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Health in Gaza Current Situation and Future Challenges

Occupied Palestinian Territory. Health in Gaza Current Situation and Future Challenges. Mahmoud Daher Head of Gaza sub-office. Health determinants Health Services Health Status Conclusions. Gaza Strip. Beit Hanoun 2003. Beit Hanoun 2008. Erez Crossing Point. 3 nautical miles

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Health in Gaza Current Situation and Future Challenges

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  1. Occupied Palestinian Territory Health in Gaza Current Situation and Future Challenges Mahmoud Daher Head of Gaza sub-office

  2. Health determinants • Health Services • Health Status • Conclusions

  3. Gaza Strip BeitHanoun 2003 BeitHanoun 2008 Erez Crossing Point 3 nautical miles Effective since January 2009 Nahal Oz Crossing Point Karni Crossing Point Source: The Economist High-risk zone: 500- 1/1.5 km 9,000 settlers and 21 settlements 15% of Gaza Strip No go zone - officially: 0-300 meters, in practice: 0-500 meters 200-300 operational tunnels Mostly construction materials Movement and access highly restricted Erez Crossing: 167 (2011) vs 26,000 (2000)people/day 1.6 million (70% refugees) ~4,000 persons km2 54% under 18 85% of fishing areas off-limits, 65,000 affected Tunnels Fence map ARA 35% of agricultural land Rafah Crossing Point Crossings Settlements (pre-2005) chart Sufa Crossing Point Tunnels Sea restrictions Kerem Shalom Crossing Point

  4. Key recent events in the last decade had implications on the health in Gaza • 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…??

  5. The Siege • 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.

  6. Demographic indicators • Population in oPt: 4.42 Million • Population in Gaza Stripmid-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

  7. Socioeconomic Indicators • Unemployment first quarter 2014: 40.8% (38.5% 4thqrt 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”

  8. 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.

  9. Environment/ Water • UNEP report- Environmental assessment of Gaza Strip: • “Underground water supplies in danger of collapse from over-use and contamination • War 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

  10. Health providers • MoH • UNWRA • NGOs • Private

  11. Primary Health care Population/ PHCC Gaza: 11480 West Bank: 4147 Palestine: 5476

  12. Distribution of in-patient beds GS vs Palestine 2012

  13. Total number of hospital beds per 10,000 population • Palestine: 13.5 • Gaza 17.3 • West Bank 12.8 • Jordan: 17 • Egypt: 22 • Lebanon: 36 • Israel: 63 • Increase in MoH beds 2005-2012: • Gaza 60% • West Bank 44% • Av. occupancy rates for MoH hospitals: • Gaza 78% • West Bank 85%

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

  15. 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 11171 • 5949 paid by PNA • 2179 paid by PNA but not working • 5222 paid by de facto authorities

  16. 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

  17. UNDAF thematic area: Health Challenges in this area: • Main health challenges facing Palestine in 21st century are non-communicable diseases • cardiovascular diseases, diabetes, chronic lung disease, cancer, mental disorders Mental hospital ward The United Nations Country Team in the State of Palestine

  18. Mental health • 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.

  19. Some other challenges • Referral and access to outside Gaza health services • Pharmaceutical shortages

  20. 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

  21. Total Number of Monthly Referral in 2011, 2012 and 2013

  22. Referral Cost in 2011, 2012 and 2013 Total cost in Million USD 2011: 44 M 2012 : 40 M 2013: 49 M

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

  24. Shortage in drugs and disposables

  25. 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.

  26. THANK YOU

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