Health and nutrition
Health and nutrition programming ensures that more vulnerable children and mothers have access to a quality comprehensive health and nutritional system and are better able to survive and reach their optimal development.
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Challenge
Children under 5-years of age remain highly vulnerable to neonatal mortality, developmental delays and disabilities:
Although the maternal mortality ratio (MMR) has reduced to 20 per 100,000 livebirths (MICS, 2014), every fourth pregnant woman in the State of Palestine is considered high-risk and requires specialized health care during pregnancy (14,000 cases annually). Some 22 children die out of 1,000 live births (Gaza: 24 deaths per 1,000 live births; West Bank: 20 deaths per 1,000 live births).
The top three causes of neonatal mortality were prematurity, respiratory infections and congenital malformations, which constitute 61 per cent of neonatal mortality, and approximately 25 per cent of children under 5-years of age that suffer from anemia.
It is estimated that 125,967 children under 5-years of age (35 per cent) are at risk of not meeting their full developmental potential due to poverty, poor nutrition, lack of access to basic services, and high levels of family and environmental stress and exposure to violence. This situation is often further compounded by inadequate care and learning opportunities.
Women remain highly vulnerability to maternal mortality:
Some 25 per cent of pregnant woman in the State of Palestine are at risk of death during childbirth. In Gaza, 14,000 women per year are at high risk, with 23 per cent of births delivered preterm and approximately 10,000 neonates1 requiring transfers to neonatal intensive care units for immediate health care and early intervention annually. Approximately 25 per cent of pregnant women also suffer from anemia.
Poverty: The most recent household survey (2017) found that 29.2 per cent of the population in the State of Palestine live in poverty (14 per cent in the West Bank and 53 per cent in the Gaza Strip), and some 16.8 per cent live in ‘deep poverty’ (5.8 per cent in the West Bank and 33.8 per cent in the Gaza Strip).2,3
The impact of poverty is particularly acute for women and children. High unemployment, the high cost of living, and low household incomes contribute to food insecurity, with 1.6 million Palestinians in need of food assistance at the end of 2015.
Access to health: Health care services are often overstretched due to the limited number of health care facilities, which in turn promotes the early discharge of mothers and their babies following birth (often within 2-3 hours). This reduces opportunities for the detection of potential medical complications and the provision of lifesaving interventions.
Health care quality: The quality of maternal health care is further compromised by the increasing rate of cesarean delivery (from 17 per cent in 2010 to 23 per cent in 2015), and under-regulated In Vitro Fertilization (IVF) that potentially places maternal and infant wellbeing at risk. Other challenges include a lack of o targeted post-natal homecare interventions for high risk pregnant and lactating mothers, few early detection interventions for children at risk of developmental delays and disabilities, and sub-standard intervention services for children with disabilities.
Nutrition: Approximately 39 per cent of children are exclusively breastfed in the first six months of life. The lack of growth in exclusive breastfeeding over the past years is due to, among other reasons, aggressive marketing of breast milk substitutes and a lack of clarity regarding optimal infant feeding practices. Only 42 per cent of children were receiving a minimum diversity diet.4 The relatively high levels of bottle-fed children is also a concern, particularly for children in Gaza who are exposed to contaminated and unsafe drinking water.
Harmful social norms and behaviors: Child and early marriage are also associated with increased risks of complications to the mother and unborn child. This is of particular concern in Gaza, where the adolescent birth rate for people aged 15-19 years is 66 per 1,000 live births, compared to 35 per 1,000 in the West Bank.5 Close birth spacing and large numbers of births – which are common - are also associated with increased risks6 Children born from consanguinity marriages are at higher risk of congenital and genetic disorders.7 According to the MICS 2010, 3 in 10 marriages of ever-married women (15-29 years) had a first consanguinity linkage to their husbands.8
Crisis upon crisis: the humanitarian context
Since 30 March 2018, the Gaza Strip has witnessed a significant increase in Palestinian casualties following mass demonstrations at the Israel/Gaza fence. Access to health care services for children and mothers has also further deteriorated, and the movement of people and medical supplies in and out of Gaza has been further restricted.
The inconsistent supply of medical items has negatively affected the quality of health care. Gaza’s Central Drug Store noted in July 2018 that 253 essential medicines out of a total of 815 essential medicines list (50 per cent) were at less than one month’s supply.
- MoH, Annual Report of Hospitals. According to the MOH report in 2015, 25% of pregnant women are classified as high risk, therefore through a twelve - month period, 80,000 pregnant of which, 25% are high risk and 12.5% will result in neonatal cases needing special treatment.
- The poverty line by national standards for Palestine, as set by PCBS in 2011, is 2,293 NIS ($637) per month for a family of two adults and three children. ‘Deep poverty’ is a monthly income of NIS 1,832 (US $509) or less per month for food, clothing, and housing.
- PCBS (2012). Living Standards in the Palestinian Territory: Expenditure, Consumption, Poverty, 2011.
- a) Minimum dietary diversity is defined as receiving foods from at least 4 of 7 food groups: 1) Grains, roots and tubers, 2) legumes and nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ meats), 5) eggs, 6) vitamin-A rich fruits and vegetables, and 7) other fruits and vegetables. b) Minimum meal frequency among currently breastfeeding children is defined as children who also received solid, semi-solid, or soft foods 2 times or more daily for children age 6-8 months and 3 times or more daily for children age 9-23 months. For non-breastfeeding children age 6-23 months it is defined as receiving solid, semi-solid or soft foods, or milk feeds, at least 4 times.
- PCBS, UNICEF and UNFPA, (2015). Palestinian Multiple Indicator Cluster Survey 2014, Palestine.
- The total fertility rate in the West Bank is 3.7 births per woman and 4.1 births per woman in the Gaza Strip. Source: PCBS, UNICEF and UNFPA, (2015). Palestinian Multiple Indicator Cluster Survey 2014, Palestine.
- Hamamy, H. Consanguineous marriages: Preconception consultation in primary health care settings, J Community Genet. 2012 Jul; 3(3): 185–192, published online 2011 Nov doi:1 , http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3419292/
- PCBS, (2014). The Eve of International Youth Day. [Online]. Available at: 12/8/2014http://www.pcbs.gov.ps/site/512/default.aspx?tabID=512&lang=en&ItemID=1184&mid=3172&wversion=Staging. [Accessed on 20th September2016]
Solution
UNICEF supports the government to improve the coordination and harmonization of health care providers and mechanisms for referral to other relevant services when necessary, including education, child protection and social protection.
Humanitarian response: Support for lifesaving health care interventions is provided to mothers and children through the procurement of essential drugs, medical equipment and consumables. Support is also provided to high-risk families with young children, through targeted outreach health services.
Raising awareness of health issues within communities: UNICEF supports community awareness interventions and programmes, with a focus on promoting families to seek information and relevant health-care when necessary, and to stimulate demand for early childhood development and intervention services. This work targets caregivers, including community leaders and adolescents, to tackle social and gender norms, including consanguinity and early marriage, by raising awareness of the risks and linking to relevant support services such as parent counselling
Resources
