Situation in the OPT - WHO Health Action Response Team (HART) newsletter (Vol. 1, No. 5)

Health Action Response Team (HART) News No. 5

HART NEWS
Volume 1, No 5

Welcome to the fifth edition of HART News. As the situation continues to evolve, HART will continue to develop more tools to help inform coordination within the health community. We welcome any comments or suggestions you might have to help us improve this newsletter.

The focus of this issue is the international response (Who, what, where in the health sector). This will include an overview of recent activities of the International Non-Governmental Organizations (INGOs); UN Agencies; Donors; and other organizations. After each section, a summary of emerging issues will be provided where available. Palestinian NGO and Health Sector Activities will be the focus of a subsequent newsletter.

International NGO Activities:

International NGOs are currently rallying to respond to the emergency situation in the West Bank and Gaza Strip, as well as meet the ongoing "developmental needs" from before the most recent incursion in April. The INGO response needs to be prompt and effective, with as little duplication or omission as possible. HART aims to facilitate the INGO response by providing information on INGO and NGO activities.

In an effort to facilitate dialogue within the INGO community, WHO and AIDA sponsored a full day workshop at the UNRWA Kalandia Training Center on the 25th of May 2002¹. The aims of the workshop were three fold²:

1) To address the question of how to ensure coordination among INGOs responding to health needs in the Palestinian territories;

2) To brief stakeholders on the role and function of HART; and

3) To consider instruments to effect the role of HART.

The workshop began with the participants providing an update of their activities. Following is a table providing an overview of the main INGO activities by type of activity and by region.³ Services at the moment seem to be concentrated on Nablus and Jenin, because of the recent military operations.

Four challenges associated with INGO responses were highlighted through the course of the workshop:

1. Accessibility at all levels:

Access is a problem at all levels, from supplies reaching distribution points to patients reaching health care providers, including the lack of freedom of movement for PRCS ambulances. Problems with access have increased over the past 2-3 months. Before this time, international staff members were permitted into restricted areas. Now this is no longer necessarily the case. The conclusion derived from this concern was that INGOs should make a joint statement about the importance of accessibility.

2. Planning and the absence of a clear and coherent strategy for the INGO response;

There was no clear indication that, under recent emergency conditions, INGO activities had been based on a coherent plan of action in response to a formal assessment of needs. Rather they were a reaction to the emergency situation, in which prioritization was based on quick, informal reviews within each community.

3. Coordination between INGOs as well as with Palestinian NGOs (PNGOs);

The emergent picture of the lack of coordination between organizations, e.g. resulting in the over-supply of medicines and disposables, drew attention to the need for HART to provide a coherent strategy to address the issue of better coordination, both in terms of the emergency response, and in the long term.

4. Gathering information from INGOs (who, what where) in order to facilitate greater efficacy

Organizations expressed hesitancy about sharing information without having a clear picture of how the information will be used and disseminated. This was particularly true of efforts aimed at advocacy. There was a clear indication that strengthening the flow of information was critical to ensuring INGO efficacy. Some suggested types of information included: analysis of the state of medical supplies and needs outstanding; an activity overview; a "snapshot" of the state of health and the health care system; and information about efforts to facilitate movement of essential medical and humanitarian supplies.

Table 1: Overview of INGO Activities:

*Activities highlighted with a * are activities not generally monitored by HART. There may be a number of organizations involved in these activities that have not been listed here. Please feel free to contact HART with corrections and updates as pertaining to your organization.

UN Agency activities:

The major focus of the UN agencies has been on procurement of emergency medical and humanitarian supplies as shown below in table 2.

Table 2: Overview of UN emergency health activities.

Note: X = underway and ongoing; O = planned.
All UN agencies are working in the whole of the West Bank and Gaza Strip.

Some of the key issues identified with respect to UN Agency activities include:

1. Access

Access is a constraint impacting all efforts underway in the health sector. This not only impacts the ability of UN agencies to implement projects and deliver supplies, but also hinders their overall programme management. Tightening of road closures has made it increasingly difficult for national staff to travel to and from their offices. The implications of this on programming are that when closure is at an extreme, many UN agencies operate below capacity.

