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Gaza: One year on

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Dr Sonja van Osch, Merlin's Country Director for the Palestinian Territories, visited Gaza earlier this month and reflects on the situation a year after the military offensive and Merlin's key achievements and challenges.

A high placed UN official visited Gaza after the military offensive in January 2009 and said: "Our humanity is being put to the test. We are failing!" I've visited Gaza almost every month since then, and now, almost a year later, unfortunately this is still the case.

Hundreds of families are still living in shacks covered with plastic sheeting or blankets in the rubble of their homes, struggling to shield themselves from the rain and cold weather in the winter months. Even if they could afford the cement, they aren't able to buy it, because of the block on imports.

And there are severe water shortages, as essential spare parts for water and sanitation equipment are unable to get through.

These water shortages and the stress that people are undergoing on a day-to-day basis, have triggered and aggravated diseases such as diarrhoea and respiratory tract infections and chronic diseases such as hypertension and diabetes.

The ongoing insecurity is also having a devastating effect on people's health. Farmers who live near the Israeli border are being subjected to almost daily incursions and only venture out when it is absolutely necessary. This can mean that they miss vital health appointments.

The last time I visited I saw a farmer who suffers from diabetes. He hadn't been going for his check-ups because of the insecurity near to where he lived. Community nurses, trained by Merlin, were aware of this and regularly paid him a visit. He didn't really understand what the disease was but now, thanks to the nurses, he is managing it well.

The community nurses have played a key role in empowering older people suffering from chronic diseases to lead healthier lives and limit the potential complications of their disease. Nursing teams of 2-5 members reviewed the registers of five clinics in Gaza covering a target population of 17,000 people. They visited the older chronic disease patients in their homes to assess their medical, social and environmental conditions as well as the medicines they were taking. They provided basic health education and helped the patients to be able to monitor their diseases and prevent complications. During a period of three months the teams conducted 821 home visits.

All of the health workers we are working with are extremely motivated to improve the health care available for the people of Gaza, despite the frustrations. For example, it took around four months to import the equipment we needed to set up a blood bank machine. Health workers were calling every day to check the whereabouts of the final bit of equipment. It was eventually installed in October and is now operating 24 hours a day, regardless of any interruptions in the power supply. This is vital, as in the past, every time there was a power cut, blood supplies and specimens were destroyed.

The restriction of staff movement has also been a major challenge, with staff members often not able to reach their patients and not able to attend important training courses. However, we are optimistic about what we are able to achieve in 2010. We will continue our support to the vital blood bank system - providing safe blood and blood products and educating community members about these services.

And in partnership with HelpAge International, Merlin will continue to help strengthen chronic disease management services through the community nursing programme. Empowering patients and their carers will be a key aspect of this work.