17 May 2023 - WHO trained 25 Palestine Medical Relief Society paramedics from the West Bank and East Jerusalem in pre-hospital trauma care during a four-day workshop, which aimed to refresh their skills and teach new techniques for stabilizing patients in emergencies and mass-casualty incidents. Participants

The course delivered during the training has been developed by WHO's Emergency Operations Unit and piloted for the first time in the Eastern Mediterranean region. It is designed to provide participants with critical life-saving skills that meet international standards and ensure that health workers speak a shared technical language during emergencies. During the training, participants particularly benefited from learning about handling patients with major injuries from gunshots and blasts.

"This training is part of a larger roadmap WHO has developed in collaboration with the Ministry of Health to improve the emergency preparedness and response capacity in the West Bank and East Jerusalem. Since 2022, efforts have been ongoing to identify and address gaps in the trauma care pathway at the pre-hospital, hospital, and post-hospital levels, aiming to reduce morbidity and mortality during emergencies," said Dr. Athanasios Gargavanis, WHO Emergency Care Technical Officer.

Since December 2021, WHO has trained 195 health workers in the West Bank and East Jerusalem in mass-casualty management protocols and supported seven main hospitals in the West Bank to update their emergency plans. 

The basic pre-hospital trauma care training was delivered through WHO's Contingency Fund for Emergencies (CFE), which provides resources for rapid emergency responses, often within 24 hours. 

"CFE has been vital in supporting WHO scale-up efforts to improve the trauma care pathway, which is extremely important in the current context given the increased violence in the West Bank," said Dr. Gargavanis.

WHO is developing plans to expand the basic pre-hospital trauma care training across the West Bank, after analysis of feedback received from participants of the recent training.

Khalid, 36 years old from Gaza city, has end stage kidney failure. For 16 years, he has been dependent on weekly haemodialysis (a procedure to remove waste and water from the blood, to perform the function of healthy kidneys).

In late 2022, Khalid required referral out of Gaza for vascular surgery so that he would be able to keep having lifesaving haemodialysis. Despite repeated surgeries in Gaza, doctors were unable to establish the vascular access needed for the procedure. At Makassed Hospital in east Jerusalem, Khalid was to receive an artificial blood vessel graft.

In total, Khalid made six permit applications to Israeli authorities. He was never approved a permit to reach Makassed Hospital but was instructed to change the destination and arrange a hospital appointment in Jordan after several appeals through human rights organizations and advocacy by the UN and partners. As of April 2023, Khalid was awaiting financial coverage from the Palestinian Ministry of Health for an appointment at a hospital in Jordan.  

Table 1: Khalid’s hospital appointments, intended hospital destination, and permit outcomes

Amal, 38 years old from Gaza city, was found to have a brain aneurysm (a potentially life-threatening ballooning of a blood vessel) in March 2022.

On 5 June 2022, Amal was referred to An-Najah University Hospital in Nablus, in the West Bank, for brain catheterization and scan (angiography), a procedure not available in the Gaza Strip. She made one permit application for an appointment on 16 June that was delayed. Amal was approved a permit to travel on 3 August but following closure of Erez (Beit Hanoun) checkpoint by Israeli authorities on 2 August she was unable to exit the Gaza Strip to receive care.

Talking about the outcome of her first application, Amal said, “I don’t know why I am prevented, I have been waiting so long! I need to have this test so the doctor can make a clear diagnosis and give me proper treatment. I suffer and worry every day.

”Amal received a further hospital appointment at An-Najah University Hospital for 1 September. She was eagerly awaiting a text message from the Palestinian Health Liaison Office, hoping for a positive response, when WHO spoke with her the day before her appointment. She received the text at 5pm that day and called to ask, “I’ve just received a text message from the Liaison Office. It says under study. What does it mean?” After her initial disappointment, she received another message later that evening saying that she had been approved and could travel the next day.

Amal finally travelled and received the scan she needed. Doctors advised the best course of action would be to manage her condition with medicines, which she now takes daily. “I finally had the tests and I feel so grateful that I won’t need brain surgery after all. The doctors at An-Najah reassured me and prescribed me some medicines. They recommended that I will need follow up to keep an eye on things,” Amal said.

Table 1: Amal’s hospital appointments, intended destination, and permit outcomes