April Highlights

  • The Ministry of Health, WHO and UNICEF launched Vaccination Week on 24 April as part of a regionwide push to raise immunization rates. Vaccination Week is intended to promote awareness and demand for routine immunisation through targeted outreach and social mobilisation. Across oPt, immunisation coverage among young children is above 95 per cent according to the Ministry of Health, and polio, measles and tetanus elimination targets are met. Next month¡¦s update will brief on the campaign¡¦s progress toward raising coverage to 100 per cent.

  • This update summarises a WFP / UNRWA / UNICEF survey of food security and nutrition among herding communities in Area C. Between 25-29 October 2009, eight teams of UNRWA social workers surveyed 5,200 families, including 510 randomly selected children. Training on data collection was provided by UNICEF and WFP. ¡§Food Security and Nutrition of Herding Communities in Area C¡¨ represents the first study of this sample size undertaken in Area C. The full report is available at www.unicef.org/opt, and on the UNRWA and WFP websites.

Overview

The Oslo II Accords signed in 1995 established the Palestinian Authority (PA) and divided the West Bank into three administrative areas known as "A", "B", and "C". Though the interim arrangements were to lead to a gradual transfer of power to the PA, Area C, which makes up 60 per cent of the West Bank, remains under Israeli security and administrative control.

The dwellings of approximately 150,000 Palestinians are either partially or totally built in this area. The construction of the barrier, expansion of Israeli settlements, and displacement of Palestinian communities over the past decade, combined with drought, have forced herding communities in Area C to rely on bought fodder and tankered water. Poverty and disease rates among the Palestinian herder and Bedouin families of this area are higher than in the rest of the West Bank, especially among children.

Although the PA is responsible for service provision, difficulties in obtaining permits from the Israeli Civil Administration for the construction of schools, health clinics or water and sanitation infrastructure, along with severe restrictions on access and movement around Area C, significantly impedes its ability to deliver services.

Throughout the survey, data from herding households in Area C is compared with the West Bank average as a whole, in order to illustrate the extent of exclusion and vulnerability.

Area C herding communities survey findings

Snapshot of poverty: Average monthly incomes among the herding communities in Area C have shrunk to NIS 1,024 (US$277), less than half the average West Bank monthly income of NIS 2,554 (US$690).

Sixty-five per cent of the households surveyed live in caves or makeshift dwellings made of concrete cinder blocks, metal sheeting or cardboard. Twenty-five per  cent live in tents. By comparison, 96 per cent of all West Bank Palestinians live in houses or apartments.

Forty-one per cent of household surveyed have no electricity compared to just one per cent of all families in the West Bank without electricity.

 At most, 68 per cent have a kitchen and of these only 20 per cent have running water compared to 97 per cent of West Bank households which have kitchens and piped water.

While nearly all West Bank families have a bathroom with piped water, at most 66 per cent of Area C households surveyed have a bathroom and of these only 20 per cent have running water. Between 59 and 70 per cent have a toilet and of these, only 20 per cent have running water.

Food security

Seventy-nine per cent of Area C herding families are food insecure, meaning they live on less than US$4.70 per adult equivalent per day. This is more than three times the proportion of the overall West Bank Palestinian population (25 per cent) who are food insecure and higher than in Gaza (61 per cent).

Families who live in the “Seam Zone”, caught between Israel’s barrier to their east and the 1949 Green Armistice Line to the west, are the most vulnerable with 88.5 per cent classified as food insecure.

Bedouin and Palestinian herders in Area C spend 62 per cent of their household budget on food.

Food insecure families said their main problem was difficulty accessing water (73 per cent).

Nutrition

Forty-three per cent of families rely on bread, rice, potatoes, sugar and oil to sustain them each day. They eat vegetables four days in seven and animal products are rarely consumed. Just 10 per cent of West Bank families overall eat like this.

Area C children are three to five times more likely to be malnourished. Six per cent aged between six and 59 months are wasted, 15 per cent are underweight and 28.5 per cent are stunted compared to West Bank averages of two per cent, three per cent, and eight per cent respectively.

