HEALTH SERVICES DEVELOPMENT IN JUDEA-SAMARIA AND GAZA

1967 – 1994

Since 1967, Israel has developed and promoted the Palestinian health and medical services in the areas of Judea-Samaria and Gaza. The development focused on many parallel fields like: public health condition, environmental health, prevention and control of communicable diseases, maternal and child health care, primary health care (preventive and curative), improvement of hospitals with development of secondary and tertiary services, training and upgrading of health and medical personnel.

Israel has handed over to the Palestinian Authority improved, promoted and well functioning health services setting up with satisfactory infrastructures and with master plans for further hospital development.

The authority and the responsibilities in the sphere of health were transferred in the Gaza and Jericho areas on the 18.5.94 and in Judea-Samaria on the 1.12.94.

Following the implementation of the autonomy in the sphere of health, good working relations between the Israel Ministry of Health and the Palestinian Health Authority (PHA) have been established. The coordination and cooperation between the two parties are satisfactorily continuing, especially in the framework of the bilateral joint professional committees.

PUBLIC HEALTH, PREVENTIVE MEDICINE AND EPIDEMIOLOGY

The health situation of the population in the areas of Judea- Samaria and Gaza has been remarkably improved throughout the years 1987 – 1994.

The Israeli system of immunization was implemented in Judea-Samaria and Gaza, including vaccinations against Diphtheria, Pertussis, Tetanus, Poliomyelitis, Measles, Mumps, Rubella and Infectious Hepatitis type 13.

More than 90% of infants and school children were immunized and this process is continued.

Over the years this resulted in an increased control and elimination of childhood contagious diseases, as shown in the current low rates in these diseases.

Diphtheria, pertussis, tetanus, polio and measles have been largely controlled or virtually disappeared.

Intensification of the epidemiological surveillance and improvement of the medical care contributed to the decrease in morbidity and mortality due to communicable diseases.

  Vaccine-preventable diseases in rates per 100,000 populationin Judea-Samaria and Gaza               Judea-Samaria          Gaza               Year     Year      Year      Year  Disease      1970     1993      1970      1993 Diphtheria    0.3      0         0         0 Pertussis     8.0      0        30.1       4.6 Tetanus      53.3      0.5      13.6       0.2 Polio         4.7      0        14.3       0 Measles     164.0     47.9     605.3       6.3  

It is worthwhile to mention that the areas of Judea-Samaria and Gaza are free from Malaria and Rift-Valley-Fever.

GASTROENTERIC AND PARASITIC DISEASES

Gastroenteric and parasitic diseases are still prevalent, particularly in the refugee settlements in Gaza primarily due to poor sanitary conditions. Diarrheal disease morbidity, hospitalization and mortality have been much reduced throughout the years. This is largely due to the use of oral rehydration solution, as well as generally improved child nutrition status.

INFANT MORTALITY RATE (IMR)

Infant mortality declined in both areas from levels estimated to be between 100-150 deaths per 1000 live births prior to 1967, to between 20 – 25 deaths per 1000 live births in 1994.

Reduction in infant mortality rate (age 0-1 year) Is the result of the cumulative effects of a number of factors. control of the major childhood infectious diseases, reduced morbidity from diarrhoeal conditions, increased hospital and medical center deliveries and rising educational, living and nutritional standards.

MATERNAL HEALTH

Maternal health status has been promoted throughout the years by the upgrading of medical, nursing and midwifery care, the establishment of special high-risk pregnancy clinics and health education programs.

Births in medial facilities increased in Judea-Samaria and Gaza from 3% prior to 1957 to 75% in 1994.

HEALTH EDUCATION AND SCHOOL HEALTH

These spheres have been promoted over the years. The key target populations for health education were: health care workers, including physicians, nurses and paramedical staff, chronic disease patients, high-risk pregnancy patients, school staff and school children.

School health teams visit the primary schools for basic clinical examination and for carrying out the school immunization program.

