§ Thecontinued18to20-hourpowercutsareplacinganincreasingburdenonhealthfacilitiesinGaza.WithfundingfromtheCentralEmergencyReliefFundandotherdonors,life-savingserviceshavebeenmaintained.However,thesefundsareonlyenoughtosustainthehealthservicesuntilendofFebruary2018.
§ Theelectricityfluctuationsareresultingindamagedmedicalequipment,withover150medicalmachinescurrentlyoutoforder.Theelectricitycrisisisalsoimpactingtheabilitytocollect,storeandtransportbloodatacceptablestandards.
§ Outofthe516medicationsontheessentialdruglist,223drugitems(43%)wereatzerostocklevelsinNovember,outofwhich198drugitemsarecompletelydepleted.Drugsusedintheemergencydepartmentsandintensivecareunitswereat48%zerostockattheendofNovember.
§ InOctober,45%ofpatientapplicationstoaccesshealthcareoutsideofGazawereunsuccessful.2017islikelytoseethelowestapprovalrateforpatientapplicationstoexitGazasinceWHObegandocumentingthisin2006,withanaverageofonly54%ofpatientapplicationsacceptedfromJanuarytoOctober2017.
§ WHOiscurrentlyprocuringover$1millionUSDworthofmedicalequipmentandover$1.2million
USDworthofdrugsanddisposables,withaspecificfocusondrugsusedinemergencydepartments,intensivecareunitsandoperationaltheatres.
HEALTHSECTOR
57 WHOSTAFF56 HEALTHCLUSTERPARTNERS
$26M HEALTHCLUSTERFUNDINGFOREMERGENCYRESPONSEIN2017 80% WHOEMERGENCY
46% HEALTHCLUSTEREMERGENCYRESPONSE
FUNDINGREQUIREMENTSFOR2018 $5M WHO
$26M HEALTHCLUSTERFUNDINGRECEIVEDFOREMERGENCYRESPONSEIN2018
0% WHOEMERGENCY
0% HEALTHCLUSTEREMERGENCYRESPONSE
PRIORITYHEALTHFACILITIESAFFECTED 30 HOSPITALS
71 PRIMARYHEALTHCARECLINICS
1 CENTRALBLOODBANK
PATIENTACCESSOUTSIDEOFGAZAINOCTOBER 1661 NO.OFFINANCIALAPPROVALS
55% %APPROVEDEXITFROMEREZ
45% %DENIEDORDELAYEDEXITFROMEREZ
WHO Special Situation Report
Mosul Crisis, Iraq
34% DISPOSABLES
AT ZERO STOCK
2 MILLION PEOPLE
AFFECTED
Highlights
WHO Special Situation Report Gaza, occupied Palestinian territory October to November 2017
36 HEALTH FACILITIES
43% DRUGS AT ZERO STOCK
45% PATIENTS
DENIED OR DELAYED
0 %
Impactoftheelectricitycrisisonhealth
• The health sector in Gaza is facing a severe fuel and electricity crisis since April 2017. Funding
releasedfromthehumanitariancommunity,mostrecentlyfromtheCentralEmergencyReliefFund(CERF) in September, has helped to sustain the life-saving services. This has directly reduced themortalityriskof452new-borns,400intensivecarepatientsand658patientsrequiringhemodialysistwiceorthreetimesaweek.
• Currently, the hospitals are using approximately 500,000 litres of fuel every month to runemergencygenerators to sustain critical services. Thedonationswill onlybeenough to cover thehospitalneedsuntiltheendofFebruary2018.
• Key services such as elective surgery, sterilisation and diagnostic services areworking at reducedcapacity.Sincethebeginningof2017,WHOhasbeenfollowingthewaitinglistforelectivesurgery1.Noticeably, the waiting period for elective surgery drastically increased to 56 weeks in July andAugust; this coincidedwith the lowest point ofmain electricity supply from the grid, at only 2-4hoursperday.
• In November, the waiting time for elective surgery was 42 weeks. Whilst there has been someimprovement,thisisstillwellbeyondtheMinistryofHealth(MoH)thresholdof24weeks.Delaysofnecessarysurgicalinterventionsmayinvolveaprolongedperiodofdecreasedhealthandaffectsthepsychological and social life of the patient. In some cases, this can lead to further medicalcomplications.Figure1belowshowsthetrendinthewaitingperiodforpatients.
