Resilience amidst chaos: 100 days of UNRWA's health response to the humanitarian crisis in the Gaza Strip, 7 October 2023 to 14 January 2024
UNRWA
24 Jan 2024
On 7 October 2023, war erupted in the Gaza Strip.
During the first 100 days, OCHA reported 24,100 fatalities1, 70 per cent of them women and children. As of 14 January, 151 UNRWA employees had been killed2, four of whom were health workers. Since 7 October, about 1.9 million out of Gaza's 2.2 million people have been internally displaced. The number of internally displaced persons (IDPs) seeking shelter in UNRWA facilities has risen exponentially. As of 14 January, nearly 1.7 million displaced people were sheltering across emergency shelters (UNRWA and public shelters), informal sites or in close vicinity to 150-155 UNRWA shelters and distribution sites and within host communities.
The health situation in Gaza was critical well before 7 October, after 16 years of blockade and previous escalations of conflict, resulting in restricted movement of people and goods, including medical equipment and supplies. The war exacerbated this already critical situation leading to the complete closure of many hospitals and primary health-care centres, and the collapse of the transportation system. UNRWA ran 22 health centres (HCs) before the war, but by January 14 only six were still operating.
People are suffering from a lack of access to essential medical care and clean, sufficient water, resulting in unattended chronic diseases and a potential for multiple outbreaks of infectious disease. Those injured in the war have been discharged from hospitals with minimal stay due to the overcrowding but still require frequent dressing changes for their war injuries. The need for medical attention is greater than ever, but the challenge lies in delivering necessary medical supplies and operating UNRWA HCs with a limited number of available health workers. Health workers themselves have been displaced, searching for shelter and daily essentials to meet their needs. Despite this, they still go to HCs to provide services to others. UNRWA's ability to continue operating HCs heavily relies on these dedicated health workers. The effort to deliver necessary medications and other hospital supplies has been ongoing through coordination with WHO and other stakeholders.
UNRWA Health Services in the Gaza Strip before the War
Through 22 HCs, UNRWA provided free-of-charge primary health services before the war. These services ranged from attending to non-communicable diseases (NCDs), maternal and child health including vaccination, outpatient care, and dental, laboratory and pharmaceutical services. The Agency also offered secondary and tertiary care through its hospitalization support by referring patients to contracted hospitals.
Over the last few decades, NCDs have been the leading burden of morbidity among Palestine Refugees. In 2022, 106,482 individuals sought care for diabetes and/or hypertension at UNRWA HCs in the Gaza Strip. Previous reports and studies conducted by UNRWA indicate that, even before the current humanitarian crisis, the population of Gaza was suffering from chronic malnutrition, high food insecurity, poor dietary diversity, and was heavily dependent on food assistance. This resulted in a high prevalence of anemia and micronutrient deficiencies, especially among children, women, and elderly people. Each year, 39,000 new pregnant women received antenatal and postnatal care at UNRWA HCs. Approximately 40,000 newborn babies received vaccination and growth monitoring services.
The recurrent cycles of violence have increasingly affected the emotional and psychological well-being of everyone in the Gaza Strip. Mental health and psychosocial support (MHPSS) services have been critical for Palestine Refugees who, prior to this war, had already endured four escalations of conflict since 2008.
The UNRWA health programme in the Gaza Field Office has an existing standard operating procedure for emergencies that was immediately activated during past conflicts. However, the unexpected scale of the current war has led to a significant increase in needs, exceeding the Agency's capability to respond.
UNRWA's Health Response to the War
Health centres
Due to increased security risks, UNRWA closed 13 HCs in the Northern Gaza Strip on 14 October. The Agency continued operating nine HCs in Rafah, Khan Younis, and the Middle area until the end of December 2023, serving both refugees and non-refugees. Services provided included critical cases of NCDs and emergency outpatients.
As the demand for health-care services surged, UNRWA gradually resumed its services. These extended services included vaccination for children, postnatal service, and the management of high-risk pregnancies, as well as outpatient and acute emergency dental care. Resuming services was a critical step in addressing the growing health-care needs amidst the war.
In the northern Gaza Strip, between 8 and 14 October, 3,490 and 4,138 patients received services in the north and Gaza city area, respectively. From 8 October to 31 December, a total of 566,901 medical consultations were provided in the nine operating UNRWA HCs.
Ongoing disruptions in electricity and internet connectivity have affected the e-health system, leading health workers to use hard copy and tally sheets to record patients' medical information. This has posed challenges to accurate and timely data recording and reporting. UNRWA had a well-established telemedicine service before the war, but the services have been hindered by telecommunication difficulties.
With violence continuing to escalate, on 3 January UNRWA had to close more HCs. As of 14 January, six out of the Agency's 22 HCs in the Gaza Strip remained open.
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