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Source: World Health Organization (WHO)
5 October 2004





Current situation in the
Northern Gaza strip
September 28- October 5, 2004

On 28/9 the IDF launched a major operation in the northern part of Gaza, which is still on-going. The objective of this operation - as declared by the IDF - is to prevent Palestinian militants from firing missiles at targets inside Israel. IDF troops, accompanied by around 100 tanks and helicopters, entered the northern Gaza Strip areas of Beit Lahiya, the Jabalya refugee camp, and Beit Hanoun early on the morning of 1st Oct. The large -scale operation is aimed at pushing Qassam rockets out of range of Sderot, and at eventually creating a buffer zone of a 9 km swathe of northern Gaza up to the outskirts of Jabalya. Nine kms is the maximum range of a Qassam rocket.

According to the MoH, the total number of Palestinian casualties from the 28th of September until the 5th of October stands at 77 fatalities and approximately 300 injured. Among the fatalities, 20 are children under 18 and two over 60 years. Among Israeli casualties, the total number of fatalities is five, including two casualties which occurred outside Gaza, in the nearby city of Siderot.

1. Areas of incursion and movement restrictions

Israeli armored vehicles have taken positions along the main ridge overlooking Jabalia, where about 80 houses were partially or completely demolished. The IDF military operations have intensified in Blocks 2,3,4,5 in Jabalia camp and in the eastern part of El Seka street, in the eastern part of Tal Zaatar, and in Al Bukhary.

Beit Hanoun has been cut off from the rest of Gaza Strip, although there are no movement restrictions within the center of the town. On the periphery there are eight areas totally under curfew: Masri, Nazaz, Basha, Farata and Zaanin, east of Beit Haoun, Sultan Abdel Hamed and Al Ska Street located in the west part, and the industrial zone located in the southern part.

In Beit Lahia, the areas under intensive military operation are those located on Salah el Deen road, whilst in the center of the town the situation is relatively calm.

2. Access to Health Care Services

Out of 12 primary health care (PHC) centers normally operating in the areas of Jabalia, Beit Hanoun and Beit Lahia, only six are currently working or accessible to the population (see details below). The immunization program, among other preventive programs, has been severely hindered. Patients with chronic diseases are particularly affected by the lack of access to PHC
services.

Up to the present, the hospitals in the northern district have been able to respond effectively to the increase in emergency care needs. Number of staff, drug and supply availability seem to be adequate. However, access to the hospitals for residents of the Beit Hanoun area has been difficult and there have been several reports of delays in the provision of emergency care.

In addition, the MoH reported experiencing difficulty in delivering drugs, blood components and medical supplies to the district hospitals.

2.1 Primary Health Care

In Jabalia, there are seven primary health care (PHC) centers. Four of them are located in Jabalia camp (MOH Jabalia old clinic; UNRWA Jabalia clinic; UNRWA Al- Fakhorah clinic; Union of Palestinian medical relief committee (UPMRC) clinic), and others are the MoH Jabalia Martyr center in Jabalia Al Balad; MoH Abu-Shebak Medical Centre in Al Jurn area; Union of Health Workers Committee (UHWC)).

Access hours to all UNRWA clinics, and to the MoH Jabalia old clinic and Martyr center have been extended to 24 per day so as to cope with the intensive military operation in the area. However, those clinics located in Jabalia camp are very close to the areas where the military operations are taking place. For this reason, these clinics cannot be reached by the population without risk – resulting in a severe limitation on access, as confirmed by the Director General of PHC in the Ministry of Health.

In Beit Hanoun there are two PHC centers located in the central area (MoH Shohada Beith Hanoun and UNRWA health center of Beith Hanoun). The UNRWA clinic is currently not operative as all of its health staff have their residence outside the area, and thus do not have access to their working place, despite attempts of coordination with the IDF. The MoH has been able to redeploy health workers residing in Beit Hanoun to the MoH Shohada Beith Hanoun health clinic, in order to guarantee 24-hour access to the center.

A third clinic, the MoH clinic of Ezbat Beith Hanoun, is currently closed because it is located in an area under IDF control and staff and patients cannot reach it. As a result, all primary health care services, most particularly the immunization program and the management of chronic diseases, are paralyzed in this clinic.

