On one-year anniversary of “Great March of Return”, MAP warns urgent international action needed to protect lives

On the one-year anniversary of the “Great March of Return” demonstrations, Medical Aid for Palestinians (MAP) warns that urgent international action is needed to protect lives and prevent the further collapse of Gaza’s health system.

One year ago, Friday 30 March 2018, the “Great March of Return” began in Gaza. Initially intended to last for six weeks, but continuing today, this series of widespread civil society-organised demonstrations in Gaza demands the realisation of Palestinians’ rights, including the return for Palestinian refugees displaced between 1947-9 and the lifting of Israel’s unlawful closure.

Ahead of the first day of the protests, Israeli security forces positioned more than 100 snipers on the perimeter fence with Gaza. That day alone 15 Palestinians were killed and 1,416 injured.

Since then, Israel’s shocking – and often lethal – use of force against protestors has continued. Over the past year, over 260 Palestinians have been killed and more than 29,000 injured. More than 7,000 people have been shot with live ammunition, causing devastating injuries, particularly to lower limbs. Among the casualties have been medical first-responders. Three health workers have been killed and more than 600 injured by Israeli forces while working to save lives in Gaza. MAP celebrates the steadfastness and resolve of Gaza’s medics and is outraged that their safety has been endangered as they carry out their vital humanitarian functions.

Injured protestors in Gaza have entered a health system that the World Health Organization described as being “on the brink of collapse” even before the protests began, beset by shortages of vital medicines and equipment, as well as electricity and fuel to keep hospital generators running.

MAP has been working to support the development of local services to treat complex limb injuries in Gaza since 2013. When the protests began last year, MAP was one of the first organisations to respond, and has provided essential medical supplies including out-of-stock medicines, disposables and over £1 million of equipment for orthopaedic surgery. Along with our partners IDEALS, we have sent seven missions of expert surgeons and rehabilitation specialists from the UK to Gaza to help treat the wounded and train local teams. In 2018, these local and international teams undertook more than 100 surgeries to repair some of the most severe injuries and supported more than 540 patients with complex limb injuries in outpatient clinics.

The past year has been devastating for people’s lives and healthcare in Gaza. The mass casualties have occurred in the context of a health system that was already buckling under the pressure of 12 years of illegal closure and decades of de-development,” said MAP CEO Aimee Shalan.

In light of the deterioration of the security situation in Gaza this week and the mass demonstration expected on Saturday to mark the one-year anniversary of the “Great March of Return”, MAP is gravely concerned for the safety of civilians in Gaza. In preparation, our team in Gaza has released 21 essential medicines, 16 disposables, and 3 blood bank items worth over £27,000 to Gaza’s hospitals. We will be monitoring the situation carefully over the weekend’s anniversary protests and respond accordingly.

The independent Commission of Inquiry established to investigate the protests found an “enormous burden of injuries from the protests” and outlined how this has affected healthcare for all people in Gaza:

“Hospitals were forced to divert resources away from ordinary medical needs, such as cancer treatment, obstetrics and routine operations … Approximately 8,000 elective surgeries were cancelled or postponed, resulting in a backlog that will take years to address.”

The Commission found that “the use of live ammunition by Israeli security forces against demonstrators was unlawful” in all the cases it investigated – 189 fatalities and over 300 of the 23,000 injuries in 2018 – with the possible exception of two incidents. It described the occupied Palestinian territory as “one of the most dangerous places in the world to be a health worker” and found “reasonable grounds to believe that Israeli snipers intentionally shot health workers, despite seeing that they were clearly marked as such.” MAP continues to call on the international community urgently step up its support to Gaza to prevent the total collapse of the healthcare system, and ensure that aid spending is matched by political action to address the root causes of these needs.

MAP is doing all it can to support the provision of vital medical care, but the international community cannot shirk its own responsibility to the people of Gaza,” said Aimee Shalan. “The UK and other influential states must not only take action to address humanitarian needs, but also ensure international law is adhered to and meaningful steps are taken to protect civilians’ lives.”

