Witness 11 by Medical Aid for Palestinians (MAP)

WITNESS

1 Dear Supporter,

IMPACT OF THE WAR ON GAZA

I write to you from Gaza City six months after the end of Israel's assault on Gaza.

On the 27th of December Israel launched 'Operation: Cast Lead' on the Gaza Strip, home to 1.5 million Palestinians. The attacks lasted for 22 days – 8 days of airstrikes followed by 14 days of combined attacks by air, land and sea.

During the attacks it gave us a huge boost knowing that people in the United Kingdom were sensitive to and aware of the tragic events unfolding. I would like to be able to say that things are better and that the situation has improved, however it would simply not be true. For many Palestinians in Gaza there is precious little hope. Families are still living in the rubble of their destroyed homes, and they lack physical security: we are in constant fear of renewed attacks.

In this issue of Witness you will learn more about the ongoing challenges impacting on the health of Palestinian families living in the occupied Palestinian territory and in the devastated refugee camp of Nahr al-Bared in Lebanon. Knowing that you are supporting us means a lot to our team here. I also know that it means a lot to the people of Gaza to know that they have not been forgotten. Nawraz Abu Libdeh Medical Aid for Palestinians Gaza April 2009

“People call this place a prison; it is not a prison because a prison in Western Europe would be much better in terms of conditions than here”. John Ging (UNRWA) March 09

1, 417 Palestinians were killed including 313 children and 116 Women1

There were an estimated 2,300 Israeli airstrikes2

1,872 children and 800 women injured in the attacks3

8,000 homes were completely destroyed4

33,767 families had their houses damaged5

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200,000 people were displaced, among them 112,000 children6 98% of the Palestinian children in Gaza Strip are suffering psychological traumas and feel unsafe7

1 WHO

Specialized Health Mission to the Gaza strip, May 2009 Oxfam WHO Specialized Health Mission to the Gaza strip, May 2009 4 Oxfam Rebuilding Gaza: putting people before politics, June 2009 5 Oxfam Rebuilding Gaza: putting people before politics, June 2009 6 Al Mezan Centre for Human Rights – “Cast Lead Offensive in Numbers”, 2009 7 Gaza Community Mental Health Programme – “Death anxiety, PTSD, Trauma, grief, and mental health of Palestinians victims of War on Gaza”, 2009 2 3

AN OVERVIEW

The Zeitoun area, in the eastern area of Gaza City, was particularly badly hit and remains a zone of destruction, resembling something that comes out of a bad dream. Many families' homes look exactly as they did six months ago, children are returning from school to houses of rubble, with only planks of wood and plastic sheeting sheltering them from the wind and dust. The Samouni family was devastated by the attacks. Thirty members of the same family were killed in one day, with twenty more severely injured. I met with and heard the terrible stories of many of the surviving members living in the rubble as MAP distributed its hygiene and nutritional kits. Sadly the Samouni family's story is not so rare, many families lost fathers, mothers, children, brothers and sisters.

The most serious health needs for Palestinian refugees in Lebanon are of those living in the devastated refugee camp of Nahr al-Bared. Located on the outskirts of Tripoli in the north of Lebanon, 82% of camp buildings in Nahr al-Bared were demolished and tens of thousands of refugees were displaced due to the fighting in 2007.

To ensure both success and sustainability, MAP's project utilises community-based health initiatives directed at pregnant women and infants. One of the core components – a community outreach nursing team comprising of midwives and nurses – is successfully working from a well-resourced clinic which provides adequate space for the variety of activities.

With camp reconstruction proceeding at a snail's pace, one of MAP's projects is addressing the health needs of vulnerable young mothers. This is done on the basis of an integrated care model including health education, health promotion, home-based support and access to professional clinical services.

Dr Ali Dakwar, MAP's project co-ordinator, is based in the clinic together with a part-time paediatrician, an administrator and ancillary staff. Dr Ali told MAP how the midwives work alongside MAP's community mothers scheme to “promote a sustainable approach to health through education and empowerment combating the effects of child stunting. In particular nutritional courses are critically important in protecting the health of the next generation".

