Health situation in Gaza - 15 January 2009
Overview
This is the 15 January update on the health sector situation since Israel launched its military offensive in Gaza on 27 December.
- 3 health facilities hit by direct or indirect fire.
- Israeli forces shelled UNRWA's headquarters – three people injured.
- At least 40 000 people displaced.
- All Gaza City health facilities and electricity supply disrupted.
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
Casualties
According to the Palestinian Ministry of Health (MoH) on 15 January at 13:00, at least 1050 people have been killed since 27 December, including at least 85 women and 311 children. Approximately 5000 Palestinians have been injured, including at least 1552 children and 652 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.
Israeli shells struck UNRWA's headquarters in Gaza City on 15 January, setting on fire warehouse facilities and workshops critical to UNRWA operations that support 70% of Gaza's population. Fuel supplies for UN and UNRWA operations were in the compound and threatened.
As of 15 January, UNRWA is supporting an estimated 40 000 displaced people in 40 emergency shelters, providing bread and drinking water to all shelters, as well as tinned meat to Gaza's three southern districts. The exact number of people who have fled their homes in Gaza remains unclear.
CASUALTIES TO HEALTH PERSONNEL
Since 27 December 2008, 13 health personnel have been killed and 22 injured while on duty, according to the MoH health information centre in Gaza.
DAMAGE TO HEALTH FACILITIES
On 15 January three health facilities were hit by direct or indirect fire. These were the:
1. Al-Quds Palestinian Red Crescent Society (PRCS) Hospital in south Gaza City, which the MoH said was hit by direct Israeli fire. Soldiers surrounded the hospital during the early hours of 15 January and opened fire on the hospital compound. The administrative building and pharmacy adjacent to the hospital were hit and caught fire. Fearing an imminent explosion or the spread of the fire, hospital authorities evacuated all patients to the hospital's ground floor and prepared for a complete evacuation. At least 50 patients, 20 of whom were confined to their beds, waited several hours to be evacuated. Fire-fighters and ambulances were prevented from being able to evacuate the patients until around 13:00. The fire was extinguished and patients began evacuating the hospital. No further information was available.
The PRCS is the recognized Red Cross and Red Crescent Movement in Gaza and is an internationally recognized organization with medical functions. It is the operational partner of the International Committee of the Red Cross in this humanitarian operation, and a member of the International Federation of the Red Cross and Red Crescent Societies.
2. Al Wafa Rehabilitation Hospital in east Gaza City came under fire and its eastern wall was severely damaged. It has a bed capacity of 52 and has 75 staff. No further information was immediately available.
3. Al Fata (Wia’m) Hospital in west Gaza City was damaged by indirect fire. Its windows were smashed, infrastructure damaged and one ambulance destroyed. All patients were evacuated.
The MoH health information centre in Gaza reports that since 27 December, 2008:
- 16 ambulances have been damaged;
- 16 health facilities have been damaged through direct or indirect shelling.
ELECTRICITY AND FUEL SUPPLY TO HEALTH CARE FACILITIES
Electricity supply was problematic for health facilities all over Gaza City, with hospitals receiving about 6 hours of power. Hospitals elsewhere in Gaza received 12-16 hours.
HOSPITAL BED CAPACITY AND OCCUPANCY RATE
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
On 14 January, 38 patients were evacuated through Rafah and no referrals were planned for 15 January. About 50 injured patients were awaiting referral, according to the hospital's director. Since 27 December, 380* patients have been transferred through Rafah, most for injuries and some for chronic conditions, according to the MoH. As of 12 January, at least 242 patients who had been referred through Rafah have been sent for treatment in Egyptian hospitals, and 79 have been admitted to hospitals in other Arab states and also to Belgium. At least 21 of the referred patients have since died, according to the MoH.
As of 15 January, 20 chronically ill patients who have submitted requests for evacuation through the Erez Crossing were still awaiting Israeli approval to cross. Israeli authorities have granted permits for the seven of the 20.
The Palestinian Referral Abroad Department remains closed due to the conflict primarily because staff are not presenting to work.
*(The reason for this sharp increase in the number we were reporting until now, is that it seems hospitals in the South of Gaza were referring without coordinating with other organization and so WHO was not informed about these until recently.)
MEDICAL SUPPLIES
One truckload of medical supplies arrived at Karem Shalom on 15 January but could not proceed as no UNRWA convoy was available to move the materials. The damage to UNRWA buildings greatly hampered the agency's activities.
PRIMARY HEALTH CARE CENTRES
WHO remains concerned about management of chronic disease patients and public health in Gaza Strip. Monitoring and surveillance of water quality has not been carried out since the central public health laboratory closed due its proximity to open conflict area on 3 January.
The childhood vaccination program had virtually ceased between 27 December and 13 January, but due to WHO and UNRWA assistance has resumed in parts of the Gaza Strip. Reduced vaccination coverage could result in outbreaks (for example for measles, polio, and hepatitis), a risk increased by Gaza's high population density and dire living conditions.
MoH PHC centres:
Of 56 MoH-managed PHC centres and two NGO-run centres serving the MoH, 37 are functioning with major interruptions on 15 January. The 1O PHC centres converted to 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 for hospitals in their respective areas.
The use of PHC activities has dramatically declined since 27 December, according to the director of PHC. About 40% of chronically ill patients regularly attending PHC centers have interrupted their treatments and are no longer attending PHC centers. Internal referrals between PHC clinics and hospitals have severely declined where only emergency cases are being referred to hospitals. Antenatal care (ANC) has resumed in all currently functioning PCH clinics, however major interruption was reported today in all Gaza City centers.
Staff attendance is improving but remains low in Gaza City, at 30% in functioning PHC centers:
- Rafah: 95-100%
- Khan Younis: 95-100%
- Middle zone: 95-100%
- Gaza: 30%
- North: 60%
UNRWA PHC centres:
UNRWA reopened two PHC centres on 12 January. Three out of 18 remain closed.
COORDINATION
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. A WHO Emergency Operational Plan for the Gaza Crisis has been launched seeking US$13.3 million for a range of urgent health interventions.
Contacts
WHO West Bank and Gaza
Ms. Chiara Stefanini
Health and Human Rights Officer
Email: cst@who-health.org
Tel.: + (972) (0)2 540 0595 – Mobile: + (972) (0)54 717 9024
WHO Regional Office for the Eastern Mediterranean
Mr Altaf Musani
Regional Adviser
Emergency Preparedness and Humanitarian Action
Email: musania@emro.who.int
Tel.: + (202) 26 76 50 25 – Mobile: + (201) 02 58 58 22
WHO Headquarters, Geneva
Paul Garwood
Communications Officer
Health Action in Crises
Tel.: +41227913462 - Mobile: +41794755546
Email: garwoodp@who.int
Old Nablus Road – Sheikh Jarrah POBox 54812 – Jerusalem 91547 Tel: +972 2 540 0595 Fax: + 972 2 581 0193 Email: info@who-health.org
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