Interim Progress Report Emergency Appeal -

Gaza Strip Crisis

Palestine Red Crescent Society

Emergency Appeal – Crisis

1 March 2009

This report covers the period of 27/12/08 to 01/03/09 of a six-month emergency appeal process, with an emphasis on the post-ceasefire period. For the 22 days in duration of hostilities please refer to “ PRCS report on the Israeli military operation on Gaza Strip ” PRCS teams remove dead bodies from under the rubble of the destroyed houses in the Gaza Strip .

In brief

Program Purpose: The overall goal of the appeal is to enable the restoration of the infrastructure, medical supplies, and program operation of the PRCS humanitarian core services to the Palestinian people in the Gaza Strip.

Programme summary: The Palestine Red Crescent Society (PRCS) launched on 31 December 2008 a six-month Preliminary Emergency Appeal followed by the Revised Emergency Appeal on 21 January 2009, in response to the humanitarian crisis resulting from Israel’s massive military operation throughout the Gaza Strip. Over the past month, PRCS staff, volunteers and International Red Cross and Red Crescent Movement partners as well as non-Movement organizations have implemented disaster management activities and provided urgently needed emergency medical and relief services. PRCS is also beginning to prepare for rebuilding of damaged infrastructure, replacement of medical supplies, and initiation of rehabilitation and psychosocial services. PRCS launched the Emergency Appeal – Gaza Strip Crisis in cooperation with the International Committee of the Red Cross (ICRC) and the International Federation of Red Cross and Red Crescent Societies (Federation).

Financial situation: PRCS launched the Preliminary Emergency Appeal – Gaza Strip Crisis for a total budgeted amount of USD 6,826,874, which has since been revised to USD 17,256,348 due to the emerging needs on the ground in the Gaza Strip. USD 14,048,776 has been received as of 7 March 2009, which accounts for 81% of the revised budget in the Mobilization Table. ICRC provided about 25% of the requested funds. Other financial contributors include: American Red Cross, Austrian Red Cross, Australian Red Cross, British Red Cross, Canadian Red Cross, Danish Red Cross, German Red Cross, Icelandic Red Cross, Japanese Red Cross, Netherlands Red Cross, Palang Merah Indonesia, Qatar Red Crescent, Spanish Red Cross, Swedish Red Cross, Swiss Red Cross, United Arab Emirates Red Crescent, and Asamblea de Cooperación Por la Paz (ACPP), Islamic Help, Italian Mission in Geneva, Norwegian Aid Committee (NORWAC), other private donors. The outstanding amount is USD 3,207,571.

The Mobilization Table is being updated and is available upon request .

Our partners: PRCS worked with many partners inside and outside the International Red Cross and Red Crescent Movement, including community-based, Palestinian government, United Nations and international humanitarian organizations. PRCS staff and volunteers worked with these organizations to provide drinking water and relief supplies, medical care, psychosocial support, rehabilitation services and assistive devices, tracking of missing persons, emergency shelter, and assessments of damage and subsequent needs. Partners inside the Movement included American RC, Austrian RC, Australian RC, British RC, Canadian RC, Danish RC, RC, German RC, Icelandic RC, Japanese RC, Jordan RC, Libya RC, Netherlands RC, Palang Merah Indonesia, Qatar RC, Spanish RC, Swedish RC, Swiss RC, United Arab Emirates RC.

Context The Palestine Red Crescent Society (PRCS) launched a six-month Revised Emergency Appeal on 21 January 2009, in response to the humanitarian crisis resulting from Israel’s massive military operation throughout the Gaza Strip. The Israeli operation began on 27 December 2008, with air strikes, artillery shelling, war ship bombardments and ground force invasi ons continuing for a total of 22 days. On 18 January 2009, both Israel and the Palestinian factions individually declared unilateral ceasefires. The attacks have left Gaza in ruins, including destruction to thousands of civilian homes and businesses, public infrastructure, bui ldings and installations. The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) reports more than 1,300 people have been killed and 5,300 wounded, of whom 1,855 are children. These numbers are likely to rise as bodies are recovered from the rubble of demolished buildings and homes.

PRCS health facilities were severely damaged and essential medical materials are depleted or in dangerously low supply. On January 15, the PRCS Al -Quds Hospital in sustained significant damage when bombed from the air and attacked by Israeli ground forces. Nearby, the 8 -storey PRCS administration building and Emergency Medical Centre were also damaged from the bombing and fires. PRCS ’s main warehouse in Gaza City was bombed and caught fire, des troying all stored supplies. In Jabalia refugee camp, the PRCS Primary Health Care centre and the EMS station were seriously damaged . PRCS vehicles, including 16 ambulances have been destroyed. Hospitals are seriously understaffed and unable to cope with t he influx of hundreds of injuries. Due to Israel’s 18 -month blockade of the Gaza Strip, medicine and medical equipment were already in short supply prior to the military operation and the few truckloads of urgently needed medicine that Israel has allowed i n is inadequate to meet the need.

Damage to critical infrastructure has compromised PRCS capacity to provide needed services and has

2 put the general health of the Palestinian population at great risk. Electrical supply is poor due to the lack of fuel and the power plants being destroyed. Lack of power has impeded proper functioning of surgical rooms. The sewage system is also impacted. Access to clean water has been a rapidly growing concern, as pumping stations are no longer running properly. Food is also in short supply.

