The public health situation continued to deteriorate rapidly and is nearing collapse. Multiple health facilities are closed and remaining health services are severely overstretched. Displacement of over 400,000 people now living in overcrowded conditions, coupled with inadequate water and sanitation, pose serious risks for communciable disease outbreaks. Days of intense violence that followed the end of the 12-hour ceasefire on July 27 (coinciding with the Moslem feast of Eid al-Fitr) resulted in a steep rise in casualties and additional displacement from bombarded areas. Many families have had to repeatedly find new refuge. On July 28, Gaza's only power plant was destroyed which caused blackouts, and largely ummobilized the water and sanitation systems. The 64 megawatts that is still being provided by several direct lines from Egypt and Israel covers less than 20% of demand.
Staff and patient access to hospitals is difficult due to lack of security and unavailability of transportation. The main hospital in the Gaza Strip, Shifa Hospital, is overwhelmed with patients and their families, many of whom --especially injured children --- are in psychological shock from multiple loss of family members. A large number of displaced families are encamped around the hospital seeking refuge and needing essential water and sanitary services. Hospitals are now almost solely dependent on back-up generators as their main power source.
Maternity services: due to access difficulties, Shifa staff shortages were acute among nurses in the maternity and neonatal departments, many of whom live in the northern and middle areas of the Gaza Strip. Nursing attendance in the maternity department was reduced this week to 40% during attacks in the area but nurses present were working round-the-clock shifts. The closure of Harazeen Maternity Hospital in Shajaiyah due to insecurity of the area increased the number of women seeking delivery assistance at Shifa by 25%, according to the Head Midwife at Shifa, which she said would affect quality of care. Electricity is being provided to the Neonatal department from generators on a 24-hour basis without interruption.
Hospital-based antenatal services for high-risk pregnancies have been closed which may have an impact on fetal and maternal morbidity and mortality.
Drug and supply shortages
Many drugs at zero stock are basic and important for managing casualties in emergency rooms, for pre-operative and post-operative care, in operation theatres and in intensive care units: anticoagulants, antibacterials and antiseptics for prevention of infections in wounds, cardiac and gastric medicines and IV fluids. Hospital staff in non-casualty sections are reporting shortages of basic medical supplies such as surgical gloves, gauze, syringes, cannulas, blood sugar and albumin tests.
Primary health care
All health centers in the 3-km "no-go zones" are closed and violence elsewhere has restricted safe access to health care. As of July 30, 34 of 75 MoH and UNRWA primary health centers in the Gaza Strip are closed. The MoH reported half of its clinics are closed (27 of 54), including 7 of 8 clinics in the northern area and 7 of 10 in the Khan Younis area. UNRWA reported one-third of its clinics are closed (7 of 21), mostly in the Middle Area. Patients took advantage of the brief ceasefire on July 27 to utilize UNRWA clinics, but when violence resumed, patient utilization was reduced by half. UNRWA reports staff attendance is almost 70% and that staff are coping but are strained.
WHO met with primary health care administrators from the Ministry of Health, UNRWA and UNICEF July 30 to discuss the closure of clinics, supply needs and coordination of services, and to assess disease surveillance and gaps in control of communicable and non communicable diseases, especially in areas that lack safe access to health care, and among displaced persons in shelters.
Health structure damages
A shell landed on the grounds of Shifa Hospital on July 28, causing damage to a border wall, gate and windows of the outpatient clinic, and to the health sciences library. It was the first time that the hospital has been affected directly. There were no injuries reported.
The top three floors of Al Quds Hospital, a newly-constructed 50-bed hopsital operated by the Palestinian Red Crescent in Gaza city, were severely damaged by an attack on July 30 which caused their partial collapse and fire. The previous hospital building had been destroyed in an attack in the 2008-9 war in Gaza. The hospital is a general medical services and diagnostics center.
At least 11 hospitals have been damaged so far in the violence (Annex). Four of the damaged hospitals are closed and six additional hospitals closed due to lack of security for staff and patients to access.
Khalil Wazir clinic, a PRCS clinic in Sheikh Ajleen in Gaza city, was damaged July 30, which cracked walls and damaged equipment. A total of 14 primary health clinics have been damaged since July 7.
Ambulance services: PRCS reported July 30 that 2 ambulance workers have been killed and 40 injured in the line of duty in Gaza since July 7, and 20 ambulances have been damaged, although clearly marked with the international Red Crescent insignia.
