Health situation in Gaza - 12 January 2009
This is the 12 January update on the health sector situation since Israel launched its military offensive in Gaza on 27 December.
- 25 Egyptian ambulances crossed the border at Rafah into Gaza to evacuate patients from Shifa Hospital.
- 17 additional patients on route for evacuation via Rafah.
- Dorah Paediatrics hospital’s emergency room was shelled.
- 1 MoH PHC clinic closed due to conflict, number clinics now closed is 28.
- 25 696 people displaced in Gaza by crisis.
- All hospitals have 6-8 hours partial power supply.
- MSF Spain in Ramallah and MSF Belgium in Rafah waiting to enter Gaza.
International Humanitarian Law requires all medical personnel and facilities be protected at all times, even during armed conflict. Attacks on them are grave violations of International Humanitarian and Human Rights laws. Access to heath is a fundamental human right.
According to the Palestinian Ministry of Health (MoH) on 12 January, 910 people have been killed since 27 December, including at least 85 women and 292 children. 4250 Palestinians have been injured, including 1497 children and 626 women*. WHO has not been able to independently verify these details.
*The reason for the high increase in the death count is the identification of many bodies that were previously not identified or found under the rubble or in areas previously not accessible.
UNRWA reports that since 27 December, at least 25 696 people have been displaced by the conflict. The people displaced are distributed between 30 schools that UNRWA has prepared to serve as shelters.
The Director of PHC in Gaza reported that Bany Suhalia clinic (Khan Younis) received 13 cases of respiratory distress after inhaling smoke or gas from bomb blasts. 10 received first aid and were discharged while three were referred to Naser hospital in Khan Younis. No further details were available.
Damage to hospitals, primary health care centres
Damage to hospitals:
Dorah Paediatrics Hospital’s emergency room was directly hit 12 January. Staff are continuing to work despite the damage caused to the infrastructure. Dorah hospital has been closed since 8 January, except for emergency services, due to its proximity to an open conflict area and earlier damage sustained to its infrastructure.
Damage sustained by the Gaza European Hospital on 10 January has not been repaired.
El Nasser Paediatrics Hospital is still functioning with major limitations due to damage sustained on 10 January.
Damage to PHC centres:
MoH PHC centres: Fukhari clinic (Khan Younis) closed 12 January due to shelling in nearby areas.
Nearby shelling on 11 January forced the closure of three MoH PHC clinics: Shuhada’ Al Shate’ clinic (Gaza district); Khoza’a and Al Zana clinics (both in Khan Younis). This brings the number of MoH PHC clinics closed to 28.
UNRWA centres: Limited damage occurred to UNRWA’s Rafah PHC centres during bombardment on 8 January.
NGO centres: The Palestinian Medical Relief Society (PMRS) reported two of its PHC centres in the northern part of the governorate have been closed since 4 January due to insecurity and restriction of movement of its staff. These centres are Um-Naser Health Care Centre, serving the Bedouin Village and providing vaccinations; and Izbet Bait Hanon Health Care Centre, which served Izbet Bait Hanon Village.
Electricity failure and fuel supply
All hospitals are receiving an average of 6-8 hours of power supply. Hospitals have received some fuel supplies. UNRWA and WHO are working to ensure hospitals are receiving adequate fuel.
On 11 January, UNRWA supplied generator fuel to four UNRWA PHC centres.
Bed capacity and occupancy rate
The Shifa hospital ICU remains overwhelmed. Some patients were evacuated but the ICU is functioning at almost full capacity, with more than 20 out of its total 30 beds occupied due to the low evacuation rate of patients through the Rafah Crossing. Shifa Hospital continues to try to keep the bed occupancy rate below 75% to allow space for urgent and emergency cases.
REFERRALS AND EVACUATIONS OUTSIDE GAZA
17 patients were evacuated 11 January through the Rafah Crossing. Another 17 were on route to Rafah for evacuation on 12 January (8pm). The number of patients evacuated through Rafah since 27 December is 218 (excludes those on route), most for injuries and some for chronic conditions.
25 Egyptian ambulances crossed the border at Rafah into Gaza on 12 January at 5.20pm to evacuate patients from Shifa Hospital.
Belgian authorities have offered to evacuate to Belgium seven children needing medical care and seven companions. WHO is working with the MoH and Egyptian authorities on this issue.
