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شارع نابلس القديم – الشيخ جراح 74519 ص ب 21845 – القدس +972 2 540 0595 :تلفون +972 2 581 0193 :فاكس
Health Cluster Meeting Gaza 25 March 2009
WHO Gaza Premises Time: 13:00 am – 14:30 pm Attendants: (Please see attendants list) The Health Cluster Coordinator HCC welcomed and thanked participants for attending the meeting to discuss the following agenda. MoH Ramallah Health Sector Monthly meetings MoH Ramallah NGOs Gaza Donations Announcement Gaza MoH CDS stock update Benchmarks and indicators for the „Framework for the provision of Humanitarian Assistance in Gaza‟ MoH Gaza take over the Referral Abroad Department Health cluster focal points for WASH and Early Recovery Clusters Health Advocacy Task Force update World Health Day Activities Organisations Activities Update HeRAMS/3Ws databases WHO Executive Board Assessment visit AOB
Announcements: MoH Ramallah Health Sector Monthly meetings The MoH at Ramallah will resume their monthly meetings, and the next meeting will be on the Tuesday 31st March at 10:00AM in the Central Public Health Laboratory, Ramallah. The HCC encouraged participants to inform him of any subject they might want to be address in this meeting, and highlighted that these meetings are usually cochaired by WHO. MoH Ramallah- NGOs Gaza Donations Announcement The HCC informed the participants that the MoH-Ramallah has decided that each NGO is responsible for coordinating the entry of their materials and donations. HCC raised a concern about the impact of this decision on NGOs, and their ability to implement it taking into account that the Israeli authorities at the moment are only accepting medical goods approved by the MoH. However, WHO will continue to support the entry of NGOs items if needed.
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Gaza MoH CDS stock update The MoH/Central Drug Store (CDS) in Gaza has been in the process of sorting and undertaking an inventory of the donated medical items that have been arriving since late December 2008. The MoH/CDS completed an inventory of the essential items currently held in the donation warehouses in Southern Gaza (Rafah, Khan Younis), as well as a rough overview of the items stored in the North – the latter contain mostly IV fluids and misc. equipment. This assessment facilitated the production of the previously mentioned MoH/CDS drug/disposable needs lists. Despite this progress, a lot of work remains in terms of the sorting, transportation, and complete inventory (data entry) of the donation warehouse items. This has proceeded at a slow pace due to a lack of CDS warehouse space, human resources, and equipment. Moreover, the MoH is feeling pressure from the landlords of these donated warehouses to transfer the goods elsewhere. The WHO is currently working in coordination with health cluster partners (such as MAP, Islamic Relief, and ICRC who have been supplying warehouse space and staff) to support an MoH/CDS plan to accelerate this process and improve the CDS's emergency preparedness (i.e. stock decentralization and buffer stocks). We are currently awaiting a response from these partners on how they will be able to support the CDS plan. An updated report on Inventory and stock management plan has been issued by CDS and WHO and is attached.
Note: After the meeting: On March 25 , The Gaza CDS finalized a list of its out-of-stock items, as well as those items that will be out of stock within 3 months. The list contained 144 items in total, 52 of which are currently out of stock. The Central Disposable Store made a list of 67 items that are currently out of stock. Both lists included a supply request for each item in order to meet MoH needs for a period of 6 months. –See attachment.
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Benchmarks and indicators for the ‘Framework for the provision of Humanitarian Assistance in Gaza’ A „Framework for the Provision of Humanitarian Assistance in Gaza‟ has been developed by the Humanitarian Country Team (HCT) to clarify stakeholder responsibilities in order to facilitate an adequate humanitarian response to the needs in the Gaza Strip. The framework includes needs in terms of access for both commodities and people into and out of Gaza. One issue that has a concern for both OCHA and HCC is how to monitor the framework based on the humanitarian principles which stand. One indicator that has been thought of is the number of referral abroad patients. MERLIN raised a concern, stating that reporting the number of denied versus approved patients may not be an accurate measure, percentages should be used instead.
