (serogically confirmed) in the refugee camps in Askar, Balata, Ein Beit eEl Ma'a and Tulkarem camp are 2470.
The total number of cases reported by the MoH is around 4000 (including the cases in the refugee camps). - The estimated number of cases that were not reported because of lack of efficient surveillance system is about 6,000.
MoH and UNRWA agreed to jointly draft a detailed report on the outbreak.
Following the meeting, a teleconference with the WHO/Headquarter and EMRO follow the meeting, resulted in some agreed recommendations:
1. To submit a detailed report on the outbreak to WHO for further technical advise and consequent actions.
2. To adopt the new schedule with two doses of Orabi strain vaccine, at 12 and 18 months.
3. To respond to the current outbreak by vaccinating identified groups with high number of reported cases, like students at the University of Jenin.
Nutrition Advisor to Support Ministry of Health Nutrition Department
USAID is sponsoring a nutrition expert from WHO to strengthen the capacity of the Palestinian Ministry of Health’s Nutrition Department. The Nutrition department is developing its capacity and leadership function to take charge of policy planning, monitoring, evaluation and the coordination of nutrition related issues. Dr. Mohammad Shahjahan, a Bangladeshi with 18 years of experience in maternal and child health care and nutrition, will provide - through the WHO project - technical guidance to the Ministry of Health on long-term activities aimed at improving the nutritional status of Palestinians in the West Bank and Gaza.
Upgrading Ibn-Sina's Nursing College Library
In a step to ensure the ongoing collaboration with the MoH , WHO donated 360 medical text books to upgrade and develop Ibn Sina college library in Betonia (near Ramallah). Ibn Sina college runs bachelor degree programmes in nursing and midwifery to about 70 students per year.
Mobile clinics to improve access in areas affected by the wall
On 18 January 2005, during the monthly Health Emergency Coordination Meeting in Ramallah chaired by the MoH and WHO, a discussion on “how to meet the health needs in areas affected by the wall and continuous closures” took place. A presentation by Medico International and Palestinian Medical Relief Society introduced the issue of using mobile clinics in these areas.
There was a suggestion by MoH and NGO health providers to send the mobile clinics schedule in different areas to Health Inforum in order to publish it on its web site and distribute it different health providers for better coordination and more effective health care services.
Medico International and Palestinian Medical Relief Society raised the issue that they can not reach the following five isolated villages (total population of 6800) in Jenin and Tulkarem and Jenin districts due to the wall construction: Barta’a Al Sharqieh, Om Al Rihan, Khirbet Jbarah, Ras Attieh and Azzoun Attmeh. These villages are located in Jenin and Tulkarem district.
For more information:
Construction of a new Primary Health Care centre in Beit Hanun
On the 25th of January, 2005, the Union of Health Work Committees started the construction of a primary health care center in a marginalized area in Beit Hanun. The centre will serve around 12, 000 people living in Al Seka Street, Al Amal Street and some people living in Ezbate Beit Hanun. The centre is financed by the French Development Agency with a total budget of EUR 105,000.
Al Hiwar Magazine by the Primary Health Care Department
On the 17th of January, 2005, the primary health care department of the MoH published the tenth edition of Al Hiwar magazine. Among the topics included in this issue there are cholesterol and diet, sexually transmitted diseases, rational use of drugs. Also, it includes international statistics on HIV/AIDS in children, and on HIV carriers in North Africa and the Middle East in 2004. This magazine can be accessed by contacting the Primary Health Care Department.
Protocols on Emergency Medical Services (EMS)
On the 3rd of January, 2005 Maram project, in cooperation with the MoH, conducted a workshop on the Palestinian emergency medical services, where protocols, procedures and polices on pre-hospital advanced life support were distributed. The pre-hospital EMS protocols aim at standardizing the care provided to sick and injured patients before reaching the hospitals. The protocols tackle different areas of emergency medicine, and include procedures and skill stations training, policies locally applicable and a drug list. (attached is the whole material of the EMS protocols).
