Despite recent easing, the embargo on the Gaza Strip continues to affect healthcare and certain medical needs are still not being met. Having assessed the situation and identified the needs, MSF has decided to open, in collaboration with the local health authorities, a reconstructive surgery programme to treat people victims of violence, domestic burn accidents and the injured.

More than a year and a half after the Israeli military operation ‘Cast Lead’ (January 2009), the health situation in the Gaza Strip remains fragile. Despite the opening of crossing points and aid sent by international NGOs, there are still chronic shortages of certain medical supplies and drugs. Some one hundred items remain totally unavailable at the Department of Health’s central pharmacy.

Health consequences of the embargo
Since the war, only one power station remains operational - the lack of adequate fuel supplies, however, means that it cannot run at full capacity and power shortages are a daily occurrence. In health facilities, the running of emergency generators is also affected by the unpredictable fuel entry permits and they are forced, at times, to reduce the healthcare services they provide. Likewise, travel for health workers, patients and ambulances is also difficult… Another health consequence of the embargo is that people have no choice but to use electric generators and low-quality, contraband bottled gas, which are a source of serious domestic accidents.    

Those injured receive treatment in our postoperative care programme (opened in 2007) or in Ministry of Health facilities. Their condition requires reconstructive surgery, but Gaza lacks services of this type. Only two hospitals can provide such treatment: the Al Shifa and Nasser hospitals, as well as a few private clinics and surgeons. Over 500 patients are due to wait between 12 and 18 months for surgery. MSF has therefore decided to open a reconstructive surgery project to treat its patients and reduce the Ministry of Health’s waiting list.

In May, an MSF team -consisting of Dr. Remy Zilliox, a plastic surgeon who works in the burns unit in Lyon, Dr Mathilde Berthelot, G.P., and Olivier Munnier, a logistics officer specialised in biomedical equipment- led assessments at Nasser Hospital, in order to set up this programme and define the terms of our collaboration with the health authorities in Gaza.

MSF will work with part of the hospital surgical team, to which it will add an expatriate surgeon, anaesthetist and theatre nurse. The aim is to share skills, both in surgery and anaesthesia and also postoperative care. Three days a week will be dedicated to surgery, the other two will be devoted to pre-operative examinations and medical monitoring.

Final preparations
Nasser hospital already has most of the necessary equipment. The surgical equipment will be supplied by MSF. The MSF operating theatre, sterilisation room and laundry room (where we will ensure sterilisation and washing of our surgical materials), have been upgraded and our pharmacy has been supplied with specialised equipment.

In June, the Memorandum of Understanding was signed. Our theatre nurse is on site to supervise the setting up of the programme. The triage of 70 patients on the MSF waiting list and their pre-operative examinations are underway. The first surgeries were carried out at the beginning of August.
 
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