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OPT Health Sector Bi-weekly Report No. 8

In this issue we will highlight food security, water availability, and issues of service suspension throughout Gaza and West Bank.

This is the eighth Health Sector Bi-weekly Report which describes data that is collected every two weeks in an effort to monitor the impact of the emergency on various aspects of the health sector. CARE/Johns Hopkins University/ANERA, under the Emergency Medical Assistance Project, has partnered with Al Quds University to design and implement a sentinel surveillance system for Palestinian households. The Maram Project has designed and implements a monitoring system for all health service delivery facilities operated by the Palestinian Ministry of Health, UNRWA and Palestinian non-government organizations (NGOs). Both EMAP and Maram are funded through USAID.

Study Design

  • The Sentinel Surveillance System (SSS) is an ongoing survey of 320 randomly sampled households of urban and non-urban clusters every two weeks in all 16 districts of the West Bank and Gaza. Findings presented in this report refer to data reflecting a period between 29 November and 12 December (Round 15) and 13 December through 26 December 2002 (Round 16), as well as cumulative data and trends representing 5,120 households since 17 May 2002.

  • The Monitoring of Health Service Delivery study is linked to the SSS, simultaneously collecting data from all clinics (levels 1-4) and hospitals located in the same clusters as the SSS households. Findings presented here represent cumulative data from 245 health facilities surveyed since 17 May 2002. The number of clinics in a given round varies depending on the number of clinics within a chosen cluster and the density of health facilities within that cluster.


Graph 1 presents the percentage of households with a decrease in food consumed by round. Findings for Round 15 should reflect that the feast of Eid Al-Fitr occurred during this time.

  • During December, 387 of 640 (60.5%) households reported that the amount of food eaten by household members had decreased for more than one day during the previous two weeks; which is a bit higher than during the month of November (57.2%)

  • Households are consuming less in all food groups (Graph 2).

  • Since July, lack of money is increasingly becoming the primary reason cited for the decrease in food consumption in the West Bank (Graph 3). This trend continues through December.

Graph 1: Percentage of households with a decrease in the amount of food in the two weeks prior to the survey, May 17 to December 1, 2002, by round.

n= 320 households in each round

Graph 2: Percentage of households with a decrease in specific groups of food in the two weeks prior to the survey by round.

n= 320 households in each round

Graph 3: Reasons for decreased food consumption, by territory.

n= 320 households in each round

  • In the first half of December (Round 15), 56.3% of households (56.8% WB, 55% GS) and in the latter half of December (Round 16), 58.8% of households (64.1% WB, 47% GS) were forced to borrow money to purchase food during the two week sampling interval;

  • In Round 15, 21.3% of households (18.2% WB, 28% GS) and in Round 16, 25.3% of households (29.1% WB, 17% GS) were forced to sell assets to buy food during the two week sampling interval.

  • Trends in borrowing money and selling assets from each specific round since 17 May 2003 are presented in Graphs 4.

Graph 4: Percentage of households borrowing money and selling assets in the two weeks prior to the survey by round.

n= 320 households in each round

  • During December, water interruption, adequate water for drinking, and adequate water for bathing showed some improvement (Graph 5); since November, water interruption decreased 9.2% in the WB and 3.5% in GS. Total water interruption in West Bank and Gaza combined was 24.4% of households in November and 17.8% of households in December.

Graph 5: Percentage of households with water interruption and decreased water for drinking and bathing by round.

n= 320 households in each round.

As at the household level, water access at the facility level has improved significantly in the West Bank and the Gaza Strip (Graph 6). During the month of December only three of the facilities surveyed, one each in Nablus, Bethlehem and Rafah, reported decreases in access to water - all others reported that their water supplies were the same as usual for that time of year. Causes and impact of water shortages in the three facilities in December were:
  • In Nablus: decreased access to water for staff and patient drinking, clinical service delivery, and housekeeping and sanitation as a result of damage to the facility's water tank;

  • In Bethlehem: decreased access to water for housekeeping and sanitation services as a result of non-delivery of purchased water;

In Rafah: decreased availability of drinking water for staff; the cause of the decreased water supply was unknown.

Graph 6: Facility Access to Water in the West Bank and Gaza (10 week periods)

Health Services:

The access to emergency care and immunization services continues to improve in the last two rounds at the household level. The percentage of households reporting inability to access emergency care when needed dropped from 7.3% of households in November to 3.5% in December and the inability to access immunization services dropped from 3.6% in November to 2.2% in December. Although in the Gaza Strip, health facilities have not reported suspending services since May of 2002, in the West Bank at least one of the facilities surveyed reported suspending at least one of their services for most of the last half of 2003 (11 out of 15 rounds). The number of facilities that have been affected has decreased since late July, as shown in Graphs 7 and 8 below, despite numerous on-going constraints and challenges to provision of care occurring in some Districts of the West Bank.

Graph 7: Service suspension reported by facilities in the West Bank and the Gaza Strip, by round

Graph 8: West Bank facilities having suspended at least one of provided service for at least two days, and those facilities with no suspension of services, by round


The graphs above represent suspension of any or all services offered, ranging from primary care to specialty services and radiology and laboratory services. Of all types of services, however, referral services have been particularly disrupted. Since late September of 2002 (six 2-week reporting periods):

- At least 4 of the facilities surveyed in each round of data collection (between 35-45% of any given round) indicated disruptions in referral services;

- 100% of the 30 facilities in which referrals were affected indicated that curfews, closures and/or impassable roads contributed to the disruptions;

- 19 (63%) of the affected facilities indicated that curfews, closures and/or impassable roads were the only factors contributing to the disruptions (other possible causes include lack of ambulances or lack of essential staff):

- The Districts most effected during that period were:

  • Hebron: 9 (69%) of 13 facilities surveyed;
  • Jenin: 6 (100%) of 6 facilities surveyed; and
  • Tulkarem: 7 (70%) of 10 facilities surveyed.

Bdour Dandies,

Maram Project
Ellen Coates,
Bassam Abu Hammad,

Fuad Ewissat
Johns Hopkins University/CARE
Derek Ehrhardt,
Gregg Greenough,

Al Quds University
Ziad Abdeen,
Mohammad Shahin,

With appreciation to Radwan Qasrawi and the Operations Research Laboratory staff, and data collectors.