The Ministry of Health in the Gaza Strip suffers from lack of financial resources and is unable to cover expenses (Al Jazeera)
Inside the Gaza Strip, besieged since 2007, residents receive medical services and care from 30 essential hospitals that, following the ongoing blockade, suffer from a permanent shortage of necessary medical equipment, supplies and medicines.
Gaza hospitals are a façade for direct and indirect targeting of the Israeli occupation army's attacks with continuous shelling and threats of forced eviction, as part of its aggression called "Iron Swords", which came in response to the "Al-Aqsa Flood" operation launched by the resistance on October 2023, 25, which led to the cessation of 51 hospitals and <> primary care centers.
History of medical facilities in the Gaza Strip
References to the Arab and Islamic medical heritage in Gaza indicate that the first medical facility in Gaza was called "Bimaristan of Gaza" (Dar al-Shifa), and was established by Emir Alam al-Din Sanjar bin Abdullah al-Jawli, who took over the prosecution of Gaza in 1311 AD, and was the agent of the righteous king Ismail al-Ayyubi.
According to the Palestinian Encyclopedia, "Bimaristan of Gaza" was part of the activity of Emir al-Jawli al-Omrani in Gaza during the 14th century AD. King al-Nasir Muhammad ibn Qalawun gave him great endowments, so he was also called "Bimaristan al-Nasiri".
"Bimaristan Gaza" was located on an area of 3,<> square meters, in the area opposite the Great Mosque from the east to Bosta Street, and from the narrow street in the north to Omar Al-Mukhtar Street in the south, surrounded by streets on all four sides.
It included several rooms for the sick, domes, iwans, a garden, a sakia, a mosque, a school for teaching medical sciences, a ribat for remembrance, and a hospice for travelers and the poor.
It had a special section for women and another for people with mental disabilities. The endowments of farms, villages and real estate that were imprisoned on "Maristan Gaza" were famous for the "Maristan Endowment", including the villages of Musayel, Batani al-Sharqi, Beit Girga, Herbia and Mughraqa.
These ruins survived until the French Emperor Napoleon Bonaparte destroyed them when he besieged Acre in 1800. Many of its stones and marble were transferred to other old buildings, especially the mosque of Sayyid Hashim bin Abd Manaf, while the land of Bimaristan was annexed part of it to some neighboring properties and built shops and a gold market, and the other part was taken to the cemetery of the Radwan family (rulers of Gaza during the Ottoman days).
Researchers in history consider that Gaza hospitals are an extension of the "Bimaristan of Gaza" or "Bimaristan of Nasiri" as it is called.
Healthcare System
Primary health care in the Gaza Strip, where more than two million people live, is provided by the Palestinian Ministry of Health, as well as the United Nations Relief and Works Agency for Palestine Refugees (UNRWA), non-governmental organizations and some private sectors.
Residents of the Gaza Strip governorates benefit from health services in 35 hospitals, at a rate of 1.59 hospitals per 100,13 inhabitants, 17 of which are governmental and 3 non-governmental hospitals, two hospitals affiliated with the Ministry of Interior and National Security, and <> private hospitals.
The hospitals are distributed in 5 areas, 18 of which are inside Gaza, 6 in Khan Yunis, 5 in northern Gaza, 3 in Deir al-Balah and the same in Rafah.
The number of beds available (before the Al-Aqsa flood) is about 3412,15 beds, at a rate of 53.10 beds per 527,130 inhabitants, of which 81 are in the non-governmental sector, <> beds are managed by the Ministry of Interior, and <> beds are managed by the private sector.
The total workforce in the health sector in the sector reaches 16,259, according to data announced by the Health Information Unit at the Ministry of Health for 2022.
There are 824 licensed private pharmacies and 3816,17 licensed pharmacists per 4,10 inhabitants.
General Medical Sector
The residents of the Gaza Strip receive health services mainly through the Ministry of Health, and the government covers the expenses of treatment within these institutions through health insurance, and until the end of 2022, the number of insurances exceeded 212,<>.
The figures of the annual report of the Ministry of Health for the year 2022 indicate that the number of employees reached 11,165 employees, an increase of 5.4% over 2018.
