• PHR-Israel delegation to the Gaza Strip, 18-19 December, 2008-12-22
• Gaza siege results in 300% increase in burn cases in the burns department at Shifaa’ hospital in the Gaza Strip
• Denial of access to healthcare continues
• PHR-Israel and the Palestinian Medical Relief Society (PMRS) issue a joint protest following the
expulsion of UN Special Rapporteur Falk http://www.phr.org.il/phr/files/articlefile_1230045569593.doc
• Gaza siege results in 300% increase in burn cases in the burns department at Shifaa’ hospital in the Gaza Strip
• Denial of access to healthcare continues
• PHR-Israel and the Palestinian Medical Relief Society (PMRS) issue a joint protest following the
expulsion of UN Special Rapporteur Falk http://www.phr.org.il/phr/files/articlefile_1230045569593.doc
18-19 December, 2008-12-22
PHR-Israel delegation to the Gaza Strip, On the 18th of December, a PHR-Israel delegation entered Gaza for a two-day visit, the eighth since the start of 2008. The delegation followed a period of three months during which the Israeli security apparatus had denied PHR-Israel access to the Gaza Strip, for various reasons.
The visit was held in order to learn about the current condition of the health system, to provide medical services in Gaza hospitals, and to plan for future delegations on the basis of medical needs.
Medical assistance and meetings
The delegation brought with it medical equipment to a value of 25 thousand US dollars, including prosthetic limbs, and transferred them to the European Hospital in Khan Younis.
Dr. Mustafa Yassin, an expert orthopedic oncologist from Rabin Medical Center ( Hasharon Campus ) in Israel, examined 25 patients at the European Hospital. Several of these were recommended for a knee replacement, which will be carried out by Dr. Yassin on his next visit to Gaza.
The delegation met with representatives of the local Ministry of Health and heard an update on the current situation, as well as a review of 2008, whose main contents follow:
According to the Palestinian Ministry of Health (MoH) in Gaza, 155,478 patients were admitted to the 14 hospitals and medical centers operating within the Gaza Strip. Some 49,000 surgical procedures were held, and 35,276 hospital births were recorded. According to statistics prepared by the Institute for Palestinian Studies for 2008, birthrates increased by 2.6% in comparison to 2007. The total budget of the Ministry of Health allocated to medical treatments for 2008 was 21 million US dollars.
The most common conditions treated in medical centers of the MoH in Gaza in 2008 were oncology diseases,liver and kidney conditions, joint diseases and arteriosclerosis.
According to Gaza MoH statistics for 2008, the number of cancer cases diagnosed this year was 520, of whom 91 were children. Breast cancer and cancer of the brain and other nervous systems were the most common types of cancer. 620 cardiac cases were registered, of whom 99 were children. 342 kidney patients are currently treated by hemodialysis. 3,199 cases of Hepatitis A were recorded, 496 of Hepatitis B, and 196 of Hepatitis C.
A shortage of 105 types of medicines, or one quarter of the medications ordered by the MoH in Gaza has characterized the majority of 2008. 30 of these are for lifesaving treatments, 21 for cancer, kidney and liver conditions. In addition, a total of 220 parts and equipment items defined as necessary for surgical procedures and for maintenance of Intensive Care Units are lacking. Several milk sterilization instruments in pediatric departments have stopped functioning.
The Ministry of Health in Gaza operates 58 emergency vehicles for medical evacuation. Half of these were put out of service due to lack of spare parts ( engine oil, batteries, internal seats and upholstery, electrical and medical equipment ). As a result the MoH purchased 64 substandard alternative vehicles, which were used for patient transfer. Many ambulances are currently still out of service and some patients are transferred in private vehicles.
In emergencies, the evacuation services suffer from substandard communications due to the collapse of the two cellular systems in Gaza: Jawwal and Mirs. As a result, ambulance drivers meet difficulties in communicating with headquarters, with hospitals, with each other and with the patients’ families. This can lead to severe delays and even to loss of lives. The proposed solution is an internal communications system for the evacuation system in Gaza, estimated costs of which are 170,000 US dollars, a sum currently unavailable to the Gaza MoH.
There is a severe shortage of several types of gases that are necessary for the functioning of the health system (e.g., Carbon Oxygen Type 2, Ethylene Oxide, dry and liquid Nitrogen, medical Nitrous and cooking gas).
There is also a chronic shortage of fuel for the hospitals in Gaza, leading to a depletion of stores in a manner that will not enable maintenance of full activities in case of further fuel cuts.
