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It was very stressful,’ Bethlehem nurse on-call during COVID-19 pandemic
In early April 2020, 56-year-old paediatric nurse Awatef Handal was called by her employer Caritas Baby Hospital in Bethlehem in the West Bank to assist with a suspected case of COVID-19, a boy from Hebron district. As the on-call nurse was Awatef’s job to stay with the young boy while he had a test taken for COVID-19.
“It was very stressful, emotionally and physically…I was worried if the boy would test positive I was worried for myself and worried that if I was exposed to this I would also bring it home and expose my family.
“On the other hand being in the full gear, wearing the personal protective equipment, is also very exhausting. I had to stay in full gear while waiting for the result. It was around eight hours, where you are breathing inside the gear and you start feeling the sweat and the humidity inside.”
Thankfully the boy tested negative and Awatef realized that she had the right personal protective equipment and training to ensure she and her five children and husband were safe during the COVID-19 response.
“When it all began it was very scary that I would go to the hospital and might be exposed and I might bring it back to my family. But now I know that if I take all the precautions and wear the protective equipment properly then I minimize the risk. I got training on the use of the personal protective equipment and how to protect ourselves, and how to make sure that we do not increase the spread. How we put on our protective equipment at the beginning of each shift, determines our fate.”
Awatef has been a nurse for more than 30 years and believes nurses are not properly acknowledged for their work in general and even now with the COVID-19 response the emphasis is on what doctors do you do not hear about the things nurses do even though they do a lot.
WHO celebrated celebrated the work of nurses and midwives on World Health Day on April 7 to remind world leaders of the critical role nurses and midwives play in keeping the world healthy. Nurses and other health workers like Awatef are at the forefront of COVID-19 response - providing high quality, respectful treatment and care, leading community dialogue to address fears and questions.
Despite this, she really appreciates her job: “I love nursing, in the past when I studied nursing, it was challenging and it was not a famous position. People looked at nursing as a job to serve people. I always loved helping others and I look at it as a humanitarian call. Especially children, I feel that I find myself with children for me being a children’s nurse is a very privileged position to be in. Watching a child get better is a wonderful experience and this gives you a feeling of achievement and satisfaction at the end of a long day.”
WHO thanks Austrian Development Cooperation for contribution to COVID19 response
April 9 2020, Jerusalem – The World Health Organization today thanked the Austrian Development Cooperation for its €250,000 contribution to support the WHO’s response to COVID-19 in the occupied Palestinian territory (oPt).
The world is facing an unprecedented challenge with communities and economies everywhere affected by the growing COVID-19 pandemic. In the oPt, a State of Emergency has been effective since March 5.
As of April 7, a total of 261 Palestinians have been confirmed to have COVID-19 in the oPt, 248 in the West Bank and 13 in the Gaza Strip. Of these, one died on 25 March and 42 people have recovered.
Despite the best efforts of local health authorities, the capacity of the Palestinian health system to cope with the expected increase in caseload remains severely impaired by longstanding challenges and critical shortages, particularly in the Gaza Strip.
“We appreciate the quick and generous response by the Austrian Government to provide support and show solidarity at a time when its needed most”, said Dr Gerald Rockenschaub, head of WHO’s office for the occupied Palestinian territory.
“This funding will support WHO and local health authorities to address critical gaps that could undermine the occupied Palestinian territory’s ability to contain and manage the epidemic, including providing the most needed items currently in short supply due to the unprecedented global demand, such as personal protective equipment (PPE) kits and supplies to conduct COVID-19 tests.”
“The spread of COVID-19 puts people living in countries with fragile health care systems especially at risk. It is our responsibility to help make sure that nobody is left behind. We therefore highly welcome WHO’s swift response and are grateful for being able to support the Palestinian authorities in dealing with this unprecedented crisis”, emphasized Astrid Wein, the Austrian Representative in Ramallah.
