Situation in the OPT – WHO Health Inforum newsletter (15 August 2003)

Health Inforum News 

Volume 2, No.33, 15 August 2003

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Welcome to the thirty-third edition of the Health Inforum Newsletter.  

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In this Issue:

Ø WHO releases survey on access to health services in occupied Palestinian territory.

Ø A visit to Al Mawasi Rafah health clinic

Ø Mapping & GIS in Health

Ø PRCS health Incidents Report (2-8 August) 2003.

WHO releases survey on access to health services in occupied Palestinian territory

SEVERE MOBILITY RESTRICTIONS IN WEST BANK AND GAZA FORCE PALESTINIAN POPULATION TO CHANGE HEALTH SERVICES

Jerusalem. During 2002, half of the Palestinian population was unable to consult their usual health services, due to border closures and curfews, a World Health Organization (WHO) survey published recently reveals. Detours and long waiting hours at Israeli checkpoints led to considerable delays and often forced the population to divert to a different health facility. According to the Palestinian Ministry of Health, more than 90 patients have died during the last three years while waiting in an ambulance to cross a checkpoint.

Yet, in spite of severe restrictions on the free movement of Palestinians living in the occupied Palestinian territory (oPt) and with great difficulty, up to 95% of Palestinians were still able to reach a health facility in 2002, preliminary findings of the survey found.

The study was carried out in collaboration with the Ministry of Health of the Palestinian National Authority and Al Quds University, in order to assess the impact of Israeli closure policy on access to health services in the oPt.

Data were collected in five districts in the oPt, including Nablus, Ramallah, Hebron, Rafah and Gaza.

For more Information visit www.healthinforum.org 

Al Mawasi Rafah health clinic

Stuart Shepherd, OCHA-Gaza

A fact finding visit was undertaken on 5 August 03 in conjunction with WFP and WHO, in the wake of a recent easing of restrictions for humanitarian agencies seeking to enter Al Mawasi and the northern Gaza enclave of Siafa.

The Al Mawasi Rafah clinic is little more than 3 km from the border with Egypt and is located on the beach.  It is one of 3 fixed site health facilities in the enclave with the other two in the center and Al Mawasi Khan Younis. All 3 sites are run by the Military Medical Services, which was originally designed to cater for military personnel, but now treats civilian patients within the Ministry of Health (MoH) structure. The clinics official hours are 08.00 – 14.00 however; the staff is permanently on call and have not taken any leave since September 2000. No patient fees are charged for either consultation or medicines. Wages for the health staff are paid by the MoH.

The total medical staff for the 3 clinics consists of two pharmacists, three GPs, four nurses and one Community Health Worker. There are two Palestine Red Crescent Society staff consisting of a driver and paramedic who have responsibility for one ambulance that is based in Al Mawasi Khan Younis. At the time of the visit, the ambulance was in fact in Khan Younis town, with the Israelis after months of negotiations having finally let the vehicle leave the enclave for maintenance on 31 July.  The ambulance has been continuously in service since May 2001.  During its absence, any critical patients would have been reliant on a private vehicle taking them to Tuffah barrier, from where a back-to-back transfer would have taken place to a PRCS ambulance on the eastern side of the barrier.

The clinic estimates a caseload of around 35 patients per day, of which a third are children.  A number of the conditions are chronic and typical of morbidity seen elsewhere in Palestine – hypertension, asthmatic, acute respiratory infections (ARI), bronchitis, diabetic and acute gastroenteritis.  Seasonal conditions also prevail, with common colds during the wet winter months, and skin disease, allergies and eye infections during the summer.   

It is estimated that up to 20 deliveries a month take place in Mawasi.  In all cases, pregnant women are encouraged to leave the enclave and to seek secondary health facilities in Khan Younis or Rafah.  In exceptional cases, deliveries have taken place at the home or the clinic however; this is strongly discouraged due to the absence of sterile equipment.  (It should be pointed out, that the practice of referral from small villages to modern secondary facilities in larger towns is common throughout the West Bank, not least   due to the absence of midwives in the MoH system, let alone Traditional Birth Attendants (TBA).  The ante natal service offered in Mawasi is basic, extending little beyond regular blood pressure tests and health education. Postnatal care is not formalized and largely does not exist. A project is due to commence shortly with SCF (US), whereby Save will offer a specific mother-child service from the clinic, with additional staff being funded by SCF.

The medical staff stated that for the last 6 months, regular vaccination has been taking place. This has been carried out by the MoH which has been able to gain access to Mawasi through advance coordination on their behalf by the ICRC. Given the absence of cold chain facilities and continuous electrical supply, it is not possible to stock quantities of vaccines or injectables that require a cool, room temperature.  In spite of the difficulties, the medical staff in the clinic was confident that 100% vaccination coverage was being achieved.  This was attributed to the fact that Mawasi is such a small area that mothers are aware of the days when vaccinations take place, and this is reinforced by prior loudspeaker announcements from the PRCS ambulance.