2. Information flow and coordination

Poor information flow and weak coordination are key operating constraints affecting all actors in the health sector. A number of coordination meetings take place on a regular basis, but not all the relevant parties are able to attend all meetings. HART and the UNOCHA Humanitarian Information Center (HIC) are working to enhance the flow of information in health and across all sectors through various channels, email, the web etc. However, the need for an entity to actively coordinate the emergency health sector response has been repeatedly cited.

Donors and other organizations:

Following is an updated overview of donor activities in the health sector:

Donor	Item	Description	Recipient	Status
Austria	Medical supplies and disposables	Medical supplies and disposables still to be approved to the UPMRC	UPMRC	Proposed
Belgium	infrastructure project	Project will mainly focus on water ,electricity and school rehabilitation in Ramallah & Nablus. An expert has arrived today for the assessment. More focus will be on income generating projects and employment. Project still to be approved in Belgium.	Ramallah & Nablus Governate	Ongoing
Denmark	Cash money	Funds given as a general grant to the UNRWA	UNRWA	Ongoing
		Funds for reconstruction and infrastructure through the World Bank	World Bank
		Funds to be used for humanitarian assistance but still not specified.
European Commission	Pledged cash money	Funds to be paid as a trust fund to the MOH through the WB and then the MOF for recurrent costs (non-salary)	WB then MOF then to the MOH	Ongoing
European Commission	Pledged cash money	Other emergency activities under ECHO projects.		Ongoing
France	Medical supplies and equipment	Providing medical supplies and equipment to the ICRC	ICRC	Completed
	Emergency Kits	providing emergency kits to the MOH in Ramallah	MOH Ramallah	Completed
	Medical supplies and disposables	Providing medical supplies and disposables to Ramallah Hospital.	Ramallah hospital	Completed
	Medical kits	Providing medical kits to the health centers in Nablus and PNGOs	Nablus health centers	Completed
	Technical experts	Technical experts to support the UNRWA, PRCS, ICRC, UNDAC efforts in Jenin camp	UNRWA,PRCS/ICRC,UNDAC	Completed
	Supporting team	Supporting team to provide assistance in drugs procurement for the INGOs	Medicins sans frontiers ( MSF )	Ongoing
	Water experts	offered support to UNDP, specified in terms of water experts for the assessment in Qalqilya	UNDP	Ongoing
	Drugs	Providing drugs to the health centers related to MOH and NGOs	MOH centers& NGOs	Ongoing
Germany	Cash money	As of the end of April, a donation been given to the Lutheran World Foundation / Augusta Victoria Hospital for drugs and medicines.	Lutheran World Foundation/ Augusta Victoria Hospital	Ongoing
	Cash money	As of the end of April, cash money been given to the UPMRC to buy drugs and medicines for needy people	UPMRC	Ongoing
	Food Aid	As of the end of April, German Foreign office donate a food aid through the German Representative Office for needy people.	German representative office to the needy people in Jenin, Nablus & Ibbziegh	Ongoing
	Structure specialists	Assessment specialists assessed the damages of houses in Jenin camp and Nablus and helped to start repair measures.	Jenin Camp & Nablus governate	Completed
	Medical assistance	Hammer Forum provides a program of medical assistance including mobile medical station in cooperation with the PRCS & PNGOs	Hammer Forum	Ongoing
Greece	Cash money	Food and medical supplies through the IOTC to the UPMRC	IOTC then to the UPMRC	Ongoing
Greece	Cash money	Funds to be allocated for the treatment of Thalassimia patients by sending them to Greece to be treated.	Ramallah Thalassimia Center	Ongoing
Italy	Emergency Kits	2 trauma +1 Emergency kit	Ramallah hospital	Completed
	Emergency Kits	1 trauma kit	Arab Care Med Ctr	Completed
	Food Aid			Ongoing
