TY - JOUR T1 - Structural violence in the era of a new pandemic: the case of the Gaza Strip JF - The Lancet Y1 - 2020 A1 - David Mills A1 - Bram Wispelwey A1 - Rania Muhareb A1 - Mads Gilbert UR - https://www.sciencedirect.com/science/article/pii/S0140673620307303 ER - TY - RPRT T1 - Triple Captivity: Palestinian Women under Israeli Military Rule in the Time of COVID-19 Y1 - 2020 A1 - Hiba Asfour A1 - Aisha Hoshiya A1 - Amani Masalmeh A1 - Rasha Ghanayem A1 - Muna Nadi A1 - Laila Othma A1 - Sameera Ryahe A1 - Yasmeen Wahdan A1 - Shatha Wahsh A1 - Ala'a Yamani A1 - Rita Giacaman A1 - Rula Ghandour PB - Institute of Community and Public Health CY - Birzeit, Occupied Palestinian Terretories ER - TY - JOUR T1 - The dilemmas of the European Union’s open access to data policy JF - The Lancet Y1 - 2017 A1 - Blandine Destremau A1 - Rita Giacaman A1 - Mona Harb A1 - Linda Herrera A1 - Maria Mexi A1 - Suzan Mitwalli A1 - Emma C Murphy A1 - Yoke Rabaia A1 - Lynn Welchman A1 - Elena Zambelli VL - 390 ER - TY - JOUR T1 - Reproductive health and rights in East Jerusalem: the effects of militarisation and biopolitics on the experiences of pregnancy and birth of Palestinians living in the Kufr ‘Aqab neighbourhood JF - Reproductive Health Matters Y1 - 2017 A1 - Layaly Hamayel A1 - Doaa Hammoudeh A1 - Lynn Welchman VL - 25 SN - 0968-8080 (Print) 1460-9576 UR - http://www.tandfonline.com/doi/full/10.1080/09688080.2017.1378065 IS - 1 ER - TY - JOUR T1 - Beyond the Physicality of Space: East Jerusalem, Kufr ‘Aqab, and the Politics of Everyday Suffering JF - Jerusalem Quarterly Y1 - 2016 A1 - Doaa Hammoudeh A1 - Layaly Hamayel A1 - Lynn Welchman IS - 65 ER - TY - JOUR T1 - Availability and aff ordability of cardiovascular disease medicines and their eff ect on use in high-income, middle-income, and low-income countries: an analysis of the PURE study data JF - The Lancet Y1 - 2015 A1 - Rasha Khatib A1 - Martin McKee A1 - Harry Shannon A1 - Clara Chow A1 - Sumathy Rangarajan A1 - Koon Teo A1 - Li Wei A1 - Prem Mony A1 - Viswanathan Mohan A1 - Rajeev Gupta A1 - Rajesh Kumar A1 - Krishnapillai Vijayakumar A1 - Scott A Lear A1 - Rafael Diaz A1 - Alvaro Avezum A1 - Patricio Lopez-Jaramillo A1 - Fernando Lanas A1 - Khalid Yusoff A1 - Noorhassim Ismail A1 - Khawar Kazmi A1 - Omar Rahman A1 - Annika Rosengren A1 - Nahed Monsef A1 - Roya Kelishadi A1 - Annamarie Kruger A1 - Thandi Puoane A1 - Andrzej Szuba A1 - Jephat Chifamba A1 - Ahmet Temizhan A1 - Gilles Dagenais A1 - Amiram Gafni A1 - Salim Yusuf AB -
Background: WHO has targeted that medicines to prevent recurrent cardiovascular disease be available in 80% of communities and used by 50% of eligible individuals by 2025. We have previously reported that use of these medicines is very low, but now aim to assess how such low use relates to their lack of availability or poor affordability.
Methods: We analysed information about availability and costs of cardiovascular disease medicines (aspirin, β blockers, angiotensin-converting enzyme inhibitors, and statins) in pharmacies gathered from 596 communities in 18 countries participating in the Prospective Urban Rural Epidemiology (PURE) study. Medicines were considered available if present at the pharmacy when surveyed, and affordable if their combined cost was less than 20% of household capacity-to-pay. We compared results from high-income, upper middle-income, lower middle-income, and low-income countries. Data from India were presented separately given its large, generic pharmaceutical industry.
