(formerly IRIN News) Journalism from the heart of crises

Intra-Palestinian strife hits health care in Gaza

Asthma patient Saeed Ghaboun, 67-years old from Gaza City, says his ventoline inhaler has been unavailable at the health clinic for six months.  He managed to find the drug after scavenging local private pharmacies, but at ten times the cost. Saeed, like
Erica Silverman/IRIN

The main reason for the worsening shortages of essential drugs and medical supplies in the Gaza Strip is that the Palestinian Authority (PA) ministry of health in the West Bank has not delivered enough drugs and medical supplies to Gaza, according to the World Health Organization (WHO), international aid organizations and Gaza health ministry officials.

WHO did not attribute the shortages to Israel’s more than three-year blockade of the Strip. “Israeli authorities are not blocking the entry of drugs and disposables to Gaza. They recognize these are priority items for humanitarian needs,” said WHO head in Jerusalem Tony Laurance.

Gaza’s health ministry is run by the Hamas-led government, but its funds and supplies are provided by the PA, led by rival Palestinian faction Fatah in the West Bank. Lack of communication between the two ministries due to internal conflict is worsening an already crumbling healthcare system in Gaza.

Thirty-eight percent of essential drugs such as antibiotic syrups for children and cancer treatment drugs were out of stock in Gaza (defined as less than one month’s supply at central level) in early 2011, WHO reports. These shortages affect all health ministry facilities, which provide 40 percent of primary health care and 80 percent of hospital care services in Gaza.

“The PA [West Bank] health ministry is responsible for supplying Gaza with the drugs and disposables for health ministry hospitals and health clinics in Gaza. The deliveries they made in 2010 to Gaza were significantly lower than in 2009,” Laurance told IRIN.

“The explanation given by the PA is that they are not being provided with reliable information from the Gaza health ministry regarding what drugs and disposables are available,” said Laurance.

According to WHO figures shown to IRIN, in 2010 only 40 percent of requested drugs and medications were sent to Gaza by the PA health ministry, and only 50 percent were sent in 2009.

The emergency room at Al-Nasser hospital in Gaza City, Gaza’s main paediatric hospital, receives 250-400 children per week, and admitted 7,150 in 2010, said director Nabil Bargouni.

“For the last six months the hospital has been short of essential drugs and supplies, such as laboratory kits for electrolyte analysis,” [which tests the basic chemicals in the body] said Bargouni. “The shortages are due to the conflict between the two health ministries,” he said.

Essential items missing or in short supply include latex gloves, exchange transfusion sets for newborns, sutures, and even the basic antiseptic ethyl alcohol, according to Maria Cecilia Goin, International Committee of the Red Cross (ICRC) spokesperson in Jerusalem.

Bargouni said his requests to the PA health ministry in the West Bank for desperately needed drugs and supplies have gone unanswered.

“Forty percent of the PA health ministry budget is supposed to be allocated to Gaza, but now the Gaza health ministry has to apply on a case-by-case basis to receive drugs and medical supplies,” said Gaza health minister Baseem Naim. “We are asking the UN and other international donors to establish a neutral system to guarantee a consistent supply,” he added.

PA health minister Fathi Abu Moghli in the West Bank declined to comment when contacted by IRIN. UN Humanitarian Coordinator for the occupied Palestinian territory, Max Gaylord, told IRIN the UN would help if both parties agreed, but stressed that “both sides should put political differences aside and focus on the needs of the people of Gaza.”

“We refuse to talk to officials from Gaza”

Spokesperson for the PA health ministry Omar Al-Nasser told IRIN US$19 million of the PA health ministry’s 2010 budget of $43 million was spent in Gaza.

“We refuse to talk to officials from Gaza,” said Al-Nasser. “The West Bank health ministry talks with nurses and doctors from Gaza, unofficially, to determine hospital needs.”

According to Muneer Al-Boursh, director of warehouses at the Gaza health ministry’s central pharmacy, the Gaza health ministry received US$28.6 million from the PA health ministry in 2009 and $6.82 million in 2010.

PA health ministry officials say medical donations entering Gaza via the Rafah crossing on the Gaza-Egypt border are filling the gap.

However, according to internal PA health ministry documents obtained by IRIN, only 26 percent of donations received were according to Gaza’s needs.

Rafah

Rafah crossing has been closed since 25 January after protests began in Egypt. The crossing was partially reopened in early June 2010 after being closed for three years, says the UN Office for the Coordination of Humanitarian Affairs (OCHA).

Wael Qadan, director of planning and development at the Palestinian Red Crescent Society in Ramallah, said donations from Arab countries entering Gaza via Rafah are disorganized, and a good portion of the drugs are beyond their sell-by date. “Often donations are stored for months in poor conditions before entering, even under the sun, affecting the quality,” he said.

“Donated drugs and medical supplies that enter through Rafah can take months to be sorted - and are sometimes not according to the needs,” said Humanitarian Coordinator Gaylord, adding: “Gaza health ministry officials informed the UN it is trying to sort the donations and will advise the PA health ministry.”

Recently 135 pallets of medication and equipment reached Gaza from the PA health ministry, but they did not correspond to all needs, and some serious shortages of medications continue, said the ICRC.

Eighty-one of the 183 essential drugs out of stock in Gaza - out of a total of 480 - entered with the shipment, but about a third of them will last no more than two weeks,” said WHO head Laurance.

Caught between two governments

Meanwhile, asthma patients like Saeed Ghaboun, 67, from Gaza City, are suffering. His ventoline inhaler has been unavailable at the health clinic for six months. He eventually managed to find one after scouring local private pharmacies, but at 10 times the normal cost. Saeed, like 45 percent of Gaza’s population, is unemployed.

“I do not care about Fatah or Hamas, I only want my treatment,” said Saeed. “Patients are caught between the two governments,” he said.

Patients are buying drugs at their own expense, although 80 percent of Gaza’s population is aid dependent - and some doctors are prescribing alternative drugs which may be less effective or have worse side-effects, say medical professionals in Gaza.

Patients are increasingly approaching non-health ministry providers in Gaza, such as NGOs and UN Relief and Works Agency (UNRWA) clinics for essential drugs.

Maj Guy Inbar, Israeli Coordinator of Government Activities in the [Palestinian] Territories (COGAT), told IRIN: “Medication and medical supplies are allowed to enter Gaza upon request from the PA in Ramallah… Israel only has a say regarding security concerns, meaning dual-use items that can be used for terror, such as X-ray machines,” he said, adding that the Israeli authorities have no contact with the Gaza government.

“The real solution, more than case-per-case support, is to establish a regular pipeline whereby drugs and disposables are sent to Gaza according to needs,” ICRC spokesperson Goin told IRIN.

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