Tabletop simulation during the WHO mass casualty management training for Gaza public hospitals, March 2022, Gaza Strip. Credit: WHO

23 August 2022 – The World Health Organization (WHO)’s long-term support for increased preparedness and response capacity in the occupied Palestinian territory, including the Gaza Strip, proved vital during the escalation of violence from 5 to 7 August 2022. This ongoing work has enabled hospitals to activate mass casualty management plans, prepositioned supplies to be mobilized, and urgent provisions to be delivered to hospitals, attesting to real change on the ground in the way health care workers are able to respond in the sudden onset of disaster. 

Distance training works

WHO began delivering virtual mass casualty management training courses in 2020, in conjunction with the NYC Medics Global Disaster Relief. This online training proved its effectiveness during the May 2021 escalation, when trained health care workers were shown to perform at a higher level. 

WHO then followed up with in-person training to equip hospitals with a standardized, unified mass casualty management plan allowing efficient response to complex emergencies such as the current one. Six (6) out of 7 hospitals in Gaza and 2 out of the 8 targeted hospitals in the West Bank have now been upscaled with mass casualty management training and plans based on the WHO Academy training guidelines, with additional technical support from the Trauma Operational Advisory Team (TOpAT) based in WHO’s Regional Office for the Eastern Mediterranean. 

Emergency medical teams 

Another significant WHO investment in increasing the preparedness of the health system when faced with emergencies was the development of 2 national emergency medical teams (EMTs) in the Gaza Strip with tailored training and standard operating procedures combined with the prepositioning of equipment and supplies. With support from the European Civil Protection and Humanitarian Aid Operations (ECHO), Swiss Development Cooperation (SDC) and the Italian Agency for Development Cooperation (AICS), critical stocks are replenished for use in times of crisis. 

WHO has initiated the process through which the 2 EMTs will become WHO-verified as national EMTs testifying for the increased preparedness of the health system in the Gaza Strip. 

With endorsement from the Ministry of Health to the EMTs initiative at high level, a number of various health professionals – doctors, nurses, logisticians and pharmacists already working at different primary health care levels, ambulance services or hospitals – were pre-identified as the EMT members and ready for deployment when triggered.

A paradigm shift

Due to the sheer volume and urgency of cases, hospitals responding to mass casualties require a different mindset altogether involving the hospital manager, heads of departments (including the Emergency Department), nurses working in the ICU, pharmacists, laboratory workers, and logisticians. With the WHO-provided training, heads of emergency departments receiving casualties are now equipped with the level-headedness that results from a structured approach, an understanding of the trigger points for various response levels and an awareness that each level is backed by specific plans to be carried out by trained workers – in addition to the existence of EMTs to be deployed as the need arises to support any echelon of health care, from the pre-hospital level to rehabilitation, and post-discharge from the hospital.

An ongoing process

Continuously reeling from one cycle of escalation to another, the health care system in Gaza is in a protracted crisis causing chronic shortages of health care supplies and medicines. The impossible decision of whether to utilize available supplies and medicines for ongoing patient treatment or to stock them in readiness for the next crisis must often be made. Additionally, despite prepositioning some equipment and supplies in stock, they can only suffice for one or two days of mass casualties before additional external support becomes necessary. 

WHO’s immediate response to the surge in needs

On the second day of the recent escalations, the Ministry of Health mobilized some of the EMTs’ pre-stocked tents, supplies and equipment to expand the capacity of the emergency departments of 3 public hospitals by setting up a supplementary management area beside the Emergency Department to cope with the surge in casualties. In response to the Ministry of Health’s appeal, WHO immediately allocated emergency funds for the procurement of critically needed medicines, equipment and supplies, and is in the process of mobilizing an additional US$ 1.2 million to respond to part of the Ministry’s appeal. 

July 2022, Gaza - Recently, the World Health Organization in the occupied Palestinian territory (WHO oPt) and the Ministry of Health (MoH) commenced a series of trainings in Gaza on the National Guideline on Infection Prevention and Control.

The trainings are part of ongoing efforts to strengthen the health system and improve health workers’ capacity. Effective implementation of the Guideline at health facilities across Gaza will contribute to decreasing the transmission of diseases, improving the quality of health service provision, and institutionalization of infection prevention and control measures at health facilities and within the MoH.

The first of 17 trainings was completed in June, with the remaining scheduled to be finished by the end of 2022. More than 600 health staff will be capacitated through these trainings.

The National Guideline on Infection Prevention and Control has been developed by the Ministry of Health in collaboration with WHO oPt, to provide clear protocols to control the transmission of diseases. 

May 2022 - Ahlam is a 5-year-old girl born in Beit-Lahia in the north of the Gaza Strip.

Since she was six months old, Ahlam’s family noticed she was not as responsive as other children her age and suspected that a problem with her hearing. They took her to two charitable organizations in the Gaza Strip, Atfaluna and Hamad Hospital in Gaza City, who examined her hearing and diagnosed Ahlam with partial hearing loss.

A year ago, Ahlam started to face further problems with her ears. Her grand-mother explained.

"Ahlam had discharge from both her ears, which had a foul smell. We took her to Beit Hanoun Hospital, where they diagnosed her as having an infection in her ear and treated her with antibiotics. Initially it helped and she improved, but then she kept getting the infection again and again."

Ahlam was seen by ear, nose and throat (ENT) specialists at Beit Hanoun Hospital, who advised her family that she should have surgery (removal of a part of bone near the ear called the mastoid process) to prevent complications of repeated middle ear infections. Because of lack of appropriate equipment in the Gaza Strip, she was referred to St Joseph Hospital in East Jerusalem. Although the hospital is within the occupied Palestinian territory, Ahlam would need a permit to exit Gaza and reach her appointment.

In December 2021, the family received financial coverage from the Palestinian Ministry of Health for surgery in Egypt. However, they could not afford to travel for the treatment.

"We did not travel to Egypt because we do not have money for that," Ahlam’s grandmother explained." Ahlam’s father works as a labourer in the fields. He earns 20 shekels a day [just under $6 a day]. We get some support from a Qatari programme for poor families [in the Gaza Strip]. It is expensive to travel to Egypt and the Ministry of Health referral doesn’t cover all associated costs. We requested to change the destination to Jerusalem.” Ahlam lives with her father, mother and 3-year-old brother in a room in the house of her extended family.

From January to May, Ahlam received three hospital appointment for St. Joseph Hospital in East Jerusalem. For the first appointment, the family was advised there was not sufficient time for processing of a permit request by Israeli authorities and so did not apply for a permit. For appointments in April and May, the family received no response from Israeli authorities to their permit application by the date of Ahlam’s hospital appointment – meaning she was unable to travel for care.