Faced with the rapid deterioration of the current humanitarian situation in the Gaza Strip, PRCS launched a six-month Emergency Appeal. The Emergency Appeal is intended to secure the necessary funding for restoring the PRCS health infrastructure in order to continue providing preventive, curative, emergency and specialized health care services with a particular focus on the most vulnerable population, including all wounded people, women, and children.

Progress towards objectives

Health and Care

Primary Health Care (PHC)

Outcome(s)/Expected result(s) : Due to the lack of safety and movement restrictions during the Israeli incursions, the five PHC centres in the Gaza Strip were forced to close and services suspended. Over the pas t three months, PRCS had provided for adequate inventory of supplies and medicine to sustain services in the event of an Israeli attack. However, these were destroyed on January 15 when Israel bombed PRCS’s Al Nur medical centre, burning down the supply warehouse. During the war, PHC made preparations for the reopening and full -functioning of its programs once the ceasefire was in place. The expected outcomes outlined in the Emergency Appeal include: (1) Assess needs for medicine, medical supplies and equip ment, (2) Distribute essential medicines for maternity/delivery, paediatric care and chronic illness, (3) Provide services through the five PHC clinics, and (4) Support PHC medical personnel with additional staff from the , as determined by the assessment.

Achievements: Even before the ceasefire began, PHC arranged to prepare supplies and personnel to go to the Gaza Strip . In the first three days of the Israeli military operation, PHC was able to transfer medicines from the West Bank to Gaza but then the Israelis blocked further entry and delivery. On January 15, the inventory from these earlier shipments was mostly destroyed when Israel bombed PRCS’s Al Nur medical centre , burning down the supply warehouse. Since the ceasefire ended, PHC has prepared a comprehensive list of all needed medical supplies, including medicine kits for adults and for children and disposable kits, serving approximately 2,000 patients. PRCS will purchase from this list with donations from the Emergency Appeal once funds are available. In the meantime, PRCS has arranged for supplies in the West Bank to be sent to Gaza along with 15 medical kits and disposables that were purchased by the Coca Cola Company in the West Bank . Additionally, the German Red Cross has donated 2,000 baby kits (e.g., hygienic supplies, powder, alcohol, dressing gowns). The baby kits along with the Coca Cola Company donations and existing supplies from PRCS stock in the West Bank are now awaiting permission from the Israelis to be transferred to Gaza through ICRC. Based on the initial assessment, PRCS planned to send 10 general medicine physicians from the West Bank to provide additional support to the PHC team in Gaza. The team is prepared to go but have not yet received permission from Israel to enter Gaza.

Since the ceasefires, PRCS has reinstated its services and reopened all five of its centres (in Khalil Wazir, Jabalia, Khan Younis, Ma’an, and Al-Mawasi). The Jabalia facility is still damaged but nylon and plastic sheeting is covering the broken w indows to make the building useable. PRCS is working with ICRC to determine an estimate for reconstruction costs. PHC centres serve chronically ill patients, including those with diabetes, heart disease and renal failure. They also provide maternal-child health centres, providing antenatal care, well -baby check-ups, nutritional assessments and information, and sick child care. PRCS is considering dedicating one tent in each of its seven displaced persons camps to be used as a clinic for the camp inhabitants . The tents would be staffed with volunteer medical personnel already inside Gaza who would be paid a small allowance of about NIS 1,500 monthly. The DMU and PHC departments are considering this proposal .

Challenges or Constraints : As is the case in all efforts to successfully meet PRCS health care, 3 emergency services and relief goals in Gaza, the primary obstacle is Israel’s cont rol over the entry of equipment, supplies and personnel into the Strip. The 2,000 baby kits, 15 medical kits and additional supplies are awaiting Israeli approval for transfer to Gaza. Similarly, the 10 physicians have not received permission to enter. Israel’s blockade of the Gaza Strip for the 18 months prior to the military operation led to minimal levels of needed medical supp lies, equipment and spare parts. The past blockade and current restrictions are of ongoing concern. PRCS is in dialogue with ICRC as how best to proceed.

Secondary health care services (SHC)

Outcome(s)/Expected result(s) : PRCS operates two hospitals in the Gaza Strip: Al-Quds hospital in Gaza City and Al -Amal in Khan Younis. Al-Quds is a 76-bed, specialized hospital that receives referrals from the Ministry of Health. For the past 1 -1/2 years, it has been operating under capacity because of the poor econ omy, which has led to reduced financial support from the Palestinian National Authority and few patients able to afford care. Up until two years ago, Al -Amal hospital was the only hospital in Khan Younis and very busy. Then two more Ministry of Health hosp itals opened and the 100-bed Al-Amal hospital was also under- utilized. This situation has led to PRCS making a strategic shift to focus on more variety of services: outpatient clinics, laboratories, x-ray facility, minor surgery, birthing centres, and emergency room. It also developed an income generation strategy by allowing other hospitals to perform surgeries at their facility.

During the incursion, the emergency medical needs were overwhelming. Doctors and nurses throughout the PRCS system responded b y working around the clock without additional compensation. This added support allowed the hospitals to quickly increase their capacity under these dire conditions. However, there were not enough beds to accommodate the huge influx of patients, neither in the emergency rooms nor for ongoing hospital -based care. This capacity was further reduced following the January 15 th Israeli bombing and ground assault on the Al -Nur medical complex. The attack also burned the Al-Quds hospital’s cultural centre, pharmacy and nursing station, and there is soot throughout the building. All the water tanks on the roof of the hospital were punctured, leaving only the ground -level storage tank to provide water for the entire complex. At the time of the attack, PRCS medical pers onnel evacuated the patients for fear that the fuel tanks and gas storage area might be hit and explode. Fluctuations in electricity damaged sensitive medical equipment, some of which PRCS will need to replace.

