World Health Organization
منظمة الصحة العالمية
Organisation mondiale de la Santé

Impact of fuel and drug shortages on patient care in the West bank and Gaza, March 2012


Patients covered by government health insurance are finding it increasingly difficult to obtain medications from Ministry pharmacies. With up to 38 percent of medicines on the essential drug list now unavailable in both Gaza and Ramallah MoH central drug store facilities, more patients must purchase their medications from private pharmacies, or seek donations from charities. Patients usually covered by government health insurance include families of government employees as well as social hardship cases living in extreme poverty with virtually no income. 

In a field survey conducted by WHO, private pharmacies in Gaza reported a 20-40 percent increase in the number of customers with prescriptions from Ministry of Health physicians who must now purchase their own medications; many are seeking cheaper alternatives to the drugs prescribed. 

The drug shortage, primarily caused by political divisions between the West Bank and Gaza, has been exacerbated by recent financial shortfalls in the Palestinian Authority budget, and compounded by the suppliers’ inability to continue to ship supplies ‘on credit.’ There is a zero stock list of 140 medicaments in the central pharmacy in Ramallah and the Ministry of Health has appealed for immediate resupply of a shortlist of critical medications. There are also 182 drugs on the zero stock list at the Gaza Central Drug Store.

The worst affected were patients needing medications for chronic life-threatening conditions. In both Gaza and the West Bank, medications needed for hemophilia patients (Factor VIII and IX) and for cardiac surgeries are on the zero stock list. Sixty Gaza patients who have had kidney transplants require “Pro-graph” anti-rejection medicine on a life-long basis, but there has been a shortage in this drug since early March. In addition, there are insufficient supplies of drugs and chemicals needed for hemodialysis machines, including disinfectant solutions in Gaza, and dialyzers in the West Bank.

According to the Pharmacy Director at Shifa Hospital, scheduled treatments for breast cancer and leukemia cannot be adhered to due to the erratic supply of drugs. There are 7200 cancer patients in Gaza, including 1000 requiring follow up as outpatients, either through chemotherapy, radiation therapy or a combination of both. The most common breast cancer drug, Taxol ($600 per vial x 6 vials per cycle x 6 cycles per treatment) is often at zero stock after administration of the first cycle alone. For patients with aggressive cancer, waiting several extra weeks between chemotherapy sessions for drugs to become available can increase the risk of drug resistance. However, the alternative, using a substitute, is like ‘going back to square one’. Referrals to East Jerusalem, Egypt or Israel cannot adequately address the problem: besides the increased expense, cancer patients with drug weakened immune systems are not good candidates for travel outside of Gaza.

Medical disposables are also in short supply. In Gaza, as of mid April 2012, 217 medical disposables are reported at zero stock, while in the West Bank, 63 medical disposable items are unavailable, including arterial lines for ICU units in Ramallah and Nablus hospitals, blood bags and surgical gloves. Last week, operations in Hebron hospital were stopped for three days due to lack of anesthetics.

Medical services severely affected by ongoing fuel crisis:

The fuel and electricity crisis, a result of a sharp decline in fuel entering via the tunnels from Egypt in February, continued during March. Consequently, the Gaza Power Plant (GPP) has either been operating at one-third of its capacity or has had to completely shut down, triggering blackouts of up to 18 hours per day, in addition to random unscheduled cuts.

Medical services, including life-saving interventions, have been severely affected due to exhaustion of the fuel reserves used to operate back-up generators and to run ambulances. Fluctuations in power supply have resulted in the malfunctioning of sensitive medical equipment, disrupting medical services. Hospitals reported to WHO that in March, requests to repair batteries, uninterrupted power supplies (UPS), and other equipment have doubled as a result of the frequent cuts in mainline electricity and overuse of back-up systems. To prioritize emergency surgery, hospitals have had to postpone some elective surgery, which, even if not life-threatening, can have a range of negative ramifications for affected patients.

You can access this text in OCHA Humanitarian Monitor, March 2012, page 9 and 10