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Urgent appeal: financial distress of East Jerusalem Hospitals, 13 December 2012
13 December 2012 Jerusalem – The East Jerusalem Hospitals (EJHs) began laying off staff and delaying non-urgent care in an effort to reduce costs and ameliorate an unprecedented financial crisis as a result of accrued debt from the Palestinian Authority (PA) for specialized patient care, totaling NIS 85.245 million as of November 30, 2012. The PA’s debt to the EJHs has persisted over the last year as donor support to the PA has decreased.
The East Jerusalem Hospitals Network(EJHN) includes six facilities --- Princess Basma Rehabilitation Center, Augusta Victoria Hospital, Maqassed Hospital, St. John Eye Hospital, St. Joseph Hospital, and the Palestinian Red Crescent Society Hospital --- which serve as the main centers for specialized care within the Palestinian health system. Patients needing services and procedures that are not available in the West Bank and Gaza are referred for treatment in the EJHN facilities by the Palestinian Ministry of Health (MOH).
In 2011, over 22,000 West Bank and Gaza patients were referred by MoH to East Jerusalem, representing almost 40% of all MoH referrals, and more than half of the EJHN caseload.
The hospitals are struggling to fulfill obligations to suppliers and hospital staff and physician consultants. There is growing concern that the vital services provided by the hospitals could be jeopardized if financial assistance is not provided soon and the debt burden continues to rise. The Princess Basma Rehabilitation Center has implemented organizational changes that included the termination of eleven staff members. St. Joseph Hospital has found itself in debt with its obligations to suppliers totaling over NIS 3.5 million and to its physician consultants, approximately NIS 6.4 million. Augusta Victoria Hospital – holding the largest debt from the PA – is attempting to counterbalance the PA’s debt by delaying medical treatment of less urgent cases. Further, August Victoria Hospital is struggling to meet its commitments to suppliers and disburse December salaries to its staff.
The EJHN and its six facilities have been supported by the European Union (EU) and the World Health Organization (WHO) for the last four years for quality improvement and institutional development. The achievements of this program will also be threatened if the financial crisis continues.
The EJHN is seeking urgent financial assistance to sustain the services of the six hospitals. It is calling on donors to support the PA to meet its obligation towards the EJHs - and requesting that funds be donated directly to the PA to be used specifically for paying down their debts to the EJHs.
Contact: WHO –Ms. Aisha Mansour, 02-540-0595
EJHN Coordinator: Dr. Tawfiq Nasser, 02-627-9902
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The Lancet publishes WHO study on restricted access to health care in oPt, 8 October 2012
8 October 2012 Jerusalem – This week the UK-based medical journal, The Lancet, published an abstract of a study carried out by WHO in the occupied Palestinian territory quantifying the extent of health access restrictions for patients, hospital staff and ambulances in the West Bank and Gaza Strip. The WHO Advocacy Unit conducted the research from data from the Palestinian Ministry of Health, General Authority for Civilian Affairs, Palestinian Red Crescent Society (PRCS) and the East Jerusalem hospitals.
About three out of four patients referred for medical treatment outside the Palestinian public health system are to nongovernmental hospitals within the occupied Palestinian territory, primarily East Jerusalem. Most of the others are referred to specialized hospitals in neighbouring countries – Jordan, Egypt and Israel. Israel requires these patients to apply for an Israeli-issued permit in order to travel through checkpoints. Patients travelling from the Gaza Strip may also be required to appear for a security interview at Erez checkpoint and several have been arrested on crossing.
The findings indicated that in 2011, 19% of patients and patient-companions from the West Bank, and 10% of Gaza Strip patients were denied or delayed permits from the Israeli Civil Administration for access to health treatment. The total number of patients and companions denied or delayed access in 2011 was 33 760. West Bank data from 3 of 15 districts in the first three months of 2012 indicated that the most frequent reason for denials of health permits was for unexplained ‘security’ reasons. Only 5% of PRCS ambulances had direct access through checkpoints in 2011, the rest carried out back-to-back transfers of patients to Jerusalem-licensed ambulances. Two-thirds of staff at East Jerusalem hospitals must apply for access permits to travel to work, with restrictions on how and where they may travel.
The WHO study was one of 32 peer-reviewed abstracts published by The Lancet in a special online series focusing on the health of Palestinians in Palestine and in refugee camps in the surrounding countries. The Abstracts were first presented in March 2012 at The Lancet-Palestinian Health Alliance third annual conference held in Beirut.
Related links
The Lancet homepage: 32 peer-reviewed abstracts on health in oPt
Transforming mental health services and attitudes: phase 2 of EU-funded mental health initiative in the West Bank and Gaza Strip, 10 October 2012
10 October 2012 Ramallah – On 10 October, International Mental Health Day, the Palestinian Ministry of Health and the WHO oPt office launched a three-year $1.5 million project, funded by the European Union (EU), to improve community-based mental health services in the West Bank and Gaza Strip.