The funding will strengthen WHO’s efforts in the oPt to combat the COVID-19 pandemic in the oPt and help protect the region’s most vulnerable people from impacts of COVID-19 on already overstretched health systems.
The situation is particularly severe in Gaza, where the health system has been undermined by chronic conflict and blockade, the internal Palestinian political divide, shortages in specialized health staff, drugs and equipment, compounded by electricity cuts impacting hospitals. The strain on Gaza’s health system has been further exacerbated over the past two years due to the high casualty toll from the events surrounding the Great March of Return.
The Austrian Government also released a statement in support of the announcement.
For more information, please contact:
Alice Plate, WHO oPt Communications Specialist,
Katharina Schreiber, Advisor Public Relations, Austrian Development Agency,
Limb Reconstruction Centre launched to assist patients with gunshot injuries in Gaza
5 March 2020, Gaza Strip - Today the World Health Organization in partnership with the Ministry of Health launched a Limb Reconstruction Centre for Gaza Strip, providing hundreds of Palestinians injured with gunshot wounds, with permanent specialized and centralised care.
Based at Nasser Medical Complex in Khan Yunis and generously funded with UK aid, EU humanitarian aid, by the Swiss Agency for Development and Cooperation, the United Nations oPt Humanitarian Fund and the Spanish Agency for International Development Cooperation, the new Centre features a 32-bed ward, two dedicated operating theatres, and 25 specialized multidisciplinary staff (including four orthopedic surgeons, psychologists and physiotherapists).
“The Limb Reconstruction Centre is a new centre of care and excellence, which will provide better quality, faster and more sophisticated treatment and rehabilitation to patients with gunshot injuries sustained during the Great March of Return. It will cater for a wide range of patient needs from wound care, surgery, infection control and physiotherapy to mental health support,” said Dr Gerald Rockenschaub, WHO’s Head of Office for the occupied Palestinian territory.
“This Centre will help transform the lives of those affected by preventing disabilities and amputations, and also restore dignity and hope to those patients who have been left powerless, unable to function and support their families and communities in what is already a difficult environment,” said Mr Jamie McGoldrick, Humanitarian Coordinator for the oPt.
Since the start of the Great March of Return in the Gaza Strip from March 2018 to 31 December 2019, 33,141 injuries and 322 deaths (including 65 children) have been reported. More than 7,951 suffered from gunshot wounds, and 88% of these presented limb wounds.
''The Great March of Return demonstrations in the Gaza Strip, has not only caused tremendous suffering for many families in Gaza but also has placed enormous strain on Gaza’s already under-resourced and over-burdened health care system. Gaza health facilities are facing a critical shortage of essential medicines and supplies, as well as a lack of specialised doctors and nurses. This new Centre will help to address some of these challenges through providing specialised treatment and support for patients requiring limb reconstruction surgery,'' said the EU Representative Sven Kühn von Burgsdorff.
''Today is yet another occasion to recall that the situation in Gaza remains fragile and unpredictable. It is the time to turn the page. Only a political solution can bring fundamental change and put an end to the violence, suffering and hardship,'' he added.
Six hundred patients have already been identified as being in need of limb reconstruction surgery (according to the Ministry of Health as of February 2020) and hundreds more wait to be assessed. Already more than 40 patients have been operated on since the Centre began operation in December 2019.
Gunshot injuries are complicated, expensive and difficult to treat: they can take up to two years to treat per patient; involve four to five surgeries for bone, muscles, soft tissue and nerves; and often involve serious bone infections. Rates of bone infection are extortionately high and an increasing number of patients are showing signs of antibiotic resistance, which increases the chance of amputation and the risk of infection to other patients. A dedicated osteomyelitis (bone infection) treatment centre, built by Médecins Sans Frontières-France in 2020, will be located adjacent to the Limb Reconstruction Centre and complement it.