Thirty eight per cent of children aged six to 17 months are stunted. WHO guidelines warn that stunting rates between 20 and 40 per cent are serious and levels above 40 per cent are critical.

Area C children are three to four times more likely to contract diseases related to poor nutrition and poor hygiene. Forty-four per cent of children aged 6-59 months had suffered diarrhoea compared to 11.5 per cent across the West Bank.

Further, 48 per cent of Area C children had, at least once, contracted an acute respiratory infection (ARI), one of the five leading causes of deaths among young children in oPt.

Ninety three per cent of Area C children do not eat the recommended five meals per day. Forty one per cent eat just two meals a day.

The introduction of complementary fluids to almost half (48.8 per cent) of infants 0-6 months old instead of exclusive breast-feeding as recommended by WHO and UNICEF, coupled with challenges in accessing safe water, pose immediate and long-term health risks for children. Almost half of mothers, 46.2 per cent, said they stopped breast-feeding because they were pregnant.

About 13 per cent of infants receive fluids and foods in their first three months and the introduction of complementary foods escalates sharply after that. Only 42.6 per cent of the infants received complementary foods (fluids and soft foods) at the appropriate age of 6-8 months.

Coping mechanisms

Herder and Bedouin families in Area C are accustomed to enduring hardship. Seventy-two per cent and 63 per cent respectively said that when their child had diarrhoea or coughing, hospital services were not needed.

Between 94 and 97 per cent said hospitalisation was unnecessary when someone broke a bone. Seventy-eight to 80 per cent said follow-up health care was unnecessary a week after contracting a chronic disease.

Up to 63 per cent said vaccination was unnecessary, 70 to 85 per cent said maternal health check-ups weren't needed and 85 to 96 per cent said access to health services for family planning was also unnecessary.

Yet many households are now reporting they don¡¦t have enough money or food. A massive 93 per cent of surveyed households in Area C are in debt. Eighty-two per cent rely on credit of which 60 per cent use it to buy food compared to 47 per cent of West Bank families. Nearly a third has sold productive assets to fund food purchases.

Parents say they are cutting rations to give children more. Eighty-one per cent report spending less on food; 94 per cent are buying poorer quality food; 86 per cent are cutting the quantity they are buying; and 93 per cent have cut their consumption of meat.

Forty per cent had not paid utility bills (water and electricity) for six months. More than 50 per cent of households said they had cut health and education spending so they can eat.

UNICEF 2010 Nutrition Programme

UNICEF works with government, national and international agencies, and civil society to support equitable access to nutrition services, and targeted assistance to vulnerable groups and those with special needs. Programmes focus on an integrated package of low-cost, low-technology and high impact interventions such as micronutrient supplementation, and the promotion of improved breast-feeding and hygiene practices within households.

 In oPt, UNICEF supports MoH efforts to scale up capacity and coverage through technical assistance at household, community and health facility levels. During 2010, UNICEF will:

  • Provide technical assistance towards upgrading and expanding the number of Ministry of Health nutritional surveillance sites from 66 to 110;
  • Support training for health workers, and social mobilization and awareness campaigns to improve infant and young child feeding at household, community and clinic levels; and
  • Procure micronutrients for 220,000 children and 100,000 pregnant mothers, specifically targetting around 30,000 under-nourished children and 9,000 high-risk pregnant mothers.

Marginal Lives

Five-year-old Amamah Tourkman lives in a tent without electricity or running water in the remote rocky West Bank mountains bordering the Jordan Valley. Her mother says that she hasn’t been vaccinated, and neither have her seven siblings, because the clinic is too far and there’s no public transportation. Next year, when she turns six, she will walk the 12 kilometres to and from the nearest school.

A Long Walk to School

Students walking home from school near Wadi Shobash, in Jenin. Learning conditions are an increasingly urgent priority for the marginalized and vulnerable communities living in Area C. Many school structures, including tents, tin shacks and crude cement buildings, fall far short of basic safety and hygiene standards, with little protection from either the heat or the cold.

