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Countries prepared for health emergencies

[COUNTRY STORY]

Enhancing the Emergency Preparedness and Response Capacity of Occupied Palestinian Territory: Focus on Gaza

Occupied Palestinian Territory

Photo: WHO Occupied Palestinian Territory A patient is rushed by ambulance to a hospital in Gaza.

Enhancing Emergency Preparedness and Response: Focus on Gaza

Gaza has been exposed to recurrent violence and escalation for many years. Until recently, complex emergencies including mass casualty incidents were being managed on an ad hoc basis by hospitals and health workers. The health system lacked a systematic approach to responding to crises. This impacted the ability of health workers to carry out lifesaving actions. To address these challenges, the WHO’s office for the West Bank and Gaza (WHO) established additional Emergency Medical Teams (EMTs), provided training to health workers for managing mass casualty incidents, supported the development of emergency plans for hospitals and pre-positioned equipment and supplies. During the escalation of violence in Gaza from 5 to 7 August 2022, newly developed emergency plans were activated, and health workers used their training to better manage casualties. These real changes on the ground in the way healthcare workers responded to emergencies played a pivotal role in reducing mortality and morbidity. WHO remains committed to scaling up efforts to improve the emergency preparedness and response capacity of the Occupied Palestinian Territory, particularly in the Gaza strip.

Key WHO Contributions

Identifying the need to improve critical aspects of the trauma care pathway
Renovating and rehabilitating three Primary Health Care Centres
Enhancing the capacity of Emergency Medical Teams and training emergency responders
Developing hospital emergency plans and training health workers in mass casualty management
Pre-positioning medical supplies and equipment
Proactively promoting a policy change to enhance preparedness.

How did the Occupied Palestinian Territory, with the support of the WHO Secretariat, achieve this?

In 2018, weekly protests in the Gaza strip, known as the Great March of Return, resulted in a surge in casualties and heavy loss of life. Emergency response to mass casualties faced many challenges as hospital emergency plans remained confidential due to security concerns, the response was based on the instructions of a few senior health workers derived from their prior experience, and health workers and medical teams at the pre-hospital and hospital level remained uncoordinated. WHO therefore identified the need to improve critical aspects of the trauma care pathway in the territories, particularly the Gaza strip.

^{A table-top exercise session during an MCM training in Gaza.}Photo credit: WHO Occupied Palestinian Territory.

In July 2021, WHO launched a training programme for health workers across seven major hospitals in Gaza. By December 2022, this provided 135 health workers with standardized skills, a shared technical language, and enabled them to follow a clear hospital emergency plan for mass casualty management (MCM) that was drafted by the trainees with WHO's technical assistance. In future, this approach will enable health workers to rapidly provide surge support by deployment from one hospital across any of the seven hospitals when needed – a first in Gaza.

“The blockade of the Gaza Strip limits the access of Palestinian medical teams to external knowledge and expertise. The Mass Casualty Management training is a much-needed form of international exchange, which is at par with global standards since it is developed and delivered by WHO accredited trainers.”

- Dr Atef Al-Hout, Director General – Nasser Medical Complex, Gaza

The health response to large-scale emergencies can often face setbacks due to gaps in the availability of skilled health workers, supplies, and equipment. In 2022, WHO therefore expanded its efforts by enhancing the preparedness capacity of two EMTs through the training of over 150 emergency responders to fill gaps in trauma care at all levels during emergencies, and pre-positioned supplies and equipment to ensure seamless deployment of lifesaving resources, when needed. Three primary health care centres were also renovated and rehabilitated to reduce the burden on Ministry of Health hospitals and ensure the delivery of a coordinated response during crises to enable easy access to health care for those affected. To further support the integration of trauma response and care within primary health care centres in Gaza, essential equipment, and training to 55 health workers was provided by WHO. These efforts are expected to benefit up to one million people per year.

“We had developed the hospital emergency plan during our training and now we are putting it into action. Though we all did our best during previous emergencies, the ad hoc approach added to the chaos. This time was different. We were like a well-oiled machine, all units working together as one against a plan.”

- Dr. Naseem, Head of Emergency at the Al Aqsa Hospital, Gaza.

During the escalation of violence in Gaza from 5 to 7 August 2022, six hospitals activated the newly developed emergency plans, and health workers used their training to divide responsibilities and control crowds so that the surge in casualties could be managed effectively. The Ministry of Health mobilized some of WHO's pre-positioned tents and emergency medical kits including supplies, and equipment which enabled three hospitals to expand their emergency departments by setting up supplementary patients’ management areas, helping to reducing mortality and morbidity.

With 50 Palestinians killed and 360 injured during the August 2022 escalation in Gaza and continuation of violence across the West Bank, enhancing the health system's emergency preparedness and response capacity remains a crucial priority for WHO across the Occupied Palestinian Territory, so that health workers and hospitals are increasingly better able to respond quickly to sudden emergencies.