While there have been medical missions for limb reconstruction in Gaza in the past, there hasn’t been a centralised service which provides permanent and dedicated operating theatres and resources from a multidisciplinary team. This Centre will help coordinate specialized limb reconstruction treatment to rationalize human resources, time, equipment and costs and also establish a patient database to unify information used by all partners deploying emergency medical teams for limb reconstruction services. The Limb Reconstruction Center will also facilitate much-needed training to upskill Gaza’s medical professionals, paving the way for a new generation of trained medical professionals in Gaza. Visiting specialist medical teams will focus their interventions in a centralized structure, maximizing training opportunities for younger resident staff.
Also at Nasser Medical Complex, WHO has installed a CT Scanner, funded by EU humanitarian aid, which will benefit an estimated 11,000 patients per year.
Background information:
The Limb Reconstruction Centre is a vital part of WHOs’ trauma and emergency care programme, which is working with the Ministry of Health (MoH) and partners on an extensive series of interventions that aim to improve the management of traumatic injuries, from the point of injury, at the prehospital level all the way to hospital care, including emergency departments and surgery, to rehabilitation and recovery. With the generous support of donors, since the start of GMR demonstrations in 2018, this programme has helped establish and upgrade 10 Trauma Stabilization Points (TSPs) in critical zones in Gaza with the Palestinian Red Crescent Society (PRCS) and MoH to reduce the burden on the overloaded hospitals substantially. At the TSPs, wounded patients receive life-saving care close to the point of injury and saved on average 1200 lives in a year (from 30 March 2018 to 30 March 2019).
As part of the trauma pathway, in 2020 WHO will:
upgrade six trauma hospitals in Gaza and four in the West Bank to create a trauma response network, providing a range of interventions, from improved infrastructure, provision of supplies, training and clinical coaching for all doctors and nurses working at the emergency departments
build on the success of the TSPs, by expanding them to the Eastern Mediterranean region to respond to conflict related trauma in the region
support the PCRS to centralize all ambulance movements through a new ambulance dispatch centre
provide training for surgeons on acute surgery in the six trauma hospitals to improve damage control surgery through basic principles of control of haemorrhage, prevention of contamination and protection from further injury
provide training to PRCS and MoH staff to provide frontline care in an acute emergency
support the running costs and supplies for the Limb Reconstruction Centre.
The World Health Organization (WHO) is appealing for US$ 20 million over three years to provide life- and limb-saving interventions to large numbers of injured patients and to build on the previous success of the WHO supported interventions and ensure better health outcomes for Palestinians through strengthened continuum of care along the trauma pathway.
For more information, please contact:
Alice Plate, WHO Communications Specialist, occupied Palestinian Territory
+972 54 6153900 |
Three-year-old Jana from Gaza gets permit to travel for cancer treatment, after five months delay.
“Jana is one of hundreds of children who depend on Israeli-issued permits to travel to health facilities outside the Gaza Strip and for accompaniment of their parents.“
Three-year-old Jana from Jabalia in the north of the Gaza Strip has cancer, but she hasn’t been able to access the treatment she needs since October last year. Jana and her mother’s applications for Israeli-issued permits, required for her to access health facilities outside the Gaza Strip, have been repeatedly delayed or denied. Jana’s mother, Maysa, was increasingly concerned, “Jana was in a very critical condition. Doctors in Gaza told us that if she didn’t get treatment in time, she would need to undergo kidney dialysis.”
On the evening of Saturday 15 February, the day before Jana’s appointment, Jana and Maysa received a text message informing them they had been approved permits to travel to Augusta Victoria Hospital in East Jerusalem. Maysa talked about her relief, “I jumped up from the bed to the floor and started shouting, I was so happy as if I’d won a 1000-dinar prize!”. At 6am on Sunday 16 February, Jana and Maysa began the journey from their home to Erez checkpoint. Up to the last minute, Maysa was anxious and afraid they might be turned back.