• Theextendedpowercutsmeanthathospitalsrelyongenerators,whicharebecomingincreasinglyoverused. The more generators are used, the more quickly they will degrade and need to berepairedorreplaced.Currently,sixadditionalgeneratorsareneededinordertosustainthehealthservices.
1WHOhasbeenmonitoringthewaitingtimeforelectivesurgeryinENT(ear,noseandthroatsurgery)asakeyindicator
SituationUpdate
2024
32
4044
48
56 56
48
40 42
0
10
20
30
40
50
60
Jan Feb March April May June July Aug Sept Oct Nov
Numbe
rofw
eeks
Monthsin2017
WA IT INGP ERIODFORE L ECT IVE SURGERY
Waitingtime forelectivesurgerymeasured inweeks
Acceptablethresholdof24weeks
Figure1
• Theheavyuseofgeneratorshasincreasedthemaintenancerequired,whichisdifficulttoprovide,assparepartsareonthe‘dual-uselist’2andrestrictedfromentrytoGaza.AccordingtotheMoH,inadditiontotheon-goingsupportprovidedbytheICRC,afurther$100,000USDisrequiredtorepairgeneratorsthathavestoppedfunctioning.
• Essential life-savingmedicalequipmenthasstoppedfunctioningduetotheconstantfluctuation in
thecurrentofelectricity.WhilstWHOisintheprocessofreplacingkeymedicalequipmentdamagedbytheelectricitycrisis,anadditional150essentialmedicalmachinesarecurrentlyoutoforderandawaitingrepairorreplacement.
• Bloodcollection,storageandtransportationisalsoaffectedbytheunstableelectricity.Bloodisusedto treat anumberofmedical conditions includingblooddisorders. It is alsoessential for surgery,suchascardiacandemergencysurgery;andsometimesitisusedtotreatbloodlossafterchildbirth.However,theelectricitysituationhashadadirectimpactontheabilitytostorehigherquantitiesofdonatedbloodatacceptablestandards.Thisposesasevererisk,particularlyifthereisahighinfluxofcasualties.InGaza,35-40,000unitsofbloodareneededannually,howeverduringperiodsofhighcasualties,theneedsincreaseby20%,whichcurrentlycannotbemet.
2Israelrestrictstheentryofalargenumberofmaterials,particularlymachineryandrelatedequipment,onthegroundsthattheseservedual-purposes(i.e.civilianandmilitary)andaremisusedbytheHamasauthoritiesandarmedgroupsinGaza.Assuch,everyimportofagoodormaterialonthedual-uselistmustbeindividuallyapprovedbytherelevantIsraeliauthorities.
DrShireenAbed,consultantneonatologistandheadoftheNeonatalDepartmentinGaza,explainsthatononeoccasion,duringanightshiftat10:00pm,thepowersuddenlywentandthebackupgeneratorsystemdidnotstartworking.Hercolleague,DrJadallahdescribesitas“oneofthemostdevastatingtimesever…wewererushingbetweenthebabiesandalternatingmanualventilationtotakeovertheventilatingequipmentforabout8minutes.Wewereafraidtolosethem”.
Photoright:oneoftheneonatesinneedofventilationandaffectedbytheelectricityshortagesinGaza.
Prepositioningsufficientquantitiesofbloodisbecomingincreasinglydifficultwiththeelectricitycrisis.
WHO’semergencyteammeetwiththeheadoftheCentralBloodBankUnitinGaza.
• Thelackofelectricityhasagraveimpactonthesupplyofsafedrinkingwaterandonthetreatment
and management of sewage. 72 water wells operating in Gaza are dependent on electricity tosupplysafedrinkingwater,asare10wastepumpstations.However,withoutelectricitytosustaintheseservices,300,000cubicmetersofpoorlytreatedsewageisbeingdirectlydischargedeverydayintotheseaanddrinkingwaterisonlyaccessibleforupto5hoursper-day.Asaresult,thereisanincreasedriskofwaterbornediseases,includingacutediarrhoeaandparasiteinfections.
• WHOhasbeenmonitoringtheprevalenceofdiarrhoealdiseaseamongstchildrenlessthan3yearsof age3. The prevalence of diarrhoea is significantly lower overall in 2017 compared to 2016 and2015,however therewasanoticeable increase in thenumberofdiarrhealcases in Juneand July,when the electricity decreased to only 2-4 hours per day. Figure 2 illustrates the prevalence ofdiarrhealdiseasesamongstchildrencomparedtothesamemonthsin2016and2017.