“The situation in Gaza is fuelled by impunity, which is something that is within the international community’s power to put right.”

(Source / 30.03.2019) 

MAP gravely concerned by dangerous escalation in Gaza

Update [12pm, Wednesday 14 November]: Since this article was published a ceasefire has been agreed. Our team in Gaza reports that it is holding. 

Medical Aid for Palestinians (MAP) is gravely concerned by the dangerous escalation in Gaza this week and is monitoring the situation closely.

According to the Palestinian Ministry of Health, six Palestinians were killed on Monday night and at least 20 others injured from Israeli airstrikes on Gaza. On Tuesday afternoon another Palestinian was killed and at least three others were injured from Israeli airstrikes.

A Palestinian resident of Halhoul in the occupied West Bank, working inside Israel, was also killed and 70 Israelis injured by rockets fired from Gaza.

It has been another day and night very similar to those of the 2014 attacks on Gaza. The airstrikes continued from 4.30pm Monday afternoon till Tuesday morning. A number of buildings in residential areas were targeted at very short notice.” Fikr Shalltoot, MAP’s Director of Programmes in Gaza

It is reported that Israeli forces targeted and demolished three residential buildings in Gaza, home to three Palestinian families, and five commercial buildings, including Al Amal hotel in Gaza City, 100m from MAP’s office.

Dr. Adnan Al Wahaidi, the Director of Ard El Insan, a local NGO MAP partners with in Gaza to challenge child malnutrition, lost his home in one of the destroyed residential buildings.

In interviews with Al Wattan and Al Jazeera, Dr. Adnan indicated that the building was residential, inhabited by families of doctors, lawyers, and university teachers.

Fikr Shalltoot said Tuesday afternoon that the situation was still very tense though the airstrikes were less intensive than during the night.

The Ministry of Health declared a state of emergency in Gaza.

MAP is in close contact with partners on the ground and is ready to respond should the situation escalate further.

MAP hopes for a swift de-escalation and return to calm.

(Source / 15.11.2018)

Watch: UK medics travel to Gaza to improve breast cancer care

October is Breast Cancer Awareness Month, an annual worldwide campaign to raise understanding of the importance of breast cancer treatment, education and research. Across the occupied Palestinian territory, Medical Aid for Palestinians (MAP) is working to improve breast cancer care and supports multi-disciplinary teams of UK specialist oncologists, surgeons, nurses, and radiologists to make regular visits to Gaza and the West Bank.

Last month, a MAP-supported breast cancer mission travelled to Gaza. The team comprised of Dr Ashwini Sharma, Consultant Radiologist, and Dr Gerard O’Hare, Oncology Clinical Nurse Specialist. Based at three hospitals, Al Shifa, Rantisi and the Gaza European, they delivered training to local health workers caring for women affected by the disease, teaching them new techniques to improve outcomes and quality of life for breast cancer patients.

Living in Gaza presents many barriers to breast cancer care. A woman treated by the breast cancer mission, Suhair Jaber, told MAP:

I hoped I would get the cancer removed as soon as I was diagnosed. If only things were available here, for example, if it were easy to get a medical transfer permit, or find the medicine, it would have been so much easier on me. But it is difficult to find your medicines, or travel for medical treatment. There are a lot of things we do not have here in Gaza due to the occupation.

One of the medics trained by the UK specialists, Ibrahim Zaqout, Head Nurse at the Tumour Clinic in Rantisi Hospital, outlined how shortages of cancer drugs undermine the treatment of breast cancer patients.

“A patient would start with a specific treatment, then this treatment is no longer available in Gaza, and after three to four months, the treatment becomes available again. This results in deepening the crisis, as the cancer cells become resistant to the treatment. This would require a change to another treatment protocol, and then the patient goes into another crisis similar to the one before.”