Achievements : Both PRCS hospitals have nearly returned to operational capacity as before the incursion. Al -Quds hospital will need renovations as a result of the January 15 th bombardment. PRCS has repaired and/ or replaced the roof water tanks, and ICRC has rented a new warehouse as an interim measure for the storage of medical supplies . However, staff is now discussing the need to locate water, supply warehousing, fuel , and medical gases underground to be better protected if Israel again attacks the facility. Some medical equipment was replaced by PR CS reserves in the West Bank, others were repaired, and a few are still needing spare parts or to be completely replaced. PRCS has identified needed medicine and disposables; it will purchase what it can from available supplies inside Gaza and the remainde r must be shipped from the West Ban k. Hospital and SHC staffs are undergoing a debriefing process to analyse their performance and propose changes in order to be better prepared should another devastating attack occur. The main challenge is to increase its capacity to handle an urgent, large influx of patients without increasing its standard running costs. The easiest way to accomplish this aim is to increase the reserve number of fully functional beds (mattress, trolley, gas connections). Estimates call for an additional 30 beds for Al-Quds hospital and an additional 10 to 14 in Al Amal hospital. Physicians also emphasized the need for a MRI machine in order to better diagnose injuries and disease.

PRCS is considering different preparation strategies for i ts SHC services if there is another Israeli attack. One possibility is maintaining an ERU field hospital, which can be readily deployed to impacted areas where the existing hospital structure is damaged or inadequate to meet the needs. PRCS has one ERU in the West Bank , and staff is considering the tradeoffs between transferring this one to Gaza or obtaining a second one. Another option is the deployment of an Advanced Medical Post (AMP), composed of a truck with one or two trolleys with three to four infla table tents and equipment for a PHC centre and operating theatre. AMPs can serve up to 100 patients daily. There is one in Gaza that has been used at the border crossing when hundreds of people were blocked from exiting into Egypt, and in Al-Nasser neighborhood when the sewage system broke. The Qatar Red Crescent Society has recently provided another.

Challenges or Constraints : The principle challenges are political and bureaucratic. Israeli restrictions on 4 medical supplies, equipment and personnel require a political solution and facilitation by ICRC. The current procurement and delivery procedures are complex and time consuming. All materials imported must pass through either Jordan at or Egypt at the Rafah crossing. Purchases requi re a competitive bidding and procurement process. Coordination of transportation of supplies from these international borders as well as from the West Bank requires coordination with multiple parties, facilitated by ICRC.

Emergency Medical Services (EMS)

Outcome(s)/Expected result(s) : In the Gaza Strip, PRCS is the second largest provider of Emergency Medical Services after the Ministry of Health , which operates approximately 60 ambulances. Prior to the war, PRCS operated 37 ambulances to respond to emergency calls throughout Gaza; however, this number was inadequate during the Israeli incursion . A post-ceasefire assessment concluded that 45 ambulances are needed to be adequately prepared for future attacks and to be able to handle the increased number of transports required not only to respond to urgent cases and inter-hospital transfers but also to transfer those with non -urgent medical needs who cannot use their private cars due to military closures and safety concerns. During the war, Israel damaged 16 of the PRCS ambulances, four of which were completely destroyed.

Also destroyed in Israel’s incursion was the central medical supply warehouse, which included EMS inventory. In the first few days of Israel’s military operation, PRCS was able to transfer supplies from the West Bank to the Gaza Strip in order to be well -prepared for emergency medical needs. However, on January 15th the Israeli bombardment of the Al Nur medical complex completely destroyed the warehouse and all supplies. Additionally, the VHF towers used for ambulance dispatch and communication were destroyed and three of the five EMS stations had to be relocated during incursion to safer locations.

To meet the current and future EMS needs in the Gaza Strip, PRCS has proposed to replace the destroyed ambulances, repair those damaged, and increase to 45 the total number of functioning ambulances in the fleet. It also proposes to locate an alternative medical supply warehouse and restock EMS supplies as well as to return the EMS teams to permanent locations.

Achievements : PRCS EMS is nearly back to full operating capacity. Fourteen of the EMS staff members were injured, 2 seriously, but now they are all back to work. Even before the ceasefire began, PRCS initiated the process of preparing t o send ambulances and spare parts for repairs to Gaza. Because ordering, preparing and shipping of ambulances from overseas is costly and time -consuming, PRCS handled the immediate need by sending 14 existing PRCS ambulances from the West Bank to the Gaza Strip. Three of the damaged ambulances have been repaired but others are still awaiting coordination for the receipt of the necessary spare parts. Some of the most urgently needed EMS supplies have been ordered and ICRC has rented a temporary warehouse whe re they will be kept. In terms of communication systems, EMS had a spare VHF system in storage to replace the old VHF in Jabalia. EMS installed this new one from storage on the UN building in Gaza City to replace the VHF tower destroyed when the PRCS admin istrative building was bombed. Three EMS stations have now been relocated. Rafah’s EMS station has been moved into a new building that is still under construction. The Jabalia EMS station was bombed and burned but is now housed in the useable sections of t he original building. More renovations are needed to be fully operational. The original EMS station in Gaza City was beside the completely destroyed warehouse so was moved to a section of Al Quds hospital during the incursion . PRCS has now relocated the station back to its original location , awaiting additional repairs to the building.