Findings: Communities were recruited between Jan 1, 2003, and Dec 31, 2013. All four cardiovascular disease medicines were available in 61 (95%) of 64 urban and 27 (90%) of 30 rural communities in high-income countries, 53 (80%) of 66 urban and 43 (73%) of 59 rural communities in upper middle-income countries, 69 (62%) of 111 urban and 42 (37%) of 114 rural communities in lower middle-income countries, eight (25%) of 32 urban and one (3%) of 30 rural communities in low-income countries (excluding India), and 34 (89%) of 38 urban and 42 (81%) of 52 rural communities in India. The four cardiovascular disease medicines were potentially unaffordable for 0·14% of households in high-income countries (14 of 9934 households), 25% of upper middle-income countries (6299 of 24 776), 33% of lower middle-income countries (13 253 of 40 023), 60% of low-income countries (excluding India; 1976 of 3312), and 59% households in India (9939 of 16 874). In low-income and middle-income countries, patients with previous cardiovascular disease were less likely to use all four medicines if fewer than four were available (odds ratio [OR] 0·16, 95% CI 0·04–0·57). In communities in which all four medicines were available, patients were less likely to use medicines if the household potentially could not afford them (0·16, 0·04–0·55).
Interpretation: Secondary prevention medicines are unavailable and unaffordable for a large proportion of communities and households in upper middle-income, lower middle-income, and low-income countries, which have very low use of these medicines. Improvements to the availability and affordability of key medicines is likely to enhance their use and help towards achieving WHO's targets of 50% use of key medicines by 2025.
Funding: Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, GlaxoSmithKline, Novartis, King Pharma, and national or local organisations in participating countries.ER - TY - JOUR T1 - A cross sectional study of maternal ‘near-miss’ cases in major public hospitals in Egypt, Lebanon, Palestine and Syria JF - Pregnancy and Childbirth Y1 - 2015 A1 - Hyam Bashour A1 - Ghada Saad-Haddad A1 - Jocelyn DeJong A1 - Mohammed Cherine Ramadan A1 - Sahar Hassan A1 - Miral Breebaart A1 - Laura Wick A1 - Nevine Hassanein A1 - Mayada Kharouf AB -
VL - 15 UR - http://www.biomedcentral.com/content/pdf/s12884-015-0733-7.pdf IS - 296 ER - TY - JOUR T1 - A glance into the hidden burden of maternal morbidity and patterns of management in a Palestinian governmental referral hospital JF - Women and Birth Y1 - 2015 A1 - Sahar J. Hassan A1 - Laura Wick A1 - Jocelyn DeJong IS - 463 ER - TY - JOUR T1 - Palestinian health research JF - The Lancet Y1 - 2014 A1 - Graham Watt A1 - Rita Giacaman A1 - Huda Zurayk VL - 383 U1 -
Child health issues are of high importance in the occupied Palestinian territories, where half of the population are children. The Royal College of Paediatrics and Child Health have developed a comprehensive paediatric training programme for primary healthcare providers with the aim of improving child health in the area. The course has taken 8 years to develop with the pilot running in 2005-2007 and is now being extended to other centres in the region. In this article, we describe the process through which this course has developed, some of the difficulties faced and the final teaching programme as it has evolved. A number of lessons have been learnt, over the years, which are of potential value to others designing similar teaching programmes. Its greatest strength lies in the partnership developed with local paediatricians, which encourages us to believe that sustainability has been achieved. Evaluation confirms that the course is meeting the needs of local doctors and nurses and improving their paediatric skills. Although developed specifically for the occupied Palestinian territory, our experience offers a process and design for a teaching programme that could be adapted for use in other countries around the world.VL - 32 SN - 1466-187X (Electronic)
This study investigated the rising rate of caesarean section (CS) deliveries between 1993 and 2002 (9.4% to 14.4%) and associated factors, including indications for CS and sociodemographic and clinical characteristics based on the register of a major Palestinian teaching hospital. Instrumental deliveries declined from 12.6% to 4.4%. Fetal distress decreased as an indication for CS, while previous CS and breech presentations contributed to the increase. Decision-making for CS needs to frame the benefits and risks of the intervention within the context of women's entire reproductive life-cycle and existing standards of care, avoiding unnecessary and costly CS deliveries to reduce iatrogenic complications and conserve resources.VL - 15 SN - 1020-3397 (Print)
OBJECTIVE: Against the backdrop of a rise in cesarean section deliveries from 6.0% in 1996 to 14.8% in 2006, the objective of this study was to investigate socio-demographic, clinical and service-related factors associated with cesarean sections in the occupied Palestinian territory. METHODS: Data from the Palestinian Family Health Survey 2006 were used to examine last births in the 5 years preceding the survey to women aged 15-49 years. Bivariate and multivariate associations between type of delivery (dependent variable) and selected factors were analyzed using logistic regression. Selected maternal outcomes were also investigated with type of delivery as the independent variable. RESULTS: Cesarean section deliveries were significantly associated with maternal age (35+ years), primiparity, low birth weight and residence area in the West Bank and Gaza. There was no significant difference in the prevalence of cesarean deliveries by sector in the West Bank, but in Gaza, they were significantly more common in the governmental sector. CONCLUSIONS: There is a need for detailed audits of cesarean section deliveries, nationally and at the facility level, in order to avoid unnecessary interventions in the context of high fertility, rising poverty and fragmented health services. Variations by governorate should be studied further for focused interventions.VL - 93 SN - 1872-6054 (Electronic)