Gaza siege results in 300% increase in burn cases in the burns department at Shifaa hospital in the Gaza Strip
In December 2008, PHR-Israel recorded an increase in patients suffering from burns applying to the organization for assistance. Further investigation revealed that a sharp increase of 300% in burns cases admitted to the burns department at Shifaa hospital in Gaza has been recorded over the past month. This is a result of the ongoing shortages in electricity, cooking gas and heating gas. These, along with the arrival of the cold winter months, have led the population of Gaza to light wood fires, resulting in dangerous conditions. Many of the burns cases reported to us have been of children playing with fire while attempting to light fires for heating or cooking, or lighting candles for light at home.
According to Dr. Nafez Abu Sha’ban, director of the burns department in Shifaa hospital in Gaza, the department is overloaded and is treating 16 patients, the vast majority of whom are children. This is despite the fact that the department is actually capable of providing adequate treatment to only 5 patients at a time.
According to Dr. Abu Sha’ban, the Israeli siege on Gaza has caused not only a severe shortage of water, electricity and other basic goods, but also in gas and fuel for cooking, heating and baking. As a result, many are now using Primus stoves or open fires for cooking and heating.
Due to the case overload in the burns department, and the current lack of basic and advanced medical equipment (e.g., resuscitation equipment for children and spare parts for existing equipment), the department cannot give immediate and appropriate response to the large number of patients. As a result of this, as well as of the high degree of severity and complexity of the cases, Palestinian doctors are referring some of the children to advanced medical centers in Israel. However, many children, some of them in life-threatening conditions, remain in Gaza without proper care, despite these referrals, due to a shortage in beds in children’s ICU and in children’s burns departments in the four medical centers in Israel that are able to treat children’s burns:
Hadassah Ein Karem in Jerusalem, Sheba Medical Center in Tel Hashomer, Rambam in Haifa, and Soroka in Beer-Sheva.
A written appointment letter for hospitalization from a hospital is a precondition set by the Israeli security apparatus for Palestinians who need to be transferred to medical care that is unavailable in Gaza. Without it,
they cannot apply for a permit to exit Gaza. In urgent and lifesaving cases, the wait for an appointment and the permit application process impair the chances of recovery and can even endanger lives. Israeli children, who are admitted to hospital immediately, must also wait for a bed, but are not further delayed by bureaucratic hurdles once they have a place.
Physicians for Human Rights-Israel has received four applications from families whose children sustained medium to severe burns over the past week, and who are referred urgently to medical care in Israel, but have not managed to get appointments for hospitalization. All these patients already have financial undertakings from the Palestinian Ministry of Health in Ramallah, to cover the costs of the care, and the invitation letter from the hospital is the only obstacle to their exit. One of these cases ended in death, and it joins two other child deaths from the past week in Gaza.
Rahaf, three and a half, has third-degree burns on 55% of her body, and she is currently hospitalized in life threatening condition in the burns department at Shifaa hospital in Gaza. Her body heat has been 35 degrees Celsius for the past three days, and she is artificially ventilated. Rahaf was seriously injured on December 17 at 3pm after trying to light a stove in the kitchen of her home. On the same day she already had all the necessary medical documents and a financial undertaking from the Ministry of Health to cover all costs of care, but from then until this afternoon, the family could not find a hospital able to admit her. This afternoon (22 December), after numerous calls made by PHR-Israel to hospital departments in Israel, Rahaf finally received an appointment for Rambam medical center in Haifa, for tomorrow morning. We hope for her speedy recovery.
Physicians for Human Rights-Israel requests that the demand to present an appointment to a specific department before applying for a permit be waived in cases of children in need of urgent transfer of this type, in order to minimize delays as far as possible and ensure speedy transfer at the first opportunity.
Physicians for Human Rights-Israel vehemently opposes the collective measures imposed on the civilian population of Gaza, and points to these burns cases as one more example of the disastrous results of the siege policy.
Denial of access to healthcare continues
Since the renewal of Israeli military operations and Palestinian Qassam rockets on the south of Israel on November 3rd, declared restrictions on exit of patients from the Gaza Strip have increased. In the past two months, the Israeli authorities at Erez Crossing rejected 11 new appeals we sent to them, following rejection of their applications for medical exit permits. Four of these patients need orthopedic care, three have kidney disease, two are cancer patients, one is in need of neurosurgical intervention and the last needs ophthalmology care. All these patients have already had their requests rejected in the past and have been waiting for weeks or even months for medical care. The GSS rejected PHR-Israel’s appeals on their behalf, despite the submission of expert opinions by specialist doctors, which clarified that denial of care could cause irrevocable damage. Nine further recent requests by PHR-Israel have not yet received any response from the GSS, which is delaying its responses increasingly in recent weeks. The delayed cases include a haemophiliac, a cancer patient and a fiveyear-old girl with heart disease, whose mother has died but her father is not allowed to accompany her.
