WHO Report: “Conflict escalation in Gaza, complex emergency” (Issue 5) – WHO situation report

HIGHLIGHTS

Situation update

The number of deaths rose sharply on July 25 and 26 as ambulance teams were able to enter areas to evacuate bodies during the 12-hour ceasefire, which had been previously inaccessible when violence was ongoing. 152 bodies were evacuated during the period. It is likely that some died from lack of access to medical treatment. Overcrowdedness and inadequate services for the 215,000 of displaced persons (OCHA) are a concern.

A total of 8 hospitals and at least 12 primary health clinics have been damaged in the violence (Annex). (Six other hospitals reported damages which WHO is in the process of verifying.) Five hospitals are closed and two partially due to damages incurred, and three others due to lack of security for staff and patients to access, reducing hospital capacity by 552 beds, almost 20% of total capacity in Gaza. http://www.ochaopt.org/documents/Health_care_facilities.pdf

Hospitals:

 Mohammed Durra Pediatric Hospital, a 91-bed small hospital located east of Gaza city, was damaged by shrapnel from intense attacks in the immediate neighborhood on 25 July. The MoH reported that one patient, a 2-year-old child in intensive care, died and 30 persons were injured. A medical team had been performing CPR on the child at the time of the attack. An ER physician who had been on duty at the time told WHO that 70 people were evacuated and that "we could save only those who we could reach and with the supplies we had." According to him, six injured persons, including two who had been transferred to Nasser hospital in Khan Younis and four to other hospitals, died of their wounds the next day. An intensive care nurse was among those wounded; she suffered severe shrapnel injuries to her arm and torso.

Beit Hanoun Hospital in the northern Gaza Strip was damaged for the second time 25 July when the entrance to the emergency room was hit and destroyed. A nurse and an international visitor were injured. Staff and patients sheltered in the ground floor until they could be evacuated in the morning.

Ambulance services: Two ambulance workers of the Palestine Red Crescent Society (PRCS) were killed on 25 July and three rescue workers injured when attempting to evacuate casualties in the eastern and northern areas of the Gaza Strip. The International Committee of the Red Cross (ICRC) noted that PRCS ambulances are clearly marked with the international Red Crescent insignia. http://blogs.icrc.org/ilot/2014/07/26/gaza-icrc-condemns-the-killing-of-a-red-crescent-volunteer/ 

In the first incident, an ambulance worker, Aaed Borei, was killed in Beit Hanoun while attempting to rescue injured in the area of the hospital. Three other ambulance workers were injured when their ambulance was attacked. Due to intense conflict, the PRCS was not able to retrieve the body until the next day.

In the second incident, the ICRC had been informed by the Israeli military authorities of an injured person in al-Qarara village in the southeast of the Gaza Strip, and coordinated the evacuation by a PRCS ambulance with the Israeli military. An ambulance rescue team of three—driver, paramedic and nurse —drove to the site and then was proceeding on foot when the driver, Mohammad Alabadla, was shot and injured in the chest and leg. When his two companions tried to rescue him they were also shot at. They called PRCS for a second ambulance which PRCS coordinated with the civil affairs coordinator themselves and received Israeli coordination. The second ambulance was also shot at and they contacted the ICRC. The ICRC reported that they could proceed, but there was more shooting. After these three attempts to evacuate their colleague, they succeeded to bring him to Nasser Hospital in Khan Younis where he died in the ER.

Medical Aid

A shipment of US$ 1.4 million in medical supplies for Gaza was procured by WHO with donations from Switzerland and Norway. They arrived to Amman from Dubai during July 25 and 26 and will be delivered on July 27 to Gaza through coordination with UNRWA for disbursement to hospitals. The supplies are mainly surgical kits, IV fluids and medications.