Writing on the week’s training Dr O’Hare said:

I would like to thank the fundraisers who have enabled this project to happen who recognise the fact that cancer is a serious public health issue in Palestine. It has a devastating effect on patients and their families. And there is hardly a family in Palestine that has not been affected by cancer. I hope that in the future the small changes that this project bring, make a significant improvement for some of the patients who are diagnosed with cancer.

(Source / 19.10.2018)

Improving care for Palestinian burns patients

Burns injuries are a prevalent health risk for Palestinians in the West Bank. Whether caused by industrial accidents, house fires or even arson attacks by settlers, they can cause extreme pain and have serious lifelong effects.

Medical Aid for Palestinians (MAP) has long recognised these risks and helped, in partnership with the International Medical Education Trust 2000, to establish the first dedicated Burns Units in Palestine in 2009 at Rafidia Hospital in Nablus, in the north of the West Bank.  For almost a decade, this centre has been providing high-quality care to burns patients – including emergency treatment and surgery, inpatient care, pain management and physiotherapy.

But for burns patients from elsewhere in the occupied West Bank, living amid a network of checkpoints and roadblocks, it could often take many hours to reach the Burns Unit in the north. Every delay increases the chance of infection, sepsis and other fatal complications, putting the lives and wellbeing of many burns patients at risk.

That is why, working in partnership with the Welfare Association and the Palestinian Ministry of Health (MoH), MAP has also helped to establish a new Burns Unit in Alia Hospital in the city of Hebron, which opened last summer. This new unit makes it much easier for patients in the southern West Bank to access timely, high-quality care with fewer health-endangering delays. The Unit serves a population of about 850,000 Palestinians.

Burns care training for Palestinian surgeons and nurses

The recovery from severe burns injuries can take a long time, and the outcomes for patients depend on both their initial treatment and quality of their long-term care. The roles played by surgeons and nurses in this process is vital, helping to minimise the pain, scarring and long term impact of the injury.

Specialist burns care training, including visits by international, muliti-disciplinary teams, is a key part of MAP’s programme to improve the quality of care received by burns patients.

This summer, working in partnership with Interburns, a global network of burns care professionals, MAP supported a three-day training at Rafidia Hospital for ten surgeons and nurses working at the two West Bank Burns Units.

The training included a wound management workshop, developing the health workers ability to categorise burns injuries according to the depth of tissue damage. They also discussed burn wound pathophysiology (the management required by different types of burns injuries), wound healing processes and how to prevent and control infections. The workshop included a practical element, with the medics practicing to apply various dressings.

The health workers were also trained on scar management, including how to assess scars and what rehabilitation measures are required.

Throughout the training, the medics discussed how they were going to implement and apply the new skills and techniques to improve burns care services at their hospitals.

The participants were enthusiastic about the course, reflecting that programme provided an important foundation in burns care and they looked forward to building this knowledge at further, advanced trainings. “The training was very informative especially that new topics were addressed during the training,” said Hiba Sharawi, a nurse from Alia Hospital.

MAP and Interburns would like to thank the MoH, in particular Dr. Anas Abu Safa and Dr. Walid Zalloum, for their help in facilitating the training. MAP would also like to thank the Interburns team: Tom Potokar, Renate Pfann, and Ioannis Goutos – for their time and energy, helping to develop burn care in Palestine.

(Source / 13.10.2018)

MAP’s Director of Programmes in Gaza speaks at Labour Party Conference

This week, Medical Aid for Palestinians (MAP) was at the Labour Party Conference in Liverpool speaking to Parliamentarians, delegates and the public about the humanitarian emergency in Gaza, and barriers to the right to health of Palestinians living under occupation and as refugees.

MAP’s Director of Programmes in Gaza, Fikr Shalltoot, spoke at Labour Friends of Palestine and the Middle East’s (LFPME) fringe event titled ‘#ExistenceIsResistance – Supporting Palestine’s Next Generation’, chaired by Richard Burden MP, who had the week before been in the West Bank on a delegation with MAP and Caabu.

