Abed Almuhdi Ghareeb is a 25-year-old paramedic and coordinator of the Palestinian Medical Relief Society (PMRS) ambulance teams and volunteers in Bethlehem governorate. He also works as youth project coordinator in the southern districts and suburbs of Jerusalem.

Abed Almuhdi lives in Dheisheh refugee camp and began volunteering with PMRS when he was just 13 years old. His journey started when PMRS teams came to his school and introduced the students to their work. Abed joined courses in first aid and field paramedic skills, but he hadn’t thought he would end up working with ambulance teams himself.

“Once I had done the courses, I found I liked the work a lot and I was first in my class. I decided to volunteer and join the paramedic team.”

Abed Almuhdi tried work in other fields, but even during those times he continued to volunteer for PMRS.  

“My work is a part of who I am… When you help someone who is injured you feel that you did something good, something to be proud of. You do not feel that in other jobs.”

In February 2020, PMRS started preparing a response plan in light of the COVID-19 public health emergency. Abed participated in several preparation sessions on how to deal with COVID-19.

On 7^th March when the first cases of COVID-19 were announced in Palestine, Abed worked to train volunteers and raise public awareness on hygiene and prevention measures. The paramedic teams initially focused on providing social support to households in quarantine.  

“When we started our work in the field, we did not have any protective clothes, then the Engineers Syndicate donated 4 protective suits. We used the same suit for around 2 months, disinfecting it each time. The first days were stressful and scary, as we did not have a full understanding of what we were dealing with. In our country we are used to dealing with injuries due to clashes, but this pandemic was something new. There was nothing and then suddenly everything closed in the country and we had to be out there doing our best to fight something we did not fully understand.”

However, later in the pandemic, with increased numbers of health workers affected by COVID-19, Abed and some of his colleagues were requested by the Palestinian Ministry of Health to support preventive medicine teams. This involved support to testing persons suspected to have COVID-19, continued awareness raising and disinfection households of persons suspected or confirmed to have had COVID-19.

“The second wave was not so scary. We were more aware of how to deal with the virus and better prepared to protect ourselves”.

Since the outbreak in Palestine, Abed moved away from the family home where he previously lived with his parents and one sibling, for their safety. Up until recently Abed only saw his family from the house window, speaking to his mother through the window.

“In the end I am dealing with the virus on a daily basis. I do not want this virus to reach my family. My father suffers from chronic diseases and I did not want to put him at risk.”

Salsabeel Salhab is a 19-year-old volunteer paramedic working with the Palestinian Medical Relief Society (PMRS) in the Bethlehem governorate. Alongside this, she works with her father in the family business. Salsabeel began volunteering when she was just 14 years old, after PMRS teams came to her school and introduced the students to their work. She joined courses in first aid and field paramedic skills. Now, Salsabeel herself introduces students and others to the works of PMRS, to raise awareness and promote community first aid skills.

“Joining PMRS changed me in many ways. I became a stronger and more confident person, I speak up in discussions and I’m ready to voice my opinions openly.”

With the onset of the COVID-19 outbreak in the West Bank on 7 March, Salsabeel was assigned by PMRS ambulance coordinator in Bethlehem to undertake public awareness raising on hygiene and prevention measures. Neighbours and extended family members urged her not to go to the field and see persons with COVID-19, fearing that she would bring the disease into the community. Salsabeel was not deterred, though, and with support and encouragement from her parents and siblings, she joined the PMRS teams and has continued her work throughout the outbreak in Palestine.

“I didn’t care about intimidation by others; and I wasn’t scared going to the field. I continued my work because I knew we were doing something good for people. We received training to protect ourselves during our work, which took away a lot of the fear associated with it. I stopped interacting with friends and family for their safety. I used to go and do my work, and then after returning I would stay in my room the whole time. I quarantined myself.”

Tackling the COVID-19 outbreak has required huge efforts to promote public awareness. Salsabeel commented, “Raising awareness is helping to improve understanding, but we still have a long way ahead of us. There is still a lot of harassment towards persons who contract the disease.” She recalls the discrimination encountered by some of her neighbours who had COVID-19.

Later in the pandemic, with increased numbers of health workers affected by COVID-19, Salsabeel was requested to join the Palestinian Ministry of Health preventative medicine teams to assist in COVID-19 testing centres. Meanwhile, she continued her efforts to raise community awareness about the disease.

Salsabeel believes in the importance of her work, which she carries out to serve her community:

“The work we do may not have financial payment, but helping someone is rewarding enough, without expecting anything back.”

Asrar, from Jabalia in the north of Gaza Strip, was diagnosed with a bone cancer called an osteosarcoma in her left lower leg in April 2018. She required radiotherapy, only available outside the Gaza Strip. From October 2018, Asrar attended Tel Hashomer Hospital, east of Jaffa, where she underwent extensive investigations, amputation of her leg, radiotherapy and chemotherapy, as well as subsequent physiotherapy to prepare her for use of her new artificial limb.

She continued to receive follow up at Tel Hashomer Hospital until February this year. After the start of the COVID-19 outbreak and limitations on movements, a local alternative for a selection of chemotherapy patients was established at Al-Haya Specialized Hospital in Gaza City. The centre began provision of a limited chemotherapy service on 21 April 2020, but is not equipped to replace the multidisciplinary and specialized services available at major Palestinian cancer referral centres.

Asrar was happy to receive care closer to home, but she missed the support of the multidisciplinary team that previously managed her care. Asrar said, “My aunt accompanied me at Tel-Hashomer but actually she did not have to do a lot in terms of care, because the health staff there do a lot for the patients, and they took care of me with respect. Even though I was far away from my family, I received good care and my family kept in touch with me every day by phone.”

In July, Asrar successfully completed her high school (tawjihi) exams and her family celebrated her success. Asrar’s father commented,

“She succeeded despite all the difficult circumstances and the long periods of treatment in and outside Gaza. I’m so proud of her and I hope she achieves all her dreams!”

Now Asrar is planning to study Information Technology (IT) at Al Quds (Jerusalem) Open University.  She said, “I think that this area of study would accommodate my current state of health, because it depends more on mental than physical ability.”

Currently there are severe barriers to access for patients requiring exit from the Gaza Strip for essential health services. The escalating numbers of COVID-19 cases in the West Bank and Israel mean continued restrictions on referrals and movement, while the end to coordination between Palestinian and Israeli authorities and of referrals to Israeli institutions have added difficulties to the already cumbersome and arbitrary permits process.

WHO is working with authorities for the protection of Gaza patients and for promoting their unhindered access to essential health services, even in the context of COVID-19.