The Rafah crossing authority reported that 130 tons of humanitarian aid had been transferred to Gaza on July 25 and 26 and is being sorted. This included 40 tons of medical aid (75% drugs and disposables and 25% IV fluids), according to the head of the donations committee. The donors were: Morocco, a Jordanian donor, Arab Physicians Union in Egypt and a shipment from Saudi Arabia for the Palestinian Red Crescent Society.

Referrals of patients to facilities outside Gaza

The Palestinian coordination office coordinated the exceptional crossing through Erez on Saturday (normally closed) seven casualty patients in serious condition. Three casualties crossed on 26 July and were transferred by intensive care ambulances to hospitals in the West Bank.

From 8 to 26 July, 79 casualties have been able to cross into Egypt through the Rafah border terminal. On 25 July 25 casualties, from serious to critical condition, crossed into Egypt with 21 companions. On July 26, one casaulty with severe burns crossed by ambulance with a companion.

Public health concerns

163,000 people are seeking refuge in 83 UNRWA shelters. There are also other unofficial shelters and places of refuge, such as make-shift encampments around hospitals, being used by hundreds of people, especially elderly and children, who have lost their homes or who have fled from insecure areas. They are in overcrowded and rough conditions, without adequate water, sanitary services or other essentials, posing public health challenges.

Health needs, priorities and gaps

The hospitals are depending more than anticipated on their diesel-powered generators after damage to one of the main turbines of the Gaza power plant reducing electric power supply further.

The delivery of medical supplies and consummables needs to be accelerated to meet demands in both government and NGO hospitals which are treating casualties.

The massive damage and destruction of public structures and homes, estimated by OCHA as affecting 30,000-35,000 families, including whole neighborhoods, and damage to water and sanitation infrastructure has serious impact on health and well-being since neighborhoods and villages are serviced by community-based organizations.

WHO action

Shipments of medical supplies procured by WHO with donations from Switzerland and Norway are enroute and expected to arrive in Gaza in the coming week. In addition to the needs of MoH hospitals, WHO has received many requests from NGO hospitals, many of which are treating casualties, and is coordinating their needs for medical supplies, fuel and other items from supplies from donations.

WHO is monitoring the situation for any outbreak of communicable diseases due to poor sanitation and interruption of vaccination programs, and also for gaps in control programs for chronic diseases.

The operations room of the Ministry of Health in Ramallah called for urgently-needed specialists for Gaza in 6 areas: neurosurgery, anesthesiology, plastic surgery, general trauma surgery, advanced orthopedics and burn management. For WHO guidelines on the sending of medical teams, see: http://www.who.int/hac/global_health_cluster/fmt/en/

WHO is appalled by the continuing trend for health-care facilities, staff and vehicles to come under direct fire in Gaza since the escalation of violence on 8 July 2014: http://www.who.int/mediacentre/news/statements/2014/gaza-health-care-safetv/en/

Resource mobilization

WHO is procuring medical supplies from US$ 3.7 million from Switzerland, Norway and Italy, and US$1.5 million from Turkey given prior to the Gaza emergency, for medical supplies. Donations from Tunisia and others are in the pipeline. The Ministry of Health reported donations totalling US$ 5.6 million from ICRC, Egyptian Red Crescent, MDM-France, UNICEF, Birzeit Pharmaceuticals, Physicians for Human Rights-Humanitarian Relief Aid Committee, Islamic Relief, Welfare, MAP-UK, Italian Cooperation, UNFPA, Indonesia, NORWAC, ANERA, World Hemophilia Federation, TdH- Italia, Ireland, Korea and donations from the Emirati Red Crescent and Turkish Red Crescent to the Palestinian Red Crescent.

Contact:

WHO West Bank and Gaza Country Office

Contact: Dr. Mahmoud Daher

Tel: +972-598944650 I daherrn@who.int Website:

http://www.emro.who.int/palestine

ANNEX

Table 1. Hospitals in Gaza damaged since July 8, 2014*

PMMS=Palestini an Medi cal Military Services

*WHO is in the process of verifying details of damage reported by 6 additional hospitals.

159

655

24