Rebuilding Lives in Gaza

Around 250 children and 50 caregivers come to the Ajyal Al-Mostaqbal family centre in Rafah each day for psychosocial support, learning and recreational activities in a protective environment. For many of them, it has been a long road to recovery since “Cast Lead”. The family centre is one of 20 set up across Gaza by UNICEF and Save the Children Sweden to provide a broad range of support to children and caregivers. To see a photoessay of a day inside the Ajyal Al Mostaqbal family centre visit http://www.unicef.org/oPt/6086.html

Basic Indicators

1

Total population (2010)

West Bank

Gaza

4,048,403

2,513,283

1,535,120

PCBS estimates, 2010

2

Child population (under 18 years, 2010)

West Bank

Gaza

1,971,824

1,172,483

  799,341

PCBS estimates, 2010

3

Child population (under 5 years, 2010)

West Bank

Gaza

596,729

344,900

251,829

PCBS estimates, 2010

4

Child population (under 1 year, 2010)

West Bank

Gaza

128,242

73,319

54,923

PCBS estimates, 2010

5

GNI per capita (US$, 2007)

1230

The State of the World’s Children

 2010, UNICEF

6

People living below the national poverty line

(%, 2007)±

West Bank

Gaza

39.6

23.6

55.7

PCBS, Poverty and Living Conditions

in the Palestinian Territory, 2007

Health and Nutrition

7

Under 5 mortality rate (per 1,000 live births, 2006)

West Bank

Gaza

28

26

32

PCBS, Palestinian Family

Health Survey, 2006

8

Infant mortality rate (per 1,000 live births, 2006)

West Bank

Gaza

25

23

29

PCBS, Palestinian Family

 Health Survey, 2006

9

Maternal mortality ratio (per 100,000 live births, 1995)

70-80

PCBS, 1995

10

Children 12-23 months fully immunised (%, 2006)

West Bank

Gaza

96.4

94.4

99.4

PCBS, Palestinian Family

Health Survey, 2006

11

Children 12-23 months immunised against measles (%, 2006)

West Bank

Gaza

97.0

95.0

99.4

PCBS, Palestinian Family

Health Survey, 2006

12

Stunting prevalence (moderate and severe) among under-5 (%, 2000-2007*)

10

The State of the World’s

Children 2010, UNICEF

13

Wasting prevalence (moderate and severe) among under-5 (%, 2000-2007*)

1

The State of the World’s

Children 2010, UNICEF

14

Malnutrition prevalence (underweight) (moderate and severe/severe (%, 2000-2007*)

West Bank

Gaza

2.9

3.2

2.4

PCBS, Palestinian Family

Health Survey, 2006

15

Births attended by skilled health personnel (% , 2006)

West Bank

Gaza

98.6

98.2

99.3

PCBS, Palestinian Family

Health Survey, 2006

HIV and AIDS 

16

Prevalence of HIV/AIDS

No data

Water and Sanitation

17

Use of improved drinking water sources (%)

West Bank

Gaza

86.3

100.0

93.8

PCBS, Household Environment

Survey database, 2003-2006

Education

18

Use of improved sanitation facilities (%)

West Bank

Gaza

99.2

99.7

PCBS, Household Environment

Survey database, 2003-2006

19

Literacy rate of 15-24 year olds (Total/Male/Female; %; 2006)

West Bank

Gaza

99.1//99.1/99.0

99.1/99.2/99.1

99.0/99.1/98.9

PCBS, Labor Force Survey

Database, 1995-2007

20

Proportion of pupils starting grade 1 who reach last grade of primary

West Bank

Gaza

99.3

99.0

99.5

PCBS, Education Census,

1994/1995 – 2006/2007

21

Primary net enrolment ratio (Total/Male/Female; %; 2006)

West Bank

Gaza

83.9/84.7/83.1

82.7/81.7/83.6

85.8/89.3/82.2

PCBS, Education Census,

1994/1995 – 2006/2007

End Notes

± PCBS uses two measures of poverty: Deep Poverty (absolute) and Poverty.

*The Deep Poverty line reflects a budget for food, clothing and housing only. For a family of six the deep poverty line in 2006 was NIS 1,837. The Poverty line adds other necessities including health care, education, transportation, personal care and housekeeping supplies; raising the line to NIS 2,300 for a family of 6. Thus, the percentage of households in Poverty includes those in deep poverty.