MAP knows that improving a child's chance of survival, health and development, particularly for children at risk, born either premature or with a disability, is dependent on the quality of the interaction between the parent and child. While refugees remain displaced in temporary housing, there is a continued negative impact on their health. Frequent bouts of illness, watery and bloody diarrhoea, viral hepatitis, fevers and intestinal infestations all limit children's opportunities to explore and learn, this during a period in early childhood is critical for developing basic intellectual and social skills.

Newborn paediatric care is also available in the clinic. The team is providing coverage which currently stands at just over 50% of the patients accessing UN services. Between January and April 2009 the project staff have carried out 947 home visits to 442 families.

Some of the key outcomes of this project's work to date include: n n

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Managing and containing nutritional deficiencies and anaemia, which are wide spread among pregnant and post-natal mothers. Safe motherhood practices are being embedded in the community. This has required a capacitybuilding approach which has involved cooperation with other NGOs in the field. Maternal and child health are supported through home nursing interventions and support. The nutritional status of children at risk and their families is being improved through current promotion of exclusive breastfeeding. This requires continued training and support of staff.

Mothers explained how home visits were welcome and that they appreciated advice and the time taken per visit. Housing is the current priority for families as well as an expansion of services offered at the clinic to include facilities for the delivery of babies.

However, one of the critical issues for people referred has been the delay in the reconstruction of Nahr al-Bared camp. There is the widespread view that the temporary shelters will become permanent homes. There was almost unanimous criticism of these 'temporary' shelters, described as grossly inadequate and inhumane, which include converted shipping containers that are unbearably hot in the summer months. Clearly the main determinants of refugee health in Nahr al-Bared camp will require longer term improvements in housing and environment infrastructure. Put simply while refugees continue the ongoing struggle to rebuild their lives whilst surviving in temporary housing, their health will be at serious risk. With the world's attention focused on Gaza, the situation for Palestinian families living in the rubble of Nahr al-Bared is often forgotten. MAP will continue to work in Nahr al-Bared to protect the health of vulnerable young mothers and their newborn children.

To learn more about MAP's projects in Lebanon visit: www.map-uk.org/regions/lebanon/

F E AT U R E : H E L P I N G FA M I L I E S, L E B A N O N

HELPING FAMILIES IN NAHR AL-BARED CAMP, LEBANON

The team of midwives and Dr Ali Dakwar at the Community Mothers Programme. © Libby Powell 2009

Ramadan, the Islamic holy month, will start in August. During this special month Muslims fast throughout the sunlight hours, and alter eating patterns especially for staple food items such as bread, nuts, fruit, and cheese which provide important nutrients to maintain good health. These food items are normally expensive and with greater demand over Ramadan, prices increase and place an impossible economic burden on family households of very limited or no income. Considering the high levels of food insecurity in Gaza, and that most families are reliant on food aid, the need for food assistance during Ramadan for the most vulnerable families is of particular importance. In the aftermath of the war on Gaza, and with the ongoing blockade, MAP will be increasing the number of families receiving support with food parcels during Ramadan. MAP met with long-term supporter Haleem Kherallah, who was born in Gaza, to discuss what Ramadan means to Palestinians living there. “Ramadan is an incredibly special month for Palestinian families. The whole pace of life slows down and you spend lots of time with your family and loved ones.

The days start early, and the whole family wakes up at around 4am. If they're not woken by the call to prayer then they will be woken by a neighbourhood drummer who makes the rounds! After a light breakfast before dawn we go to work, leaving early at 2pm to return home. Then we're off to the market with the children to buy food, it is a special feast and families across generations come together in one room.