The institutions of the public medical sector are distributed between:
Primary Care Centers:
Centers operating under the supervision of the Primary Health Care Department at the Ministry of Health, and the residents of the Gaza Strip receive primary health care services in 159 centers distributed as follows:
- 52 centers affiliated to the Ministry of Health, representing 32.7%, employing 1748 employees, representing about 16% of the total employees in the Ministry.
- 22 UNRWA centres, constituting 13%, provide free care services to 2.6% of the total population of the Gaza Strip.
- 80 specialized centers and clinics for non-governmental organizations, constituting 51%, of which 19 centers provide services according to the ministry's standards, the rest provide specialized medical services, in addition to 5 centers affiliated with military medical services, constituting 3%.
Government Hospitals:
The Ministry of Health is the main provider of secondary care in the Gaza Strip and is responsible for managing 13 hospitals in the five governorates of the Gaza Strip, employing 7,65 employees, constituting 7.<>% of the total number of employees in the Ministry.
The capacity of these hospitals is estimated at 2674,12 beds, or 17.10 beds per 0,7 inhabitants, at a rate of 1.1 doctors per bed, as well as <>.<> nurses per bed.
Surgery constitutes the largest percentage in the Ministry's hospitals, reaching 29% of the total number of beds, followed by internal medicine and pediatrics at 23%, obstetrics and gynecology at 12%, and central treatment at 14%.
As of 274, 2009 intensive care units in government hospitals were distributed in the governorates of the Gaza Strip.
Classification of hospitals
Central Hospitals:
Al-Shifa Medical Complex: It is the oldest and largest in the sector, established in 1946, and includes 3 specialized hospitals: surgery, internal medicine, gynecology and obstetrics, and 642 beds, and employs about 1500 employees.
Nasser Medical Complex: Established in 1956, it includes 4 specialized hospitals, including Al-Nasser Children's, Al-Rantisi Specialist, Ophthalmology and Psychiatry, with 424 beds.
European Hospital: Established with a grant from the European Union in 1989, it has 308 beds. It is run by the Palestinian Ministry of Awqaf and Religious Affairs in the Gaza Strip.
General Hospitals:
Jerusalem (Red Crescent): It is the second largest hospital in Gaza, which began work in 2001, and was reconstructed, built and equipped with full funding by King Mohammed VI of Morocco, after it was bombed by Israeli warplanes in 2008. It includes several specialized departments, the most important of which are the intensive care department, the operating rooms of the obstetrics and gynecology department, and 10 nurseries for premature babies.
Algerian military hospital: opened in 2014, at an estimated cost of $ 150,<>, contributed in large part by the Association of Scholars in Algeria.
Indonesian Hospital: Established in 2011, funded by the Indonesian Mercy Foundation.
Kamal Adwan Hospital: Established in 2002, it was originally a small medical center called the "Beit Lahia Project Clinic" before it was developed into a hospital.
Abu Youssef Al-Najjar Hospital: It started a primary health care clinic and was converted into an emergency hospital in 2000. Its capacity increased after its expansion in 2007.
Al-Aqsa Martyrs Hospital: It is the main hospital in the central governorate of the Gaza Strip.
Al-Awda National Hospital (North Gaza): Opened in 1997, about 75% of the cost of its construction was from private donations, and improvements were made to increase its capacity.
Al-Hayat Specialized Hospital: It is only 500 meters away from Al-Shifa Hospital, and it provides multiple medical services.
In addition to Al-Helou International Private Hospitals, Al-Amal (Red Crescent), Beit Hanoun, Nasser and Al-Awda (Al-Wusta).
Monoclinic Hospitals:
Al-Khair Hospital, which specializes in obstetrics, gynecology and children, was established by Al-Khair Foundation in partnership with a local organization.
Rehabilitation Hospitals:
Sheikh Hamad Hospital for Rehabilitation and Prosthetics: Established in 2016 by the Qatari Committee under the guidance of the Father Emir Sheikh Hamad bin Khalifa Al Thani, and operated by the Qatar Fund for Development and officially opened in 2019, it is one of the largest rehabilitation hospitals operating in the sector, providing rehabilitation services and free examination for neurological, bone, muscle, amputees, curvature of the spine, hearing problems and cochlear implants.
