Casualties now exceed the number of the previous two conflicts in Gaza combined, in 2008-9 and in 2012. From initial assessments, 3,000 structures have been completely destroyed and 30,000 damaged.
A ceasefire began August 5 following several days of intense violence in many areas in the Gaza Strip. The Ministry of Health (MoH) estimates that at least 100 people may have been buried under rubble of destroyed buildings but ambulances could not evacuate them during the continuous violence. Three ambulance workers were killed evacuating patients in Rafah. Several hospitals reported damages, forcing one hospital to close, and were facing shortages of services staff and fuel, water and food due to difficult access and supply lines being cut. One-third of hospitals and one-half of primary health clinics are closed due to damage or due to being in an insecure location for staff and patients.
286,987 displaced persons are now sheltering in 90 UN Relief and Works Agency (UNRWA) schools prepared as temporary shelters, with the average number of persons per shelter rapidly increasing. The Palestinian Red Crescent (PRCS) reported that 15,741 persons were in government schools and public buildings, and 200,000 are estimated to be with host families.
Hospitals are treating a constant influx of new casualties in already overcrowded facilities and with vastly reduced supply of electricity, following last week's destruction of the Gaza power plant and most of the main power lines into Gaza from Israel. Only 40% of hospital staff have been able to report for work and existing health staff are fatigued, with critical staff working 24-hours shifts. Resources are limited: donated medical supplies had been maintaining only minimum levels of essential medicines due to the heavy caseload of wounded.
The Gaza European Hospital, located in an area where access has become dangerous, between Rafah and Khan Younis, reported stoppage of its water supplies, forcing the 250-bed hospital to bring water by trucks which can supply only 50% of its needs. On August 2 one of its two main generators failed, the daily supply of bread did not reach the hospital, and the laundry services were not working due to the manager not able to report to work.
Primary health care
More than 17,000 patients utilized UNRWA's 13 open clinics on August 2 and 3, higher than the pre-war average of 14,000 patients a day. Currently more than 30% of clinic patients are displaced persons staying in shelters.
WHO and UNRWA are monitoring health in shelters in order to prevent and control any outbreak of communicable disease. A team of WHO, UNRWA and UNICEF visited three shelters for displaced persons on August 2 and found them to be crowded, and in need of water for washing and basic hygienic kits. One non-UNRWA center lacked drinking water. About 5% of the shelter population was being referred to nearby clinics or hospitals for health care, many of whom were children with diarrhea. UNRWA reports that diarrhea is within the ordinary range and there are no obvious outbreaks of disease reported so far.
With water and sanitation facilities unable to function, the public health situation has become very difficult for most households without generator power, and for the several hundred thousand of displaced persons who have sought refuge in UNRWA and government shelters.
Health structure damages (see Annex)
The only government hospital serving the Rafah district, the 80-bed Abu Yousef Najjar Hospital, was damaged on August 1, at a time when it was receiving more than 200 casualties from heavy bombardments of surrounding neighborhoods, and 39 bodies were brought to the morgue, overwhelming capacity. The hospital's electricity and water lines were also damaged. On August 2 the hospital administration decided to evacuate patients and staff to the Kuwait Field Hospital to the west and to hospitals in other districts, and the Ministry of r Health later announced the closure of the hospital. On August 6, the hospital was reported to be reopened and receiving patients.
Both Najjar Hospital and Shifa Hospital received anonymous phone calls on August 1 theatening the hospital
staff with an imminent attack, and causing panic. Telephoned warnings preceded attacks on al Wafa hospital in Gaza, which was evacuated and later destroyed.
Al Amal Hospital compound in Khan Younis was hit by a missile which impacted the top floor of its multipurpose building, where its guest house, rehabilitation department, mental health department, and the hospital administration are located.
The Cardiac Hospital in Gaza, operated by the Public Aid Society, suffered damage to the cardiac lab, administration building, windows and an ambulance and one person was injured.
Al Asqa Hospital reported being hit on the roof by a missile on July 30 which caused major damage to the female medical department and injured a nurse on July 30. The hospital has been working at 50% capacity following an attack on July 21 in which 6 people died.
Three UNRWA clinics were damaged on August 3 and 4 for the second time, Bureij, Maan and Tel al Sultan in the eastern and southern areas of Gaza. In total, nine UNRWA clinics out of 21 have been damaged since July 7.
A Ministry of Health ambulance evacuating patients from Najjar Hospital was hit shell and three paramedics killed. A total of five ambulance workers have been killed since July 7, 3 from the MoH and 2 from the Palestinian Red Crescent Society.
Referrals of patients to facilities outside Gaza
The Ministry of Health in Gaza is planning to refer more patients to outside hospitals to access life-saving treatment as well as to reduce the case load in the hospitals to a more managable level. The average number of referrals per month is 1250 patients, primarily seeking treatment in the main East Jerusalem specialty hospitals and in West Bank hospitals. The lack of security for patients to travel to Erez and the chaotic situation of referral procedures reduced the number in July to about 20% of normal. Ambulances required special security coordination to take patients to Erez during the military incursion in the north, but now the main north-south access route, Salah ad-Din Street, is accessible without coordination.
Improvement is being made in matching patients to particular destination hospitals by the needed specialization, streamlining the bureaucracy involved in referral procedures, and arranging for transportation for patients and accommodations for their companions. Reported Israeli efforts to divert patients to a field clinic set up within the Erez terminal also complicates the passage of patients through Erez. There is also the permit system bureaucracy for patients and companions in obtaining required permits and security clearance. For the past three years, men aged 18-40 have been much more likely to be called for a security interview and refused a permit, yet this cohort represents the greater number of casualties in this war.
Only seven PRCS ambulances are licensed and able to go to Erez checkpoint. There are efforts underway to expand this by mobilizing other ambulances. Cars can also be used for normal referral patients if access to Erez, permits and other logistical matters are facilitated. There are other issues involved in referring patients which the MoH, ICRC, WHO and the East Jerusalem hospitals are trying to address at the moment.
The 250-bed Makassed Hospital is the main referral hospital in East Jerusalem for Gaza and West Bank patients. It reported receiving only 30 patients from Gaza since July 7, as well as 350 emergency cases from Jerusalem and the West Bank from recent clashes, all of whom it treats without charge. In a statement issued on August 5, the hospital appealed for US$ 5 million for medicines, disposables and medical equipment.
Public health concerns
On August 2, the WHO together with the UN Office for Humanitarian Coordination in the occupied Palestinian territory and UNRWA issued a statement warning of a "rapidly unfolding" health disaster in Gaza. http://www.emro.who.int/countries/pse/index.html
A WHO team will be engaged in a week-long rapid assessment of the health sector to estimate health restoration and reconstruction needs in the coming days with OCHA and a comprehensive assessment later organized by UNDP. "Recovery needs will be enormous", according to WHO Regional Director for the Eastern Mediterranean Region, Dr. Ala Alwan on August 3.
WHO is working with health partners including the MoH, ICRC, MAP-UK and PRCS on improving the process of referrals, access and treatment destinations for casualties and other patients.
WHO procurements of medical aid and donations from Bahrain are being tranferred to the MoH in Gaza in the coming days.
The Ministry of Health reported donations from more than 30 UN agencies, international humanitarian organizations, governments, charities and businesses totalling US$ 15 million.
WHO West Bank and Gaza Country Office Contact: Dr. Mahmoud Daher