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Source: World Health Organization (WHO)
1 January 2004

Health Inforum News
Volume 3, No.42, 01 January 2004

Welcome to the forty-first issue of the Health Inforum Newsletter.
We hope this year will bring peace and prosperity to the Palestinian people and to all nations.
In our ongoing efforts to provide useful information to the health community, we welcome any comments or suggestions that you might have to help us to improve this newsletter. Please help us to distribute this update by forwarding it to your colleagues and friends. If you wish to subscribe, please send an email to

In this Issue:
q The Palestinian Guidelines For Chronic Non Communicable Diseases (CNCD)
q Palestinian Medical Personnel Harmed and Humiliated by Israeli forces
q PRCS Health Incidents at Checkpoints (December 13-26, 2003)
q Emergency Support for the Palestinian Hospitals in East Jerusalem, Component A: Coordination between East Jerusalem Hospitals

The Palestinian Guidelines For Chronic Non Communicable Diseases (CNCD)

Globally, chronic conditions are increasing , regardless of the region or the social class concerned. Developing countries are going through a demographic and epidemiological transition from communicable to non communicable diseases.
By the year 2020, chronic conditions, including injuries and mental disorders, will be responsible for 78% of the global disease burden in developing countries. Palestine is one of the developing countries in which the burden of such diseases is expected to exhaust its medical and financial system -- thus urgent action should be taken.

Part of this action is the development of clinical practice guidelines to assist practitioner and patient decisions concerning appropriate care for specific clinical circumstances. These guidelines will also play a vital role in standardizing the health care provided to chronic patients.

The Palestinian Ministry of Health is therefore committed to improving the quality of health care provided to chronic patients. This commitment resulted in the establishment of the National Chronic Disease Committee in 2000. The aim of the National Chronic Disease Committee is to develop a comprehensive and integrated chronic diseases care system, part of which is the development of clinical practice guidelines for ten selected chronic diseases.

This process started with the development of the “Guideline for Clinical Guideline Development”, in which the model and the methodology of evidence-based clinical guidelines are well explained.

Multidisciplinary teams were formed according to the subject of the guideline. More than 90 health personnel in both West bank and Gaza were trained in the methodology of guideline development. These teams were technically supported by the Quality Health Care Experts at the Quality Improvement Project/ Ministry of Health, throughout the entire period of guideline development.

For more Information please visit Health Inforum Website:

Guidelines of Hypertension

Guidelines of Diabetes

A joint report of B'Tselem and Physicians for Human Rights-Israel:

Palestinian Medical Personnel Harmed and Humiliated by Israeli forces

A joint report of B'Tselem and Physicians for Human Rights-Israel, published recently (December 2003), showed that Palestinian Medical Personnel in oPt are being harmed, delayed, abused and humiliated at Israeli checkpoints.

Israel's siege policy that has been implemented in the Occupied Territories over the last three years has unquestionably altered the lives of hundreds of thousands of Palestinians. As of early November 2003, the Israeli army had established fifty-six staffed checkpoints in the West Bank, as well as 607 physical roadblocks that prevent the passage of motor vehicles, 457 dirt piles, 94 concrete blocks and 56 trenches.

These restrictions on movement impede the functioning of an emergency medical system. As a result of the physical roadblocks, ambulances must travel along winding, makeshift roads, and patients must make their own way over mounds of dirt or be carried on stretchers to the other side. The absence of soldiers at these physical roadblocks makes it impossible for the sick to even explain the urgent nature of their medical problem.

Medical personnel frequently experience difficulties in crossing staffed checkpoints. The Israeli army does not have special procedures for ambulances to cross-checkpoints, but have issued only a general procedure relating to Palestinians who seek to cross. The procedures do not provide a proper solution for the severe problems ambulances have in reaching hospitals; in addition, soldiers at times ignore the procedures. Ambulance medical teams have also reported that they are often humiliated by the security force personnel stationed at the checkpoints, and in some cases have been beaten. In a few extreme cases, medical personnel have reported soldiers' use of ambulances for military purposes.

As a result of these difficulties, ambulances are able to reach the sick and wounded only thirty percent of the time. The rest of the time, patients are forced to get to a physical roadblock or checkpoint by themselves. As a result, many Palestinians forgo calling ambulances. This phenomenon is demonstrated by the drastic drop in Palestinian women who give birth in a hospital. The rate of hospital births has dropped from ninety-five percent before the Intifada to less than fifty percent

For more Information please visit Health Inforum Website:

Denying access for Union of Health Care Committees (UHCC) Medical Crews’ Work

On the morning of December 28 2003, whhile heading from Nablus to Azoun, Amateen, & Asira Al-Qblya clinics UHCC’s two ambulances were stopped at Howara checkpoint for at least an hour. The Israeli army did not allow them to proceed and forced them to return to Nablus; the same happened to other ambulances present in the area. The Israeli army ignored what the medical teams expressed concerning the necessity of crossing to aid patients. It is worth mentioning that one of the ambulances was carrying a gynecologist and health educator, who were heading to Azoun clinic; while the other ambulance was carrying a GP, health educator and lab technician, who were heading to Amateen & Asira Al-Qblya clinics.
In another incident, the main street at Seelt Al-Daher has been under curfew for more than ten days. This has made it difficult for UHCC medical teams to reach theirCenter, which is situated at the main street. The Israeli army also prohibited patients from reaching the Centre.

