Humanitarian Health Action

Gaza Strip Health Cluster Weekly Bulletin No 1. - 20 January 2009

Highlights

WHO/P. Garwood
1 of at least 16 ambulances damaged during Gaza's current crisis.

The Gaza Health Cluster Bulletin provides an overview of the health sector response to the Gaza crisis.

  • Israel, Hamas issued respective cease-fires
  • Large amounts of medical supplies threaten to overwhelm logistics systems
  • Hospitals and primary health care centres continue to function despite damage
  • 16 health facilities damaged
  • Vaccine programmes resuming
  • Detailed assessment of health needs to be conducted

HEALTH ASSESSMENT

According to the Palestinian Ministry of Health (MoH)*, at least 1300 people were killed and around 5300 injured during Israel's military operation in the Gaza Strip from 27 December 2008 to 18 January 2009. Health services were severely affected, with at least 16 health facilities damaged and 16 ambulances either damaged or destroyed. Israel declared a unilateral cease-fire with effect from 18 January, while Hamas declared a separate one-week conditional cease-fire.
(*Figures provided on 18 January 2009. WHO has not been able to independently verify these figures.)

During the crisis, Gaza health services and staff provided round-the-clock care in extremely difficult conditions. Health personnel were themselves among the casualties, with 13 killed and 22 injured.

The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) reports that up to 100 000 people have been displaced, with many staying at emergency shelters established by the United Nations Relief and Works Agency (UNRWA). As of 14 January, approximately 500 000 people had no access to running water, and the rest of the population had access for only a few hours each week.

Various organizations have begun rapid needs assessments for the health sector. WHO, as Health Cluster coordinator, asks that health assessments be coordinated as much as possible through WHO in order to maximize efforts and avoid duplication.

Priority needs and gaps include:

Case management:
  • Ensuring appropriate treatment and/or referral of injured and chronically ill patients.
Coordination of supplies and staff:
  • The large volumes of medical supplies entering Gaza are threatening to overwhelm the Central Drug Store, which has been inundated with supplies at a time when it is already operating at reduced capacity. Donors are asked to contact the Ministry of Health for information on the specific supplies that are needed.
  • Similarly, health professionals willing to volunteer their services in Gaza are asked to contact the MoH and WHO to ensure appropriate specialists are identified and deployed.
  • All staff assigned from primary health care centres (PHCCs) to hospitals will need to be redeployed to their original place of work in order to ensure the full resumption of primary health care services.
  • Supplies, distribution channels and end-points need to be mapped to ensure that stocks are delivered where they are needed. Additional warehouse space is needed (the MoH and other organizations have already rented extra warehouses).
Needs assessment:
  • An assessment of health needs is crucial to ensure an appropriate health response can be planned and implemented. Assessments carried out by different agencies must be coordinated to avoid duplication and ensure the comparability and consistency of data collected in different sites.
  • The MoH in Gaza has initiated its own needs assessment and has asked each hospital to assess damages.
  • Detailed assessments will support resource mobilization efforts and health sector coordination.
  • WHO's Gaza office began a rapid needs assessment on 19 January. Medical Aid for Palestinians (MAP) is also assessing health facilities to identify needs and gaps.
Response team:
  • Response teams must be assigned to Gaza (in close consultation with the MoH) as soon as conditions on the ground permit, in order to stabilize the health situation and strengthen capacity in health facilities.

COORDINATION

Health Cluster
  • WHO, as lead agency of the Health Cluster, convened a meeting in Jerusalem on 19 January attended by representatives of UN agencies, national and international nongovernmental organizations (NGOs) and donors.
  • WHO has deployed a Health Cluster coordinator to Jerusalem, who will relocate to Gaza as soon as possible. WHO has also deployed two logisticians, an early recovery specialist and a communications officer to Jerusalem to support the Health Cluster.
  • The Health and other Clusters plan to complete rapid needs assessments as soon as possible. The information will be used to prepare a Flash Appeal to be launched shortly.
  • Health Cluster members are urged to coordinate and share the findings of all health assessments with WHO to avoid duplication. There is a risk that exhausted health staff on the ground will be further overwhelmed by the demands of different health assessments.
  • WHO, on behalf of the MoH, has stressed the need to coordinate all emergency staff and supplies with WHO and the MoH.
  • The various Clusters in Jerusalem are coordinating activities closely. OCHA has convened a meeting of all Clusters in Jerusalem on 20 January. The Health and Logistics Clusters are working closely together to manage and coordinate medical supplies.
  • WHO staff on the Egyptian side of the border at Rafah and El-Arish are coordinating the delivery of supplies and the passage of medical staff into Gaza. The First Lady of Egypt has assigned the Egyptian Red Crescent Society to lead medical coordination activities.
Palestinian Ministry of Health