Rafah crossing into Egypt remains closed, and last time it was opened was on September 20.
At unpredictable intervals since November 3rd, the Israeli government has ordered the total closure of Erez
Crossing to all but the “most urgent, lifesaving, humanitarian” cases. In practice, such a closure makes the exit of even very serious and urgent cases close to impossible. In the opinion of PHR-Israel, the prioritization of exit according to medical severity/urgency is unethical, as the rest of th patients will stay behind without care. This constitutes an improper use of medical criteria for non-medical, political purposes.[1]
PHR-Israel and the Palestinian Medical Relief Society (PMRS) issue a joint protest following the
expulsion of UN Special Rapporteur Falk.
Physicians for Human Rights-Israel and the Palestinian Medical Relief Society (PMRS) vehemently protest the expulsion from Israel of UN Special Rapporteur Prof. Richard Falk, on December 17. PHR-Israel had been invited to participate in a meeting with the Rapporteur and to provide evidence regarding violations of the right to health in the OPT, access to healthcare and rights of prisoners and detainees. The expulsion of Prof. Falk is also injurious to the ongoing work of PHR-Israel.
PHR-Israel and PMRS have issued a letter of protest to Israeli government ministries on this issue. Please see this to read the letter http://www.phr.org.il/phr/files/articlefile_1230045569593.doc
For further details please contact Miri Weingarten, miri@phr.org.il , +972 546995199, or Ran Yaron, ranyaron@phr.org.il , +972 547577696.
For more on the ethical ramifications of such prioritisation, see PHR-Israel’s medical-ethical position paper,
August 2007.
PHR-Israel delegation to the Gaza Strip, On the 18th of December, a PHR-Israel delegation entered Gaza for a two-day visit, the eighth since the start of 2008. The delegation followed a period of three months during which the Israeli security apparatus had denied PHR-Israel access to the Gaza Strip, for various reasons.
The visit was held in order to learn about the current condition of the health system, to provide medical services in Gaza hospitals, and to plan for future delegations on the basis of medical needs.
Medical assistance and meetings
The delegation brought with it medical equipment to a value of 25 thousand US dollars, including prosthetic limbs, and transferred them to the European Hospital in Khan Younis.
Dr. Mustafa Yassin, an expert orthopedic oncologist from Rabin Medical Center ( Hasharon Campus ) in Israel, examined 25 patients at the European Hospital. Several of these were recommended for a knee replacement, which will be carried out by Dr. Yassin on his next visit to Gaza.
The delegation met with representatives of the local Ministry of Health and heard an update on the current situation, as well as a review of 2008, whose main contents follow:
According to the Palestinian Ministry of Health (MoH) in Gaza, 155,478 patients were admitted to the 14 hospitals and medical centers operating within the Gaza Strip. Some 49,000 surgical procedures were held, and 35,276 hospital births were recorded. According to statistics prepared by the Institute for Palestinian Studies for 2008, birthrates increased by 2.6% in comparison to 2007. The total budget of the Ministry of Health allocated to medical treatments for 2008 was 21 million US dollars.
The most common conditions treated in medical centers of the MoH in Gaza in 2008 were oncology diseases,liver and kidney conditions, joint diseases and arteriosclerosis.
According to Gaza MoH statistics for 2008, the number of cancer cases diagnosed this year was 520, of whom 91 were children. Breast cancer and cancer of the brain and other nervous systems were the most common types of cancer. 620 cardiac cases were registered, of whom 99 were children. 342 kidney patients are currently treated by hemodialysis. 3,199 cases of Hepatitis A were recorded, 496 of Hepatitis B, and 196 of Hepatitis C.
A shortage of 105 types of medicines, or one quarter of the medications ordered by the MoH in Gaza has characterized the majority of 2008. 30 of these are for lifesaving treatments, 21 for cancer, kidney and liver conditions. In addition, a total of 220 parts and equipment items defined as necessary for surgical procedures and for maintenance of Intensive Care Units are lacking. Several milk sterilization instruments in pediatric departments have stopped functioning.