Challenges or Constraints : The major challenge to providing reliable emergency services is Israel’s control over the entry of medical supplies as well as spare parts for r epairs of equipment and ambulances. With the increase number of injured persons and serious damage to ambulances during the incursion, the situation had become even more serious. Ambulances are difficult to first obtain from overseas and then to transport across the border. In several cases, the Israeli border authorities unilaterally removed dispatch radios from the new ambulances being transferred into Gaza, making radio communication impossible in these newly shipped vehicles. ICRC is assisting in coordination of the transfer of materials into Gaza but this is a long and bureaucratic procedure. Under the best of circumstances, the approval process requires over two weeks and usually much longer.

PRCS is currently discussing with ICRC how best to handle future attacks on EMS stations. Better protection 5 must be assured for the EMS personnel, dispatch offices and ambulances themselves. PRCS is considering the implications of evacuating these stations during crises. If evacuation is determined to be necessary, PRCS needs to develop a policy as to the consequences on protection of staff when relocating to an unrecognized facility, such as a private home or community centre instead of an established medical facility.

Psychosocial Support Programme (PSP)

Out come(s)/Expected result(s) : During the period of crisis, PRCS Emergency medical teams, volunteers and psychosocial workers worked round the clock to rescue and provide support to the population of Gaza. One volunteer lost his life during the operations. Most of the Emergency Medical personnel have been highly exposed to extreme violence, fear, death and suffering. Under these circumstances, PRCS Pyschosocial Support Programme (PSP) department has proposed to enhance the psychosocial wellbeing and preparedne ss of 300 EMTs, volunteers and psychosocial workers who have been involved during the military operation in Gaza by a 12-day retreat, if possible outside of Gaza, preferably in Egypt. This retreat will: (1) Provide an opportunity for impacted rescue workers to rest, relax, and receive appropriate psychosocial support and complementary training. (2) Improve the overall PSP capacity to respond to this and other crise s, (3) Improve the capacity of the Egyptian Red Crescent Society in the field of psychosocial support, on a nati onal basis but also in case of mass movements of population from Gaza to Egypt, and (4) Improve the International Red Cross and Red Crescent Movement coordination mechanism in providing psychosocial support response in acute crises in the MENA Zone.

Achievements : PSP has completed a Psychological Needs and Capacity Assessment mission in the second week of February to assess the psychosocial needs of the Gaza population and the capacity of PRCS and Movement partners to respond to those needs in the short and long term. The mission was conducted in cooperation with PS P’s Consortium partners: Italian RC, Danish RC, Icelandic RC and French RC. The field assessment team included a delegate from the French RC and the PRCS psychosocial coordinat or and supervisor in Gaza. The team assessed PRCS personnel and volunteer psychosocial needs using a Risk and Resiliency questionnaire. Interviews were conducted with five medical or paramedical staff members or volunteers in each of the five PRCS EMS stations as well as in the Khan Younis PSP centre. The team also met with key informants in PRCS EMS stations and the Khan Younis PSP centre as well as PRCS branches in order to have a better understanding of psychosocial needs within the PRCS staff and the co mmunity at-large. Other field team activities included: (1) facilitating a needs assessment of ongoing PSP activities in the seven Internally Displaced Persons (IDP) camps established by PRCS in the Gaza Strip; (2) facilitating field cooperation between PR CS, Palestinian Counselling Centre and YMCA / Gaza Community Mental Health Centre; (3) liaising with other PSP agencies (e.g., Médecins Sans Frontières, Mercy Corps, UNICEF) ; (4) facilitating online (video link) intervision/supervision between PRCS psychosocial teams in Gaza and Ramallah ; and (5) identifying possible locations for three additional PSP centres in the Gaza Strip.

Preparations for the planned retreat in Egypt are nearly complete. The Field Team compiled a list of the most affected PRCS staff and volunteers who could benefit from a psychosocial retreat. PSP in Ramallah has prepared the retreat itinerary, which will include opportunities for rest and relaxation as well as sessions on debriefing/defusing, stress management/release, fear/loss man agement, communication and teamwork under stress, and basic psychosocial support training. PSP has been working with Qatar Red Crescent, Libya Red Crescent and Egypt Red Crescent as part of the MENA Region Team (established two years ago) to provide additi onal personnel for leading and participating in these sessions. Logistics determining retreat location, facilities and transportation are also complete.

During the first month of the ceasefire, PSP staff personnel were very active in providing support fo r both people impacted by the war as well as PRCS personnel who worked day and night for over three weeks during the assault. In Khan Younis and Jabalia, PSP provided both individual and group support for 466 persons, including 40 men, 76 women and 350 children, many of whose homes had been destroyed. PSP facilitated debriefing sessions for 130 PRCS employees, including 25 EMTs for 8 sessions and 20 UNRWA teachers on a weekly basis.

Challenges or Constraints : The most significant obstacle for this retreat is obtaining permission for participants to cross the Rafah border from the Gaza Strip into Egypt. Even prior to the most recent Israeli military operation, it has been extremely difficult for Palestinian PRCS staff and volunteers to leave Gaza. PRCS is se eking permission for both exit and re-entry of its staff and retreat participants. Egypt RC, the

6 Federation , and ICRC are working to arrange coordination. If permission is not secured, PSP is considering conducting the sessions inside the Gaza Strip. Howev er, this alternative is undesirable because it will not provide one of the key conditions for recovery: removal from the anxiety -provoking context and provision of a sense of s afety. The other obstacle is a USD 300,000 gap in funding. If the project budget is not fully covered, PRCS PSP is considering reducing the number of days of the retreat or the number of participants. Neither of these are attractive options in order to achieve the overal l objective of supporting the psychosocial wellbeing and prepared ness of 70% of PRCS staff and volunteers.