The Ministry of Health in Ramallah has established an Emergency Operations Room (ERO)**, in conjunction with WHO, to manage relief operations. The ERO issues regular updates on the latest casualty numbers and urgent needs. The MoH has asked anyone interested in sending inkind donations of staff, supplies and equipment to first coordinate with health authorities.
(**Contact details for the ERO are tel: 02 241 4013, telefax: 02 241 4014, mob: 059 8919738; email:moh.operation.room@gmail.com and pmohor@who-health.org

FILLING GAPS

UNRWA, which has a strong presence in Gaza, forms the backbone of overall relief efforts, with 9000 staff performing a wide range of services including the provision of health care and medical supplies. UNRWA runs 18 PHCCs in Gaza.

Immunization
  • Immunization services have resumed throughout Gaza following the cease-fire. Fifty-six PHCCs managed by the MoH and another 18 managed by UNRWA have all resumed childhood vaccination programmes.
  • UNICEF is supporting immunization activities.
Drug and medical supplies
  • WHO is helping the MoH manage the large volumes of medicines and medical equipment that have entered the Gaza Strip. WHO has prepared a logistics operations plan.
Rehabilitation of health infrastructure
  • WHO, in its role as Health Cluster coordinator, is assessing damages to health infrastructures following the ceasefire. Initial overall damage costs for all sectors is estimated at US$2 billion. Saudi Arabia has reportedly pledged US$1 billion to support reconstruction.
Water and sanitation
  • UNICEF has activated the Water, Sanitation and Hygiene Cluster.
  • CARE is supporting clean water and sanitation activities.
  • Water and sanitation control resumed on 19 January with quality-control tests.
Mental health
  • Medical Aid for Palestinians (MAP) is providing community-based rehabilitation and mental health support.
  • The Palestinian Red Crescent Society (PRCS) is providing psychosocial treatment and trauma rehabilitation at Al-Rafah hospital.
  • UNFPA is providing psychosocial support.
Primary and reproductive health care
  • UNICEF is providing ongoing child survival and immunization support and scaling up integrated maternal and child illness services, psychosocial support and nutrition aid.
  • Through the Khan Younis Pediatric Hospital, Médecins sans Frontières France (MSFFrance) has been providing follow-up care to children discharged from the facility.
  • The United Nations Population Fund (UNFPA) has delivered emergency reproductive health equipment, supplies and medicines to health facilities, and rehabilitated several health facilities. UNFPA is also supporting emergency obstetrical care at primary and secondary health care levels
  • Save the Children is operating in Gaza City and the Middle Zone of the Gaza Strip. It is undertaking community assessments of health and nutrition needs and supporting PHC and community-based initiatives, as well as secondary health care services including paediatric, maternal and neonatal care. It is also promoting breastfeeding.
  • CARE employs 18 national staff who provide primary and secondary health care services, assist with supplying medicines and support clean water and sanitation activities.
  • Merlin is in the planning phase of establishing community-based, primary and secondary health care services in Gaza. Merlin currently has significant capacity in the West Bank, where its mobile teams: support 90 MoH PHC facilities; manage 70 women health education volunteers; undertake outreach follow-up of pregnant women not attending health facilities; and conduct school education in health, hygiene and nutrition.
Medical teams
  • Four surgeons from the International Committee of the Red Cross (ICRC) are working at Shifa Hospital after entering the Gaza Strip through the Erez Crossing on 5 January. The team is supporting the hospital's operating theatre and intensive care unit. They brought with them 1000 units of tetanus oxide.
  • The ICRC has been negotiating with the Israeli Defense Forces (IDF) for the safe movement of health personnel throughout Gaza.
  • A five-member surgical team from MSF-France is waiting to enter Gaza through the Rafah Border Crossing, with the aim of assisting Shifa Hospital. Four more medical staff are in the pipeline (including a general surgeon and two nurses).
  • An MSF-France team has been working in Al-Wafa Hospital in Khan Younis since before the crisis began. The team provides psychosocial care and trauma rehabilitation and manages two clinics and three mobile teams.
  • Médecins du Monde (MDM) is supporting medical emergency staff at Shifa Hospital. MDM is also assisting MoH PHCCs throughout Gaza, as well as supporting a mobile team, laboratory and psychosocial services.
  • 4 medical staff from Mission Humanitaire have provided surgical support to Nasser Hospital in Khan Younis.
  • 5 medical staff from Help the Doctors provided surgical support to Shifa Hospital.
  • Handicap International is operating mobile teams in Gaza City to provide home physiotherapy, conduct disability assessments, administer first aid and provide dressing kits. The number of staff is expected to increase from three to seven.
  • The Swedish Organization for Individual Relief is managing 20 staff who are caring for 90 children at the Beit Lahia and Beit Hanoun PHCCs in North Gaza.
Disabilities
  • Three national technicians and one intern from Handicap International are helping register patients with disabilities and provide physiotherapy at Shifa, Al-Quds PRCS and Kamal Al-Wan hospitals. Another 12 physiotherapists, one prosthetist and four nurses are expected to be deployed.
  • Handicap International is also supporting the production of prostheses at the Artificial Limb and Polio Centre.
  • Mercy Corps is providing crutches and wheelchairs for people with disabilities.
  • Hagar is providing home care for people with disabilities in Gaza City, as well as support to Al-Rafah Hospital and Palestinian NGOs in refugee camps. Hagar is also providing equipment needed by people with disabilities. Hagar carries out its work in partnership with seven MoH hospitals and 30 Palestinian NGOs.
  • Diakonia is managing two community-based rehabilitation projects.
Referrals and evacuations

