Transcript nex management workshop lac 2012

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.
Gaza
Population
Surface
1.8 million
Population density
360 km2
5000 per
sq. km
Number of women of
reproductive age
425,000
Live births per year
57,800
Live births per month
4,817
Live births per day
Number of currently pregnant
women
160
43,350
C- Section rate
22%
# of deliveries requiring a csection in one month (Max)
723
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.
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.
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.
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”
Data Collection
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
Findings
findings
findings
Shifa Neonate dept.
Findings
Findings
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
Cinderella
Victims in the shadows
Recommendations
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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.