OBJECTIVES: The postpartum period is a very important period for the health of the mother and the newborn. Despite its importance, research on this period is limited and tends to be more focused on biomedical aspects of the postpartum period. In the Occupied Palestinian Territory, little is known regarding women's postpartum wellbeing. This study utilizes the Maternal Postpartum Quality-of-Life instrument to assess Palestinian women's postpartum quality of life and the factors associated with variations in their quality-of-life scores. METHODS: A cross-sectional survey utilizing the adapted Maternal Postpartum Quality-of-Life Questionnaire was completed in the Occupied Palestinian Territory with a final sample size of 1020 women. RESULTS: The mean overall quality-of-life score for the sample was 21.53 (maximum = 30), suggesting that women are slightly satisfied with their lives in the postpartum period. Main variations in quality-of-life scores were associated with regional district, refugee status, the loss of a relative due to Israeli occupation violence, standard of living and pregnancy wantedness. CONCLUSION: The results of this study highlight the diversity and complexity of the social context, in particular the region where women live, and the issue of pregnancy wantedness in postpartum quality of life. They also call into question the services currently offered to postpartum women.VL - 9 SN - 1744-8379 (Electronic)
The Countdown to 2015 intervention coverage indicators in the occupied Palestinian territory are similar to those of other Arab countries, although there are gaps in continuity and quality of services across the continuum of the perinatal period. Since the mid 1990s, however, access to maternity facilities has become increasingly unpredictable. Mortality rates for infants (ageVL - 373 SN - 1474-547X (Electronic)
This article explores the intersection between the professional politics of medicine and national politics during the second Palestinian uprising, which erupted in 2000. Through an analysis of stories about childbirth from actors in the birth process--obstetricians, midwives and birth mothers--it examines two overlapping movements that contributed to building the public health infrastructure, the movement of sumud or steadfastness (1967-87) and the popular health movement (1978-94), as well as their contemporary afterlife. Finally, it deals with relations between medicine and governance through an analysis of the interpenetration of medical and political authority. The birth stories bring to light two contrasting visions of a nation in the context of restrictions on mobility and a ground chopped up by checkpoints. The quasi-postcolonial condition of Palestine as popular construct, institutional protostate organism, and the lived experience of its experts and of its gendered subjects underlie the ethnographic accounts.VL - 32 SN - 0165-005X (Print)
OBJECTIVES: The Palestinian DHS2004 reports on pregnancy intentions and their determinants are analyzed for the first time. Through this analysis, the survey instrument limitations are also highlighted. METHODS: Data on 15-49 years old ever married, non-pregnant women reporting on their last pregnancy were selected from a nationally representative cross sectional survey dataset. RESULTS: Older women were more likely not to desire the pregnancy at all, and younger women more likely to have desired to wait; with higher reports of not desiring the pregnancy at all or desiring to wait among those with a higher number of children; with higher reports of not desiring the pregnancy at all, or desiring to wait, among women who reported ever using family planning methods. Women who experienced prenatal and postnatal complications reported higher levels of having desired to wait or not having wanted the pregnancy at all, calling for the inclusion of process measures in pregnancy intention studies. CONCLUSIONS: While some of our findings are comparable to those cited in the international literature, the analysis was limited to the type of questions asked in the Palestinian DHS survey. There is a need to further develop the survey instrument in order to address women's needs from a public health policy perspective. We call for the inclusion of additional social measures to identify some of the contextual factors that influence pregnancy intentions.VL - 85 SN - 0168-8510 (Print)
The purpose of this study was to assess the quality of maternity care in a large, public, Palestinian referral hospital, as a first step in developing interventions to improve safety and quality of maternity care. Provider interviews, observation and interviews with women were used to understand the barriers to improved care and prepare providers to be receptive to change. Some of the inappropriate practices identified were forbidding female labour companions, routine use of oxytocin to accelerate labour, restriction of mobility during labour and frequent vaginal examinations. Magnesium sulfate was not used for pre-eclampsia or eclampsia, and post-partum haemorrhage was a frequent occurrence. Severe understaffing of midwives, insufficient supervision and lack of skills led to inadequate care. Use of evidence-based practices which promote normal labour is critical in settings where resources are scarce and women have large families. The report of this assessment and dissemination meetings with providers, hospital managers, policymakers and donors were a reality check for all involved, and an intervention plan to improve quality of care was approved. In spite of the ongoing climate of crisis and whatever else may be going on, women continue to give birth and to want kindness and good care for themselves and their newborns. This is perhaps where the opportunity for change should begin.VL - 15 SN - 0968-8080 (Print)