The Rafah clinic is basic, but not entirely dissimilar from many other small, rural clinics that can be found throughout the West Bank in that it has a referral couch, oxygen facilities, weighing scales and a small, but well stocked pharmacy. Pharmacy supplies including medicines, injectables, dressings and other consumables are supplied monthly by the MoH in conjunction with the ICRC.  It was pointed out by WHO that some of the antibiotics were not on the MoH essential drugs lists and it transpired that these had actually been supplied by a European NGO.  In general however, the WHO representative felt there was a good coverage of medicines, although there was no indication qualitatively of how these were applied.

The clinic contrary to prior expectation had running water, and electricity also came on during the latter part of the visit. The staff stated that this was exceptional, as normally it is only available between 19.00 and 01.00 in that area of Al Mawasi Rafah.  No laboratory facilities can be found in Mawasi meaning that even for simple blood tests patients will need to leave the enclave. The ability to set up a laboratory is again severely constricted by the lack of continuous electricity. The absence of laboratory facilities has implications for being able to detect anemia and multi nutritional deficiencies which were recognized particularly in the context of Gaza, in last summer’s CARE-John Hopkins survey.

The immediate availability of fish and vegetables including peppers, onions, sweet potatoes, olives, egg plants, dates as well as guava ensures a regular intake of vitamins however, concern exists over the lack of protein due to the absence of meat in the daily diet. Theoretically meat including beef and chicken can be brought into Al Mawasi however when delays of several hours if not days are common, then it is clear that the meat will quickly go off given the high temperatures throughout summer.  Similarly, the absence of fridges due to the lack of continuous power means that meat can not be stored, so if a goat is killed then it must be eaten immediately so meaning that protein intake is on a random and not regular basis.  WFP is trying to address this issue through introducing canned meat however the IDF has concerns that the discarded tins could be used to pack around explosives in mortar devices.  Another option being considered by WFP is to bring in small number of chickens and rabbits that would then provide protein but in sufficient quantities that storage would not be an issue.

Mapping & GIS in Health

In order to properly plan, manage and monitor any public health programme, it is vital that up-to-date, relevant information is available for decision-makers at all levels of the public health system. As every health problem or health event requires a different response and policy decision, information must be available, reflecting a realistic assessment of the situation at local, national and global levels. This must be done with best available data taking into consideration the changes in the existing health situation and the influences based upon it.

Geographic information systems (GIS) provide ideal platforms for the convergence of health facilities specific information and their analyses in relation to population settlements, surrounding social and health services and the natural environment. They are highly suitable for analyzing epidemiological data, revealing trends and interrelationships that would be more difficult to discover in tabular format. Moreover GIS allows policy makers to easily visualize problems in relation to existing health and social services and the natural environment and so more effectively target resources.

Since June 2002, Health Inforum’s public health mapping programme has been leading a local partnership in the promotion and implementation of GIS to support decision-making for a wide range of public health programmes. West Bank map has been produced including the localities of the health facilities, type of services, level of services, bed ratio, and type of health provider.

Recently Health Inforum has produced the First Map of Gaza, which includes the localities of the health facilities, type of services, level of services, bed ratio, and type of health provider.

Both Health Facilities Maps are available on our website:  www.healthinforum.org ,  in addition, the Health Inforum is distributing those maps for each health stakeholder office.

Goal and strategic objectives 

The overall goal of the Public Health Mapping Programme today is to strengthen the capacities of public health programmes at local level through the use of GIS and mapping technologies, and to enhance the health providers to make their analysis in an easier way.

PRCS Health Incidents  (2-8 August), 2003

Qalqilia, 7 August 2003 (21:20):  A PRCS ambulance received a call from the Qalqilia EMS dispatch reporting that there was a person in an unconscious state at the District Coordinating Office (DCO) checkpoint.  When the ambulance reached the scene, PRCS medics administered first aid to the patient and prepared to transport her to hospital.  However, the Israeli soldiers refused to allow the medics to transport the patient, alleging that they were still checking the IDs.  One half hour later, an Israeli jeep arrived on the scene and permitted the ambulance to transport the patient to Qalqilia Hospital.

Jenin, 8 August 2003 (15:40):  A PRCS ambulance was dispatched to the eastern part of Jenin after receiving a call reporting a number of injuries due to Israeli Army gunfire.  While the ambulance crew were attending to one of the injured persons, four bullets hit the ambulance, damaging the engine and slightly injuring one of the medics in the left knee.  The crew called the EMS station and requested another ambulance, which on arrival, transferred the patient to hospital and the crew back to base.  

For more information please contact Press Office at: phone: +972 2 240 6515/6/7

E-mail: pressoffice@palestinercs.org

For more Information visit www.healthinforum.org

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