Post on 01-Jan-2016
description
transcript
Health in Gaza Current Situation and Future Challenges
Occupied Palestinian Territory
Mahmoud Daher
Head of Gaza sub-office
2 |
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
4 |
WHO-oPt
• 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
5 |
WHO-oPt
• 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
6 |
WHO-oPt
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
7 |
WHO-oPt
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”
8 |
WHO-oPt
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 |
WHO-oPt
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
10 |
WHO-oPt
Health providers
• MoH• UNWRA• NGOs• Private
11 |
WHO-oPt
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
12 |
WHO-oPt
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
13 |
WHO-oPt
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
14 |
WHO-oPt
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
15 |
WHO-oPt
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
16 |
WHO-oPt
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 |
WHO-oPt
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
18 |
WHO-oPt
• 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
19 |
WHO-oPt
Some other challenges
• Referral and access to outside Gaza health services• Pharmaceutical shortages
20 |
WHO-oPt
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 |
WHO-oPt
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
22 |
WHO-oPt
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
23 |
WHO-oPt
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
24 |
WHO-oPt
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
25 |
WHO-oPt
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 |
WHO-oPt
THANK YOU