Health in Gaza Current Situation and Future Challenges

Occupied Palestinian Territory

Mahmoud Daher

Head of Gaza sub-office

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WHO-oPt

• Health determinants

• Health Services• Health Status• Conclusions

HUMANITARIAN OVERVIEW

Settlements (pre-2005)Crossings

Sea restrictions

Fence

Erez

Crossing Point

Nahal Oz

Crossing Point

Karni

Crossing Point

Sufa

Crossing Point

Kerem Shalom

Crossing Point

Rafah

Crossing Point

3 na

utic

al m

iles

Effect

ive

sinc

e Ja

nuar

y 20

09

ARA

Tunnels

Tunnels

Gaza Strip

Movement and access highly restricted

1.6 million (70% refugees)~4,000 persons km2

54% under 18

No go zone - officially: 0-300 meters, in practice: 0-500 meters

High-risk zone: 500- 1/1.5 km

35% of agricultural land

85% of fishing areas off-limits, 65,000 affectedErez Crossing: 167 (2011) vs 26,000 (2000)people/day200-300 operational tunnelsMostly construction materials

Source: The Economist

9,000 settlers and 21 settlements 15% of Gaza Strip

chart

map

Beit Hanoun 2008Beit Hanoun 2003

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• September 2005: Israeli Disengagement from Gaza• January-March 2006: Elections in oPt and forming of new

Palestinian Government.• June 2006: Israeli soldier kidnapped - Israel retaliate by

destruction of power plant and closure of borders.• June 2007: Internal disputes lead to separation between

West Bank and Gaza, Hamas take over control of Gaza and Israel imposed siege on Gaza.

• December 2008: Israeli military assault (Alforqan or Cast lead)

• November 2012: Israeli Intensive airstrike assaults (Column of clouds or stones of hill)

• April 2014: Palestinian reconciliation…??

Key recent events in the last decade had implications on the

health in Gaza

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• Severe restrictions on access and exit for people and goods

• Major impact on economy, reconstruction and daily life of citizens

• Tunnels until recently were providing alternative route for supplies of all kinds, including fuel and construction materials, now these are completely closed.

The Siege

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Demographic indicators

• Population in oPt : 4.42 Million• Population in Gaza Strip mid-2012: 1.7 million

(38.5% of oPt), estimates to be 2 million in 2018 (PCBS)

• Registered refugees in Gaza: 66.1% of Gaza population

• Less than 18 yrs: 51% of Gaza population

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Socioeconomic Indicators

• Unemployment first quarter 2014: 40.8% (38.5% 4th qrt 2013) PCBS

• 38.8% of Gazans lived under the national poverty line. (World Bank)

• 57% of households in the Gaza Strip are food insecure (2012) WFP

• Gross domestic product per capita $1156. PCBS

• “Ever more aid dependent”

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Education & Literacy

• Literacy age 15+ – 92%• Primary completion rate – 83% in 2007. Down

from 95% in 2005. • Schools in Gaza recorded failure rates of 40 to

50 percent in 2006 and 2007, according to UNRWA.

• UNWRA schools overcrowded. Children attend classes in two shifts—one in the morning and one in the evening.

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Environment/ Water

• UNEP report- Environmental assessment of Gaza Strip: “Underground water supplies in danger of collapse from over-use and contaminationWar impact: sewage; rubble; land; waste disposal.

• concerns about water shortages, lack of chemicals for water disinfection, pollution (levels of nitrates) - access to safe water for the population

• Av. consumption of potable water estimated at 52 litres per capita per day, (half the international standard of 100 to 150 l/cap/d.)

• Sewage and waste water management systems totally inadequate. Sanitary inspection of water-supply systems and use of water safety plans limited; corrective measures are not done promptly.

• Water authorities dumping 60,000 cubic meters of sewage daily into Mediterranean Sea since January 2008 to avoid flooding residential areas.

