Gaza Report

Chronic shortage of drugs

The cancer started in Fatima Hassami’s breast before spreading to her bones, leading to multiple fractures in her left leg and constant pain for the 70-year-old.

“I feel so sorry for my mother,” her daughter Ahlan Hassami said. “Every time she complains, I suffer with her.”

Fatima is among 15 cancer patients currently admitted to the oncology ward at Shifa Hospital, the largest such facility in Gaza. But the hospital, according to Ziad Khazander, head of the oncology department, has no medicine to treat cases like Hassami’s.

“She needs medication to strengthen her bones,” he told IRIN. “There’s a treatment available but we haven’t had the necessary drug here at Shifa for six months now.

“She has a spinal cord compression, which requires urgent radiotherapy. But because her bones are so weak and she already has multiple fractures it’s impossible to move her.”

Gaza is suffering chronic shortages of painkillers, surgical equipment and critical drugs, including for chemotherapy due to delays in the approval of drugs bound for Gaza by the Palestinian Authority in Ramallah and restrictions imposed by Israel’s blockade.

Radiotherapy is not available at all, according to medical sources. As a result, most cancer patients in Gaza have to be referred abroad for treatment, but this process can be costly, time-consuming and bureaucratic.

From a list of 460 essential drugs, Gaza’s health ministry medical store is currently missing 170 items, said the store’s director Mohamed Zemili. While the shortage has affected all departments in Gaza’s hospitals, oncology is among the hardest hit.

“For instance, we are currently missing a drug used to strengthen the bones of cancer patients,” Zemili said. “We haven’t had this for three to four months. We’re also missing painkillers. Without these drugs, patients are suffering greatly.”

According to Gaza’s health ministry, 1,523 cancer patients were referred through Egypt or Israel in 2010, of whom 165 were children.

Security concerns

The Israeli authorities say the transfer of medical supplies to the occupied Palestinian territory depends on requests from Gaza and is largely unimpeded, except when there are security concerns.

“All of the medical supply we transfer to Gaza is based on requests from Gaza and approval from the Palestinian Authority in Ramallah,” Maj Guy Inbar, the Israeli Coordinator of Government Activities in the (Palestinian) Territories, told IRIN.

“Israel only becomes involved when there is a security issue,” he added. “There are some drugs that have a dual use and can be used for terror activities. These, we will only allow to enter with international organisations. There is also some medical equipment, such as MRI and X-Ray machines, which can be used for terror.

“In 2010, 18,000 people and their companions passed from Gaza through Israel to receive medical treatment – 80% of applications were permitted to enter.”

The cost of hospital treatment outside Gaza is covered by the Palestinian Authority, but travel, food and accommodation costs for anyone accompanying a patient, are not.

Security concerns also mean that anyone from Gaza accompanying a patient referred for treatment in an Israeli hospital cannot leave the hospital grounds during their stay. They are obliged to buy food from the hospitals’ shops and cafes. Yet, some courses of treatment require patients – and their companions – to stay in hospital for up to six months.

With more than 40% unemployment in Gaza, these costs can be crippling. As a result, some of the 100 cancer patients referred out of Gaza every month, Khazander said, could not afford treatment.

Costly treatment abroad

Wafer Abu Habel, 43, who has ovarian cancer, is in the room next to Hassami at Shifa. Before the February unrest in Egypt, Abu Habel had crossed into that country for a treatment to correct a fistula that had resulted from a particularly aggressive tumour.

Now she was back in hospital in Gaza within days of her return, with diarrhoea and pain. “We spent two and a half months in Egypt,” her mother, Sobhaya Abu Habel, said.

“We had to rent a flat and go back and forth from the hospital. The flat alone cost US$1,000 a month. We are both widows. I had to borrow the money from friends to pay for all this. We had a very tough time – it was so expensive we struggled to buy food.

Gaza, she believes, could offer equally good treatment. “It is just that they don’t have the facilities here or the medication,” she said. “They have good intentions but they don’t have the means to treat us.”

Khazander said his ward had struggled to provide adequate treatment despite the blockade. “Circumstances here were better before the blockade – we were able to administer chemotherapy,” he explained. “We have seen an increase in mortality rates here because cancer patients are not receiving the right treatment, and they develop complications.”