BACKGROUND: Analysing the Palestinian Central Bureau of Statistics (PCBS) Demographic and Health Survey 2004 (DHS-2004) data, this article focuses on the question of where women living in the Occupied Palestinian Territory give birth, and whether it was the preferred/place of choice for delivery. We further identify some of the determinants of women's dissatisfaction with childbirth location. METHODS: A total of 2158 women residing in the West Bank and Gaza Strip were included in this study. Regression analysis established the association between dissatisfaction with the place of birth and selected determinants. RESULTS: A total of 3.5% of women delivered at home, with the rest in assisted facilities. Overall, 20.5% of women reported that their childbirth location was not the preferred place of delivery. Women who delivered at home; in governmental facilities; in regions other than the central West Bank; who had sudden delivery or did not reach their preferred childbirth location because of closures and siege; because of costs/the availability of insurance; or because there were no other locations available, were significantly more likely to be dissatisfied with their childbirth location compared to those who birthed in private facilities, the central West Bank, and in locations with better and more available services. CONCLUSION: The findings demonstrate that Palestinian women's choice of a place of birth is constrained and modified by the availability, affordability, and limited access to services induced by continuing closures and siege. These findings need to be taken into consideration when planning for maternity services in the Occupied Palestinian Territory.VL - 17 SN - 1101-1262 (Print)
This randomised controlled trial of routine amniotomy was carried out in a developing country setting to investigate the effect of this common procedure on the duration of labour, intra-partum interventions and selected newborn and maternal outcomes. In a Jerusalem teaching hospital, 533 multiparous and 157 nulliparous low-risk women were randomised to either amniotomy or intent to conserve membranes. For multiparae, the median duration from randomisation to full dilatation was 95 and 160 min, respectively in the intervention and control arms (p < 0.001); for nulliparae it was 210 and 270 min, respectively (p < 0.001). In both groups, oxytocin was used less in the intervention arms (p < 0.001), and no difference in mode of delivery and immediate outcomes was detected. However, given the risks of this intervention and these study findings indicating an overall short duration of childbirth, amniotomy should be limited to cases of abnormal progress of labour.VL - 27 SN - 0144-3615 (Print)
OBJECTIVE: This study describes staffing, caseloads and reported routine practices for normal childbirth in Palestinian West Bank (WB) governmental maternity facilities and compares these practices with evidence-based care. METHODS: Data on routine childbirth practices in all eight governmental hospitals were obtained through interviews with head obstetricians and midwives. Data on staffing and monthly number of births were collected by phone or personal interview from all 37 WB hospitals. RESULTS: Forty-eight percent of WB deliveries took place in crowded and understaffed governmental hospitals. Reported practices were not consistently in line with evidence-based care. Lack of knowledge and structural barriers were reasons for this gap. CONCLUSION: The implications of limiting unnecessary interventions in the normal birth process are particularly important in a context of limited access and scarce resources. More skilled birth attendants and a universal commitment to effective care are needed.VL - 89 SN - 0020-7292 (Print)
The impact of warlike conditions on the lives of Palestinian women and children is far reaching. Beginning in September 2000, curfews, closures, siege and the parceling up of the country into small isolated entities have all led to a lack of access to basic maternity services, rendering pregnant women and their newborns a highly vulnerable group. Because any discussion of childbirth in the Occupied Palestinian Territories (OPT) cannot be separated from the larger historical context of international health politics, we begin with a brief review of international historical trends in childbirth policies, focusing on the relationship between discourse in the developed and developing world contexts to show how these models have intersected and diverged. We point to the similarities between the OPT and other developing countries, but also highlight the specificities that characterize the Palestinian experience today that include local political systems, medical dominance, professional group interests and the politics of gender, as well as the legacy of colonialism intertwined with an ongoing national conflict. We then provide a review of the history of childbirth in the OPT and analyze the various forces that led to the emergence of today's chaotic and contradictory de facto policies and practices. By assessing the health policy environment, we demonstrate the seeming impossibility of developing national level childbirth policies, given the current political conditions and a mix of other determinants that are not all within Palestinian control. Finally, we emphasize the importance of establishing a process as opposed to a blueprint of health policy-making based on people's immediate and long-term needs in all areas of the country. We also propose interim measures that rest on the notion of developing decentralized sub-strategies relevant to different zones of political reality and stages of system and human resource development, aiming at combining survival imperatives with those of improving women's birth experiences and women's health.VL - 72 SN - 0168-8510 (Print)
To document facility-based practices for normal labour and delivery in Egypt, Lebanon, the West Bank (part of the Occupied Palestinian Territory) and Syria and to categorise common findings according to evidence-based obstetrics.
