Health situation in Gaza - 8 January 2009
This is an update from 8 January on the health sector situation since Israel launched its military offensive in Gaza on 27 December.
- UNRWA suspends operations in Gaza .
- Dorah Paediatrics hospital has closed, except for emergency services due to its proximity to an open conflict area and damage sustained to its infrastructure.
- WHO continues to be concerned about the public health situation in the Gaza Strip: PHC services are severely restricted and vaccinations have been interrupted since 27 December.
- 10 PHC are effectively functioning as emergency centres.
- Some hospitals started to partially receive mains electricity 8 Jan. Shifa hospital continues to function on back-up generator since 3 January - the fifth consecutive day - having received some fuel supply.
- On 7 January, 17 patients were evacuated through Rafah crossing
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.
The total number of people killed in the Gaza Strip since 27 December is 758, at least 85 being women and 257 children, according to the Palestinian Ministry of Health (MoH). At least 3100 Palestinians have been injured including at least 1080 children and 452 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.)
Among those reported killed on 8 January was a Palestinian forklift driver in an UNRWA convoy in Gaza near the Erez Crossing. "UNRWA decided to suspend all its operations in the Gaza Strip because of the increasing hostile actions against its premises and personnel," Adnan Abu Hasna, the agency's Gaza-based spokesman, said. It was unclear how long the suspension would last.
Primary health care centres in focus - see annex
WHO is greatly concerned by the public health situation in Gaza and the potential impact of the total halt in vaccinations since 27 December, 2008. This could result in outbreaks of epidemics, a risk increased by Gaza's high population density and dire living conditions.
Of 58 PHC centres managed by the MoH, only 34 are functioning (with major interruptions) as of today 8 January. Those not functioning are located in risky areas. The number of PHC centres open in each of Gaza’s five districts is as follows: Rafah three out of four; Khan Younis 11 out of 11; Middle zones 10 out of 16; Gaza six out of 16; North Gaza four out of 11. 10 PHC centres are currently functioning as emergency centres. See annex for the location of all PHC centres.
The director of PHC reported that since 27 December, the use of PHC activities had declined by about 90%. About 70% of chronic patients regularly attending PHC centres have interrupted their treatments and are no longer attending PHC centres. The PHC centres affected by this sharp decline are Shuahada’a Rafah, Tal Al Sultan clinic, and New Buriej clinic.
Many staff who had been on strike since 30 August 2008 have returned to work. But most are either unable to get to work due to movement restrictions or have been redeployed to support hospital staff. The breakdown of staff attendance is: North Gaza 40-50%; Gaza 25%; Middle zone 90%; Khanyounis 80%; Rafah 90%.
As a result:
- All 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.
- PHC team in Khan Younis is trying to operate its vaccination program, 0-10% of the vaccination program is functioning as of 8 January.
- PHC laboratory services have been halted since military operations began due to lack of electricity, staff and laboratory re-agents.
- 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.
- 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.
- Dental care is not functioning due to lack of staff and electricity.
Damage to hospitals and ambulances
Dorah Paediatrics hospital was closed 8 January except for emergency services due to its proximity to an open conflict area and to infrastructure damages it has sustained. Staff are unable to reach the hospital. All in-hospital patients have been evacuated to Nasser Paediatrics hospital.
No damage to hospitals or ambulances was reported 8 January; three ambulances have been damaged and three mobile clinics destroyed since 27 December. Fear of possible attacks on ambulances and medical personnel remains high.
Islamic Relief brought into Gaza three new ambulances, one of which has an Intensive Care Unit (ICU).There are now 151 ambulances in the Gaza Strip. Of these, 20 include ICU, 92 are ordinary ambulances, and three are 4-wheel drives and 34 for transporting health personnel. Three mobile clinics remain operational.
Electricity failure and fuel supply
Some hospitals began receiving partial mains electricity 8 January, on an average of 4 hours a day, after the Gaza power plant resumed partial operations.
Shifa hospital (Gaza’s main hospital) has received fuel supply, coordinated by ICRC, and has been functioning on its back-up generator since January 3 - the fifth consecutive day.
The ICRC’s four surgeons and two Norwegian doctors are working at Shifa hospital.
Some health personnel are working 24-hour shifts to meet needs. Health personnel are having increasing difficulty reaching their place of work. The ICRC and the UN are coordinating with Israeli authorities to secure passage for health staff between zones, which can take 5-6 hours.
Bed capacity and occupancy rate
Stabilized patients are discharged as soon as possible to free space in hospitals and ICUs but evacuation to NGO-run hospitals remains essential. Shifa hospital is trying to keep bed occupancy below 75% so as to keep 25% of beds free for emergency cases. Non-governmental hospitals receiving patients include Ahli Arab Hospital, Al Quds Palestinian Red Crescent Society Hospital, Patients Friends Benevolent Hospital, and El Awda Hospital.
REFERRALS AND EVACUATIONS OUTSIDE GAZA
On 8 January, 17 patients have been evacuated through the Rafah crossing for referral to hospitals in Egypt, Saudi Arabia and Libya – 5 in ICU. On 7 January, 22 patients were evacuated. This brings the number of patients evacuated through Rafah crossing since 27 December to 170, most for injuries and some for chronic conditions.
The Palestinian Liaison Officer is awaiting answers on requests made for 12 patients seeking referral for cardiac and cancer care. The Palestinian Referral Abroad Department remains closed.
Three of the 9 trucks facilitated by WHO and planned to pass through Karem Shalom on 7 January were permitted to enter today 8 January. The remaining six trucks are planned to enter 9 January.
The Palestinian MoH in Ramallah with WHO collaboration continues its activities from the emergency operations room to respond to the health crisis. The operations room has been providing assessments of requirements (pharmaceuticals, consumables, equipments and spare parts), following up on the response of international community and addressing referrals of injured and other patients.
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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