Rehabilitation and ability development

Outcome(s)/Expected result(s) : The Israeli bombardment has led to unprecedented types and complexity of reported inju ries. According to the Ministry of Health, approximately 200 of the 5,300 injured are likely to require amputation of limbs. An estimated 13% of injuries will lead to permanent disability. In addition to facing the challenge of dealing with physical injuries, injured Palestinian s also must cope with the trauma of the Table I circumstances under which they were wounded and the Distribution of Palestinians injured, gene ral anxiety of the community at-large. PRCS’s by governorates Number of rehabilitation objective is to support 800 Palestinians with a Governorate % newly acquired disability by providing them with their urgent Injured needs and assisting them to integrate into society according to Gaza 2,023 38% their new situation . PRCS will work with persons who have Northern Gaza 1,754 33% sustained a variety of injuries, including: orthopaedic fractures, spinal cord injury, head injury, limb amputation, hearing Rafah 527 10% problems, and articulation p roblems. Interventions will include Mid-Zone 521 10% providing prostheses, assistive devices (crutches, wheel chairs, Khan Yunis 475 9% walkers and hearing aids), and comprehensive rehabilitation programs (physiotherapy, occupational therapy, psychological Total 5,300 100% support, speech therapy, auditory services).

Achievements: PRCS has reactivated all its rehabilitation and ability development programs that were serving Palestinians prior to the latest Israeli military operation. These services include special education , rehabilitation treatment services, vocational workshops, art studios, children’s recreation centres, and the Ability Development College, which is the only college in Palestine for training rehabilitation specialists. PRCS is working with the Physical Therapy & Rehabilitation Unit of the Ministry of Health in Gaza to assess the level of need and appropriate response. PRCS has contacted all its medical institutions to collect information about the people with disabilities caused by the war and classified them according to location on the body of injury and place of residence. To date, Gaza’s MOH aggregated data shows the distribution of inju red by governorates (see Table I) and by site of injury (see Table II). Most of those injured were in Gaza City (38%) with another third in Northern Gaza (33%). The most common injury site was shrapnel in all parts of the body (43.7%) with a significant percentage of head and neck injuries (15.4%) and injuries to the lower extremities (11.6%).

PRCS is now seeking to identify the names and location of those needing rehabilitation and follow-up services . It is also working with the MOH in Gaza, community-based organizations and other local partners to provide these services in the most efficient manner and to avoid duplication.

Challenges or Constraints : Although the MOH in Gaza has identified the approximate number and type of injuries, PRCS ’s biggest challenge is to identify the specific names and contact details of those needing care. Handicap International is considering providing financial and techni cal assistance to fund PRCS to manage a centralized information centre to serve southern Gaza (Khan Younis, Rafah and surrounding villages). This centre would facilitate coordination of the Ministry of Health's Physical Therapy & Rehabilitation Unit and all other rehabilitation organizations and programs in order to collect data on and evaluate needs of the newly disabled in the area. It would also track those that leave the Gaza Strip for intensive services outside the country. Handicap International is also considering funding Union of Palestinian Medical Relief Committees to manage a second centre in Gaza City and Society of Rehabilitation of Physically Disabled Persons to manage a third in northern Gaza.

7 Table II PRCS currently has no funding to cover Distribution of injuries, by site of injury rehabilitation services and equipment costs for these Number newly disabled. Once those needing care are Injury Site % of Injured located, new staff will be needed to properly Shrapnel in all body parts 2,315 43.7% evaluate them and then provide follow-up services, such as additional surgery, fitting for and training in Head and Neck 815 15.4% use of prostheses, and psychosocial support. Then Lower extremities 615 11.6% each individual will need to begin a plan for long- term rehabilitation therapy. Mobile rehabilitation Neurological trauma 321 6.1% centres are needed to provide services for those Upper extremities 303 5.7% unable to travel to PRCS facilities. Funding for staff Gas inhalation 286 5.4% is needed to support a project coordinator, outreach workers to locate those needing services, physical Chest 162 3.1% therapists (2), occupational therapists (2), social Back 143 2.7% workers (2), and speech therapists (2). Additionally, the program needs assistive devises, prosthesis and Abdomen 117 2.2% consumables. The Swedish RC is sending used Eyes 85 1.6% assistive devices to be inspected and then Amputation 78 1.5% distributed by PRCS headquarters. Additionally, Asamblea de Cooperación Por la Paz (ACPP) of Burns 60 1.1% Spain is currently seeking funding from Junta de Total 5,300 100% Andalucia to provide partial support for equipment purchases and staff salaries.

Originally, PRCS had proposed that amputees needing prostheses be able to travel outside the country to receive proper care and equipment. However, covering the cost of travel and equipment as well as gainin g the proper travel documentation has been challenging. Additionally, those needing services have said that they prefer to stay inside the Gaza Strip in order to be close to family support and encouragement while they adjust to using their artificial limbs and to more readily access prosthetic maintenance, repair and replacement. To address this challenge, PRCS is exploring the possibility of working with the Specialized Centre in Gaza City, which provides prosthetic equipment, maintenance and follow -up. Th e Specialized Centre is funded by ICRC and Handicap International but owned by the Gaza Municipality. These parties are in discussions with PRCS to develop a proposal for Jameleh, a Palestinian child who lost her two cooperation. legs.