As of 12 January, the Palestinian Health Liaison Officer had submitted 20 requests for evacuation of chronically ill patients through Erez Crossing. Israeli authorities have granted five but patients are waiting to cross Erez. The Israeli liaison officer informed WHO that seven of the 20 patients will be evacuated 13 January (the five granted permits plus two more). The Palestinian Referral Abroad Department remains closed.
On 10 January, 203 tons of medical supplies and five new ambulances donated by several donors (Saudi, Jordan Turkey, Qatar, Libya, south Africa, and Arab medical society, Egyptian Sharia Society, Algeria, Morocco) crossed from Rafah into Gaza.
On 11 January, UNRWA supplied drugs and vaccines to four UNRWA PHC centres in the Gaza Strip.
PRIMARY HEALTH CARE CENTRES
WHO remains concerned about public health and public sanitation in Gaza while waste management has not been assured and garbage is not collected in the Gaza Strip. The vaccination program has been dramatically interrupted, with some trials to operate in several centres. Reduced vaccination coverage could result in outbreaks, a risk increased by Gaza's high population density and dire living conditions.
MoH PHC centres:
Of 58 PHC centres managed by the MoH, only 30 were functioning (with major interruptions) as of 12 January. The 1O PHC centres that have been converted into emergency evacuation centres continue to function. For the geographical distribution of functionality of the MoH PHC centres see Annex 1.
Bani Suhalia clinic (in Khan Younis District) and Shuhada’a Nusierat clinic (in Middle Zone District) are functioning as triage centres to back up hospitals in their respective areas.
The use of PHC activities have dramatically declined since 27 December, according to the director of PHC. About 70% of chronically ill patients regularly attending PHC centres have interrupted their treatments and are no longer attending PHC centres.
On average, staff attendance is around 30% in all functioning PHC centres.
As a result:
- Most vaccination programmes (EPI and adult vaccinations) have been interrupted due to closure of clinics, unavailability of electricity or fuel at clinics equipped with generators, movement restrictions affecting distribution of vaccines and lack of staff. The vaccination program is now increasing its capacity to operate to 30-40% in most of areas around the Gaza Strip in coordination with UNRWA
- Antenatal Care (ANC) is not being provided due to lack of staff and electricity needed for ultrasound and other diagnostics. Women can't attend ANC due to conditions on the ground. Both antenatal and dental care resumed functionality today 12 Jan for emergency cases.
- PHC laboratory services have been halted since military operations began due to lack of electricity, staff and laboratory re-agents.
- Nutritional surveillance has stopped because the main centre is closed as it is located in a risky area.
- School health services are not functioning since schools are closed and staff not reporting to work.
- Preventive medicine is not functioning due to lack of staff.
- Epidemiology department is not functioning since no information is flowing from peripheral facilities, hospitals are overwhelmed with casualties, PHC centres are not fully functional and laboratories are not reporting.
- Occupational medicine is not functioning due to lack of staff.
- Health education and promotion activities have been suspended due to lack of staff.
An additional four MoH PHC clinics have closed during the past two days due to damage suffered during the conflict.
UNRWA PHC centres:
UNRWA reopened two PHC centres. Three out of 18 remain closed: the Elshouka and Zaitoun centres were closed after IDF instructed people living in an adjacent building to evacuate prior to bombardment, while a centre in Beit Hanoun was closed due to being in a high risk area.
NGO PHC centres:
PMRS reports that Haeder Abed Shafi PHC centre in Jabalia (Al- Fahoura area) has been providing PHC services and functioning as an emergency centre (24 hours). PMRS reports that the staff at the centre have observed a 250% increase in the attendance to this centre during the last four days.
WHO is coordinating the emergency health response through its offices in Jerusalem, Gaza, Cairo and Geneva, working closely with the Palestinian MoH in Ramallah and with health cluster partners.
WHO West Bank and Gaza
Ms. Chiara Stefanini
Health and Human Rights Officer
Tel.: + (972) (0)2 540 0595 – Mobile: + (972) (0)2 542326532
WHO Regional Office for the Eastern Mediterranean
Mr Altaf Musani
Emergency Preparedness and Humanitarian Action
Tel.: + (202) 26 76 50 25 – Mobile: + (201) 02 58 58 22
WHO Headquarters, Geneva
Health Action in Crises
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