§ 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

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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.

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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”.

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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.

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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

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§ 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:rockenschaubg@who.int2. MahmoudDaher,HeadofGazasub-office,WHOemail:daherm@who.int3. SaraHalimah,TechnicalOfficerHealthCluster&Emergencies,WHOemail:halimahs@who.int4. AbdelnaserSoboh,NationalOfficerHealthClusterGaza,WHOemail:soboha@who.int

HealthCluster

Response

Upcomingactivities