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Primary Healthcare during a Genocide

Courtesy of Palestinian Medical Relief Society

Primary healthcare has never been more important in Gaza. With the complete collapse of secondary and tertiary healthcare across the Gaza Strip, the burden of care and disease naturally falls onto the primary healthcare (PHC) system. In this context, the focus of attention and funding frequently goes to emergency and trauma care to cope with the deluge of injured patients. However, chronic and ongoing health needs do not stop during genocides.  Those needs have increased exponentially due to the horrific state of healthcare and living conditions in Gaza as a result of systematic military attacks on health institutions, housing, and public infrastructure.

While there has been much discussion on the humanitarian crisis that exists and continues to deepen in Gaza, it is important to remember that this is a man-made and completely preventable crisis. This crisis that has deteriorated considerably since October 7 has, in fact, existed in Gaza for 17 years as a result of the Israeli government having authority over all 2.3 million Palestinian bodies trapped inside the Gaza Strip.

To clarify what man-made means in this context, let’s look at the issue of starvation in Gaza as one example. The lack of food results from entire food systems being destroyed within Gaza and aid being denied entry from outside Gaza to feed the severely malnourished and starving millions. Food trucks can be seen only a few kilometers outside of Gaza, waiting to be permitted entry. Ribboning across the Sinai in their hundreds, they hold food that could markedly ease the suffering on the other side of the apartheid wall.

This crisis is man-made in the sense that every single hospital in Gaza has been attacked, destroyed, or damaged in some way. Made-made in the sense that 90 percent of Gaza’s population have been forced to flee due to the targeting of residential and public infrastructure, and are now considered internally displaced people. Displacement of people and destruction of infrastructure create the perfect conditions for the proliferation of preventable infectious diseases resulting from the horrendous living conditions – overcrowding in shelters, lack of clean water, lack of sanitation, lack of access to medications, and severe malnutrition leading to impaired immune systems.

The most recent WHO cluster report i (08/05)* indicates that there are currently  761,327 acute respiratory infections, 415,766 cases of watery diarrhea due to lack of clean water, and almost 62,000 cases of acute jaundice syndrome. A very important body of research recently published,ii showcases the projected additional death toll and increase in disease due to the devastation of the healthcare system.

Further, for everyday health needs, including for pregnant and lactating women, the needs simply don’t stop during the ongoing violence. Currently, there are still approximately 5,500 pregnant women in Gaza who need to deliver. Furthermore, for those with chronic conditions such as diabetes, cancer, heart disease, etc., their need for medication and care also continues, yet thousands are not able to access the treatment or care they need and deserve.

After trauma injuries and infectious diseases, elevated blood pressure and cardiovascular diseases continue to be leading causes of morbidity. As of January 22, 2024, there were 225,000 people with high blood pressure, 45,000 patients living with cardiovascular disease, 1,100 patients in need of kidney dialysis, and 71,000 patients living with diabetes.

This current epidemiological landscape underscores the critical need for primary healthcare services. PHC, often forgotten or deemed less important in emergency contexts, plays an essential role in saving lives, preventing complications that can cause further injury, disability, or death, and helps to ensure that Palestinians can access the healthcare they need.

The Palestinian Medical Relief Society (PMRS), the largest Palestinian-led medical organization on the ground, has continued to provide essential lifesaving primary healthcare, offering services that cater to the most vulnerable demographics, including women, children, youth, the elderly, the chronically ill, and those with disabilities. Due to the extreme and comprehensive nature of the destruction of the overall healthcare system, PMRS continues to expand teams and services, constantly assessing the gaps in care and working to close them.

Currently, PMRS has 41 teams across the Gaza Strip, consisting of PHC centers, field sites, and outreach teams. PMRS works collaboratively within what is known as the healthcare cluster, collaborating with other health providers for referrals or to develop ways to strengthen the healthcare system.

It is important to highlight, that all PMRS teams are from Gaza, the majority of whom have been displaced several times over the last seven-plus months. Just recently, with the attacks on Rafah, most teams were forcibly evacuated to Khan Younis. The PMRS teams report that many of them sleep in their cars and shelters, and now some have managed to secure tents. It is also important to emphasize that PMRS health workers have been providing health care ceaselessly, while not having access to basic needs like adequate food and water for themselves and their families.

Despite all the destruction and the constant attacks on healthcare, the PMRS teams continue to treat on average just under 10,000 patients every week, from the northern area to the southern area of the Gaza Strip. Offering services such as general practitioner consults, specialist consults, women’s health services, including pre- and post-pregnancy support, and referral for gender-based violence and sexual reproductive healthcare. PMRS prides itself on being a leader in offering women’s and youth health services and comprehensive mental health care. PMRS has continued, when possible, to supplement the work on the ground with tele/digital health services provided by its hotline Shabbak Shebab and mobile application Mostashari.

The work of PMRS from January to March this year indicates widespread impact on primary healthcare in Gaza, particularly sexual and reproductive health and mental health, registering 70,837 and 137,574 direct beneficiaries, respectively. PMRS is also a leader in rehabilitation services, offering several community-based rehabilitation services via its clinics and outreach teams. This also includes the distribution of and support for using assistive devices.

These services are extremely important since 15 percent of the population in Gaza is estimated to have some level of disability, almost half of whom are women. The holistic care that PMRS can provide these patients is particularly important, but rare, in Gaza. Offering comprehensive PHC means, for example, that a woman who has been displaced and who has a disability can be supported from a health, rehabilitation, mental health, and rehabilitation perspective all by the one team, ensuring continuity of care for that woman, which is almost unheard of these days in Gaza.

The PMRS team members not in Gaza remain in a constant state of anxiety and fear for their fellow teammates. Many feel helpless as they watch the devastation unfold only a few dozen kilometers from Ramallah, Jerusalem, or Bethlehem, for example. The knowledge that their peers are only a couple of hours away by car, and yet they cannot enter Gaza to support them, is harrowing and frustrating.

Bahia Amra, director of external relations, also remains constantly concerned about her staff, knowing that they often need to pack up their lives and clinics and flee while under constant threat of bombs and violence. She is often unable to reach staff for days during such active periods of violence, saying that it is not just a disruption in work for PMRS staff, but, more importantly, the patients lose continuity of care, and “that is not fair to them.”

Despite the ongoing challenges and personal and professional sacrifices, the PMRS teams remain committed, always managing to set up their clinics again and again and continue their essential lifesaving work for thousands of Palestinians. Some teams have also begun returning to their original locations, working on refurbishing damaged buildings or repurposing community buildings to turn them into clinics. PMRS health workers, like all their health-worker peers, remain steadfast and resilient, saying that their work nourishes them so that they can continue pushing through the very real and deep pain. PMRS health workers are not just Palestinian heroes, they are heroes for all of humanity, for they continue to put themselves in harm’s way, sacrificing their health and potentially their lives for the sake of their fellow human beings. Like all Palestinian health workers, PMRS health workers remain an inspiration.

*There is often a delay in reporting information due to the destruction of all infrastructure and the constant displacements.

i https://reliefweb.int/report/occupied-palestinian-territory/opt-emergency-situation-update-30-7-oct-2023-8-may-2024-1600.

ii https://gaza-projections.org/.

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