Of the 480 medications on the essential drug list, 178 (37%) were reported at zero stock levels in the Ministry of Health’s Gaza Central Drug Store (CDS) at end of May 2011. The CDS supplies the Ministry’s 13 hospitals and 54 primary health care clinics in Gaza.
While the shortage of essential drugs has been a chronic problem and zero stock levels have increased steadily since 2007 (2007: 14%; 2008: 16%; 2009: 18%; 2010: 24%), the protracted period of low stocks is now deemed critical for the continued delivery of health care.
Of the 700 medical disposables on the essential list, 190 (27%) were reported at zero stock levels in the CDS-Gaza.
Impact of Shortages:
On patients: The inability to benefit from proper medications and supplies puts patients at substantial risk of medical complications and deterioration in health status. The shortages force patients to cope by trying to procure medications from other health providers or from the local market at greater cost, using inappropriate substitute medications, and by seeking treatment abroad. Cancer patients requiring on-going chemotherapy have also been referred outside for treatment. Patients with kidney diseases, transplants, hypertension, blood conditions and chronic illnesses who require a regular regime of medications, some of which are unavailable, are exposed to special risk.
On the Ministry of Health: Due to the need for vital drugs and supplies that are out-of-stock, surgeries in all major specialties have been either curtailed or stopped altogether, and the most serious cases have been referred to hospitals outside the Gaza Strip. The Ministry has coped with supply shortages by reusing some disposable items which compromises infection control, and by rescheduling dialysis patients to maximize use of existing functioning machines. Overall, referrals to hospitals outside of Gaza for conditions that heretofore could be treated within Gaza have increased.
150 drugs are currently out of stock in the West Bank because suppliers have not been making deliveries. Despite this, some shipments to Gaza are currently in process from the MoH-Ramallah as well as from the ICRC and NGOs. However, shortages in Gaza have remained at critical levels since January 2011 and the situation will require close monitoring and possible contingency measures.
Shortages of drugs and disposables at the CDS- Gaza, June 2011 2
There are 480 drugs on the essential drugs list and 700 items on the essential medical disposables list considered by the Palestinian Ministry of Health as necessary for the provision of essential health care. Disposables include a wide variety of essential items such as syringes, line tubes, filters for dialysis and dressing materials. "Zero level stock" designates critical supplies that will be totally depleted in less than one month at the Central Drug Store (CDS-Gaza), which supplies all 13 MoH hospitals (1937 beds) and 54 MoH clinics in Gaza.
The Palestinian Ministry of Health in Ramallah is responsible for providing drugs and medical disposables to MoH facilities in both the West Bank and Gaza and for sending regular shipments according to the requests of the CDS-Gaza. A "zero level" designation prompts an urgent re-supply request to the Palestinian MoH in Ramallah. In practice, drug deliveries have not made regularly or in sufficient quantities: the last supply of medications occurred in early April, and the last shipment of disposables in February 2011. Moreover, the CDS-Gaza reports that items sent generally cover 70% of those requested for the 2 months period, which results in the steady deterioration of stocks.
While the shortage of essential drugs has been a chronic problem and zero stock levels have been depleted steadily in Gaza since 2007 (2007: 14%; 2008: 16%; 2009: 18%; 2010: 24%), addressing the protracted period of low stocks is now deemed critical for the continued delivery of health care.
Current Drugs and Disposables Crisis in Gaza
The MoH-Gaza has reported 178 drug items at zero stock level, in addition to another 69 items at low stock which means sufficient for less than 3 months consumption. 190 medical disposable items were reported at zero stock level, in addition to another 70 items at low stock sufficient for less than 3 months consumption. (See Annex1 and 2.)
Essential drugs and disposables at zero stock level, 2011.
1. Zero Stock Drugs:
The categories of drugs at zero stock are: 17% antibiotics for acute infections, 10% for chronic diseases (diabetes, hypertension, cardiac conditions, osteoarthritis, etc.), 9% chemotherapy, 8% analgesics, narcotics and anti inflammatory drugs, 8% psychotherapeutics and anticonvulsants, 7% for blood disorders 6% for ophthalmological disorders, 5% for immunity disorders, 4% antidotes, and others including special milk formulas (5 items), vitamins, solutions and formulas for external application (ointments, creams, etc).
Shortages of drugs and disposables at the CDS- Gaza, June 2011 3
2. Zero Stock Medical Disposables:
The shortages of the 190 medical disposable items include some basic and very critical items such as: syringes, Central Venous Pressure devices, ECG and CTG paper, X-Ray film, gauze, disposables used in laparoscopies, and filtration cartridges used in haemodialysis for patients with kidney failure.
The shortages in Gaza are compounded by shortages faced by the MoH in the West Bank where 150 drugs were reported to be out of stock. This is because suppliers have held back deliveries to the MoH due to uncertainty about receiving payment in the aftermath of the political reconciliation between Fatah and Hamas in late April. The suppliers’ issue was reported to have been resolved in mid June and suppliers began starting to supply back orders. The MoH-Ramallah prepared 170 pallets of 80 types of drugs and 130 pallets of disposables for immediate shipment to Gaza. The ICRC was assisting with logistics of transferring 5 types of essential supplies, while NGOs also sent in emergency supplies: the Physicians Association of Egypt sent 3 trucks of 19 types of essential medications to the Rafah border, MAP-UK was releasing some of its buffer stock in Gaza, and Islamic Relief was also shipping drug items.
Examples of Impact of Shortages on Health Services
1. The relatively big shortages in drugs and medical disposables have forced hospitals to curtail or stop the following kinds of surgeries:
Elective surgeries stopped
Laparoscopic surgeries stopped
Vascular surgeries stopped (shortage of embelectomy catheter)
Neurosurgeries stopped (shortage of Gellfoam, and other supplies)
Spinal vertebrae and joint surgeries stopped (shortage of transpendicular screw, rods, artificial joints)
Pediatric surgeries (curtailed due to lack of sutures)
ENT, burns and plastic surgeries stopped at the main Shifa Hospital
2. Referrals to outside hospitals for treatments previously done within Gaza:
Cancer treatments, and cardiovascular, orthopedic and neurosurgeries.
3. Improvised methods for coping with shortages of medical disposables:
Re-sterilizing disposable tubes
Reusing gloves and other disposable items (increasing risk of cross-infections and hospital-acquired infections.
4. Patients at special risk:
Kidney disease patients:
Rescheduling of 200 patients for haemodialysis at Shifa hospital to machines not requiring filters which are currently unavailable (increasing risk of infections)
Insulin shortages for insulin-dependent patients
Calcium shortages for the 450 patients on haemodialysis in Gaza (shortage for 2 months).
Cellcept (immuno-suppressant) shortages for 100 kidney transplant patients
Patients requiring adenoviral, an antiviral used to treat hepatitis
Patients with hypertension (out of stock at primary health care level for past 3 months)
Patients with blood disorders requiring Factor VIII medication (increases risk of complications)