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The below are the recommended benchmarks or indicators in the health sector: % of permits for medical referrals granted in a timely manner (<7days) % of permits for medical referrals delayed % of applications for permits for medical referrals denied % of PHC facilities without the 3 month stock of available essential drugs
MERLIN representative recommended that Sentinel Cases should be used in lieu of statistical indicators taking into account the current Referral Abroad Department recent events. Each selected case should be accurately documented and outcomes reported. OCHA also noticed the possible duplication of the benchmark indicator selected by the Protection cluster; Medical referrals in and out of Gaza are timely and unhindered access to adequate treatment. The HCC will follow with the protection cluster to avoid possible duplication in the benchmarks indicators. MoH Gaza take over the Referral Abroad Department On the afternoon of 22 March 2009, the Ministry of Health under the local authorities in Gaza took control of the Department of Medical Referral Treatment. A press release from the PCHR has been distributed to participants. A copy is attached. MDM-France commented that, “if we know the medical interventions that the patients are referred for, may be we can either bring equipment or expertise for these medical interventions. HCC explained that Oncology, Cardiology, Ophthalmology and Orthopaedic are the main reasons for referring patients. Furthermore, the HCC explained the role of the referral abroad department in the journey that patients pass through in the referral process, and highlighted the problem between WB and Gaza. Besides permits the partners emphasised the importance of the financial coverage component. Ms. Maha Mehanna, the Liaison Officer in Gaza for Handicap International related this personal story to the participants:
“My nephew Mohammed is a 14 years old Palestinian boy from Gaza. He has a rare immune disorder and doctors in Gaza couldn't reach a definite diagnosis for his disease. He was referred to Safra Children's Hospital, Sheba Medical Centre at Tel-Hashomer in Israel, to assess the possibility of primary immunodeficiency. He has history of severe life threatening bacterial and fungal infections and was diagnosed immunologically and genetically as Chronic Granulomatous Disease (CGD), which is an autosomal recessive p47 deficiency. For his disease, he underwent Bone Marrow Transplantation (BMT) from his sister on Nov. 6th, 2008. Currently he is recovering from the procedure and doctors hope full immune reconstitution to occur in few years. Therefore, he will still be considered as immunodeficiency patient for a long time, and he will need close follow-up with Safra Children's Hospital for a long time. He has been sent home in the middle of his post BMT follow-up treatment because the Palestinian Authority suspended the financial coverage of all patients at Israeli hospitals. Mohammed now has serious infection in his lungs and an elevation of his liver function. His life is at risk and he needs close follow-up.
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Mohammed has seven siblings. His oldest sister died four years ago of CGD at the age of 16, in a hospital in Egypt, before the doctors were able to diagnose her, and his younger brother (12 years old) was recently diagnosed as CGD at Safra Children’s Hospital and he needs to undergo Bone Marrow Transplantation as quickly as possible especially that he has a related match donor. We have all medical reports ready for his BMT, but we don't know how to get financial coverage for it. He is on medications till we are able to set up a hospital appointment for his BMT. The financial coverage is a big issue in this regard. For us, we don't have problems regarding coordination and permits because the Peres Centre for Peace in Tel-Aviv is helping us with the permits. The Physicians for Human Rights Organization is also helping Gazans with coordination and permits”.
At the end of her comments she stated that “the main problem always remains with the financial coverage”. The HCC will follow this case and it will be presented to Protection cluster members as well as other agencies following the issues regarding the referral abroad programme and the rights of the Gazan population. WHO mentioned that their head of office is talking to the MoH and the HCC is following up also with the Egyptian counterparts. Also WHO as well as the Humanitarian Coordinator are preparing a public statement.
Health cluster focal points for WASH and Early Recovery Clusters HCC has reminded participants that the Health Cluster is still looking for a focal person from NGOs to represent the cluster in the WASH cluster, and another for the Early Recovery cluster. It was informed that Ms. Dalia Salha will be WHO focal point for the WASH cluster and during the meeting Ms. Adelheid Marschang from Save the Children- US agreed to represent the Health cluster in the WASH cluster. Ms. Joanna Kotcher from MERLIN will represent the Health cluster in the Early Recovery cluster. In addition, Mr Mahmoud Daher will be WHO focal point for the Early Recovery cluster. The HCC was happy with the decisions taken and the pertinent cluster will be informed accordingly. Health advocacy task force update The first health advocacy task force meeting has been conducted under the lead of WHO. The group has decided to work on a framework, and the next meeting they are looking into the development of action plan. It is foreseen that the work on advocacy in WB and Gaza will be activated.
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World Health Day Activities The HCC informed that 2009 World Health Day focuses on the resilience and safety of health facilities and the health workers who treat those affected by emergencies. Events around the world will highlight successes, advocate for safe facility design and construction and build momentum for widespread emergency preparedness. All well applicable to the Gaza Strip current situation. The World Health Day will be on the 7th of April, 2009, with the theme of “Save lives. Make hospitals safe in emergencies”. WHO will send invitations to the health cluster participants, and encouraged them to attend the opening ceremonies day at the PRCS in Tal Al Hawa and to participate by doing activities related to the theme through the year. Visit www.who.int/world-health-day for information and activities through the year.
Organisations Activities Update Handicap International (HI) informed participants that they have formed a mapping sub-cluster, to map disability in terms of who does what and where; in order to avoid duplication of activities and improve donors‟ funding. HI also expressed their wish to have a disability sub-cluster link with OCHA web site. The HCC agreed to link the site under the Health cluster. Save the Children USA informed that their emergency-related health project with PMRS which aims to reduce morbidity and mortality of pregnant women and children under 5 is on-going, and the doctors continue to detect critical cases to hospitals for intensive follow up and treatment. The health team sees approximately 60 patients per day from which, up to now e.g. at least 15 cases of previously undetected preeclampsia in the early stage were discovered, thus preventing the deterioration of the health situation for the expectant mother and the unborn child. At least 300 children up to now have been screened for infectious and communicable diseases by the medical team through lab exams and complete physical exams which would not have been available to these children otherwise. The current health education program is running on an individual case-case basis, as health workers inform patients about disease prevention, mother and child nutrition, and personal hygiene. Children receive “Well Baby Care” from birth until the age of five, as per MOH protocols and policy. Preventive interventions for children include screenings for malnutrition and anaemia, and provision of nutritional supplements. Children are monitored for their general growth and development in order to prevent disability or delays in physical or mental growth. Another ongoing project is the provision of medical supplies to local hospitals and primary health care providers who were primarily involved in health care during the hostilities to supplement for depletion of medical equipment and to enable them to appropriately address neo-natal care. SC US will be delivering these to hospitals of the Patient Friend Society, Alawda hospital and Public Aid Society within the next 3 weeks.