Jana’s family discovered she had a tumour in 2018 when she was unable to pass urine and her family took her to Al-Shifa Hospital in Gaza City. A CT scan showed a tumour in her bladder and she underwent surgery to have it removed in January 2019. Initially the doctors at Al-Shifa had thought the tumour was benign. However, a biopsy in May 2019 confirmed that Jana had a cancer called a rhabdomyosarcoma.
From July 2019, Jana underwent a course of chemotherapy. Due to the size of her tumour, Jana then needed radiotherapy treatment that is not available in the Gaza Strip. She was referred to Augusta Victoria Hospital in East Jerusalem in October 2019, which required travel out of Gaza and an Israeli-issued permit. However, her permit application to Israeli authorities was delayed, remaining ‘under study’ by the time of her hospital appointment, and her mother’s application was denied.
“I jumped up from the bed to the floor and started shouting, I was so happy as if I’d won a 1000-dinar prize!“Jana’s family discovered she had a tumour in 2018 when she was unable to pass urine and her family took her to Al-Shifa Hospital in Gaza City. A CT scan showed a tumour in her bladder and she underwent surgery to have it removed in January 2019. Initially the doctors at Al-Shifa had thought the tumour was benign. However, a biopsy in May 2019 confirmed that Jana had a cancer called a rhabdomyosarcoma.
From July 2019, Jana underwent a course of chemotherapy. Due to the size of her tumour, Jana then needed radiotherapy treatment that is not available in the Gaza Strip. She was referred to Augusta Victoria Hospital in East Jerusalem in October 2019, which required travel out of Gaza and an Israeli-issued permit. However, her permit application to Israeli authorities was delayed, remaining ‘under study’ by the time of her hospital appointment, and her mother’s application was denied.
Since October 2019, Jana and Maysa applied three times for permits to exit Gaza so Jana could access the radiotherapy treatment she needs to have the best chance of recovery. Jana’s applications were delayed, remaining ‘under study’ by the time of her hospital respective appointments. Maysa’s applications to accompany Jana were once denied and twice delayed. The process has been a difficult and stressful one for Jana’s family, especially for Maysa: “I am Jana’s mother. I should have priority to accompany my daughter for such significant treatment. In any case, my daughter is a small child and she would have been distressed to be away from me for this amount of time.” Jana has four other siblings at home, two sisters and two brothers. Her oldest sister is a first-year student at university and youngest sister is in fourth grade.
Jana’s mother is waiting to find out the full treatment plan for her daughter at Augusta Victoria Hospital, which will depend on the test results. She is waiting to hear how long they will need to stay in Jerusalem and whether they will be able to go back to Gaza between treatments. The Palestinian Ministry of Health covers treatment costs, but the family has to pay for the transportation and other needs. The process can become a costly one, placing strain on the families of patients from the Gaza Strip, which has some of the highest rates of unemployment in the world, with nearly half (46%) of people living below the poverty line.
Hundreds of children like Jana in the Gaza Strip continue to face barriers and delays to health access, as well as potential separation from their parents. In 2019, more than a quarter (28%) of the 7,566 permit applications for children to exit the Gaza Strip for healthcare were unsuccessful – either denied (5%) or delayed (23%), with families receiving no definitive response to their permit applications by the time of their hospital appointments. In the vast majority of cases, Israeli authorities provide no explanation for why permit applications are not successful.
For children receiving permits to travel for healthcare, almost two-fifths (38% or 2,068 of the 5,459 approved permits for children) were approved for exit without the accompaniment of their parents.
The benefit of family support to children is not only critical for emotional support of paediatric patients, but close involvement in a child’s healthcare improves family understanding of the child’s illness and needs for longer-term care. Non-approval of permits for patient companions represents a major barrier to ensuring effective care for children and others who are strongly dependent on families for longer-term care and recovery.
Related links:
WHO Monthly report on referral of pateints from the Gaza Strip, January, 2020