The Ministry of Health in Gaza operates 58 emergency vehicles for medical evacuation. Half of these were put out of service due to lack of spare parts ( engine oil, batteries, internal seats and upholstery, electrical and medical equipment ). As a result the MoH purchased 64 substandard alternative vehicles, which were used for patient transfer. Many ambulances are currently still out of service and some patients are transferred in private vehicles.
In emergencies, the evacuation services suffer from substandard communications due to the collapse of the two cellular systems in Gaza: Jawwal and Mirs. As a result, ambulance drivers meet difficulties in communicating with headquarters, with hospitals, with each other and with the patients’ families. This can lead to severe delays and even to loss of lives. The proposed solution is an internal communications system for the evacuation system in Gaza, estimated costs of which are 170,000 US dollars, a sum currently unavailable to the Gaza MoH.
There is a severe shortage of several types of gases that are necessary for the functioning of the health system (e.g., Carbon Oxygen Type 2, Ethylene Oxide, dry and liquid Nitrogen, medical Nitrous and cooking gas).
There is also a chronic shortage of fuel for the hospitals in Gaza, leading to a depletion of stores in a manner that will not enable maintenance of full activities in case of further fuel cuts.
Gaza siege results in 300% increase in burn cases in the burns department at Shifaa hospital in the Gaza Strip
In December 2008, PHR-Israel recorded an increase in patients suffering from burns applying to the organization for assistance. Further investigation revealed that a sharp increase of 300% in burns cases admitted to the burns department at Shifaa hospital in Gaza has been recorded over the past month. This is a result of the ongoing shortages in electricity, cooking gas and heating gas. These, along with the arrival of the cold winter months, have led the population of Gaza to light wood fires, resulting in dangerous conditions. Many of the burns cases reported to us have been of children playing with fire while attempting to light fires for heating or cooking, or lighting candles for light at home.
According to Dr. Nafez Abu Sha’ban, director of the burns department in Shifaa hospital in Gaza, the department is overloaded and is treating 16 patients, the vast majority of whom are children. This is despite the fact that the department is actually capable of providing adequate treatment to only 5 patients at a time.
According to Dr. Abu Sha’ban, the Israeli siege on Gaza has caused not only a severe shortage of water, electricity and other basic goods, but also in gas and fuel for cooking, heating and baking. As a result, many are now using Primus stoves or open fires for cooking and heating.
Due to the case overload in the burns department, and the current lack of basic and advanced medical equipment (e.g., resuscitation equipment for children and spare parts for existing equipment), the department cannot give immediate and appropriate response to the large number of patients. As a result of this, as well as of the high degree of severity and complexity of the cases, Palestinian doctors are referring some of the children to advanced medical centers in Israel. However, many children, some of them in life-threatening conditions, remain in Gaza without proper care, despite these referrals, due to a shortage in beds in children’s ICU and in children’s burns departments in the four medical centers in Israel that are able to treat children’s burns:
Hadassah Ein Karem in Jerusalem, Sheba Medical Center in Tel Hashomer, Rambam in Haifa, and Soroka in Beer-Sheva.
A written appointment letter for hospitalization from a hospital is a precondition set by the Israeli security apparatus for Palestinians who need to be transferred to medical care that is unavailable in Gaza. Without it,
they cannot apply for a permit to exit Gaza. In urgent and lifesaving cases, the wait for an appointment and the permit application process impair the chances of recovery and can even endanger lives. Israeli children, who are admitted to hospital immediately, must also wait for a bed, but are not further delayed by bureaucratic hurdles once they have a place.
Physicians for Human Rights-Israel has received four applications from families whose children sustained medium to severe burns over the past week, and who are referred urgently to medical care in Israel, but have not managed to get appointments for hospitalization. All these patients already have financial undertakings from the Palestinian Ministry of Health in Ramallah, to cover the costs of the care, and the invitation letter from the hospital is the only obstacle to their exit. One of these cases ended in death, and it joins two other child deaths from the past week in Gaza.
Rahaf, three and a half, has third-degree burns on 55% of her body, and she is currently hospitalized in life threatening condition in the burns department at Shifaa hospital in Gaza. Her body heat has been 35 degrees Celsius for the past three days, and she is artificially ventilated. Rahaf was seriously injured on December 17 at 3pm after trying to light a stove in the kitchen of her home. On the same day she already had all the necessary medical documents and a financial undertaking from the Ministry of Health to cover all costs of care, but from then until this afternoon, the family could not find a hospital able to admit her. This afternoon (22 December), after numerous calls made by PHR-Israel to hospital departments in Israel, Rahaf finally received an appointment for Rambam medical center in Haifa, for tomorrow morning. We hope for her speedy recovery.