Alongside Fikr on the panel were Chris Gunness, Spokesperson for UNRWA; Professor Karma Nabulsi, Associate Professor in Politics and International Relations at Oxford University; and Dr. Mezna Qato, Junior Research Fellow in Middle Eastern History at King’s College Cambridge.

Fikr opened by discussing the severe movement restrictions Palestinians in Gaza face. She described her lengthy journey to get to conference, requiring a visa from the UK, a permit to exit Gaza from Israel and a non-objection letter from Jordan to fly out of Amman – a journey which took five days. Fikr stressed that, by being able to travel out of Gaza at all, she was “one of the lucky ones”. She reflected that Israel restricts the exit of all Palestinians from Gaza with few exceptions: business owners with permits, international NGO staff like herself, and urgent medical cases. “Being able to leave at all is rare for people in Gaza, and most young people have never left Gaza at all” she said. Approval of permits for members of these categories is far from guaranteed, however. With 48% of patients’ exit permit applications either denied or not responded to last year, Fikr stressed that restrictions can have serious consequences for those needing urgent medical care outside of Gaza.

Following the event’s focus on the “next generation” in Palestine, Fikr described life for young people in Gaza: “We are two million people, half are under 15 years old. More than two-thirds are refugees, expelled from our former homes and lands in what was Palestine and is now Israel”.

Starting at birth, high rates of maternal malnutrition means babies in Gaza have increased chance of low birthweight. At birth, if babies need intensive care, they will be treated in a hospital running on back-up generator power for up to 20 hours per day. Fuel for these provided by the UN is running out because of lack of funding, and switching from mains to generator power causes fluctuations which can damage equipment.”

While around the world infant mortality has declined, in Gaza deaths among children aged one year or less have not declined since 2006 – covering the period of Israel’s closure.

If a child gets ill and needs to be treated outside of Gaza, assuming they are able to get a permit to exit from the Israeli Authorities, they may have to do so without their mother or father by their side. In August 2018, almost half of all permit applications for patient companions – including parents trying to accompany their children to appointments for treatment in East Jerusalem or elsewhere in the West Bank – were denied or delayed by Israel. “This means that children’s wards in hospitals in East Jerusalem contain children going through scary treatments for diseases, such as cancer, without their parents with them,” said Fikr. “MAP – and some MPs here who have been on delegations with MAP and Caabu to the West Bank – see new-borns and neonate babies from Gaza in intensive care in Al Makassed Hospital separated for weeks and months from their mothers due to lack of a permit from the occupying power”.

Fikr stressed the importance of thinking not only of children’s physical health, but their mental health too. An 11-year-old child in Gaza has witnessed three major Israeli military offensives. In 2015, UNICEF estimated 300,000 Gaza children need psychosocial care:

They will have never experienced a full day of electricity in their lives, and they are unlikely to have ever left the 40km by 12km Strip. They are now growing up in a place where the economy, healthcare, education, water and sanitation infrastructure are all de-developing. Unemployment among youth is 60%. They will see the daily suffering and struggles of their parents, including how serious health conditions deteriorate while Israel does not give them permits to travel to East Jerusalem for treatment. Last year 46 cancer patients died after this. Imagine watching that happen to your mother.”

Fikr also outlined the mass casualties in Gaza as a result of Israeli military’s shocking use of force against demonstrators at the “Great March of Return”, and outlined how MAP is helping Gaza’s health sector to respond to complex limb injuries.

At the event, MAP made three recommendations for the UK Government to support the health of young Palestinians in Gaza were:

  • Contribute to the UN Humanitarian funding appeal for Gaza, including for vital hospital generator fuel;
  • Prioritise sustainable development work through DfID, including skills and opportunities in the health sector; and
  • Call on Israel to lift Gaza’s closure, in line with calls by UN bodies and the ICRC, and in particular lift restrictions on the movement of patients trying to get to treatment and health workers trying to get to training and opportunities in the West Bank, including East Jerusalem.

