^^ WORLD HEALTH ORGANIZATION A44/INF.D0C./8 ORGANISATION MONDIALE DE LA SANTE 6 May 1991 FORTY-FOURTH WORLD HEALTH ASSEMBLY Provisional agenda item 31 HEALTH CONDITIONS OF THE ARAB POPULATION IN THE OCCUPIED ARAB TERRITORIES, INCLUDING PALESTINE At the request of the delegation of Israel, the Director-General has the honour to transmit to the Forty-fourth World Health Assembly, for its information, a report by the Ministry of Health of Israel. 1 See Annex. A44/INF.D0C ANNEX STATE OF ISRAEL MINISTRY OF HEALTH HEALTH IN JUDEA/SAMARIA AND GAZA 1990-1991 APRIL, 1991 JERUSALEM TABLE OF CONTENTS Table of Contents i Tables and Figures ii Foreword V 1. Highlights 1 2. Demography and vital statistics 6 3. Socio-economic conditions 8 4. Primary health care 12 5. Hospital services 38 6. Manpower and training 4 7 7. Environmental protection 56 8. Administration and finance 58 9. Research 61 10. International cooperation 63 11. Planning 65 12. Summary 67 13. Bibliography 68 14. Index 73 TABLES Table 1: Population in Judea/Samaria and Gaza 1970-1990 . 6 Table 2: Percentage Annual Growth, Judea/Samaria and Gaza, 1970-1990 7 Table 3: Births and Birth Rates, Judea/Samaria, 1970-1990 7 Table 4: Births and Birth Rates, Gaza, 1970-1990 7 Table 5: Gross Domestic Product, Judea/Samaria and Gaza, 1972-1987 8 Table 6: Home Facilities in Judea/Samaria and Gaza, 1972, 1981 and 1985 11 Table 7: Calories Per Capita in Food Supplies, Judea/ Samaria and Gaza, 1970-1986 12 Table 8: Homes with Less Than Three Persons Per Room, Judea/Samaria and Gaza, 1975-1989 ... 12 Table 9: Primary Care Facilities Operated by the Government Health Services in Judea/Samaria and Gaza, 1970-1990 14 Table 10: Infectious Disease Rates Reported in Judea/Samaria Gaza, 1970-1990 15 Table 11: Immunization Program for Infants, Judea/Samaria, 1991 18 Table 12: Immunization Program for Infants,Gaza, 1991 . 18 Table 13: School-Age Immunization Program, Judea/Samaria and Gaza, 1991 19 Table 14: Circulating Antibody Levels Determined in Sero-surveys in School-Children aged 6-7 Years in Judea/Samaria 20 Table 15: Tuberculosis Incidence Rates in Judea/Samaria and Gaza, 1972-1990 22 Table 16: % of Total Births Occurring in Hospital or Medical Centers, Judea/Samaria and Gaza, 1970-1990 . 22 Table 17: % of Low Birth Weight of Newborns in Government Hospitals/Medical Facilities, 1983-1990 ... 23 Table 18: Reported Infant Mortality Rates, Judea/Samaria and Gaza 1970-1990 25 Table 19: Child Mortality Rates by Cause, Ages 1-4, Judea/Samaria, 1988-1990 27 Table 20: Mortality from Selected and All Causes of Death, Judea/Samaria, 1988-1990 27 Table 21: Brucellosis: Reported Cases and Incidence Rates, Judea/Samaria, 1981-1990 34 Table 22: Ambulance Service in Judea/Samaria and Gaza, 1990 36 Table 23: Present and Projected Hospital Beds, Judea/Samaria, 1990 39 Table 24: Hospital Utilization, Judea/Samaria, 1977-1990 40 Table 25: Hospital Beds in Gaza, 1977-2000 Projected . 40 Table 26: Present and Projected Acute Care Hospitals and Beds, Gaza, 1990-2000 41 Table 27: Hospital Utilization, Gaza, 1977-1990 .... 41 Table 28: Manpower in the Government Health Service, Judea/Saroaria 54 Table 29 : Manpower in the Government Health Service, Gaza 54 Table 30： Health Manpower in Government Hospitals, Judea/Samaria 1990 55 FIGURES Figure 1: Distribution of Government Health Services by District, Judea and Samaria, 1990 9 Figure 2: Distribution of Government Health Services by District, Gaza, 1990 10 Figure 3: Pertussis, Judea/Samaria and Gaza, 1970-1990 • 16 Figure 4: Measles: Judea/Samaria, Gaza 5 year annual average rates, 1968-1987 17 Figure 5: Polio： Judea/Samaria, Gaza, 5 year annual average rates, 1968-1988 17 Figure 6: Gaza Infant Growth Patterns : Weight-for-Age, 1987-1989, Under the 10th Percentile 24 Figure 7: Reported Infant Mortality Rates, Judea/Samaria, Gaza, 1970-1990 26 Figure 8: Brucellosis, Judea/Samaria, 1980-1990 .... 34 FOREWORD A number of important steps forward occurred during 1990. This was highlighted by the opening of the fully modern new surgical building at Shifa Hospital in Gaza. New projects were also completed in several government hospitals in Judea/Samaria, including the new physiotherapy, emergency and other service building in Rafidia Hospital in Nablus, and the new operating wing at Hebron Hospital. The Israel Government Health Services (IGHS) in Judea/Samaria and in Gaza have continued to develop their own services, and to encourage the development of non-government health services fostered by charitable organizations• New hospitals have been approved for construction and operation by non-governmental agencies in both areas. The new Hebron Hospital is under construction and will become operational in stages over the coming years. Emphasis continues to be placed on developing primary health care, especially in prevention of infectious diseases, pregnancy care, hygiene, and nutrition, in keeping with recommendations of the international health community. Great success has been achieved in control of dreaded infectious diseases including polio, and more recently measles, contributing to the improvement in infant and child health. Studies also show very great improvement in nutrition of infants. The year 1990-91 has been a difficult one in Israel, Judea/ Samaria and Gaza. Nevertheless, the health services have continued to provide needed health care, including preventive services and curative care. The following report documents this progress. 