Physicians for Human Rights-Israel “on the Day after Disengagement”
PHR-Israel released on 27 January 2005 a position paper entitled “The Day After” stating that Israel will still be required to allow Palestinian patients to receive life-saving treatment in Israel and abroad, even after disengagement from Gaza, and explains the legal reasons for this. Also, Israel must rehabilitate the Palestinian health care system over the next decade, and raise the standards to at least those of Jordan.
To read the full position paper please visit
Medical treatment abroad for Gaza residents: closures and access
31st January, 2005
The Palestinian Authority purchases services from institutions in neighboring countries for the residents of Gaza Strip. Some specialized services do not exist in the Gaza Strip, including: catheterization and cardiac surgery, burn treatments, pediatric cardiology, neurosurgery, orthodontic surgery, radiotherapy, all types of transplants and various specialized diagnostic tests (such as MRI, bone and bone marrow tests, metabolically tests, etc.). In addition, there are many fields where, although services exist in the Gaza Strip, they are performing at a level of specialization that is insufficient for managing the most complicated cases.
These services are purchased by the Palestinian Authority at full cost mainly from Egypt, Israel and Jordan. In 2003, the MoH issued 7,805 certificates for referral to medical treatment outside the Gaza Strip in order to meet local medical needs.
Since 13th of December 2004, restriction of passage through Rafah and Erez crossing in Gaza Strip has prevented most patients to reach health care facilities abroad, in order to receive specialized care.
Up to January 31st, the two borders are still closed. However, according to the Israeli authority (Directorate of Civil Liaison in Erez) and to the MoH liaison person with Israel, Rafah terminal will open in short time for Palestinians, with precedence given to patients.
According to the MoH-Palestinian Health Information Center (PHIC) between 13th December 2004 and 30th January 2005 the number of patients certified by the MoH as in need of being referred to neighboring countries for specialized care is 582. The destinations of these patients are Israel, East Jerusalem and West Bank (through Erez crossing); Egypt and Jordan (through Rafah crossing).
The type of health care needed by these patients is the following
Cardiac surgery (134 patients)
Radiotherapy for cancer (72 patients)
Internal medicine diagnostic procedure (22 patients)
Pediatric surgery for newborns with congenital malformation (78)
Urological and nephrology specialized medical treatment, including treatment for renal failure (52 patients)
Intensive care and burn units (21 patients)
Ophthalmology diagnostic and treatment (70)
Among these patients, 6 have been permitted to leave through Rafah crossing - on January 26 - as a result of an appeal to the Israeli High Court of Justice launched by the Israeli human right organization “Physicians for Human Rights”.
Further 45 patients were permitted to leave Gaza through Erez check point between December 13th and January 13th , all of them seeking radiotherapy treatment for cancer.
Since January14th, following extended closures in the Gaza Strip, the transit of patients through Erez check point has virtually stopped. During this period, the MoH has been negotiating with the Israeli authority for the crossing of the patients in need, but so far only 10 patients have been allowed to pass.
As an effect of the closures, many Gaza residents have been trapped outside Gaza on their way back home. Among them, 877 patients who had previously left to be treated in Egypt and Jordan. Among these, 42 were children under 5 and 454 were women. The main reasons for their referral abroad had been cardiovascular surgery and radiotherapy for cancer. During the waiting period, 7 of these patients died and were buried in Alarish, at the Egyptian border, as the Israeli authority did not allow the transfer of the bodies in Gaza. After 40 days of waiting, the remaining patients have been allowed to enter Rafah crossing, that has opened, only in one direction, from January 21st.
MoH (Palestinian Health Information Center, Referral Abroad Department, Emergency Department);
Physicians for Human Rights Israel, ICRC.
CASUALTIES AND HEALTH INCIDENTS
According to the Palestinian Health Information Center (MOH), during the month of
the total number of deaths and injuries reported in the West Bank and Gaza Strip was
(including 24 children) and 192 injuries (Including 77 children)
During the same period, there were 14 episodes of ambulance delay (for a total delay of 11 hrs). In 4 cases the access was totally denied –according to PRCS, in addition to 1 delivery incident for a pregnant woman in the ambulance that was transferring her to give birth in a local Palestinian hospital in Gaza, where she experienced labor complications due to the delay. (source: PRCS weekly press release 22-28 Jan, 2005).
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:
FOR MORE INFORMATION
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