MAP was also at the LFPME evening reception – see next week’s Monitor – and will have a stall and be hosting a meeting at the Scottish National Party Conference, on 8 October at the SEC in Glasgow (Confronting Gaza’s health emergency, with a focus on breast cancer: Dr Philippa Whitford MP,  with Neil Sammonds, MAP, Boisdale Room 9am).  If you are attending, see you there!

(Source / 29.09.2018)

UN: “Gaza health sector is collapsing” amid international inaction

Amid a deteriorating humanitarian situation in Gaza and massive cuts to aid announced by the US administration, the UN has outlined a significant funding shortfall as it seeks to address immediate humanitarian needs in Gaza and across the occupied Palestinian territory (oPt).

The UN Office of the Coordinator for Humanitarian Affairs (OCHA) has called for international support to respond to casualties arising from Israel’s use of force in the context of the continuing ‘Great March of Return’ protests. Since 30 March, 179 Palestinians (including 29 children) have been killed, the majority during the demonstrations. More than 19,000 Palestinians have been injured, with half of these hospitalised:

“The large number of casualties among unarmed demonstrators who did not pose an imminent threat of life or deadly injury to Israeli soldiers, including a high percentage of demonstrators hit by live ammunition, has raised concerns about the excessive use of force.”

OCHA warn of growing despair in Gaza, with these casualties entering a health system facing chronic challenges:

“Gaza’s health sector is collapsing in the wake of the now 11-year blockade, the deepening intra-Palestinian political divide, the energy crisis, inconsistent and reduced payment of public sector staff, and growing shortages in medicines and disposables.”

With hospitals facing high casualties and dwindling resources, some 8,000 surgeries, including some critical cases, have been postponed. These delays can negatively impact patients’ physical and psychological health and lead to further health complications.

OCHA has appealed for $21 million (£16 million) to fund trauma management and emergency healthcare interventions, including for public hospitals managing high numbers of patients needing complex inpatient care and post-operative rehabilitation.

Of critical concern to Gaza’s health system is the availability of emergency fuel. Chronic electricity shortages have left hospitals and clinics running on back-up generator power for up to 20 hours per day, on fuel provided by the UN. Funding for this has dried up, however, with stocks set to run out within days. OCHA reports:

  • 14 public hospitals are running at reduced capacity in key services including elective surgery, sterilisation and diagnostics;
  • 4,800 patients require access daily to lifesaving or life-sustaining healthcare with a constant supply of electricity
  • 300 of these patients need constant connection to lifesaving medical equipment such as ventilators, dialysis machines, incubators and anaesthetic equipment

OCHA further reports that any disruption or electricity cut puts patients at immediate risk of brain damage or death. Just $4.5 million (£3.4 million) is needed by the UN needed to provide fuel to sustain services until the end of the year.

Gaza’s ‘eviscerated’ economy

Meanwhile, UNCTAD, the UN body responsible for trade, investment and development issues, issued its annual report on the economy of the oPt. In it, the agency warns of accelerating de-development of Gaza, stating that Israel’s 11-year blockade has “eviscerated Gaza’s economy and productive base and reduced the Strip to a humanitarian case of profound aid-dependency.” Gaza’s per-capita income is now 30% lower than the start of the century, and poverty and food insecurity are rife with 80% of people reliant on some form of international aid.

These conditions have a profound effect on the health of Gaza’s population, with UNCTAD reporting that “enduring pressure and deprivation of basic human, social and economic rights inflict heavy toll on Gaza’s psychological, social and cultural fabric as manifested by widespread psychological trauma, post-traumatic stress disorder, desperation, high suicide rates and drug addiction.” According to UN figures, 225,000 children – more than 10% of Gaza’s population – required psychological support in 2017.

