GAZA STRIP
INITIAL HEALTH NEEDS ASSESSMENT
Gaza, 16 February 2009
The Gaza Strip has been the setting for a protracted political and socio-economic crisis. Recent events have resulted in a severe deterioration of the already precarious living conditions of the people in Gaza and have further eroded a weakened health system.
During the last Israeli military strike between 27 December and 18 January:
– 1380 Palestinians were killed, of whom 431 were children and 112 women. At least 5380 people were injured, including 1872 children and 800 women. Among the casualties, 16 health staff were killed and 25 injured while on-duty. Injuries were often multiple traumas with head injuries, thorax and abdominal wounds. Israeli fatalities were 14, and 183 were injured.
– Vital infrastructure has been compromised or destroyed, resulting in a lack of shelter and energy sources, deterioration of water and sanitation services, food insecurity and overcrowding. An estimated 100 000 people were newly displaced; 49 693 of them were residing in 50 shelters organized by United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), the remaining being sheltered with host families. Fifteen hospitals and 41 primary health care (PHC) clinics in the Strip were damaged during the strike. Twenty-nine ambulances were damaged or destroyed. 21 out of 56 Ministry of Health (MoH) and three out of 17 UNRWA PHC centres were closed during part or all of the period of the crisis.
– Access to health care was severely restricted and hampered by security constraints. Maternal and child health services at PHC level were disrupted. Despite the critical conditions, maternity assistance for normal deliveries was provided as well as specialized health care for obstetric and neonatal complications, though many times in improvised settings within health facilities where maternity wards and operating theatres were transformed into trauma units. The consequences are unclear in terms of maternal and child morbidity and mortality among the 3500 deliveries that were expected to have taken place during the 23 days of military operations. Findings from a recent UNFPA assessment indicate that, during that period, there was an increased number in miscarriage cases in the surveyed hospitals (Shifa, Al Aqsa, Naser, Rafah) and an increased neonatal mortality in Shifa Hospital, in Gaza City.
– Specific concerns exist for the chronically sick. It is estimated that, during the military operation, 40% of the chronically ill interrupted their treatment. These concerns were exacerbated by the virtual halt of referrals of ordinary patients outside Gaza as life-threatening injuries had a higher priority in an overwhelmed system. Elective surgery and non-urgent routine medical interventions were delayed or interrupted during the crisis. This indicates that a growing number of patients, mainly with chronic conditions, are awaiting treatment.
The state of Gaza's health services was already precarious before the military strike. The strict closure of the Gaza Strip since mid-2007 resulted in intermittent shortages of fuel, electricity and water and led to reduced services at PHC and hospital level. Materials needed for rehabilitating and building health facilities were prevented from entering Gaza. Gaza's internal political turmoil and extensive health worker strikes added to the reduced health service delivery and public health programmes capacity.
The quality of health care has been further affected by deterioration in the functionality of medical equipment due to the lack of maintenance and spare parts, as well as by shortages of drugs and medical supplies and restricted training opportunities for medical staff that were already at poor levels precrisis. Routine operations were affected and many elective interventions suspended. Consequently, the need for referrals outside of Gaza grew, restricted by delays and denials of passage.