3MethodofcollectioninvolvespassiverecordingofcasesatthehospitalandprimaryhealthcarelevelforMOH,UNRWAandNGOfacilitiesacrossthewholeoftheGazaStrip.
2000
3000
4000
5000
6000
Jan Feb Mar Apr May Jun July Aug Sep Oct Nov Dec
Num
bero
fcases
Month
Numberofcasesofdiarrheaoldiseaseamongchildrenunder3
2015 2016 2017
SituationUpdate
Figure2
Source:OCHA
Shortagesindrugsanddisposables§ The Central Drugs Store inGaza supplies all 14MoHhospitals (2,243 beds) and 49MoHprimary
healthcareclinicsinGaza.Thesehealthfacilitiesprovide40%ofGaza’sprimaryhealthcarecoveringapproximately600,000peopleand90%ofallhospitalcareservices.
§ Onthe9thNovember,theMinistryofHealth(MoH)releaseddrugsfromtheMoHwarehouseintheWestBanktoGaza’sCentralDrugsStore.Thisshipmentincludedatotalof160essentialdrugsand204essentialmedicaldisposablesitems,inadditiontootheritemsrelatedtolaboratoryservices.
§ InOctober,outoftheessential516drugsontheessentialdrugslist,230drugs(45%)wereatzero
stock4.AfterthebulkdeliveryfromtheMoHinNovember,thisdecreasedto223drugs(43%)atzerostock.However,thenumberofcompletelydepleteddrugscontinuedtosteadilyincreasefrom191drugs out of the 516 essential drugs (37%) inOctober to 198 drugs (38%) inNovember. Figure 3illutrates the number of essential drugs at zero stock and completely depleted since the start of2017inGaza.
4 "Zerolevelstock"designatescriticalsuppliesthatwillbetotallydepletedinlessthanonemonthattheCentralDrugStore(CDS).
SituationUpdate
Impact of the electricity cuts onmental health patients: Dr. Sami Awedeah, the only childpsychiatrist in Gaza, explains how the electricity crisis has impacted mental health: “Aspsychiatrists, we can see that the electricity situation is provoking patients, worsening theirsymptoms and delaying their recovery. Many people suffering from depression or post-traumaticstressdisorder(PTSD)finditdifficulttosleepincompletedarkness. Ittriggersdeepanxiety and this can have a knock-on impact on their health. There are some patients,particularlythosesufferingfromObsessive–compulsivedisorder(OCD),whoneedtowashtheirhandsexcessively.Butwithoutelectricity,theyhavenoaccesstowater.Thismeansthatbasicactivities, such as washing hands and flushing the toilet is not possible. As a result, OCDpatientsaresufferingextremerelapses”.
175 175
145
170177
184 183
204 210
230223
128
156
125 128
148161 164
180 186 191198
0
50
100
150
200
250
Jan Feb Mar Apr May Jun Jul Aug Sep Oct NovNumbero
fdrugsoutoftheessentia
ldrugslist
2017
DRUGS AT Z ERO S TOCKANDDRUGSCOMPLETELYDEPLETED ATTHE CENTRALDRUGSS TOREIN GAZA
Availableatzerostock(lessthanfourweekssupply) Completelydepleted
Figure3
§ AnumberofkeyhealthservicesbenefitedfromtheMoHdelivery:
o Primaryhealthcaredrugsatzerostockdecreasedfrom71%to63%o Cancerdrugsatzerostockdecreasedfrom43%to37%o Kidneydialysisdrugsatzerostockdecreasedfrom6%to4%o Ophthalmologydrugsatzerostockdecreasedfrom10%to9%o X-rayanddiagnosticimagingdrugsremainedat3%zerostock
• However,someofthemostcriticallyvulnerablepatientsremainwithoutdrugs,evenaftertheMoH
delivery:o Drugsforemergencydepartmentsandtheintensivecareunitswereat46%zerostockin
Octoberandincreasedto48%inNovembero Essentialdrugsformentalhealthpatientswereat14%zerostockinOctoberandincreased
to17%inNovembero Essentialdrugsforblooddisorderswereat26%zerostockinOctoberandincreasedto27%
inNovember
Shortagesindisposables§ Thereare853itemsontheessentialmedicaldisposableslistconsideredbythePalestinianMoHas
necessaryfortheprovisionofessentialhealthcare.Disposablesincludeawidevarietyofessentialitemssuchassyringes,linetubes,filtersfordialysisanddressingmaterials.