Three studies (Lebanon, West Bank and Syria) interviewed a key informant (providers) in maternity facilities. The study in Egypt directly observed individual labouring women.
Nationally representative sample of hospitals drawn in Lebanon and Syria. In the West Bank, a convenience sample of hospitals was used. In Egypt, the largest teaching hospital's maternity ward was observed.
Shared practices were categorised by adapting the World Health Organization's (WHO) 2004 classification of practices for normal birth into the following: practices known to be beneficial, practices likely to be beneficial, practices unlikely to be beneficial and practices likely to be ineffective or harmful.
MAIN OUTCOME MEASURES:
Routine hospital practices for normal labor and delivery.
There was infrequent use of beneficial practices that should be encouraged and an unexpectedly high level of harmful practices that should be eliminated. Some beneficial practices were applied inappropriately and practices of unproven benefit were also documented. Some documented childbirth practices are potentially harmful to mothers and their babies.
Facility practices for normal labour were largely not in accordance with the WHO evidence-based classification of practices for normal birth. The findings are worrying given the increasing proportion of facility-based births in the region and the improved but relatively high maternal and neonatal mortality ratios in these countries. Obstacles to following evidence-based protocols for normal labour require examination.PB - Blackwell Science Ltd VL - 112 IS - 9 ER - TY - JOUR T1 - Seasonal variation of bacteriological and chemical quality of drinking water: a case study in a Palestinian district JF - Water and Environment Journal Y1 - 2005 A1 - Al-Khatlb,I A. A1 - Daoud,F. A1 - Rasmawl, F. A1 - S Wa'rra A1 - Kassabry, M. VL - 19 ER - TY - JOUR T1 - Health sector reform in the Occupied Palestinian Territories (OPT): targeting the forest or the trees? JF - Health Policy Plan Y1 - 2003 A1 - Giacaman, R. A1 - Abdul-Rahim, H. F. A1 - Wick, L. KW - *International Agencies KW - *Politics KW - administration KW - Arabs KW - Colonialism KW - Financing, Organized KW - Health Care Reform/economics/*history KW - Health Care Sector/*history/legislation & jurisprudence/organization & KW - History, 20th Century KW - History, 21st Century KW - Humans KW - Israel KW - Private Sector KW - Public Sector KW - United Nations KW - War AB -
Since the signing of the Oslo Peace Accords and the establishment of the Palestinian Authority in 1994, reform activities have targeted various spheres, including the health sector. Several international aid and UN organizations have been involved, as well as local and international non-governmental organizations, with considerable financial and technical investments. Although important achievements have been made, it is not evident that the quality of care has improved or that the most pressing health needs have been addressed, even before the second Palestinian Uprising that began in September 2000. The crisis of the Israeli re-invasion of Palestinian-controlled towns and villages since April 2002 and the attendant collapse of state structures and services have raised the problems to critical levels. This paper attempts to analyze some of the obstacles that have faced reform efforts. In our assessment, those include: ongoing conflict, frail Palestinian quasi-state structures and institutions, multiple and at times inappropriate donor policies and practices in the health sector, and a policy vacuum characterized by the absence of internal Palestinian debate on the type and direction of reform the country needs to take. In the face of all these considerations, it is important that reform efforts be flexible and consider realistically the political and economic contexts of the health system, rather than focus on mere narrow technical, managerial and financial solutions imported from the outside.VL - 18 SN - 0268-1080 (Print)