Gaza Strip: Health Embargo
December 7, 2010
Since 2007, the date Hamas took over control of the territory, an Israeli-imposed embargo has been weighing heavily on the Gaza Strip. MSF Head of Mission, Jean-Luc LAMBERT, describes the consequences on the humanitarian, medical and health fronts: restrictions on entry and exit of people and goods - including patients and health workers, medicines, medical supplies and fuel - reduction in the provision of care, causing delays in treating patients.
The embargo is hampering the entry and exit of people, both patients and medical staff.
Patients like Mohammed, who cannot be treated in Gaza, have to ask permission from the Israeli authorities to leave Gaza to be treated in Israel, the West Bank, Egypt, Jordan etc. 25% of the 1,200 monthly requests are refused, or granted too late, which is equivalent to a refusal, the medical appointment originally made in the third country then expires and the whole procedure has to start again with no guarantee of a timely, positive response. MSF has also been trying in vain to send patients from Gaza to their reconstructive surgery programme in Amman, Jordan for two years.
Palestinian health workers cannot receive training abroad. But these regular refresher programmes are essential in health care, more than any other sector. As part of our activities, and particularly through our surgical programme, our international staff members are trying to pass on their medical expertise and certain techniques to local teams.
MSF also suffers from travel restrictions: our Palestinian staff based in Jerusalem, cannot be on the ground to lend their medical or technical expertise. Our Palestinian staff in Gaza cannot leave. However, in order to guarantee the best possible quality of care our health staff- especially those who work on our psychological care programme who are very aware of the suffering of patients – need be able to leave on a regular basis in order to unwind and receive training too.
The Embargo restricts the entry of goods, even medical supplies
According to the Office for the Coordination of Humanitarian Affairs (OCHA), 600 lorries per day are needed to supply the Gaza Strip. For the moment there are only 100 to 200 coming in daily.
While essential equipment and drugs are available, more than 100 specialised items are regularly out of stock, things like paediatric cardiac electrodes, some paediatric medications or treatments for anaemia and haemophilia. In 2009, MSF gave €40,000 worth of equipment and drugs to various health facilities to help overcome this.
Around 1,200 amputees, like Jamila, are waiting to receive one or more artificial limbs and have been for months, years even. It is estimated that at the beginning of 2009 over 5,000 people were wounded during Operation “Cast Lead”, as well as following clashes between Palestinian factions. MSF treated 1,9000 patients last year in its postoperative care clinics (dressings and physiotherapy). Its programmes are currently treating some fifty amputees. However, the only prosthesis centre on the Gaza Strip barely meets its needs: staff and specialist supplies are still needed.
Supply disruptions in oil and reduced care provision
Since the Israeli military offensive Operation Cast Lead and also due to lack of cooperation between the ministries in Ramallah and Gaza, production at Gaza’s sole electric power plant is still restricted because of a lack of fuel supplies. Power-cuts occur daily and can last up to 8 to 12 hours. The people manage as best they can using generators, black-market gas cylinders, candles, and oil lamps, etc., which are all potentially sources of serious accidents whose victims are often children like Zainab.
Without fuel to run their own generators, hospitals and health centres are sometimes forced to reduce their health care provision. Last April, MSF supplied 17,000 litres of fuel to the second hospital on the Gaza Strip, which was short of fuel and was forced to close some of these services as a precautionary measure.
Delay in treating patients
In 2009, in our postoperative care clinics, we found that the number of burn victims, victims of domestic accidents or direct victims of the conflict, had markedly increased. The surgery waiting list at Gaza hospital is very long: over 500 people have to wait between 12 and 18 months to be operated on. In early August 2010, in cooperation with the Nasser hospital and its staff, MSF opened a programme for reconstructive surgery, which aims to reduce this waiting list and help restore patients’ functional abilities more quickly, and facilitate maximum independence. In two months, MSF has carried out 185 consultations and 51 surgical operations.
Slow, continuous deterioration in the supply and quality of care
The main consequence of the embargo on the humanitarian, health and medical situation in the Gaza strip is a slow, but gradual and continuous deterioration in the supply and quality of care
1.5 million Gaza Strip inhabitants are trapped on this piece of land locked between the sea and borders. Currently, between 75% and 80% of the population is totally dependant on international aid. Because of the embargo, nearly 50% of the population is unemployed. Living conditions in Gaza are pathogenic. The psychological impact is obvious. Every year, through its psychological care programme, MSF take in charge 400 patients and gives on average 4,000 consultations. But according to the World Health Organization (WHO), there are between 20 and 50,000 inhabitants on the Gaza strip who suffer from serious psychological disorders.