The report highlights that international efforts to address the situation have failed to reverse this trend, stating: “Efforts at revival have been feeble and all interventions necessarily focused on reconstruction and humanitarian relief, leaving few resources for development or resuscitating the productive base.”

UNCTAD further outline the action needed to provide sustainable economic recovering in Gaza, including a complete lifting of the blockade; political, fiscal and economic reunification with the West Bank; urgent overcoming of the electricity crisis; and enabling Palestinians to develop offshore natural gas fields.

(Source / 14.09.2018)

UN warns “collapse of critical life-saving services” in Gaza as emergency fuel runs out

This week, the UN Humanitarian Coordinator for the occupied Palestinian territory, Mr. Jamie McGoldrick, warned of the “collapse of critical life-saving services” in Gaza as UN emergency fuel runs out.

With no mains electricity for 16-20 hours per day, hospitals in Gaza are reliant on backup generators to keep essential services running. UN-donated fuel to keep these life-saving services running is expected to be used up in the next few days unless emergency funding is secured.

On Monday, Mr McGoldrick called on the international community to urgently prevent essential services from shutting down:

Life-saving services in the Gaza Strip rely heavily on donor-funded emergency fuel. We have now run out of funds and are delivering the final supplies in the next few days. Without funds to enable ongoing deliveries, service providers will be forced to suspend, or heavily reduce, operations from early September, with potentially grave consequences.”

The severe shortage of emergency fuel endangers patients’ lives, including new born babies in intensive care – a service supported by Medical Aid for Palestinians (MAP) in Gaza. This was emphasised by the UN this week:

Among the most vulnerable to shortages are 4,800 patients in Gaza’s hospitals, who rely each day on electrical devices in intensive care units, including newborns, and those on dialysis or in trauma departments. Medical services for over 1.6 million other Palestinians will suffer from reduction or cessation of services, due to lack of emergency fuel at the main health facilities, and over half the population face the risk of possible sewage overflow, if fuel runs out for the 41 main sewage pumping stations in the Gaza Strip. Overall, the reduced functioning of water and sanitation facilities risks an increase of waterborne disease and outbreaks in a densely-populated, urban area.”

It is vital that international donors, including the UK, step in immediately to keep Gaza’s health system running. In the long-term, they must also work towards sustainable solutions to the electricity crisis, including through a lifting of Israel’s 11-year illegal closure. The UN estimates that US$4.5 million is required to cover humanitarian fuel costs until the end of 2018.

The crisis affecting the provision of health services in Gaza is further compounded by the mass trauma casualties which have entered hospitals in the context of Israel’s use of force against protesters taking part in the “Great March of Return” since 30 March.

On Friday 17 August, the twenty-first Friday of the “Great March of Return” demonstrations, a high number of casualties were again reported. According to the Ministry of Health, two Palestinians were killed and 270 injured by Israeli forces. Karim Abu Fatair, 30, was fatally shot in the head by an Israeli sniper near to the perimeter fence in central Gaza. Saadi Akram Ahmad Abu Maamar, 27, also succumbed to his wounds at demonstrations in central Gaza.

Since 30 March, 160 Palestinians have been killed and 18,000 people injured. According to the World Health Organization, 9,447 people have been hospitalised, of whom 48% (4,508) were shot. Of those hospitalised 5,924 received limb injuries.

Outside of hospitals, frontline health workers have come under attack by Israeli forces using live ammunition, tear gas and rubber bullets. From 30 March to 13 August, three paramedics have been killed and 379 injured. Two health facilities – a health centre for people with disability and a Ministry of Health ambulance station – were also reportedly damaged in and Israeli air strike on 14 July.

MAP is currently calling on the UK Government to take action to protect health workers in Gaza: You can join this campaign by signing and sharing our petition today.

(Source / 24.08.2018)