§ In October, out of the 853medical disposables on the essential disposables list, 260 (30%)werereported at zero stock levels in the CDS in Gaza; in November 231 (27%) were reported at zerostock.Figure4belowillustratesthelevelofessentialdisposablesatzerostocksincethestartoftheyear.
253
280
249267 270 271
293 291282
260
231
0
50
100
150
200
250
300
350
Jan Feb Mar Apr May Jun Jul Aug September October November
Numbero
fdisp
osableso
utoftheessentia
ldisp
osableslist
2017
D IS POSABLESATZ ERO S TOCKAT THECENTRALDRUGSS TOREIN GAZA
Availableatzerostock(lessthanfourweekssupply)
Figure4
AccesstopatientsreferredoutsideofGaza § Eachmonth,patients intheGazaStriparereferredtohospitalsoutsideofGaza inordertoaccess
necessary, often life-saving medical services that are unavailable locally. Before applying for anIsraelipermittoexitGazafromErez,patientsmustfirstobtainapprovalfromthePalestinianMoHforadecisionregardingsupport.Ifthereferralisgranted,thisimpliesMoHwillcoverthecostofthepatient’streatmentatthefacilitytheyhavebeenreferredto.
§ In themonth of October, a total of 1661referralswereapprovedbytheMoH.Thenumber of referrals approved in Octoberstill represents less than 80% of theaverage monthly referrals of the firstquarterof2017.Furthermore,onlyathird(33%) of application are being processedwithinoneweek,whereasfromJanuarytoMay 2017, 99% of the applications wereprocessed within one week. Figure 5illustrates the financial approvals ofmedicalreferrals.
§ AllpatientswithapprovalfromtheMoH,mustthenapplyforapermitfromtheIsraeliauthoritiesto leave Gaza from Erez crossing. In October, 45% of patient applications to access health careoutside of Gaza were unsuccessful. 2017 is on track to see the lowest approval rate for patientapplicationstoexitGazasinceWHObegandocumentingthisin2006,withanaverageofonly53.7%ofpatientapplicationsacceptedfromJanuarytoOctober2017.Figure6illustratesthetrend.
Figure5
Figure6
47% 60% 55%58% 47% 50% 57% 55% 55% 55%
4%3% 4%
3% 2%1%
2% 3% 3% 2%
50%37%
42%
39%51%
49% 40% 42% 42%43%
2792
2391
2626
1980
2282
1920 1847 1883 18582017
Jan Feb March April May June July Aug Sept Oct
Trendintotalnumberofpatientpermitapplications,approved,deniedanddelayedin2017
Approved Denied Delayed
Figure6
2320
1937
2190
1756
1484
477
1300 12971077
1661
0
500
1000
1500
2000
2500
Jan Feb March April May June July Aug Sept Oct
Num
bero
ffinancialapp
rovals
Monthin2017
NUMBEROFMONTHLYFINANCIALAPPROVALSIN 2017
§ Thereasonsforreferralinclude:lackofmedicalequipment(37%),lackofneededdrugs(23%),lackofdiagnosticservice(14%),andlackofmulti-disciplinarycareandskilledstaff(16%)
§ Provisionoflife-savingdrugs,disposables,medicalequipmentandgeneratorsforhealthfacilities§ Provisionofsparepartsforgeneratorsandmedicalequipment§ Equiphospitalsandhealthfacilitieswithfuelorsolarenergysystemunitsinordertomeetthebasic
energyrequirements§ Provisionofresourcestosupportthecollection,storageandtransportofbloodacrosstheGazaStrip§ BuildlocalcapacitywithinGazatoconductlifesavingsurgeriesandtreatment,inordertoreducethe
needforreferralsoutside§ Preposition drugs, disposables and medical equipment in order to strengthen emergency
preparedness§ EnhancecoordinationandhealthinformationamongstkeyemergencyplayerswithinGazaandwith
WestBankcounterparts§ Ensureaccessforpatientstotheirreferraldestinationandadvocatefortherighttohealth
§ WHOisprocuringover$1millionUSDworthofmedicalequipmenttoreplacesomeofthelife-saving
machinesinGaza’shospitals§ WHOisdisseminatingemergencylife-savingdrugstoGaza’shospitalsworthover$1.2millionUSD.