Disaster Management (DM)

Objective/s : During the Israeli military operation, PRCS staff and volunteers focused on emergency response to the crisis. Hundreds of people participated in these efforts with 75 PRCS volunteers injured and one killed before the ceasefires came into effect. However, directly following the ceasefires, the Disaster Management Unit (DMU) shifted its attention to relief efforts. Due to the large number of impacted individuals, families and neighbourhoods, the level of relief needed is beyond the capacity of any one organization. Therefore, DMU expects to provide relief efforts in close coordination with Gaza municipalities, ICRC, UNRWA, and many other international and community-based organizations, as well as PRCS’s own interdepartmental and inter -branch integrated response. DMU will begin with an assessment of basic water, sanitation and hygiene needs. Based on this assessment, it will procure and distribute water treatment supplies, Water -Sanitation kits, bottled water, women’s sanitary kits, and family hygiene kits for up to 5,000 persons. For those that have lost their homes, DMU plans to assist UNRWA and the local municipalities in the set -up of temporary tent shelters. In an effort to prevent further harm to the Gaza population, DMU will conduct a large Disaster Risk Reduction campaign, focusing on hygiene promotion and risks of water-borne diseases and food poisoning . Related to this campaign is DMU’s Mine Risk Education initiative, focusing on explosive remnants of war and unexploded ordinances (UXO).

8 Achievements: In coordination with ICRC, PRCS has initiated a Rapid Damage Assessment, which will take another two months to complete. These assessment activities will lead to three reports: Economic-Security (shelter and food), Health, and Water -Sanitation. Preliminary findings indicate 4,250 homes have been damaged with 2,500 completely destroyed. Most of the damage is in Northern Gaza but Khan Younis, Rafah and Jabalia also sustained significant levels of destruction. As of 16 February, Gaza’s water utility—the Coastal Municipalities Water Utility (CMWU)—reports that 50,000 people still do not have access to piped water and an additional 100,000 receive water every 7 -10 days. Locations PRCS volunteers distributed hygiene kits to affected include parts of Beit Hanoun, Jabalia, Gaza City and injured. Rafah. According to the United Nation’s World Food Program (WFP) and Food and Agriculture Organization (FAO) , food consumption and nutritional status are also likely to deteriorate if urgent repairs of the water network and damaged housing units are not undertaken.

Acting on the preliminary assessment, DMU has activated over 50 staff and 400 PRCS volunteers, following a decentralized community-based preparedness and swift response model. Prior to the incursion, PRCS had trained many of these volunteers in relief distribution and Internally Displaced Persons (IDP) camp deployment . The most urgent need facing the population was finding shelter. At the height of the crisis, UNRWA reported housing 5 0,000 persons in its emergency shelters. Because the schools are back in session, t hose that had been seeking safe haven in UNRWA schools have had to find other arrangements. For those people able to return home, volunteers have distributed plastic sheets to cover broken windows and cracked walls for 10,000 houses. For those that have completely lost their homes, volunteers have distributed 1,200 House Destruction kits, which include mattresses, blankets, kitchen set, hygiene kit, food parcels and Jerry cans. PRCS has established seven tent camps of 100 tents each, housing approximately 700 persons in each camp and nearly 5,000 in total. They have dug latrines in accordance with Sphere Standards , although the land area available for the camps is too small to comply with Standards for total area of the camps . Because it is not within PRCS’s mandate or capacity to manage refugee camps, PRCS has coordinated with the relevant municipal governments and city councils for ongoing management and care of these seven camps. As a prerequisite of establishing the camps, the local communities agreed to provide food and daily needs, i n cooperation with UNRWA and WFP. The communities also coordinated supply of drinking water and water kits (Jerry cans, bottled water and water treatment supplies) with UNICEF and the Palestinian Water Authority. PRCS volunteers distributed family hygiene kits and women sanitary kits in the camps and hospitals.

In coordination with ICRC and under the supervision of PRCS headquarters in Ramallah, five PRCS volunteers contacted families throughout the Gaza Strip to track missing persons. The locations of all those that had gone missing have been determined.

Immediately following the ceasefire, ICRC assessed the risks associated with explosive remnants of war and unexploded ord nances (UXO). This report determined that there were no land mines used but did exist a serious concern regarding contamination from phosphorous and UXOs. It was also determined that both the general population as well as EMS staff were unfamiliar with detecting and handling UXOs. Even before the ICRC report was distributed, PRCS headquarters immediately launched an awareness campaign of radio and television spots, warning people of the hazards of UXOs . Within the first two weeks of the ceasefire, ICRC and PRCS conducted an UXO training of 27 volunteers and field staff. In coordination with ICRC, DMU has designed an informational leaflet and distributed it throughout the Gaza Strip.

Challenges or Constraints : The biggest constraint facing DMU activities is the Israel’s closure of the Gaza Strip . More than once, DMU has had to stop distribution of relief supplies because materials were not only sitting on the border of Gaza but also on the Amman border waiting to get into the West Bank. The bureaucratic requirements are further slowing the process of ordering and coordinating delivery of relief supplies. It is taking months for the necessary generators and spare parts to arrive, including the much - needed VHF communication network. Until now, Israel has not allowed any construction materials and equipment entry into Gaza for needed infra structure repairs and rebuilding projects. OCHA has confirmed that COGAT has no plans to change this policy .