As a child I remember never wanting Ramadan to finish. Despite the difficulties of fasting the evenings were always filled with celebration. I would be showered with kisses from aunties I hadn't seen smile for months, and as to get angry is to break fast I could never get in trouble! Even bed time rules were relaxed as the family gathered round to watch the special Ramadan soap operas. Today, living in London it is hard to enjoy Ramadan without thinking of the suffering of those Palestinians struggling to live with dignity in Gaza. Despite the

horrors of the recent attacks, Ramadan allows people to come together in family solidarity which is stronger than any occupation. I continue to support MAP's annual programme to distribute food parcels to the poorest families in Gaza – families who for much of the year have little guarantee of clean water and are blockaded from receiving many different types of food”. MAP was a recent co-signatory to a letter signed by 38 aid agencies protesting the two year blockade of Gaza. For more visit www.map-uk.org/news

F E AT U R E : RAMADAN IN GAZA

INTERVIEW WITH HALEEM KHERALLAH

Families suffering from the blockade in Gaza. © MAP 2009

RAMADAN IN GAZA

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Six year old Sharif and his five year old brother Ahmed both have cerebral palsy. The brothers need twenty four hour care, including intensive physiotherapy to maximise their movements and help them remain as physically able as possible. Their mother Suhair lives with her husband and her nine children in an impoverished area of Rafah city, in the southern Gaza Strip. Until April last year, Suhair was struggling to cope with her sons' complex needs, but now she has found support through an innovative local association that teaches physiotherapy skills to mothers of disabled children in Rafah so they in turn can support their own children. The Ameera Association was set up by a local woman from Rafah, Akhlam Ferwinaa, in response to the needs of her own physically disabled daughter. With the support of MAP, Akhlam and her team are now training 240 mothers of disabled children in Rafah to administer daily physiotherapy to their children.

'This project is vital because instead of working shortterm with the children, we are giving long term support to their mothers who learn how to support their own children', says Akhlam. 'We have a lot of mothers on the waiting list to join our project.' Suhair and her sons joined the Ameera Association physiotherapy project last year, and attend physiotherapy training sessions twice a week, plus speech therapy sessions. One of the association project workers also visits them at home on a regular basis for additional support. 'I can now do all the physiotherapy for my two boys myself', says Suhair. 'We also learn other practical skills â&#x20AC;&#x201C; how to toilet our children, and new ways to play with them.' She says both her sons are now more physically mobile, and that attending speech therapy sessions has made a huge difference to their communication skills. 'Ahmed only used to say 'Baba' ('Daddy') but I've learnt to encourage them to repeat words after me - and now he says everything!' Whilst Israel maintains its blockade and closure of the Gaza Strip, resources for disabled children like Sharif and Ahmed continue to be absolutely minimal, which places more strain on their families. For their mother

Physiotherapy session at The Ameera Association. ÂŠ MAP 2009

Suhair holds her young sons close as they both wriggle in her arms. 'My two boys cannot walk alone, and they both have problems speaking', she says. 'It is a difficult situation.'

F E AT U R E : D I S A B I L I T Y I N G A Z A

FAMILIES LIVING WITH DISABILITY IN GAZA

Suhair, one of the most important things about the Ameera Association project is the social support she receives both from the workers and other local mothers who have disabled children. 'It is really good to exchange experiences with other mothers like me' she

says. 'We have taken our children out together to the beach, and I'm not shy to take my boys out now. We've been going to the Ameera Association for a year, and it has made a real difference to all three of us.'

A family in Gaza sit amongst the rubble of their home.

THE BIG PICTURE

ÂŠ Maan Images / Hatem Omar

MAPâ&#x20AC;&#x2122;s Rapid Response Programme provided nutritional & hygiene support to children under 5, families with children and young adults with disabilities. 51,000 vulnerable residents of Gaza benefitted from the kits at a time of critical need.

