Palestine Report




Healthcare in Gaza on brink of collapse

The Israeli siege of Gaza has forced healthcare to the brink of collapse resulting in many, what would otherwise be avoidable, deaths. Several presentations were made to the recent World Health Assembly about the dire health conditions not only in Gaza but also in the other occupied Palestinian territories, resulting in the Assembly adopting a resolution calling on Israel to end the siege. Middle East Health provides an overview of the current health conditions in the occupied Palestinian territories summarised from the reports presented at this year’s WHA.

The Israeli siege of the Gaza is causing unprecedented trauma to the inhabitants – as the importation of critical medications, medical devices and spare parts for medical equipment is blocked at the border. To compound the issue, patients who need healthcare at better equipped facilities outside the borders, such as at those facilities in East Jerusalem, are often barred from crossing the border resulting in many, what would otherwise be, avoidable deaths.

The following extracts from the 2010 reports to the World Health Assembly of the Permanent Observer of Palestine to the United Nations and the director of health, UNRWA (United Nations Relief and Works Agency for Palestinian Refugees in the Near East), provide a current overview of the Palestinian health system and its main services, as well as the principal health indicators for 2009.

The reports highlight the deterioration of the health situation in the Gaza Strip resulting from the continued occupation and the severe restrictions imposed by the Israeli siege, now in its third year.

The Permanent Observer of Palestine to the United Nations report points out that the only hope of saving the health sector from total collapse lies in ending the blockade, returning the political situation to normal and, above all, returning the entire Gaza Strip to the control of the central management of the Palestinian National Authority.

The World Health Assembly at their annual meeting in May this year adopted a resolution calling on Israel to end the siege. See the report on page 25.

Deteriorating health

According to the report of the Permanent Observer of Palestine to the United Nations presented at the World Health Assembly this year, “the determinants of health in Palestine are no better than those observed last year. Poverty and unemployment rates in the Gaza Strip have considerably worsened owing to the enduring stranglehold of the Israeli blockade. Demographic indicators such as high fertility rate and high population growth rate and epidemiological changes exemplified by the prevalence of chronic diseases still constitute formidable challenges facing the Palestinian health system.”

The report points out that the blockade will lead to catastrophe if it is not lifted.

“No one will be able to assess or predict the dire consequences for the Gaza Strip because of the impossibility of monitoring the various indicators in these conditions. This endeavour requires more strenuous efforts and the provision of better technical and logistic support to the Ministry of Health of the Palestinian National Authority in order to allow it to better monitor health indicators,” notes the report.

Demographics

In 2009, the population of the occupied Palestinian territories was estimated to be 3,935,249, including 375,167 in occupied Jerusalem. The population distribution was 62.2% in the West Bank and 37.8% in the Gaza Strip. Men accounted for 50.8% of the population and women 49.2%.

Refugees

According to the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), approximately half the total population – 1,885,000 are refugees living in the occupied Palestinian territory. A total of 1,106,000 refugees live in the Gaza Strip (constituting 74% of the resident Palestinian population) and 779,000 in the West Bank (making up 31% of the resident Palestinian population).

There are 27 refugee camps in the occupied Palestinian territory (19 in the West Bank and 8 in the Gaza Strip). Approximately one third of Palestinian refugees still live in refugee camps (making up 45.4% of all refugees in the Gaza Strip and 25.4% of those in the West Bank); the remaining refugees live in towns and villages with the host population.

Crude birth and death rates

Data from the Palestinian Central Bureau of Statistics indicate that in 2008, the crude birth rate was 32.7 per 1000 and the crude death rate was 4.4 per 1000.

Population distribution

Palestinian society is still young. In 2009, children under five years of age constituted 14.8% of the total population living in the occupied Palestinian territories; 41.9% were in the age group 0-14 years and 3.1% were in the group 65 years and above.

Primary health care

Since the installation of the National Authority, the Ministry of Health, discharging its responsibilities for health, has attached considerable importance to the application of the principles of primary health care through the provision and development of health services, facilitating access to such services for different sectors of the population, and providing health services to different social groups and areas in an equitable manner.