The Al-Quds Hospital in Gaza City, managed by the PRCS, is continuing to provide referrals and handle medical evacuations, despite having suffered heavy damage on 15 January. Since 27 December, more than 400 patients have been transferred through Rafah, most for injuries and some for chronic conditions, according to the MoH. At least 21 referred patients have since died.

CAPACITY BUILDING

  • The Welfare Association is supporting 17 Palestinian NGOs, as well as supporting infrastructure development, training, outreach and community-based health services.
  • The MoH has a 10-year strategic operational plan for community-based mental health services covering the period 2004-2013. WHO is helping the MoH implement the five components of the plan (capacity building within the MoH; training and education; public education; development of family and user associations; and the application of evidenced-based practices).

REGIONAL and INTERNATIONAL RESPONSE

Egypt:
  • The Egyptian Red Crescent Society has been mandated by Egypt's First Lady to coordinate health services on the Egyptian side of the border with Gaza.
  • Scores of Egyptian ambulances have been entering Gaza to evacuate patients for referral to hospitals outside of the Gaza Strip, mostly within Egypt and Saudi Arabia.
Israel:
  • Alongside its military operations in Gaza, Israeli authorities have stated they are facilitating delivery of humanitarian relief into Gaza. A mobile clinic has been established at Erez Crossing.
Italy:
  • Italy is providing financial support for WHO's emergency response plan in Gaza. Italy has also donated 40 tons of medicines and other relief supplies to support WHO, UNRWA and WFP activities.
Belgium:
  • After consultation with WHO, Belgium has evacuated 13 children to Brussels for emergency treatment for serious injuries, mainly to limbs. The first six children (each accompanied by a relative) were transported from Gaza to El-Arish, from where they flew on a private plane to Belgium on 14 January. A second group comprising seven children left El-Arish for Belgium on 18 January.
For more information, please contact:

Tony Laurance, Head of Office WHO OPT
Tel: +97225400595, email: tla@who-health.org

Patricia Kormoss, Health Cluster Coordinator
Tel: +972547179032, email: kormossp@who.int

Chiara Stefanini, Health & Human Rights Officer
Tel: +97225400595, email: cst@who-health.org

Dr Mahmoud Daher, WHO Technical Officer (Gaza)
Email: mda@who-health.org

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