Referrals of patients to facilities outside Gaza
Rafah crossing: Egyptian authorities are apparently giving casualty patients priority to travel for humanitarian reasons, although numbers are small.
July 28: 7 causalities and 6 companions (1 companion returned by Egyptian authorities)
July 29: 4 causalities and 4 companions
July 30: 11 causalities and 10 companions (1 companion returned by Egyptian authorities)
July 31: 3 causalities and 3 companions (up to 12:00)
Erez crossing: Delays were reported by patients and ambulances in movement to and from Gaza through Erez, often delaying patients or parents of sick children for hours due to security and adminsitrative procedures.
July 31: 8 causalities and 8 companions crossed by ambulance, to reach hospitals in Nablus and Jerusalem. 4 non-casualty patients and 3 companions crossed. All patients traveled to Erez by ambulance and with special coordination.
Public health concerns
As of July 30, 204,165 people were in 85 shelters (UNRWA schools), averaging 2,400 persons per shelter. An additional 200,000 are estimated to be in informal shelters (including in hospital grounds) or living with relatives. Water and sanitation facilities are grossly inadequate in the overcrowded shelters. In addition, without electricity, most households in Gaza now suffer inadequate water supplies and poor sanitary conditions. These circumstances pose a high risk for outbreaks of communciable disease, especially waterborne diseases and skin infections. Furthermore, disruption of immunization programs risks the emergence of vaccine preventable diseases.
WHO and UNRWA continue to monitor the situation in order to prevent and control for possible outbreaks of endemic disease in shelters and identify gaps in control programs for chronic diseases.
Health needs, priorities and gaps
Emergency care for the large numbers of injured remains the priority.
Furthermore, high numbers of patients are seeking care at hospitals for acute, non-trauma related reasons.
The immediate health needs of displaced people remain a high priority, especially those with chronic diseases, those who are more vulnerable to communicable diseases, and pregnant women, new mothers and infants.
The health needs of convalescing casualty victims who have been discharged home is also a concern for follow-up at community level.
Hospitals are using down their fuel reserves more quickly than anticipated due to the loss of the Gaza power plant. WHO is seeking solutions for fuel resupply through donations from other sources, in addition to that provided by the Islamic Development Bank which had been intended to meet hospital needs for a six-month period.
The long supply route and complicated security coordination over multiple borders for delivery of medical supplies to Gaza through Rafah and via Jordan to Keren Shalom crossing between Israel and Gaza has slowed humanitarian aid delivery to the hospitals.
WHO participated in the 2014 Gaza Crisis Appeal with a target of US$ 369 million required in emergency humanitarian assistance for the most vulnerable in Gaza, to be implemented by UN and international humanitarian agencies. The Appeal was launched August 1 in Ramallah and was coupled with a call for safe access.
http://www.ochaopt.org/documents/HC Statement Gaza Crisis Appeal.final.pdf
WHO shipments of medical supplies procured thanks to $1.4 million in donations
from Switzerland, Norway, and Italy began to arrive to the MoH Central Drug Store in Gaza this week and will continue to arrive over the next week. Donations in kind from Bahrain and the Jordanian army are also enroute. The supplies are for distribution mainly to MoH hospitals.
WHO held a coordination meeting July 30 for primary health care providers to ensure all needed services are being covered.WHO facilitated the travel and coordination of a 5-member medical team of specialists from Augusta Victoria Hospital in East Jerusalem to Gaza on August 1.
A 24-member team of MoH specialist physicians and surgical nurses, led by the MoH Director of Hospitals, traveled to Gaza on August 1 to assist colleagues in Gaza hospitals. The MoH in Gaza had called for specialists in neurosurgery, anesthesiology, plastic surgery, general trauma surgery, advanced orthopedics and burn management.
The Ministry of Health reported donations from more than 30 UN agencies,
international humanitarian organizations, governments, charities and businesses totalling US$ 6 million. The most recent were donations from Oxfam, Medico International and Noran Charitable Society.
WHO West Bank and Gaza Country Office
Contact: Dr. Mahmoud Daher
Tel: +972-598944650 I firstname.lastname@example.org Website:
Table 1. Hospitals in Gaza damaged from July 7 to July 31, 2014 *
*WHO is in the process of verifying details of damage reported by additional hospitals.