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FAMILIES IN THE UK REACT TO EVENTS IN GAZA

Much closer to the events was Tamara's mother Lubna, who was in Jordan and described to MAP "the torrent of disbelief, anger and helplessness at the daily sights of murdered families, the high number of children in the victims. An overwhelming state of stupor engulfed the people in what was an undeclared public wake”. Meanwhile back in London Tamara and her cousin Lulu decided to transform their feelings of frustration and helplessness by doing something positive to help. Lulu had a very personal connection to the unfolding carnage in Gaza: her parents are originally from the beleaguered territory and she watched helplessly from abroad. Tamara spent weeks during and after the assault working as a volunteer in MAP's London office, helping the team support the field offices in the West Bank and Gaza whose work was saving the lives and safeguarding the health of thousands of Palestinians.

Tamara was ready to take on the 290 kilometre ride, the equivalent of over seven times the length of the entire Gaza Strip.

By February, Lulu and Tamara decided to raise £100,000 to support MAP's work in Gaza. To do so the pair decided to take on the challenge of cycling from London to Paris, raising not only funds but also spreading awareness of the critical situation in Gaza.

Through their tireless efforts, Tamara and her team recruited twenty-six cyclists to join them on the ride. Included in the team was renowned Israeli historian Avi Shlaim, author of 'The Iron Wall' and his wife Gwyn. Tamara told MAP that she hopes her efforts can be replicated across the country; “the only way to counter the frustration of witnessing such events is to get out and do something about it here that can effect real change”.

Tamara's mother spoke to MAP about her daughter's challenge:

“When I learned that Tamara and some friends had decided to form this charity cycle, I was needless to say the happiest mum, who took great pride not only in her daughter but in a whole inspiring generation who put words into action, speaking volumes and reaching out to others who have been endlessly victimized. It is through such acts of altruism that one hopes that the deaths of innocents will never be in vain". Training has been no easy matter. Tamara could initially barely balance on a bike and suffers from mild asthma: her longest cycle previous to the Paris challenge was twenty minutes long! However after hundreds of spinning classes and hours of training at the gym,

Tamara Ben-Halim. © MAP 2009

As the bombs fell on Gaza, Tamara Ben-Halim, a twenty-three year old student from London, joined the millions in the UK who watched on in horror and disbelief.

To learn more about their cycle visit: www.cycling4gaza.com If you want to get involved and take part in fundraising for MAP, please contact our London office on 0207 226 4114 or email: info@map-uk.org

FUNDRAISING: CYCLING 4 GAZA

FUNDRAISING STORY

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HEALTH IN THE OCCUPIED PALESTINIAN TERRITORY F E A T U R E : H E A LT H C O N C E R N S

March saw the launch of a special series on Health in the Occupied Palestinian Territory in The Lancet, one of the world's leading medical journals. This publication is the culmination of

over two years of work by Palestinian academics and their international counterparts, and was led by MAP's partner, the Institute of Community and Public Health of Birzeit University.

The series looked at the main determinants of Palestinian health, the most powerful being the State of Israel, whose economic, political, military and territorial superiority continue to be applied to both Gaza and the West Bank. However, the Lancet papers also considered the lesser, yet significant, power that internationally-funded agencies can exert over the direction of health development in the region; the combined activities of such organisations, despite huge financial investment, can lack co-ordination and coherence. Furthermore, the Palestinian Authority, which has lacked the ability to develop a coherent health system, has failed too often to rise above serving factional interests. In this way, the series of articles describes the more complex background of a strangulated Palestinian economy, gross restrictions on ordinary movement and a pervasive environment of intimidation, uncertainty and insecurity, in which attempts to establish a coherent health system are set to fail. The occupied Palestinian territory is unique, not only for being under external military and economic control, but also because of the 40 year duration of these circumstances. This series of Lancet articles illustrates the many ways in which the Palestinian right to health is compromised