World Malaria Report 2010

Control programmes effective – many lives saved

A massive scale-up in malaria control programmes between 2008 and 2010 has resulted in the provision of enough insecticide- treated mosquito nets (ITNs) to protect more than 578 million people at risk of malaria in sub-Saharan Africa. Indoor residual spraying has also protected 75 million people, or 10% of the population at risk in 2009. The World Malaria Report 2010 describes how the drive to provide access to antimalarial interventions to all those who need them, called for by the UN secretary-general in 2008, is producing results.

In Africa, a total of 11 countries showed a greater than 50% reduction in either confirmed malaria cases or malaria admissions and deaths over the past decade. A decrease of more than 50% in the number of confirmed cases of malaria was also found in 32 of the 56 malaria-endemic countries outside Africa during this same time period, while downward trends of 25%-50% were seen in eight additional countries. Morocco and Turkmenistan were certified by the director-general of WHO in 2009 as having eliminated malaria. In 2009, the WHO European Region reported no cases of Plasmodium falciparum malaria for the first time.

Dr Margaret Chan, the WHO directorgeneral, highlighted the transformation that is taking place, “The results set out in this report are the best seen in decades. After so many years of deterioration and stagnation in the malaria situation, countries and their development partners are now on the offensive. Current strategies work.”

“The phenomenal expansion in access to malaria control interventions is translating directly into lives saved, as the WHO World Malaria Report 2010 clearly indicates,” said Ray Chambers, the UN secretary-general’s Special Envoy for Malaria. “The strategic scale-up that is eroding malaria’s influence is a critical step in the effort to combat poverty-related health threats. By maintaining these essential gains, we can end malaria deaths by 2015.”

The strategies to fight malaria continue to evolve. Earlier this year, WHO recommended that all suspected cases of malaria be confirmed by a diagnostic test before antimalarial drugs are administered. It is no longer appropriate to assume that every person with a fever has malaria and needs antimalarial treatment. Inexpensive, quality-assured rapid diagnostic tests are now available that can be used by all health care workers, including at peripheral health facilities and at the community level. Using these tests improves the quality of care for individual patients, cuts down the overprescribing of artemisinin-based combination therapies (ACTs) and guards against the spread of resistance to these medicines.

While progress in reducing the burden of malaria has been remarkable, resurgences in cases were observed in parts of at least three African countries (Rwanda, Sao Tome and Principe, and Zambia). The reasons for these resurgences are not known with certainty but illustrate the fragility of malaria control and the need to maintain intervention coverage even if numbers of cases have been reduced substantially.

The report stressed that while considerable progress has been made, much work remains in order to attain international targets for malaria control:

- Financial disbursements reached their highest ever levels in 2009 at US$1.5 billion, but new commitments for malaria control appear to have levelled-off in 2010, at US$1.8 billion. The amounts committed to malaria, while substantial, still fall short of the resources required for malaria control, estimated at more than US$6 billion for the year 2010.

- In 2010, more African households (42%) owned at least one ITN, and more children under five years of age were using an ITN (35%) compared to previous years. Household ITN ownership reached more than 50% in 19 African countries. The percentage of children using ITNs is still below the World Health Assembly target of 80% partly because up to the end of 2009, ITN ownership remained low in some of the largest African countries.

- The proportion of reported cases in Africa confirmed with a diagnostic test has risen substantially from less than 5% at the beginning of the decade to approximately 35% in 2009, but low rates persist in the majority of African countries and in a minority of countries in other regions.

- By the end of 2009, 11 African countries were providing sufficient courses of ACTs to cover more than 100% of malaria cases seen in the public sector; a further 5 African countries delivered sufficient courses to treat 50%-100% of cases. These figures represent a substantial increase since 2005, when only five countries were providing sufficient courses of ACT to cover more than 50% of patients treated in the public sector.

- The number of deaths due to malaria is estimated to have decreased from 985,000 in 2000 to 781,000 in 2009. Decreases in malaria deaths have been observed in all WHO Regions, with the largest proportional decreases noted in the European Region, followed by the Region of the Americas. The largest absolute decreases in deaths were observed in Africa.

In summary, the report highlights the importance of maintaining the momentum for malaria prevention, control, and elimination that has developed over the past decade. While the significant recent gains are fragile, they must be sustained. It is critical that the international community ensure sufficient and predictable funding to meet the ambitious targets set for malaria control as part of the drive to reach the health-related Millennium Development Goals by 2015.

ate of upload: 10th Jul 2011


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