Primary health care is delivered by a variety of health staff working for the Ministry of Health, nongovernmental organisations, UNRWA, the military health service, and the Palestinian Red Crescent. In this regard, the central administration of primary health care at the Ministry of Health plays a remarkable role. The network of healthcare centres has been extended throughout the national governorates, from 454 centres in 1994 to 693 in 2009 – an increase of 52.9% compared with 1994. Government-run centres represent 63.5% of all centres operating in the area of primary health care. In the West Bank in 2009, the number of visits to primary health care centres administered by the Ministry of Health totalled 1,775,388 for consultations with physicians and 1,042,284 for visits to nurses.

Maternal and child health

Major health indicators have been set up in order to measure the progress made by the Ministry of Health and other health service providers.

Maternal mortality

The proportion of Palestinian women of reproductive age (i.e. 15-49 years) is 48.8% of the total number of women in Palestine. The mortality rate recorded at the national level was 38 per 100,000 live births. The Ministry of Health has set up a high-level national committee to monitor the recording and reporting of maternal mortality. Due to the current political situation in the Gaza Strip, reporting of these rates is extremely poor. The reported rates do not always reflect reality.

Total fertility rate

According to the Palestinian Central Statistical Office, the total fertility rate among women of reproductive age (15-49 years) is 4.6 at the national level (5.4 in the Gaza Strip and 4.2 in the West Bank).

Births

The report showed that most births in Palestine occur in hospitals or in maternity homes (98.9%), mainly in hospitals administered by the Ministry of Health (56%). This confirms that most Palestinian women prefer to give birth in a hospital setting, and especially hospitals administered by the Ministry of Health, in view of the good service they offer, and because most of the Palestinian population benefits from the health insurance system covering childbirth. Government hospitals therefore represent the most appropriate choice.

Family planning programmes

Family planning programmes are a major priority for health service providers in general and for the Ministry of Health in particular. The number of primary health care centres offering such services has increased by 159 in the course of 2009 in different governorates. There are currently 139 such centres in the West Bank and 2,018 in the Gaza Strip.

In 2009, a total of 142,789 women visited family planning centres (51,591 in the Gaza Strip and 91 198 in the West Bank). The number of first visits to a planning service during the same period was 43,582. Oral contraceptives were the most common birth-control method among women making their first visit to such services in 2009; (64.8%) of them used contraceptive pills compared with (14.7%) who used an intrauterine device.

Laboratories and blood banks

The Ministry of Health runs 192 laboratories, including four central laboratories (two in the West Bank and two in the Gaza Strip). There were 23 hospital laboratories (12 in the West Bank and 11 in the Gaza Strip) and 165 laboratories located at primary healthcare centres (128 in the West Bank and 37 in the Gaza Strip).

The total number of blood donors was 53,072, of whom 42% were voluntary donors, while 58% donated their blood to relatives or to friends.

Laboratory tests for blood-borne diseases are carried out on all units of donated blood prior to transfusion. In 2009, the rate of viral hepatitis B detected was 1.8%, and 0.22% of donations were found to be infected with viral hepatitis C. Two patients tested positive for HIV in preliminary tests. These two cases require further tests for confirmation.

Hospitals

The Ministry of Health is considered the major provider of secondary care (hospitals) in Palestine. It owns and administers 2,917 beds in 25 hospitals in all governorates. These hospitals are among the 75 hospitals operating in Palestine with a total capacity of 5,058 beds. Fifty of these hospitals, with 3,045 beds, are in the West Bank; the rest are in the governorates of the Gaza Strip. In addition to hospitals administered by the Ministry of Health, there are 30 hospitals owned by private institutions with capacity for 1,639 inpatients, and 19 privately-owned hospitals with 439 beds. UNRWA owns a single hospital in Qalqilya governorate with 63 beds. The Ministry of Health’s services cover almost all specialisations including general and specialised surgery, internal medicine, paediatrics, and psychiatry.

Rehabilitation and physical therapy are provided by private hospitals, which also offer other services such as outpatient and emergency treatment. Dialysis is provided by 12 units distributed among government- administered hospitals. These units performed 107,026 dialysis interventions in 2009.

The main services offered by government hospitals include diagnostics, such as radiology.

However, the report of the Permanent Observer of Palestine to the United Nations notes that primary healthcare centres and hospitals no longer operate as they should in all governorates of the Gaza Strip owing to the deterioration of medical equipment and devices, poor maintenance, and the lack of spare parts, medicines and medical appliances. Consequently, many patients have been referred to hospitals abroad for treatment at the expense of the Palestinian National Authority and then face the difficulty of getting the requested authorisations to exit the Gaza Strip.


 Date of upload: 15th Aug 2010