ENVIRONMENTAL HEALTH

Gradual improvement has been achieved throughout the years in drinking water inspection, food control and waste disposal sites planning.

PRIMARY HEALTH CARE SERVICES

Israel developed the primary health care system (preventive and curative) by the establishment of a network of new general clinics and mother and child health centers, as well as by the promotion of their professional functioning level.

  PRIMARY HEALTH CARE IN JUDEA-SAMARIA -  GOVERNMENT SERVICES                                      1970    1994  General clinics (family medicine)    105     171 Mother and Child Health Centers       25     147 Community Health Units in Villages     0      72 Specialty clinics                      0      40   NON-GOVERNMENT CLINICS IN JUDEA-SAMARIA (1994)  Non-government organizations         131 Charitable societies                  73 UNRWA                                 20 Private sector                       152   PRIMARY HEALTH CARE IN GAZA - GOVERNMENT SERVICES                                   1970       1994  Community Health Centers           3          29 High-risk pregnancy clinics        0           2  

All the community health centers in Gaza are providing both preventive and curative services.

AMBULANCE SERVICES

Total number of 102 ambulances operated in Judea-Samaria and Gaza in 1994, 57 ambulances in Judea-Samaria and 45 in Gaza. The ambulances belong to the government health services, the Red Crescent, UNRWA, municipalities, nongovernment hospitals and other charitable societies.

About 150 ambulance drivers from Judea-Samaria have been trained by Magen David Adom in Israel in courses of first aid and emergency medicine.

HOSPITALS

In 1967 the general hospitals in Judea-Samaria were basic hospitals consisting only the four basic departments, internal medicine, general surgery, gynecology and obstetrics and paediatrics, as well as a few units of orthopaedics, urology, ear-nose-throat surgery and haemodialysis. Israel developed the hospitals and converted them to secondary and tertiary care hospitals, and opened departments of orthopaedics, urology, paediatric-surgery, ophthalmology, general and coronary intensive care and haemodialysis. Israel opened departments of open heart surgery, vascular surgery and neurosurgery. Diagnostic radiology departments have been renovated and improved and C.T. as well as ultrasound diagnostic services are functioning. Modem medical equipment was purchased by Israel for the hospitals. Tenths of physicians were trained in Israel in various residency and training programs in clinical specialties as well as in continuous medical education programs. The majority of the registered nurses graduated at the Ramallah nursing school established by Israel. The teaching program is that of the nursing administration in the Israel Ministry of Health.

  HOSPITALIZATION BEDS IN GENERAL HOSPITALS IN JUDEA-SAMARIA        Government beds   Non-government beds   Total  1970       618                400             1018 1994       702                668             1370  320 psychiatric beds are located in one government  mental hospital   HOSPITALIZATION BEDS IN GENERAL HOSPITALS IN GAZA        Government beds   Non-government beds   Total  1970       745                 75              820 1994          820              80              900  

COMPLEMENTARY MEDICAL SERVICE IN ISRAEL

Since 1967 Palestinian patients have been referred to Israeli hospitals for hospitalization and ambulatory care in cases that deserve specialized sophisticated departments that do not exist in Judea – Samaria and Gaza, or in cases that are in need of clinical specialists for diagnosis and treatment. All complementary services are continuously given to Palestinian patients from the autonomous areas.

TRAINING OF HEALTH AND MEDICAL PERSONNEL

Tenth of physicians, nurses, paramedical workers and employees from the administration and services sector were trained in Israel during the years in various programs, and courses, besides training programs, which were organized in Judea Samaria and Gaza.

There were long, medium and short term programs as well as many workshops, post-graduate studies and seminars in plenty of professional topics.

For instance, below are presented the accumulated number of trainees from Judea – Samaria between the years 1967 – 1993.

             Training programs  Training programs             up to 6 months    more than 6 months  1967-1971         14                  1 1972-1976          2                  51 1977-1981        104                  33 1982-1986         46                  25 1987-1993        347                 121 Total number     513                 242