• Increased risk of water and sanitation related diseases such as diarrhoeal diseases, hepatitis A

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Health providers

• MoH• UNWRA• NGOs• Private

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Primary Health care

  MoH NGOs UNRWA TotalWest Bank 406 140 41 587

Gaza Strip 54 66 21 141

Total 460 206 62 728

Population/ PHCC

Gaza: 11480

West Bank: 4147

Palestine: 5476

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Provider

Gaza Strip Palestine

No. of Hospital No. of Beds % of BedsNo. of

HospitalNo. of Beds % of Beds

Ministry of Health 13 1578 67.9 25 2979 54.3

UNRWA 0 0 0 1 63 1.1

NGOs 14 596 24.5 33 1789 32.6

PMS 3 177 7.6 3 177 3.2

Private 17 479 8.7

Total 30 2324 100 76 5487 100

Distribution of in-patient beds GS vs Palestine 2012

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o Palestine: 13.5o Gaza 17.3o West Bank 12.8

o Jordan: 17 o Egypt: 22o Lebanon: 36o Israel: 63

o Increase in MoH beds 2005-2012:o Gaza 60%o West Bank 44%

o Av. occupancy rates for MoH hospitals:o Gaza 78%o West Bank 85%

Total number of hospital beds per 10,000 population

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Health workforce in Gaza (MOH, UNRWA, main NGOs)

  Gaza Strip Per 1000 popProfession/

Region Number Per 1000 pop Jordan Israel

Physicians 2784 2.7 2.0 3.8

Dentists 277 0.2 0.1 1.2

Pharmacists 603 0.35 0.1 0.7

Nurses 3020 1.8 3.0 6.3

Midwives 234 0.2 0.3 0.2

Paramedicals 1233 0.72 1.2

Administration 4248 2.5 3.2

Grand Total 12406

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August to Dec 2008 –strike by Gaza MoH staff. 1,1171 MoH staff as of December 2013 of whom 8992 working

Out of the total of 111715949 paid by PNA 2179 paid by PNA but not working5222 paid by de facto authorities

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Some key Health status indicators

Life expectancy 71-72

CDR: 3.1

IMR: 20/1000 live births

MMR: 23.4/100,000 live birth

48% of Gaza population are not doing enough physical activity

61.7% of all Gaza population are overweight (while 31.8% obese)

44.8% of Gaza population 15-64 with high BP

8.4% of Gaza population 15-64 with DM

32.5% of Gaza population have high cholesterol blood level

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Challenges in this area:

• Main health challenges facing Palestine in 21st century are non-communicable diseases o cardiovascular diseases, diabetes, chronic lung disease, cancer,

mental disorders

UNDAF thematic area: Health

The United Nations Country Teamin the State of Palestine

People 15-64 years with high blood pressure (2011) 36%

People 15-64 years with diabetes mellitus (2011) 9%

Adult primary care users with mental problems (2012/2013)

West Bank 26% Gaza Strip 38%

Leading causes of death in Palestine (2012)

Heart disease 31%

Cancer 14%

Cerebrovascular diseases (stroke) 12%

Mental hospital ward

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• The prevalence rate of post-traumatic stress disorder among children in Gaza ranged from 10.6-54%

• The prevalence rate of post-traumatic stress disorder among adolescents in Gaza is 25.8%

• The prevalence of mental health problems among adults attending governmental primary healthcare centers is 37.8% in Gaza

• In General, the mental health resources are scarce and fragmented to respond to the extensive burden of mental disorders.

Mental health

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Some other challenges

• Referral and access to outside Gaza health services• Pharmaceutical shortages

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Referrals for specialized care - oPt

• Referrals by MoH (WBG) increased 10 folds from 2000 to 2011. (world Bank)

• Costs also increased from $10 m in 2000 to $121m in 2011 (world Bank)

• Main specialties: cancer, cardiovascular, opthalmology, neurosurgery

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Total Number of Monthly Referral in 2011, 2012 and 2013

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000

2013

2012

2011

Nu

mb

er o

f R

effe

rals

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Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec0

2,000,000

4,000,000

6,000,000

8,000,000

10,000,000

12,000,000

14,000,000

16,000,000

18,000,000

20,000,000

2013

2012

2011Co

st N

ISReferral Cost in 2011, 2012 and 2013

Total cost in Million USD

2011: 44 M

2012 : 40 M

2013: 49 M

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Total number of approved permits out of the total number of applications (2011-2013)

2011 2012 20130

2000

4000

6000

8000

10000

12000

14000

16000

10560

5631

13776

9478

5284

12120

Total number of permits Approved

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2007 2008 2009 2010 2011 2012 20130.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

14%16%

18%

24%

33% 34%

30%

11%13%

12%15%

12%

22%

53%

% of shortage of drugs

% of shortage in disposables

Shortage in drugs and disposables

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Challenges

• Tightening restrictions of movement of populations, goods and activities of humanitarian actors

• Deterioration of determinants of health in the West Bank and Gaza

• Reduction of funding for humanitarian health programs• Limited human recourses to implement the cluster/sector

coordination activities.

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THANK YOU