	Hosting the emergency team	Hosting the Health Action Response Team (HART)	HART	Ongoing
	Assessment Convoy	14th of May, a visit to Bethlehem for the assessment.		Completed
Norway	Ambulances & Emergency kits	A fund has been provided including 4 ambulances, emergency kits	PRCS	Ongoing
	Oxygen extractors	Provision of 3 oxygen extractors including separate building for the extractor and replacement parts.	Shifa Hospital, Rafidya Hospital, Ramallah Hospital	Ongoing
	Medical supplies	Medical supplies through Norwac( INGO),and the Norwegian Red Cross	MOH;WB & Gaza	Ongoing
	Emergency Kits	Emergency kits, part of a rescue team including two experts on unexploded ordinants through the Norwegian Red Cross	PRCS Jenin	Ongoing
	First aid kits & Medical stuff	A labor intensive project, first aid kits and medical stuff through the Norwegian Church Aid.	Augosta Victoria -Jerusalem	Ongoing
	Emergency coordination office	Established an emergency coordination office and taking a lead on the area assessment for the Jenin district.	Jenin governate	Ongoing
	Oxygen extractors	Plans for 4 additional oxygen extractors to be provided through Norwac (to be confirmed)		Proposed
Spain	Drugs & Disposables	A list of drugs provided to the MOH, will be available as soon as they receive the invoices.	MOH	Ongoing
Sweden	Cash money	Providing financial support to UPMRCs primary health and emergency health for infrastructure, medicines and salaries.	UPMRC	Ongoing
		Financial support for primary health in rural clinics
		Additional funds still to be approved for the child health.
	Cash money	Funds for detention activities applied to the ICRC and to buy a number of ambulances to the PRCS.	ICRC & PRCS	Ongoing
	Medicines	Supply of medical input to hospitals, relief and cash assistance to poor families, mental health.	Diakonia	Ongoing
	Food Aid	Food parcels been distributed to 10,000 families.	10,000 families	Ongoing
	Cash money	Providing funds to the GCMH to support the psychosocial health care mainly in Gaza.	GCMHP(Gaza community mental health programme)	Ongoing
The Netherlands	ER budget	ER central budget to international NGOs ,UNRWA and ICRC
The Netherlands	Area assessment	Leading the area assessment in Ramallah of institution and infrastructure (including the MOH facilities)
The UK	Convoy	Convoy to Jenin $ 14,350.
The UK	Aids	Blankets, Diapers, Baby food and drugs been provided to those who get their homes destroyed in Jenin	Private Homes	Ongoing
USA	Generators	2 500KVA generators to MOH hospitals in Nablus& Ramallah.	Nablus Hospital & Ramallah Hospital	Completed
	Generators	2 portable 80 KVA genarators to Ramallah Hospital and Jenin Hospital.	Ramallah hospital & Jenin Hospital	Completed
	Disposables	Medical disposables to 12 NGOs / private sector hospitals in JENIN, Nablus, Ramallah, Hebron, Gaza and Tulkarem.	NGOs	Completed
	Disposables & Equipments	Medical disposables and equipment to hospitals in Jenin.	Hospitals in Jenin	Completed
	Disposables	Medical disposables, mainly for NGOs Clinics in Gaza	NGOs Clinics (Gaza)	Ongoing
	Disposables	Medical disposables for MOH throughout WB & Gaza	MOH	Ongoing
	Medical Equipment	Medical equipment for MOH with priority for Jenin.	MOH	Ongoing
	Emergency care pharmaceuticals	Emergency care pharmaceuticals		Planned
NGOs and other charitable organizations
Consortium of Welfare Association	Medicines & medical supplies	Medicines & medical supplies to 9 major and 14 minor Government and NGO hospital in all WB towns.	9 MOH hospitals, 13 NGO hospital.	Implemented
Jordan MAP and Friends of East Jerusalem Hospitals	Medicines & medical supplies	Medicines and medical supplies to 34 NGO health centers and clinics in all WB regions	34 NGO health centers in WB	Implemented

ACTION POINT: If any information provided in these tables has been misrepresented and/or is need of revision, please feel free to contact HART and we will made adjustments accordingly. Your active cooperation on these points is greatly appreciated.