In Beit Lahia, there are two centers for primary health care (MoH Beit Lahia old clinic and MoH Al- Sheima centre). The MoH northern Gaza district health officer reported that the two clinics are working 12 hours a day. People living in Al Sheikh Zayed residential neighborhood, Qlabo area, Tal Zaatar road, do not have access to primary health care clinics because of the
incursions into these areas.

On October 2nd the PRCS, during a series of home visits, distributed drugs for acute and chronic conditions to some families in Seka Street, Nada towers and Soshaa Street. The medications for chronic patients are sufficient to cover 10 days. In Beit Hanoun there are shortages in medications for neurological disorders such as epilepsy and for psychiatric disorders, according to PRCS.

2.2 Referral care

The referral hospitals for the Northern area are Kamal Edwan hospital in Beit Lahia and Al-Awda hospital in Jabalia. So far, these hospitals are coping with the additional demand for emergency care, in terms of availability of health personnel and medical supply. However, patients seeking non-urgent referral care are directed on to primary health care clinics, as a strategy to rationalize the resources and to give priority to the high number of injured people in need of emergency care.

Although there are no movement restrictions in the central Beit Hanoun, access to outside Beit Hanoun is denied. MoH and the PRCS reported difficulties in coordination with the IDF to ensure referral of patients to secondary health care that does not exist inside the town. PRCS reported that on the 30th of September a woman in labor needed to be referred from Beit Hanun to Kamal Edwan hospital because of a breach baby. Despite its repeated attempts, the PRCS did not succeed in coordinating with the IDF to allow for the woman to leave Beit Hanoun and reach the hospital. Only after 8 hours the MOH succeeded in referring the woman to Kamal Edwan hospital.

Staff of MDM visited the two hospitals in northern Gaza : Kamal Edwan and Al Awda. The hospitals have been able to manage the casualties up to now. They have sufficient physicians, most supplies, and most drugs (although both hospitals had a list of needed material - equipment and consumable supplies). There is a need for replacement oxygen before the current supply is exhausted (ICRC reported that it has been obtained), and for a thoracotomy set for Kamal Adwan (which MoH pledged to supply). In addition, Kamal Adwan has a shortage of nurses.

According to the Director of PHC, in Beit Hanoun there are 10 children suffering from Thalassemia in need of monthly blood transfusion from the tertiary hospital in Gaza city.

2.3 Ambulance Incidents

The PRCS reported that on the 30th of September the IDF shot an ambulance driver while he was trying to evacuate an injured patient in Jabalia. The driver was shot in the arm. On the same day, the IDF fired a missile at a target in Jabalia. An ambulance in the area was physically damaged and the driver was injured by the glass from broken windows. The telephone lines were disconnected affecting access to 101 PRCS emergency line.

3. Water and electricity

The PRCS reported the lack of electricity in some areas in Jabalia, especially in blocks 2, 3, 4, 5, on Schools street and on eastern part of El Seka Street, in Jabalia camp. Most people rely on wells for their water supply, and if the electricity lacks, the well pumps are not working. Most of the water tanks used for water storage are damaged from the on-going shooting. ICRC reported that only on the 4th of October, with the help of the municipality, they were able to deliver water to these areas and to Shoshaa Street and Kahlout area in Jabalia and to Nada towers.

In Beit Hanoun there are no shortages in water or electricity, according to the MoH northern Gaza District Health Officer.

On the 4th October, municipality workers fixed the water infrastructure in block 2,3,4,5 and in Seka Street, after the ICRC facilitated the coordination with the IDF. The main water network is repaired. However, there is massive destruction to the minor water pipes in the same areas which require urgent repair. In addition, municipality workers are currently fixing the water wells in Qlabo area in the east north of Jabalia.

For more information:
Health Inforum , WHO, Gaza office, Tel: 08-2822033, Fax: 02-2845409 .
Emails : dsa@healthinforum.org or who@palnet.com ,
Health Inforum , Jerusalem, Tel: 02-5327447, 02-5400595 , Email: info@healthinforum.org
Website: www.healthinforum.org



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