PRCS Health Incidents at Checkpoints (December 13-26, 2003)

Nablus, 17 December 2003 (14:00): A PRCS ambulance was shot at by Israeli soldiers while on its way to transport injured people from Balatah Refugee Camp. The bullets penetrated the rear side of the ambulance causing damage to the stretcher.

Bethlehem, 22 December 2003 (19:00): Israeli soldiers at the Container checkpoint stopped a PRCS ambulance team on route to check on colleagues who had previously been detained by Israeli soldiers for 13 hours at the same checkpoint. As one of the PRCS team exited the ambulance and attempted to inquire regarding the detained medical staff, he was attacked by one of the soldiers at the checkpoint.

In addition to the above, the following table lists incidents of denial and delay of access during this reporting period.

PRCS Branch DateCheckpoint
    Delay of access (unless indicated 'denied access')
Nablus 17/12/2003Shafi Shamron
    90 minutes
18/12/2003Entrance to the Old City
    45 minutes
19/12/2003Jerusalem street
    30 minutes
    15 minutes
Hebla Gate
    35 minutes
    30 minutes
13/12/2003Near Jen Safoot village
    30 minutes
13/12/2003Amteen intersection
    Denied access
    85 minutes
    60 minutes
Bethlehem 17/12/2003Gilo
    Denied access
Gaza/ Khan Younis 17/12/2003Al-Mawasee area
    50 minutes
Nablus 26/12/2003Balata refugee Camp
    15 minutes
    35 minutes
26/12/2003Al-Dahya neighbourhood
    20 minutes

    Denial access

26/12/2003Balata refugee camp
    7 hours
Qalqilia 21/12/2003Jaljolia
    120 minutes
26/12/2003Amteen intersection
    90 minutes
Tubas 20/12/2003 Sora checkpoint
    40 minutes
Gaza 20/12/2003 Al- Mawase area
    55 minutes

    Denial access

22/12/2003Khan Younis/Abu Holi
    3 hours
25/12/2003Khan Younis/Al-Dalta area
    Denial Access
25/12/2003Khan Younis/Al-Dalta area
    4 hours

    Denial access

Bethlehem22/12/2003Al-Walaja checkpoint
    Denial access
23/12/2003Housan checkpoint
    3 hours

Emergency Support for the Palestinian Hospitals in East Jerusalem

Component A: Coordination between East Jerusalem Hospitals

In its continuous efforts to share and exchange Information, Health Inforum will highlight, on a bi-monthly basis, one of the main ongoing Health projects in the oPt.
Health Inforum will publish an overview on the project and will clarify any related information by asking the implementing agency about any queries.
For the current issue, many thanks to Ricardo Sole, the EU Technical Consultant of the project, for providing Health Inforum with this valuable information.

Implementing Agency: Welfare Association
Project Duration: Two years, December 1, 2003 to November 30, 2005.
Budget: 606,000 Euro
Funding Agency: European Commission

Overall Aim: The overall aim of the two-year support is to promote better health care services for the community by improving the viability and long-term financial sustainability of Palestinian hospitals in East Jerusalem, as part of the Palestinian health care system.

The specific objective of the of the project is to develop mechanisms for the coordination and cooperation between hospitals of East Jerusalem for improving the quality of care and training, hospital management and financial strategies, particularly accessibility and cost efficiency.

Target Group: Augusta Victoria hospital, Palestine Red Crescent Society, Princess Basma Center, St. John Ophthalmic hospitals, St. Joseph’s hospital, Makassed hospital.

The direct beneficiaries are the Palestinian population living in East Jerusalem which totals 395,000 people, of which 250,000 people live within the municipal boundaries, and other users of hospital services and training.

Main Activities:
· Developing formal mechanisms of coordination and common strategies related to hospital and financial management, such as a common strategy for negotiations with Sick Funds, tender procedures for procurement, fund raising, cost-saving strategies or cooperation initiatives between two or more hospitals.
· Developing common standards and protocols for improving existing services on the basis of quality and patient-focus, including joint training courses and workshops on drug and laboratory management, quality control systems and information sharing.
· Developing the hospitals as a credible teaching consortium for undergraduate and postgraduate medical teaching by promoting training and continuing education for staff.

The expected results are that improved coordination and cooperation between East Jerusalem’s hospitals will provide a) better definition of the role of each hospital in the Palestinian health care system and b) the development of common policies in terms of service provision and management, leading to improved health care for the community.


Please feel free to contact us for information at:
Health Inforum, c/o Italian Cooperation. Sheik Jarrah, East Jerusalem
Tel: 02 532 7447, Fax: 02 532 2904
or at
Health Inforum, c/o WHO, Gaza office, Al-Bayed building, Al-Halbi Str.
Tel: 08-2822033, Fax: 02-2845409


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