Al-Wafa Hospital: Established in 1996 for medical rehabilitation with occupational physiotherapy services, and licensed in 1999 as the first and only hospital in the field of comprehensive medical rehabilitation, it was developed in 2007 from a single building to an integrated complex, and during the aggression on Gaza in 2014, it was completely destroyed. The hospital is now operating in a temporary headquarters in Madinat al-Zahra.
Maternity Hospitals:
Emirates Crescent Hospital: Established in 2005 to provide natural childbirth, childbirth, nursery and emergency services, it has 72 beds.
Financial constraints
The Ministry of Health faces several obstacles that burden health care services in the Gaza Strip, the most important of which, according to the ministry's report, is the lack of financial resources and its inability to cover expenses, as cash revenues exceeded $ 7 million, of which about $ 200,<> is manpower expenditures.
Claims and debts amounted to nearly $7 million, and the amount of repayments did not exceed $3 million.
The sector's needs for medicines, medical supplies and vaccines amount to $44.3 million annually, according to a local report in 2022, and there is a need to increase the number of beds by at least 5% annually.
Occupation practices against hospitals
In 1967, the medical services in the Gaza Strip were operated by a government agency under the administration of the Israeli occupation authorities, the second of which was run by UNRWA.
The military administration took control of the existing health care systems in the Gaza Strip and made them subordinate to the Israeli health care system, operating 4 hospitals, 25 clinics and health centers.
The occupation permanently closed the Fever Hospital and Tal al-Zohour Hospital, which was the only central hospital in Gaza during the 19th century, then known as Tell al-Sakan, and turned them into military departments in 1980.
The number of beds at the Chest Hospital, the only one in Gaza, was reduced to 70 in 1980. Between 1974 and 1982, the number of beds available to provide health care to the population of the area was reduced from 1004,755 to 1984, and the surgical department at Nasser Hospital in Khan Yunis was closed, before being permanently closed in <>.
In early July 1988, the Gaza Strip included military command instructions to hospital directors, including that anyone treated for a security incident pay 280 shekels ($170) for each night in the hospital.
In the event of admission to the hospital, the patient pays a fee of 3 days in advance, and after the end of the period, he pays a fee of another 3 days, and anyone who does not pay his property is withheld without a court order. The patient signs a pledge of full payment before admission to the hospital.
The PLO documented these Israeli actions in a memorandum addressed to the Emergency Arab Summit in 1990.
A few days after these instructions were issued, the military leadership announced its decision to terminate about 10% of the contracts of workers in the health system and hospitals.
Effects of the blockade
The health sector in the Gaza Strip suffers from the low efficiency of health facilities, due to a set of restrictions and measures imposed by the Israeli blockade since 2007, including:
- Constant power outages and fuel depletions, which disable many medical devices.
- A severe shortage of medical equipment, including imaging and diagnostic equipment, which the occupation authorities prevent entry to, except with special permits that extend for nearly a year.
- These restrictions also hinder the import of essential medical supplies, such as medicines and medical equipment, and necessary medical items such as nitrous gas, which is used for anesthesia purposes.
- Restrictions on the freedom of movement of patients in urgent need of treatment outside the Gaza Strip, and the policy of reducing the number of medical referrals to patients.
Israeli incursions and attacks
On many occasions, Gaza's hospitals have been the target of Israeli attacks, such as the Al-Ahli Arab Hospital, known as the Baptist Hospital, was bombed in 1989, and the occupation also committed a massacre on October 17, 2023.
Israeli forces also stormed Nasser Hospital in Khan Yunis, arresting dozens of wounded, and destroying hospital equipment in February 1990.
On November 14, 2023, the Israeli army stormed al-Shifa Hospital in Gaza, took control of some of its buildings, and bombed its surroundings and parts of it.
In the same month, the occupation also targeted Al-Quds Hospital, Al-Nasr Children's Hospital and the Eye Hospital in Gaza, and bombed Al-Rantisi Children's Specialized Hospital and the Indonesian Hospital.
Due to the Israeli aggression on the Gaza Strip in 2023, 21 hospitals and 47 health centers were out of service.
Source: Palestinian Press + Websites