1. Health Status in Palestine

2. Palestine - Demographic
From a health perspective OPt consists of two geographical areas- the West Bank (including East Jerusalem) and the Gaza strip .
The West Bank is an area of about 5,800 Km2 with a population of just over 2 million.
The Gaza is a densely populated area of 360Km2 with a population of a little over 1 million

3. Palestine – Demographic, Cont..
26% of the population of the West Bank are refugees.
65% of Gaza population are refugees.
The Palestinian population are young with nearly 20% being under 5 years old, 47% under 15, and only 5% being over 60 years old.
Average household size is just over 6 .
Population growth 3%.
85% of Palestinians have access to water networks.
34% of Palestinians in the West Bank and 54% in Gaza are connected to sewage networks
Per capita spend on health ( year 2000) US$ 100 ( 6.5% of per capita GDP).

4. Selected Health Indicators1
Indicator
2002
2000
1997 2
Population Growth Rate
3.7% 3%
3.1% 3
Crude Birth Rate
27.2/1000
33.2/1000
34.5/1000 4
Crude Death Rate
3.1/1000 birth
3.2 / 1000 birth
3.5 5
Life Expectancy Rate
71.9
71.8
71.5 6
Infant Mortality Rate
23.3
22.7 /1000 birth 24 7
Maternal Mortality Rate (per 100,000)
13.8 (reported)
37.3 ( reported)
77( Estimated) 8
Total Fertility Rate
4.31
5.58

5. Health Care Services
There are four major health care providers operating in Palestine
Ministry of Health
UNRWA
NGOs
Private sector

6. Health Care Services Distribution of Health Care Facilities by Provider
Government
UNRWA
NGOs& Private
TOTAL
PHC
359 51
185
595
Hospitals 21 1 47 69
H. Beds
2303 58
1895
4256

7. Impact on Health since September 2000
High number of victims
High number of injured
High number of expected disabilities
Lack of access to health services duo to checkpoints and closures.
performance of health providers and quality of services (next slide)
Budget constrains
Implementation of development of health care system affected badly

8. Cont.. Health insurance revenues decreased by 60%
Number of food samples and bacteriological water samples for laboratory tests decreased by 33%
Accumulation of garbage in cites and villages causing severe in both health and environment
The immune response of children for measles vaccine was affected duo to disturbance of cold chain.
Discontinuation of vaccination campaigns duo to prevention of medical teams from reaching villages and remote areas
Decrease vaccination of anti-rabies vaccine for animal bites cases by 17%, hepatitis A cases by 16% , hepatitis B for adults by 23% and anti tetanus vaccination by 35%

9. Cont.. Surveillance of inf. Diseases decreased
Shigelloses outbreak ( 556) was reported in Hebron
50 cases of infectious diseases were unable to visit the central labs. For diagnosis and follow up, 200 patients of hepatitis B &C could not continue follow up
1500 contacts to hepatitis B delayed from receiving immunization on time
Patients with chronic diseases could not receive proper follow up and medication

10. Segregation wall

11. General Effect of the wall
Economic effect- poverty- malnutrition
Stress
Destruction of the health and referral systems
Increased costs
Prevention of patients movement
Prevention of health workers movement
Cutting off communities
Blocking ambulances
Blocking vaccines & medical, supplies
Blocking preventive care
Decline in care for chronic patients
Serious effect on Cancer patients

12. Impact of separation wall
The wall will affect 161,700 dunams which is 2.9% of West Bank land area.
It was estimated that the wall will cause direct harm to at least 210,000 Palestinians residing in 67 villages, towns and cities.
The wall will affect all the life aspects of the Palestinians including Health, Education, Employment, farming and social life.
145 out of 190 Km (stage 1) start operating since July 2003.

13. Implications on the health care system
Creation of 22 vulnerable enclaves (71 clinics) separated from the West Bank.
A change in the geographical distribution of health care facilities.
Isolation of rural communities from urban centers.
Lower quality of health care services.
Reliance on Humanitarian Aid.

14. Complete enclosure 9 pockets of isolated communities.
These communities are served by a total of 36 clinics.
Ramallah enclaves mostly affected.

15. Time of openings