8 December 2013, Jerusalem - The accumulation of shortages in basic supplies in Gaza is leading to rapid deterioration in the social determinants of health for the population of 1.7 million Palestinians. It is also straining the health system’s ability to continue to provide a good standard of health care. The chronically ill, newborns, transplant recipients, the elderly, persons with disability, emergency patients, and the poor are most vulnerable, but the mental health and public health of the whole population is also at risk from increasing stress and declining services. And with 60 000 births a year, Gaza’s health care needs are growing.
Public health representatives from various Gaza institutions met last week to discuss the decreasing ability of the fragile health infrastructure to cope with critical shortages. With 30% of medicines and 50% of medical disposables out of stock at the Central Drug Store in Gaza, health care providers cannot supply patients with the right kind or amount of medications. Large generators for powering hospitals during 14-hour electricity cuts have frequent breakdowns. One of two generators powering the Gaza European hospital burned out last month. The remaining generators are unreliable and diesel is scarce, expensive and can supply only partial needs, such as the 200 patients in intensive care units. In recent months, government hospitals have reduced non-urgent surgeries by almost half in an effort to conserve fuel and medical supplies for urgent cases.
Government health services are relieved only in part by health services of UNRWA and non-governmental organizations, since the Ministry of Health in Gaza is the sole provider for a number of critical medical interventions such as chemotherapy, haemodialysis, hepatitis treatment, coronary artery bypass grafting and referrals outside of Gaza. Except for a stoppage in life-saving treatments, for example dialysis for patients with kidney disease, the impact on health is largely invisible. It translates as more suffering for the patient, unnecessary complications, lower quality of life and often premature death. For the Ministry of Health and other health providers, health care costs increase when interventions are not timely, accurate and adequate. Shortages of drugs such as those for chemotherapy put greater demand for higher cost referrals outside of the Gaza Strip.
Most recently Gaza residents are suffering from disruption in fuel access, making long electricity blackouts a constant problem for every household and health facility. Power shortages cause a chain reaction of consequences that directly and indirectly affect population health and the health system, as water supplies are curtailed, sewage pumps rendered inoperable, and ground transportation, even for basic public health services such as solid waste removal, becomes less frequent.
The severe and prolonged shortages of fuel, electricity and medicines along with widespread poverty stem from 6 years of tight restrictions into and out of Gaza’s borders for people and goods. Resupply of medicines and disposables has been sporadic due in part to chronic shortages in the main drug warehouse caused by the Palestinian Authority budget deficit. Palestinian Authority resupply of drugs and disposables has been reduced over the past six months to one shipment of US$ 1 million compared to US$ 5 million in the previous half year. Medical donations and medical missions that used to arrive to Gaza from charities in the Arab world have almost halted.
Middle income families can rely on small generators for domestic use --- expensive to operate and often dangerous --- but they are no substitute for direct power. At home, patients, and especially the poor, who depend on portable medical equipment to aid their breathing, heart function, monitoring, home dialysis, and even to supply heat, in the case of infants or elderly patients, are particularly stressed by unstable supply of electricity.
WHO calls for long-term systemic solutions to the chronic humanitarian crisis of shortages, rather than short-term aid which relieves but fails to improve the underlying social determinants of health in Gaza.