Thesedrugswillbedistributedtotheemergencydepartmentstoservesomeofthemostvulnerablepatients
§ $362,000USDwas released fromWHO’sheadquarters to respond tourgenthealthneeds,mainlythrough supplying fuel to sustain critical services in hospitals. The fuel distributed was used tosustainkeyemergencydepartmentsforaperiodoffourweeks
§ WHOhas requested $5million as part of theHumanitarianResponse Plan (HRP) for 2018,whichincludeshumanitariansupporttoaddressnon-communicablediseases,inadditiontoinstallationofsolarpanels,andpre-positioninganddisseminatinglifesavingmedicalsupplies.Todate,nofundingforWHO’sHRPrequesthasbeenreceived
§ WHOreleasedmonthlyupdatesontheaccesstohealthcareforpatientsbeingreferredoutsideofGazaandismonitoringandreportingattacksonhealthcare
§ InOctober,WHOsupportedaDisasterManagementConference.WHOas theCluster leadagencyalsoconductedsessionsduringtheConferenceoncoordinationandemergencymanagement
§ WHO mobilized Norway funded emergency health supplies (three Surgical Supply Kits, andpharmaceutical supplies from two Inter-Agency Emergency Health Kits); two Inter-AgencyEmergencyHealthKitswerereceivedasin-kinddonationfromtheSwissDevelopmentCooperation
§ WHOhasenhancedthehealthmonitoringinGazawiththeaimtorapidlyandcontinuouslyassess,mapandmonitorhealthserviceavailability,responsereadinessandthehealthimpact
§ WHOinitiatedanumberofkeyhealthassessments,includingmalnutritioninAreaC,andontheuseofillicitdrugsinGazaandtheWestBank.
Healthneeds&priorities
WHOResponse
§ WHO, as Health Cluster lead agency, coordinatedwith Health Cluster partners the Humanitarian
ProgrammeCyclefor2018-2020,anddevelopedtheHumanitarianNeedsOverview(HNO)andtheHumanitarianResponsePlan(HRP)forthehealthsector.Atotalof$26millionUSDisrequestedtorespondtothehumanitarianhealthneeds.
§ In October, the Health Cluster trained a cohort of 20 health staff and managers from key NGOpartnersandinternationalorganisationsonanalysingthedisruptiontothehealthsector.
§ TheHealthClusterhasestablishedaHealthEmergencyTechnicalWorkingGroup,comprisingofkeyemergencypartnersincluding,WHOastheHealthClusterleadagency,UNICEF,MAP-UK,MedecinsDuMonde,UNRWA,UNFPAandtheMoH.TheobjectiveoftheHealthEmergencyTechnicalWorkingGroup is to enhance emergency response planning, preparedness, and technical capabilities torespondtothecrisis.
§ ICRC is continuing tosupport themaintenanceofgeneratorsandthesupplyof spareparts to theMoHanddeliveredsuppliesofreproductivehealthdrugs.
§ MDMFrancehaveprocuredanddeliveredlargequantitiesof3specificessentialdrugstobeusedintheemergencydepartmentsacrossGaza
§ UNICEF is intheprocessofprepositioning38typesofdrugsanddisposablesworthover$460,000USDandprocuringadditionaldrugsanddisposablesworthover$500,000USD for theemergencyunitsinGaza
§ MAP-UK has implemented 8 blood donation campaigns to enhance the preparedness foremergencies at ShifaHospital; procured and released7 typesof emergencydrugs and3 typesofmedical disposables; conducted one neonatal life support training targeting MoH neonatal andobstetrichealthprofessionals;andsuppliedtheMoHlaboratorieswith3typesof infectioncontrolitems.
§ PalestineMedical Society Relief (PMRS) is supplyingmedication for patients suffering from cysticfibrosisforaperiodofthreemonths
§ Onthe10th-11thandthe13th-14thDecemberWHOwillconducta2-daytrainingcourseonEmergencyMedical Teams in West Bank and Gaza, respectfully. Over 60 participants across the occupiedPalestinianterritorywillbetrained.
Contacts:1. GeraldRockenschaub,HeadofoPt,WHOemail:[email protected]. MahmoudDaher,HeadofGazasub-office,WHOemail:[email protected]. SaraHalimah,TechnicalOfficerHealthCluster&Emergencies,WHOemail:[email protected]. AbdelnaserSoboh,NationalOfficerHealthClusterGaza,WHOemail:[email protected]
HealthCluster
Response
Upcomingactivities