1. Victims in the Shadows, Gaza post-crisis reproductive health assessment IAWG annual meeting 2015, Jordan UNFPA- Palestine Ali Shaar, MD. MSc. Osama Abueita, MPH, BSc.

3. Gaza Population1.8 million Surface360 km2 Population density 5000 per sq. km Number of women of reproductive age425,000 Live births per year57,800 Live births per month4,817 Live births per day160 Number of currently pregnant women43,350 C- Section rate22% # of deliveries requiring a c- section in one month (Max)723

4. Background Massive deterioration of living conditions, impairment of development, decline in the standard of healthcare, due to closures. Crisis hit an overstretched health system; According to MoH, 42% of medications and 60% of medical consumables were at zero stock as of July 2014. Decreased functional ability of a significant proportion of medical equipment critically needed for ICU and surgical departments including obstetrics, gynecology, and radiology.

5. 2014 crisis Third major military operation in 6 years 2008- 2014; 51 days of attack; 2,133 people were killed among them 283 women, 16 were pregnant, more than 11,000 injured. 500,000 people, 28% of Gaza population, were displaced at the peak, 108,000 remained displaced up to now.

6. Context UNFPA as leader of RH Sub-cluster Coordination with Health cluster, WHO, MOH, UNRWA and other major stakeholders. Work during the crisis, availing days of ceasefire Assessment report is integral part of WHO national Health Assessment report.

7. Methodology Triangulated research methodology that combined quantitative and qualitative methods Focus on qualitative research “filed work” …. quantitative data from facility registries, and published literature. To ensure representativeness, we selected different: - health care providers, - levels of care -communities “shelters and hosting families”

8. Data Collection

9. Impact of crisis on health services 17 out of 32 hospitals sustained physical damage 58 out of 97 PHC were damaged 19 physicians, health staff ad paramedics were killed 14 patient transport ambulances were damaged

10. Findings

11. findings

13. Shifa Neonate dept.

14. Findings

17. Findings- GBV More details in special assessment devoted to GBV Crowded shelters and houses at host families Poor environment Lost privacy Deepened poverty changed socio-economic role of male head of household Led to increased violent behaviors

18. Cinderella

19. Victims in the shadows

20. Recommendations There is an urgent need to rehabilitate the health care system in Gaza. Physical rehabilitation of both infrastructure and function is needed not only as an emergency preparedness measure, but also to allow the system cope with and effectively respond to daily and growing needs of the population in Gaza It is recommended that rehabilitation effort is built around the transformational idea of (building back better) taking into consideration infrastructure, equipment and material resources needed to fulfill functions of health care facilities. Rehabilitation health care services needs to take into account the logical and proper continuity of care from community to primary health care and ultimately to hospital in a manner to allow smooth transition of users within the three levels at all times. Immediate action on reaching displaced population with a full package of services is mandatory immediate action as physical and economic barriers to care is widely present. Expansion of existing services within displacement centers and mobile health services to remote areas stand as options for immediate actions. Reproductive health services, psychological support and management of gender-based violence stand as critically needed services at this point of time. Improvement of living conditions at shelters in terms of environment, sufficient supplies for daily life and means for psychological ventilation is critically needed as an immediate action. Provision of adequate food and non-food aid is an urgent need that falls beyond health sector mandate, but is leading to physical and psychological impairment. Further assessment and reach out to displaced people within communities is needed immediately as those fall below the aid and services radar.