Health Inforum News Vol 1, No.18

Welcome to the eighteenth edition of the Health Inforum Newsletter. We hope that the next year might bring Peace and Prosperity to Palestinian People and for all nations.
In our ongoing efforts to provide useful information to the whole of the health community, we continue to welcome any comments or suggestions you might have to help us improve this newsletter.

This newsletter discusses the following items:

1. PRCS Weekly Report on Health Incidents (15-27 December 2002).
2. Health Sector Bi-weekly Report, Number 6 (25 November 2002).
3. Pre-hospital and In-hospital Emergency Medical Services Training.
4. Emergency Room (ER) Nursing Education Assessments.
5. HDIP Directory of Non-Governmental Health Organizations.

Review of the Palestinian Health Sector

The MOH has recently requested support for the review of the Health Sector. Different stakeholders including the European Commission, Italy, WHO, DFID and UNICEF responded to carry out this review with the MOH.

The review aims to analyze major areas of the health sector, to assess the constraints resulting from the Intifada, and to suggest elements for a refocused mid-term strategy.

The Sector Review represents a joint exercise among the main stakeholders in the health sector, under the leadership of the MOH.

The Health Sector review will start officially in January 2003, and is supposed to last for 6 months. A pool of International and National experts and all the major stakeholders will participate in this joint exercise. The health sector review will lead to an Institutional Reform process for the health sector.

PRCS Weekly Report on Health Incidents (15-27 December 2002)

Nablus 21 December 2002 (09:05 pm):

An Israeli Army Personal Carrier (APC) blocked a PRCS ambulance in Azmout while on duty to transport a diabetic patient. The crew was forced out of the ambulance and ordered (at gunpoint) to lie on the road for 40 minutes.

Nablus 20 December 2002 (12:00 pm):

At Howara checkpoint, Israeli soldiers denied access to a PRCS ambulance while on its way to Beta village to transport a woman in labour to a hospital. The ambulance could not reach the woman. While on its way back to Nablus, the ambulance carried a patient (Mohammad Khaled Awad) with cardiac complications, this patient was transported in a private ambulance; however, the Israeli soldiers refused to allow the ambulance access. By the time PRCS crew reached Al Watani hospital, Mohammad lost his life.

Nablus 18 December 2002 (12:30 pm):

At Howara checkpoint, the Israeli army blocked a PRCS ambulance carrying an injured man, shot by Israeli soldiers positioned in one of Ramallah checkpoints. Despite the serious injuries sustained by the patient, Israeli soldiers stopped the ambulance for 1 hour.

Nablus 18 December 2002 (12:45 pm):

On Nablus-Jerusalem road, an Israeli army jeep stopped a PRCS ambulance on a routine dispatch from Yassouf village for 2 hours.

Nablus 18 December 2002 (05:35 pm):

On Nablus-Jerusalem road, an Israeli army vehicle blocked a PRCS ambulance, while en route back from Beta village, for 1 hour.

Jenin 15 December 2002:

Israeli soldiers based at the checkpoint of Shafi Shamron settlement (near Deir Sharaf village), stopped a PRCS ambulance carrying a wounded foreign international from Khalil Suleiman Hospital for 1 hour and half. Israeli soldiers claimed that PRCS was smuggling a foreigner.

Nablus, 26 December (6:15 p.m.)

In the old city area, Israeli soldiers denied access to a PRCS ambulance. The ambulance was on its way to transport an injury case, it was ordered at gunpoint to return back. The ambulance, however, moved to a different location away from where the soldiers were located and stood by for clearance to enter. The PRCS ambulance eventually re-entered the old city and proceeded to evacuate the injured. As the injury case was being prepared for evacuation, a PRCS volunteer was shot at by Israeli gunfire. Within seconds, the injured volunteer, medic and ambulance driver were detained by the Israeli soldiers and forced to walk in front of the soldiers as human shields. The PRCS ambulance team was later released only after they pleaded with the soldiers. The injured volunteer, who sustained a live gunshot wound to the shoulder and the injury case was taken to the hospital for treatment.

Ramallah, 26 December (2:45 a.m.)

At Qalandia checkpoint, Israeli soldiers stopped a PRCS ambulance en route to Tulkarem. The ambulance was transporting three patients. The soldiers confiscated the identity cards of the medics and blocked them for 2 hours.

Health Sector Bi-weekly Report, Number 6 (25 November 2002)

This is the fifth 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.

Highlights from rounds 11 and 12 covering the period from 4/10 to 1/11/02:

  • Decrease in the amount of food consumed: Round 11: 51.3% of households and round 12: 58.1%.

  • Reasons for decrease in food: Increasingly, lack of money is becoming the reason in the West Bank (more than 90% of households), nearly rivaling the percentage in Gaza (100%).

  • Water interruption: Round 11 34% and round 12 31.9% of households; West Bank, 34.3%; Gaza, 61.6%; improvements in amount for drinking and bathing.

  • Borrowing money: Round 11: 47.5% of households and round 12: 52.8%.

  • Selling assets: Round 11 16.3% and round 12: 20.3% of households.

  • Of health facilities seeing acute respiratory infection, 88.2% report increase from a year ago.

  • Improved access to primary care and emergency services.