Physicians for Human Rights-Israel requests that the demand to present an appointment to a specific department before applying for a permit be waived in cases of children in need of urgent transfer of this type, in order to minimize delays as far as possible and ensure speedy transfer at the first opportunity.
Physicians for Human Rights-Israel vehemently opposes the collective measures imposed on the civilian population of Gaza, and points to these burns cases as one more example of the disastrous results of the siege policy.
Denial of access to healthcare continues
Since the renewal of Israeli military operations and Palestinian Qassam rockets on the south of Israel on November 3rd, declared restrictions on exit of patients from the Gaza Strip have increased. In the past two months, the Israeli authorities at Erez Crossing rejected 11 new appeals we sent to them, following rejection of their applications for medical exit permits. Four of these patients need orthopedic care, three have kidney disease, two are cancer patients, one is in need of neurosurgical intervention and the last needs ophthalmology care. All these patients have already had their requests rejected in the past and have been waiting for weeks or even months for medical care. The GSS rejected PHR-Israel’s appeals on their behalf, despite the submission of expert opinions by specialist doctors, which clarified that denial of care could cause irrevocable damage. Nine further recent requests by PHR-Israel have not yet received any response from the GSS, which is delaying its responses increasingly in recent weeks. The delayed cases include a haemophiliac, a cancer patient and a fiveyear-old girl with heart disease, whose mother has died but her father is not allowed to accompany her.
Rafah crossing into Egypt remains closed, and last time it was opened was on September 20.
At unpredictable intervals since November 3rd, the Israeli government has ordered the total closure of Erez
Crossing to all but the “most urgent, lifesaving, humanitarian” cases. In practice, such a closure makes the exit of even very serious and urgent cases close to impossible. In the opinion of PHR-Israel, the prioritization of exit according to medical severity/urgency is unethical, as the rest of th patients will stay behind without care. This constitutes an improper use of medical criteria for non-medical, political purposes.[1]
PHR-Israel and the Palestinian Medical Relief Society (PMRS) issue a joint protest following the
expulsion of UN Special Rapporteur Falk.
Physicians for Human Rights-Israel and the Palestinian Medical Relief Society (PMRS) vehemently protest the expulsion from Israel of UN Special Rapporteur Prof. Richard Falk, on December 17. PHR-Israel had been invited to participate in a meeting with the Rapporteur and to provide evidence regarding violations of the right to health in the OPT, access to healthcare and rights of prisoners and detainees. The expulsion of Prof. Falk is also injurious to the ongoing work of PHR-Israel.
PHR-Israel and PMRS have issued a letter of protest to Israeli government ministries on this issue. Please see this to read the letter http://www.phr.org.il/phr/files/articlefile_1230045569593.doc
For further details please contact Miri Weingarten, miri@phr.org.il , +972 546995199, or Ran Yaron, ranyaron@phr.org.il , +972 547577696.
For more on the ethical ramifications of such prioritisation, see PHR-Israel’s medical-ethical position paper,
August 2007.
O jornalista Antonio Luiz M. C. Costa, na reportagem O FIM DE UMA ERA, publicada pela CartaCapital, revela o que está acontecendo no setor: “A crise da GM é também a do modelo de sociedade de consumo que a empresa ajudou a construir em seu país”. Faz ainda essa surpreendente constatação: “Mais de 50% dos carros vendidos nos EUA já são de empresas estrangeiras”. Isso era impensável até pouco tempo. Já Nouriel Roubini, economista e professor da Universidade de Nova York, é pessimista: “O que nos aguarda em 2009? O ano que vem será doloroso, com recessão global, mais desgaste financeiro, prejuízos e falências”.
An injured Palestinian prisoner reaches for help after being buried in the rubble of the Hamas security headquarters and prison in Gaza after it was hit in an Israeli missile strike on Sunday. (AP)
"It looked like the breach delivery of a baby, coming out of the brain," Grabb told The Associated Press. "To find a perfectly formed structure is extremely unique, unusual, borderline unheard of." 
“Por aproximadamente 1h30 choveu forte principalmente nas Zonas Norte, Leste, Oeste, Centro e Sul da Capital. A chuva forte veio acompanhada de muita queda de granizo e ventos de rajada”, informou, à noite, o CGE.
