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Overview of Public Health in Palestine

 

According to the Palestinian Central Bureau of Statistics (2017), the estimated population living in Palestine is 4,780,978; around 2,881,687 of them live in West Bank (5,655 sq. km) and 1,899,291 live in Gaza Strip (365 sq. km). The biggest percentage of the population is younger than 17 years old (43.9%), with a sex ratio of 103.3.

 

Average family size is 5.1 (4.8 in West Bank and 5.6 in Gaza). Around 78.3% of the population (excluding residents of East Jerusalem) is health insured, 98.1% is educated, 27.2% is unemployed, and 5.8% is disabled.

 

For further information and statistics, please refer to the Palestinian Central Bureau of Statistics (PCBS) report published in February 2018: http://www.pcbs.gov.ps/Downloads/book2364-1.pdf

 

A World Bank report (2018) shows that around 29% of Palestinians live in poverty, while 2.5 million are in need for humanitarian assistance. Moreover, 22.5 million are food insecure according to the World Food Programme (2018).

 

Access to health services in West Bank is restricted by the Israeli wall and checkpoints. Palestinian patients, health workforce, and ambulances are refrained from accessing referral hospitals in East Jerusalem, as entrance to the city is possible for holders of Israeli-issued permits only. The process of obtaining a permit is complicated, and may result in delays or denial of care.  Gaza patients in need for specialized health care may also be denied care as a result of the closure of Rafah border crossing with Egypt or the complicated process of passing through the border.

 

For further information and description of the geopolitical situation in Palestine, please refer to OCHA website via the below links:

 

 

Based on the Palestinian Central Bureau of Statistics (2016), total current expenditure on health reached 1.419 million US Dollars (10.7% of GDP). Expenditure is covered by the government (around 37%), private insurance companies (around 3%), households/out-of-pocket (around 41%), non-profit organizations (around 18%), and others (around 1%).

 

The Palestinian Ministry of Health (MoH), UNRWA, Military Health Services, NGOs, and the private sector cover primary, secondary, and tertiary health care services. The total number of primary health care centers in Palestine until 2017 as disclosed by the Palestinian Ministry of Health, are 743 (583 in West Bank and 160 in Gaza), and hospitals are 81 (51 in West Bank including East Jerusalem and 30 in Gaza).

 

According to the Palestinian Ministry of Health (2017), burden of non-communicable diseases in Palestine is high. The leading causes of death are consecutively cardiovascular diseases, cancer, cerebrovascular diseases, conditions in perinatal period, and diabetes. Related risk-factors such as smoking, unhealthy diet, and sedentary lifestyle are widespread.

 

Life expectancy in Palestine (MoH, 2017) has increased up to 73.8; 74.1 in West Bank and 73.3 in Gaza; 75.4 for females and 72.3 for males. Disabilities are 2.7% in West Bank and 2.4% in Gaza.

 

Due to political instability and worsening living conditions in Gaza, disabilities, traumatic injuries, and amputations are on the increase. Moreover, burden of mental and psychological disorders is expected due to the occupation’s continuous use of violence, lack of personal security, violation of human rights, and restrictions on movement.

 

Water scarcity in Palestine has a serious impact on the Palestinian public health scene.  According to the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation, the percentage of the population served by piped water services dropped from 88% in 1995 to 56% in 2015. In Gaza, high proportions of fecal indicator bacteria have been detected in drinking-water supplies. Furthermore, coastal aquifer is low, contaminated, and overused. Wastewater treatment is inadequate, which results in untreated sewage causing further contamination of coastal seawater in Gaza.

 

PCBS states that infant mortality in 2017 reached 10.7 deaths per 1000 live births, and under-five mortality rate reached 12.1 deaths per 1,000 live births, which reflects a significant improvement when compared to death rates in prior years. On the other hand, maternal mortality rate in Palestine was estimated by MoH to be 5.9 per 100,000 live births.

 

WHO continues to support MoH in sustaining high vaccination coverage for communicable diseases and effective monitoring of health indicators. According to MoH (2017), incidence rates of reported communicable diseases are: 3.71 H1N1, 6.5 other Bacterial Meningitis, 3.0 food poisoning, 9.4 Hepatitis A, and 2.4 Acute Flaccid Paralysis (AFP) per a population of 100,000. On the other hand, reported sexually-transmitted infections in 2017 were more than 50,000. In addition to communicable diseases, mental disorders incidence rate per 100,000 population was 117.2.

 

Based on PNIPH 2017 research on extent of illicit drug use in Palestine, only 1.8% of the male population above 15 (26,500 high-risk drug users) were identified as high-risk drug users.