For more information refer to Health Inforum Web Portal http://hart.itcoop-jer.org

Pre-hospital and In-hospital Emergency Medical Services Training


As a result of the deteriorating political environment resulting from the Al-Aqsa Intifada and the increased demand placed on the Palestinian health infrastructure to provide quality emergency care to its citizens, the United States Agency for International Development's Mission to the West Bank and Gaza (USAID/WBG) is funding two important programs in the training of emergency response and medical practices and procedures to laymen and health care providers. The MARAM Project, implemented by IBM, will focus on pre-hospital care while the Emergency Medical Assistance Project (EMAP), implemented by Care International and Johns Hopkins University, will focus on hospital-based care.

A great number of West Bank and Gaza-wide villages and towns have been and still are under tight closures and curfews, leaving citizens many times isolated and restricted in movement. These restrictions have resulted in a decreased accessibility to health services, both for providers and beneficiaries. The difficulty in accessing health care provision and in receiving timely medical attention is many times deemed critical and could be the determining factor of whether a person lives or dies as well as the person's overall long-term quality of life. Time is of the essence and the faster the patient is stabilized and treated, the less severe the consequences of his/her disease or injury are. In cases of cardiac arrest and anaphylactic shock, it is in minutes that the application of advanced life support skills can make a significant difference in the case outcome.


The MARAM project will focus on Pre-Hospital Training aiming at providing and improving skills of laymen, community health workers, nurses, midwives, paramedics and physicians at the community-level. The training will vary according to the audience. For example, laymen and community health workers will be trained to conduct Cardio Pulmonary Resuscitation (CPR) and Basic First Aid, while nurses, midwives, paramedics and physicians will be trained to conduct more medically based interventions. The purpose for including all the various levels of individuals is the fact that emergency medical services is a system with a continuum of services from the first response up to the intervention within the hospital. This continuum of quality emergency care is essential from the moment the symptom appears through the time the patient is moved into the hospital setting and receives definitive care.

EMAP will introduce Emergency Medical Services (EMS) Training for hospital personnel, including physicians, nurses and midwives. This training will introduce best practices in emergency care and the chain of command required to maintain the quality and pace of response needed to save the patient's life. Included in the training are the principles of triage and stabilization in addition to the approach towards the patient and different case management and procedures that are followed in an emergency situation.

Both MARAM and EMAP team members have coordinated closely to identify their respective roles and medical links in order to secure complimentarily and continuity of care.

MARAM will begin their training in February 2003. It is expected that by March 2004, approximately 650 community-based laymen and health care providers will be trained in state of the art first responder and medical stabilization training.

EMAP will begin the "training of trainers" component of their EMS early January 2003. It is expected that by September 2003, approximately 700 hospital-based health care providers will be trained in state of the art EMS techniques.

Emergency Room (ER) Nursing Education Assessments

A component of the Emergency Medical Assistance Project (EMAP), funded by USAID, is the training of emergency room (ER) nurses and physicians at the hospital level. During July 2002 ER nursing assessments were conducted at six hospital facilities in the West Bank and Gaza Strip. The six facilities, Al-Makassed Hospital, Jericho Hospital, Al-Ahli Hospital, Nasser Hospital Khan Younis, European Gaza Hospital, and Al-Shifa Hospital in Gaza City were identified due to the amount of ER patients seen, their ability to train others, and their location.

Executive Summary

All ER nursing departments assessed are very keen on the training for select key ER nurses. The preferred language for training is English with an Arabic medical interpreter on hand. Once the trainers go into the field to train other ER nurses it was suggested that all material be translated into Arabic for reference. It should be noted that the majority of the nurses, in the six ERs sampled, have studied nursing in the English language.

The consensus from nurses is that ER nurses and physicians should receive the same training together. It was noted that many physicians working in the ER were new to the specialty and could learn from the nurses who had an average of at least four years experience in the specialty. Of course the nurses could also learn from the physicians. All Directors of Nursing felt it was extremely crucial to incorporate a team approach into the development and implementation of the curricula. The curricula must be a balance between clinical and classroom experiences.

The morning hours, from (07:00-08:00) to (13:00-14:00), is the best time to conduct trainings in light of the current Al-Aqsa Intifada.

For more information refer to Health Inforum Web Portal http://hart.itcoop-jer.org

New Published by HDIP

A Directory of Non-Governmental Health Organizations

To best utilize health services in Palestine, HDIP issued recently a health directory of all non-governmental health organizations working in the field of rehabilitation, primary health care and counseling including their addresses, telephone numbers, faxes as well as the person responsible for getting further details about these organizations. In addition, organizations that provide home visits and governmental and non-governmental hospitals were added.

A need arouse to issue this health directory from the tightened Israeli closure that paralyzed the freedom of movement of Palestinians. This restriction of movement has included patients whom many of them were prohibited from receiving health services and died on the Israeli military checkpoints. Therefore, HDIP deemed appropriate to issue a health directory that can identify all health centers in the West Bank and Gaza Strip so that people would make best use of the health centers and clinics in their area or the neighboring areas.

This initiative is the first of its kind attempting to organize and classify most significant health services in Palestine since it will facilitate the more efficient use of health services, improve the referral system among various health institutions, inform the public and health providers about the available health facilities. It will help also policy makers in setting up health policies and plans targeting areas that need them most.

To get a copy of the directory or any other publication, please contact mai@hdip.org or call us at (02) 2985372.


Please feel free to contact us for information at:

Health Inforum, c/o the Italian Cooperation
Sheik Jarrah, East Jerusalem
Tel: 02 532 7447
Fax: 02 532 2904
Email: healthinforum@undp.org


Health Inforum posts daily news and announcements concerning health issues on our website: http://hart.itcoop-jer.org.

We welcome your inputs, comments and suggestions.