9 As with all disaster response efforts, coordination is also a significant challenge. Cooperation is obviously important to avoid duplication of e fforts as well as to ensure efficient use of scarce resources. Sharing data on needs, aid recipients and supplies enables a more accurate aggregate picture of both the gaps in needs and adequacy of response. At the beginning of the ceasefire, it was not clear who should be the lead agency in relief response. Some local organizations that were unaccustomed to working collaboratively on disaster management did not see the benefit or necessity of taking time to share information or of joining efforts. Others f elt competitive for appropriate acknowledgement of their individual organizational efforts. PRCS is in conversation with international humanitarian aid organizations as well as the Ministry of Health and local community -based programs to respond to current needs as well as prepare coordination for future disasters.

Management and Coordination

Objective/s : The Israeli military attacks affected a significant proportion of the Palestinian population living in the Gaza Strip. Over 1,300 were killed immediat ely or died of their injuries, nearly 80% of these in Northern Gaza and Gaza City . Another 5,300 were injured many of them seriously with an estimated 13% suffering from permanent disabilities, including severe burns, head and neck injuries and amputations . Moreover, the Israeli military operation resulted in a mass de struction of private properties. According to the preliminary report done by the Ministry of Health, 21 health facilities (4 hospitals and 17 PHC clinics) have been t otally or partially damage d in direct or indirect shelling. In addition, approximately 1,500 factories, shops and markets were damaged. UNRWA estimates that 50,000 civilians have been housed in their shelters for internally displaced civilians across the Gaza Strip. At a meeting in Cairo in early March, international donors committed USD 5 billion for reconstruction efforts.

With this level of destruction, the relief and rebuilding efforts are immense. As the largest national non - governmental provider of health services to the Pale stinian people, PRCS is a primary provider of humanitarian aid in response to this crisis. Recognizing that the need s far exceeded PRCS’s resources, it turned to the International Red Cross and Red Crescent Movement and National Partner Societies for suppo rt. And the response in provision of humanitarian aid has been rapid and substantial. The situation has demanded immediate and comprehensive mechanisms for coordination of this response. Procedures were needed for the movement of goods and equipment from o utside Palestine, as well as between the West Bank and Gaza and internal to Gaza Strip. In particular, coordination with the Jordan Red Crescent was essential for receipt of goods into the West Bank, and with Egypt Red Crescent for the huge quantities of donations arriving through Egypt (Al ). A mechanism for coordinating with other humanitarian aid organizations, such as UNRWA, WFP and UNICEF, was also necessary.

Achievements: PRCS has worked in close partnership with ICRC and the Federation in developing the necessary coordination mechanisms for managing the acquisition and distribution of humanitarian aid. The Movement coordination mechanism was built on the Operational Alliance principles with extended cooperation with ICRC, the Federation and Partner National Societies (PNS) with a permanent presence in Palestine. The Movement Coordination Cell is the key component of the Movement Coordination Structure for the Gaza Crisis. It is comprised of PRCS, ICRC, and the Federation. The Movement Coordination Cell is located at the PRCS headquarters in Ramallah with a parallel Cell being developed in Gaza. It meets weekly to discuss offers of assistance, tracking of donations, and outstanding needs. Its objectives are to: (1) Provide clear logistical direction and flow of information to Movement partners, (2) Support efficient management of Movement in-kind and cash donations for Gaza, (3) Act as a focal point for communications with ICRC in Geneva, (4) Ensure coordination with supporting Movement operations and mechanisms in Egypt and Jordan, (5) Ensure monitoring and measurement of Movement contributions and actions.

The Movement Coordination Cell has established several tools for managing logistics. It developed a Mobilization Table with budgets, listing all needed equipm ent, medical and relief supplies, and activities requiring funding. The items listed are based on PRCS assessment of needs. The transportation and receipt of assistance is monitored through a Tracking Table. PRCS compares all offers to the Mobilization Tab le to determine that the offered assistance is listed and not yet covered. Once PRCS has officially accepted a donation, the Coordination Cell informs the interested Movement Partner of the procedures and instructions related to all matters of logistics. If the proposed assistance is not listed or it is already covered by another donor, PRCS makes the determination of acceptance based on whether an offer meets the needs and can

10 be utilized in Gaza. The Movement Coordination Cell liaises with ICRC logistics to determine the best shipping route for the donation, either through Jordan or Egypt.

Challenges or Constraints : Due to the large scale of the effort and restrictions on movement imposed by Israel, coordination and provision of humanitarian aid has had many challenges. The most serious constraint has been Israeli restrictions of aid into Gaza. ICRC’s representatives on the Movement Coordination Cell manage all coordination with the Israeli authorities. ICRC continues its confidential and bilateral approa ch to the Israeli communications. However, based on these challenges and recognizing that political efforts are needed to bring a sustainable solution to the conflict, PNSs are encouraged to approach their national authorities or stakeholders to improve th e PRCS working conditions as well as the overall situation in Gaza.

The Movement Coordination Cell has faced several logistical challenges as well. As mentioned previously, Israel destroyed PRCS’s medical supply warehouse on January 15. ICRC has rented a temporary warehouse, but this one is often too small to manage all the supplies. For example, a donation of 800 tents form the Netherlands Red Cross had to be delayed for shipping because there was no storage. PRCS is in discussions with its staff on mana ging the warehouse space and ICRC is helping in repacking. Part of the challenge has been that PRCS Gaza has sometimes been obliged to accept donations coming across the Rafah border. Also, ICRC cannot transport goods into Gaza that have a supplier located in Gaza, as has been the case in mattress donations. PRCS is also facing a challenge with utilizing the Free Zone because of insurance concerns.