WHO will provide technical support for the project which the Ministry of Health will implement in 48 health facilities in the West Bank and Gaza Strip, in line with the National Mental Health Strategy, 2012–2014. The project also aims to increase patient access by strengthening Palestinian civil society involvement in service provision and in fighting stigma and discrimination.
WHO and the Ministry of Health have worked together over the last decade, most recently in an EU-funded phase 1 project (2008–2011), to reshape mental health and psychosocial support services from a traditional institutional-based approach to a community-based approach. This EU-funded phase 2 project builds on this work and emphasizes effective prevention, diagnosis, and treatment of common and severe mental health disorders, and will be implemented across a continuum of care levels: primary assessment and ongoing care in primary health care clinics, specialized and community care in community mental health centres, acute care units in general hospitals and promoting rehabilitation services in tertiary care facilities.
Minister of Health Dr Hani Abdeen said, “In Palestine mental illness results in preventable suffering and a huge burden on families. We will continue to improve our primary health care services so that patients can easily access the care they need and we must strengthen community-based services. I am very pleased that the EU and WHO are working with us to support this programme.”
Major project activities 2012–2015
The current project will focus on strengthening primary mental health care as the first level of mental health service provision. The integration of mental health into primary health care will include 28 primary care facilities. 180 doctors and nurses working in these clinics will be trained on mental health, and intervention and referral guidelines will be developed to manage common mental health problems.
The community mental health centres will be supported by providing specialized training and supervision for 90 community mental health workers. A training plan will be developed and operational policy will be established in all community centres. The centres will be supported to provide rehabilitation services for people with severe mental illness.
The project will support the strengthening of rehabilitation units in the two psychiatric hospitals, and establishment of two acute care units in two general hospitals to improve patient access to mental health services. Patient care between levels of services will be strengthened by establishing an information system, and developing a code of practice for mental health professionals and referral methods.
Individuals will be encouraged to seek health care through measures that improve accessibility to mental health services. The project will support the existing family and users associations in the West Bank and will establish a new association in the Gaza Strip. Civil society organizations will be supported in developing anti-stigma campaigns and improving mental health awareness among the population.
“People with mental illness are stigmatized and badly served by the health sector in the occupied Palestinian territory, as in the Region and most of the world. The programme is about improving services for people with mental health disease and changing attitudes,” summed up Mr Tony Laurance, WHO Representative for oPt. “It requires everyone to participate to achieve the goals.”
Mental health in occupied Palestinian territory
In the West Bank and Gaza Strip, mental disorders such as depression and anxiety, as well as more serious mental illness, such as schizophrenia, are underreported, under-resourced and under-treated. The occupation of the West Bank, blockade and siege of the Gaza Strip, violence, poverty and unemployment contribute substantially to the burden of mental health illness in the occupied Palestinian territory, and disproportionately affect the most vulnerable population groups – women, children and older people – as well as young adult men.
No reliable national data exist but WHO estimates that, globally, 25% of the general population can be expected to develop common mental disorders at some point in their lives, and some may develop serious mental illness. Comparing WHO surveys in post-conflict countries and local studies, WHO estimates that 5%–10% of the population in the oPt may currently suffer some form of common mental disorder; less than one in five of those in need currently accesses health care services: about 4500 individuals a year. Many Palestinians do not seek treatment as a result of neglect, or fear of discrimination or stigma. If treatment is sought and an accurate diagnosis is made, most mental disorders can be treated successfully at community mental health centres and with simple low-cost medications.
World Mental Health Day: focus on depression
Today, 450 million people in developed and developing countries suffer from mental disorders, contributing substantially to the burden of disability worldwide. Five of the 10 leading causes of disability result from mental health conditions. Mental and neurological disorders account for an estimated 12% of the total disability-adjusted life years (DALYs) lost due to all diseases and injuries, taking an enormous toll in terms of suffering, disability and economic loss.
WHO has identified depression as the most common mental health disease globally, and the leading cause of disability, as well as a risk factor for poverty. By 2020, depression is expected to be a leading cause of the global burden of disease, second only to ischemic heart disease.
Social determinants of mental health
WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community. In this positive sense, mental health is the foundation for individual well-being and the effective functioning of a community.
Mental health wellbeing requires that individuals enjoy the security and freedom provided by basic human rights, Rapid social change, stressful work conditions, gender discrimination, social exclusion, unhealthy lifestyle, risks of violence and physical ill-health and human rights violations increase vulnerability, as do specific psychological and personality factors and some biological causes, including genetic factors and chemical imbalances in the brain.
This project is funded by the EU.