Update on HART's ongoing activities:

Supply update:

The MoH Distribution Schedule:

Efforts are underway to continue with facilitation of distribution of essential medicines and supplies from the Ministry of Health Central Stores in Ramallah to the District hospitals and Primary Care Directorates.

To date, 8 out of 20 planned deliveries have been completed. A further 3 are planned for the coming days. Nine deliveries remain outstanding. Efforts have been severely hampered by fluctuations in the security situation. The ICRC and the World Food Programme (WFP) have been instrumental in making these deliveries. However, given the urgency in some areas, e.g. Bethelehem, HART is calling upon the wider international community for assistance with these efforts.

ACTION POINT: If your organization has access to large trucks (8-10 tons) that can be used to help move essential medical supplies for the MoH, please contact HART as soon as possible.

Supply analysis:

HART has been conducting an overview of incoming requests for drugs and disposables in an effort to match requests with procurement activities. Preliminary findings of this analysis suggest some of the following patterns:

Out of 22 requests processed from health facilities across the West Bank, only 40% of the items were listed on the Guide List to Essential Drugs. Even fewer (~35%) of the items procured in response to these requests were on the Guide List. This suggests that the Guide List to essential drugs is not being used uniformly. Consensus needs to be reached about which items, presumably those on the guide lists, should be prioritized in order to ensure a minimum level of operating capacity.
The fact that the Guide Lists have not yet been unilaterally endorsed has complicated efforts to match requested items. Many items listed are listed by their Brand Names, while items on the Guide List are given by their Generic Names. In addition, many donors have provided medical kits containing international (imported) items. Matching foreign 'brand name' items with items from the essential drug list has also proved difficult.
One of the most alarming observations has been that many of the drug donations have been delivered outside the central system. This is particularly true for donations to the MoH. While responding directly to the requesting facilities (exact number matches still to be determined), may help alleviate immediate needs, complicates efforts to estimate the actual level of need for that facility. Moreover, given the likelihood that the state of emergency is likely to continue at least for the next 6 months, the sustainability of ad-hoc interventions in this context is questionnable. HART has been encouraging the international community NOT to bypass the normal distribution channels and RATHER to support the existing mechanisms through direct support to the central levels. Efforts are being directed to support the distribution mechanisms through the provision of UN vehicles and increased negotiation for the passage of essential medical items.
Matching the requests with items supplied has proven to be an enormous task. It has also become clear that getting a detailed and accurate picture of what has really been happening will be difficult. What will become clear are some of the patterns and key issues with respect to needs, availability and distribution.

WEB SITE:

HART will be launching its Web Site on Wednesday the 5rd of June. A formal announcement will be sent about the site. Please come and visit us.

UPCOMING MEETINGS:

There will be a WHO Health Coordination Meeting this Wednesday 5 June from 10 – 12:00 in the Central Public Health Laboratory in Ramallah. Please contact WHO directly for more information on this meeting.

ASSESSMENT TEMPLATES AND REFERENCE DOCUMENTS:

For all of those individuals and organizations planning emergency sectoral health assessments, the World Health Organization office in Jerusalem has a range of reference materials to help you design and implement your intervention. For more information about this emergency health information library, contact WHO at 02 628 6680.

FOR MORE INFORMATION

Please feel free to contact us for information at:

Health Action Response Team (HART)
c/o The Italian Consulate
Jerusalem

Tel: 02 532 7447
Fax: 02 532 2904
Primary email: hart@undp.org

Footnotes:

¹ Invitees: MSF, STC/USA, Lutheran World, Federation, Solidaridad International, CARE, MDM, TDH, ANERA, EMDH, Hammer Forum, CRS, MAP-UK, MPDL, Movimondo, CRIC, CISP, Caritas.

² For more information about the agenda and minutes of this workshop, please contact HART or WHO.

³ Efforts are underway to map this information. This should be made available and posted on the HART website (www.hart.intcoop-jer.org) within the coming week.

Situation in the OPT – WHO Health Action Response Team (HART) newsletter (Vol. 1, No. 5)

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Situation in the OPT – WHO Health Action Response Team (HART) newsletter (Vol. 1, No. 5)

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