Working in partnership

PRCS has been working in close partnership with governmental agencies and nongovernm ental organizations, both in Palestine and in the international community. The most important mechanism for coordinating this work with the ICRC and PNS has been the Movement Coordination Cell, described in the section above. In addition to Movement partne rs, PRCS’s major international cooperation is with the relevant agencies of the United Nations. UNRWA has provided temporary shelter during the crisis for as many as 50,000 persons in its schools, clinics and community centres. It also is the main distributor of food and relief supplies to registered refugees, which makes up approximately two-thirds of the Gaza population. UNRWA has assumed responsibility for ongoing management of the seven IDP camps initially established by PRCS. The UN World Food Program (WFP) has delivered over 5,000 metric tons of food, distributed by UNRWA, UNICEF and other international NGOs reaching over 30,000 people daily in the second week of the ceasefire . OCHA has facilitated the sharing of information and analysis through its Clusters of related humanitarian aid organizations, including Mine Action, Early Recovery, Water -Shelter, Food Security and Nutrition, Health, Protection, Shelter, Education, Agriculture and Logistics. PRCS is a participating organization in the OCHA Cluster on Health, as well as in other relief committees.

Additionally, PRCS works under the regulations of the Palestinian Ministry of Health, which is the largest provider of health services in both the West Bank and Gaza Strip. MOH provides PRCS with vital st atistics on deaths, injuries, displacement and humanitarian needs of the population. This information is essential for conducting PRCS’s assessment of humanitarian needs and response.

All humanitarian aid organizations are facing similar challenges in te rms of movement across the Gaza border. According to the Feb ruary 16 field report from OCHA’s Humanitarian Coordinator: “Aid workers with NGOs continue to face difficulty in obtaining access to the Gaza Strip to carry out humanitarian work. Humanitarian pe rsonnel are only allowed to enter Gaza through after receiving prior clearance by the Israeli authorities. A key problem remains inconsistency and lack of clarity in the application process.” The same report goes on to explain restrictions on types and quantity of supplies crossing into Gaza. The report notes that the average number of truckloads allowed by Israeli authorities should be 150 daily but averaged only 103 truckloads from 8 to 14 February, and never more than 120. The report also confirms that COGAT has “as yet no intention to revise the policy prohibiting clearance of reconstruction materials which would enable aid agencies working in Gaza to transition to rehabilitation and reconstruction. ”

11 Contributing to longer -term impact

Current and future assessments will determine the needs, capacities and programs that should and are feasible to be implemented in the Gaza Strip. During the Gaza crisis, PRCS actions and procedures have been in accordance with PRCS’s mission and values, the International Red Cross and Red Crescent Movement principles and International Humanitarian Law. Despite the political pressure arising from poor relations between the Fatah and parties, PRCS has continued to abide by the Movement principles of im partiality and independence by providing care and assistance to all Palestinians in need, regardless of religion, political affiliation, nationality or gender. PRCS attempts to provide high quality services, despite the difficulties during this crisis of b eing understaffed and lacking essential medical supplies. Israel’s attack on PRCS’s medical facilities and personnel and its blocking of ambulances from access to injured victims further frustrated these efforts. Whenever possible, the Disaster Management and relief efforts were guided by Sphere Standards.

Looking ahead

PRCS will have the opportunity to consult on the Gaza Crisis with ICRC, the Federation and PNS at the upcoming PRCS 10 th General Assembly. In particular, the General Assembly agenda will include a special panel discussion, entitled “Disaster Management & Risk Reduction – The Case of Gaza.” The President of PECDAR will moderate the panel, and panellists will include a member of the Presidential Committee for Gaza Relief, PRCS’s Head of Disaster Management Unit, Head of Palestinian Civil Defence, and NORWAC physicians who worked in Gaza during the crisis. Over the course of the Assembly, PRCS will report on an assessment of actions in the first two months of the Emergency Appeal, the Movement humanitarian aid response, and the evolving situation and outstanding needs. This status report, PNS input and the ensuing discussions will guide future action for the remainder of the Emergency Appeal in response to the Gaza Crisis.

How we work All International Federation assistance seeks to adhere to the Code of Conduct and is committed to the Humanitarian Charter and Minimum Standards in Disaster Response (Sphere) in delivering quality and accountable assistance to the most vulnerable. For support to or for further information concerning Federation programmes or operations in this or other countries, or for a full description of the national society profile, please access the Federation’s website at http://www.ifrc.org The International Federation’s Global Agenda Goals: activities are aligned with its Global • Reduce the numbers of deaths, injuries and impact from Agenda, which sets out four broad disasters. goals to meet the Federation's • Reduce the number of deaths, illnesses and impact from mission to "improve the lives of diseases and public health emergencies. vulnerable people by mobilizing the • Increase local community, civil society and Red Cross Red power of humanity". Crescent capacity to address the most urgent situations of vulnerability. • Reduce intolerance, discrimination and social exclusion and promote respect for diversity and human dignity. Contact information For further information on this Appeal, contact: Palestinian Red Crescent Society: General Tel: +972 2 240-6515, Fax +972 2 240-6518 Dr. Younis Al Khatib, President, [email protected] Majed Abdulfattah, Cooperation, Communication & Planning Director, [email protected] Tanya Shawar Abu Ghosh, Head of International Cooperation Unit, [email protected]

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