by the current extraordinary circumstances of occupation, siege and invasion. The official launch, held at the Royal College of Paediatrics and Child Health, brought together a wide range of international academics, health specialists and advocates. Drawing together a diverse and international audience from the health, development and political sectors, this conference considered the key issues faced by Palestinians in the region and how to take the recommendations of the Lancet series forward. Building on this launch, MAP also held a conference entitled: Health under Occupation: Health Under Fire. With the series being published in the shadow of Israel's assault on Gaza, MAP's conference highlighted the key findings of the Lancet series but also focused on more recent health-related violations in Gaza. Physicians for Human Rights-Israel presented findings including the targeting of medical personnel and equipment, while the World Health Organisation presented their initial assessment of health needs for Gaza after the conflict. MAP will continue to support the capacity of local partners to initiate such important research, and sustain the momentum for policy change following the series. The full text articles of the Lancet series on Health in the Occupied Palestinian Territory are available on MAP's website at: www.map-uk.org/projects/

F E A T U R E : H E A LT H C O N C E R N S

Left to right, Abdullatif Husseini (Institute of Community and Public Health, Birzeit University), Richard Horton (Editor, Lancet), Espen Bjertness and Samia Halileh (Institute of Community and Public Health, Birzeit University). ÂŠ MAP 2009

As MAP wrote in the edition the health and welfare of Palestinians within the occupied territory has been secondary to powerful outside interests.

SPEAKING OUT LIBBY POWELL

“

Libby spoke to Witness about her experiences of passing through the system of Israeli checkpoints that crisscross the occupied land: As you arrive into Jerusalem you become very aware of the system of segregation that exists. There are different coloured number-plates signifying which cars can go where, and as soon as you enter the West Bank, the smooth paved roads are replaced by dusty potholed tracks. My first experience of Qalandia checkpoint (controlling access between East Jerusalem and the rest of the West Bank) was crowds of Palestinians queuing in the baking heat. Families were huddled together, some carrying an array of bags that would get trapped in the automated cattle grid gates that would close without notice, separating mothers from

their children. The hanger-like structure is characterised by a complete absence of actual people, instead automated metal controls the conveyor belt of humanity that slowly makes their way through. Once through the checkpoint, travelling around the West Bank is a sharp awakening to what an occupation really looks like. The territory is a spider web of roadblocks, checkpoints and prohibited areas. Driving to visit a MAP project near Hebron I saw the Israeli military pull a teenager out of a public bus, where his permit papers were scrutinised in the shadow of fenced-off Israeli settlements that dominate the hilltops. Travelling near Jericho I saw whole communities of once nomadic Bedouin struggle to get by in semipermanent dilapidated housing. Tragedies occur at these checkpoints. I heard the story of Fawziya Qabb who died of a stroke in Tulkarem last year when an ambulance was prevented from travelling to her house. Her husband spent twenty minutes trying to persuade the soldiers to let the ambulance through but to no avail.

At a paediatric advanced lifesaving training session, where MAP works with the Royal College of Paediatrics and Child Health and Juzoor in training health practitioners in advanced lifesaving and neonatal skills, I saw how MAP's projects have adapted to the occupation. Living with ever-present constraints means 'satellite training' is crucial: training doctors and nurses who work in marginalised areas that can gain confidence in treating cases locally and not having to run the gauntlet of daily hold-ups and humiliations that characterise travelling through the West Bank.

”

To learn more about MAP's projects in the West Bank visit http://www.map-uk.org/regions/opt/projects/

MAP's new Programme Officer Libby Powell visited the West Bank this June. In May the United Nations reported that in the West Bank approximately 28 percent of the land over the years has been declared as either closed military zones or nature reserves, where Palestinian access and use is either banned or restricted.

SPEAKING OUT: LIBBY POWELL

“RESTRICTING HEALTH IN THE WEST BANK”

Thank you from the entire team at MAP for your generous support. With your help we were not only one of the first international aid agencies to respond to the recent war on Gaza, but we never lost sight of our long-term programmes helping to protect Palestinian peoples’ right to health in the oPt and Lebanon. Our work would not be possible without you.

SPECIAL THANKS

DONATION HOTLINE 020 7226 4114 Donate online at www.map-uk.org

Cover: Jabaliya Refugee Camp, ÂŠ Maan Images

Registered Charity, Number 1045315.

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