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OCHA web site database OCHA explained to the participants how the system operates, and expressed their welling to hold orientation session for the HC participants if invited to do so. HCC explained that he is planning to organize that in the near future. WHO Executive Board Assessment visit The WHO Executive Board Mission who have been appointed to assess the impact of Gaza war on the health sector, have introduced themselves and encouraged the participants to provide them with any updated information that may have emerged after the Initial Health Assessment report issued by WHO. The encouraged the participants to pass information to them via WHO office or the HCC.
AOB Save the Children is concerned about health risks for children from unexploded ordinance (UXO) as one recent example shows: Two children (14 and 15 year of age) were killed in a suburb of Gaza City on Saturday 21 March, whilst playing with a suspicious object near their homes in Al-Zaytoun (Zeitoun area) in the afternoon, approx 17.30 hours. We visited this wider area just a few hours earlier on that Saturday, when following up on SC supported activities of PMRS in this area, mainly providing prenatal screening for mothers and children under 5 in field clinics set up there twice a week. We urge to undertake every possible effort regarding systematic clearance activities combined with an appropriate and continued information campaign for the population to keep awareness on this subject high and to minimize and mitigate risks for UXOs as much as possible to avoid similar incidents in the future. Especially children are prone to be victims of such material, as they love to play outdoors. According to certain sources such as the PCHR, the number of such incidents was on the rise. SC is now inserting child friendly pictorials into NFI kits that show children and families the dangers of UXOs. These are being distributed throughout the Gaza strip; however more needs to be done. The HCC will follow up with MAG and UNMAS to get an update in the UXO situation. HCC proposed the possibility to conduct the HC meetings in other health places beside WHO, asking those who would like to host HC meetings in their places to coordinate with him. UNRWA, Ahli Arab Hospital, and NECC expressed their wish to host future meetings in their premises.
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Health Cluster Coordination Meeting Wednesday 25 March 2009 WHO Gaza, Gaza Strip Attendance: 1. Kristin Oren, NORWAC coordgaza@norwac.no 2. Margaret Chilcott, Help Age International mchilcott@helpage.org 3. Marianne Whittington, ICRC gaza.gaz@icrc.org 4. Cecilia Utas, OCHA utas@un.org 5. Ahmed Abusshammaleh, OCHA abushammaleha@un.org 6. Samah Abulanthy, Handicap International, sabulamthy@hi-me.org 7. Firyal Snounu, USAID fsnounu@usaid.gov 8. Veronique Maeva Fages, UNDP veronique.fages@undp.org 9. Elena, MDM Greece, elendoct@yahoo.gr 10. Lubna Alsharif, UNICEF lubna_alsharif@yahoo.com 11. Rami Hamarna, The Flagship Project rhamarna@flagshipproject.org 12. Mhadeb Ben Khelifa, Premiere Urgence pupal@pcgaza@gamail.com 13. Maha Mehana, Handicap International, lo.hi.pal@gmail.com 14. Joanna Kotcher, MERLIN hc.gaza@merlin-opt.com 15. Dr. Mustafa Elmasri, IMC mustafa.elmasri@gamail.com 16. Heba Hamarna, MDM-France mdmg2@palnet.com 17. Elise Peron, MDM-France mdmg@palnet.com 18. Reham Owda, MDM-Spain mdm.gaza2@gmail.com 19. Cristina Minana, MDM-Spain palestina@medicosdelmundo.org 20. Richard Alderslade, WHO Geneva, richard.alderslade@softhome.net 21. Hanno Vuori, WHO EB mission, hannu.vuori@hotmail.com 22. Jo E Asvall, WHO EB mission, jo@asvall.dk 23. Paivi Muma, ACT International p_hieta@yahoo.com 24. Suhaila Tarazi, Ahli Arab Hospital Suhaila@palnet.com 25. Graham Henderson, WASH Cluster, graham@notomys.com 26. Dr. Salim Alabadllah, NECC necc@neccgaza.org 27. Jamal El Hawajri, UHWC jamal_hawajri@hotmail.com 28. Osama Abueita, UNFPA Abueita@unfpa.org 29. Dr. Amna Shurbasi, UNRWA a.shurbasi@unrwa.org 30. Dr. Mohamed Maqadma, UNRWA m.maqadma@unrwa.org 31. Mohasen Abu Hassan, Save the Children mahasen2@yahoo.com 32. Adelheid Marschang, Save the Children USA amarschang@savethechildren.org 33. Mahmoud Daher, WHO mda@who-health.org 34. AbdelNaser Soboh, WHO, aso@who-health.org 35. Dr. Jorge Martinez, Health Cluster jma@who-health.org
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