1. HIGHLIGHTS OF 1990/1991 !•! JUDEA/SAMARIA 1.1.1 Emergency Health Services ** Preparation for management in the event of chemical attacks; Staff training for 605 medical, nursing, administrative and ambulance personnel in the principles and practices of chemical injury management; ** Designation and preparation of б hospitals for chemical injuries - evacuation, reception, decontamination, triage, and treatment of chemical injuries； ** Equipping hospitals for potential emergency treatment of chemical warfare injuries with showers for removal of chemical contact agents, as well as treatment, antidotes and drug therapy, positive pressure respirators, as well as other equipment and supplies for other types of war injuries； 1.1.2 Hospital Development 1 Hebron Hospital s new East Wing, including an out-patient department, cardiac assessment unit, laboratories and new surgical wing is under construction with the financial support of the Government of Italy; ** Hebron Hospital's new operating theater suite was completed and put into operation, including 3 modern operating rooms, a recovery room, and a central sterile supply department; ** Rafidia Hospital in Nablus has completed construction of the emergencf y department, administration, physiotherapy, physicians residence and pharmacy wing which is now being equipped and prepared for operation； 1 ** Ramallah Hospital s new surgical wing was expanded to 4 modern operating rooms, and a recovery room, which are now being equipped for operation； ** Ramallah Hospital has completed construction of the new building for the Computerized Tomography and Cardio/Pulmonary Assessment units; 1 Ramallah Rehabilitation Center operated by the Patient s Friends Society of Ramallah саше into operation with a large out-patient department, staffed by highly professional medical, nursing, physiotherapy and occupational therapy staff from Sweden and Norway, with a training program for local staff; Beit Jallah Rehabilitation Center has commenced operation of its outpatient service, along with its Occupational Rehabilitation Service for cerebral palsy, post-polio, congenital malformation, and other medical rehabilitation cases; Holy Family Maternity Hospital was opened in Bethlehem with 31 beds, sponsored by the Knights of Malta Order. 3 Primary Health Care The immunization program has been further expanded by adding the third dose of IPV at age 12 months to the 4 feedings of OPV and adding a second dose of measles vaccine for school age children in grade 1. The measles immunization program has been expanded with a special campaign in 1990 for grades 1 to 3, and addition of booster doses of TOPV for pupils in grades 1 and 9; Mid-term Evaluation of the Expanded Primary Health Care Project serving 49 villages in Hebron District was carried out measuring Knowledge, Attitudes and Practices of pregnant women. Process and outcome measures of pregnancy and child care in the Village Health Rooms showed a major impact of the Village Health Room program; Opening of 2 new Maternal and Child Health Centers• 4 Staff Professional Development Nurse training in a neonatal and pediatric intensive care course of 7 months commenced at Assaf Harofe Hospital; The health services administration course conducted by Haifa University over a 2 year period was completed by 23 Arab and Israeli senior physicians, administrators and A 2-month course in biostatistics, research methods and computers for 14 medical and statistical staff of the Israel Government Health Service (IGHS) in Judea/Samaria, and 3 from Gaza is being given at the School of Public Health and Community Medicine of Hadassah-Hebrew University in Jerusalem; Training of ambulance drivers from government and non- government health services, including Red Crescent, UNRWA and others, continued during 1990, with 102 completing the 12 day course operated by Magen David Adorn of Israel, with Arabic speaking staff; Training in first-aid for Village Health Workers from the Hebron program in primary health care in small villages was carried out in Jerusalem by Magen David Adorn staff