9 September 2019
Babies born into Gaza amid the decade-long closure and blockade are born into a context of economic decline and a collapsing healthcare system with shortages of basic medical supplies and equipment. Whereas the rate of deaths among ‘neonates’ (babies less than four weeks old) continues to drop around the world, in Gaza it has troublingly stalled at 14 per 1,000 live births.
Medical Aid for Palestinians (MAP) has been working since 2008 to ensure that Gaza’s youngest and most vulnerable residents are provided with the best possible care and medical support in their first weeks of life, despite these challenges. Following his latest visit to Gaza, the Consultant Paediatrician and MAP trustee at the heart of this programme, Dr Ezzedin Gouta, explains MAP’s work and why it is so vital to protect Gaza’s new-borns:
My visit to Gaza in August this year (2019) is part of a long-term commitment by Medical Aid for Palestinians (MAP) to develop and support the neonatal services there. The project is coordinated by the MAP team in Gaza and I visit regularly to provide regular direct support as well as quality assurance to this work. I am a consultant in paediatrics and neonates and Foundation Training Programme Director in Barnsley in South Yorkshire, UK, and a MAP trustee.
Sadly there are many new-borns in Gaza who either suffer or die as a consequence of inadequate training of staff and/or due to lack of healthcare resources. There are many potential reasons for this, such as worsening nutritional status of mothers; increasing rates of prematurity and low birth weight babies; the limited availability of some equipment, essential drugs and consumables; significant overcrowding of the available neonatal intensive care units (NICUs); increasing difficulty/delay transferring critically ill babies between units and outside Gaza, and lack of access to training and support available to nurses and doctors looking after the new-borns.
MAP has been working to support neonatal services in Gaza since 2008, targeting the six Ministry of Health (MoH) NICUs. For the first few years the focus of our work was on building capacity in neonatal life support (NLS), but the project has developed to include neonatal safe transfer (NST; the safe and appropriate transfer of new-borns from one unit to another); the provision of life saving drugs and equipment; the development of a service and training of staff for the early detection of retinopathy of prematurity (ROP; a disease which can cause visual impairment and even blindness in premature babies); and, since 2015, a parallel project to improve infection control measures within the NICUs (through a training programme and the provision of essential infection control supplies).
These projects remain a priority to MAP, with between 4,000-5,000 of the total 57,800 new-borns in Gaza each year identified as ‘high risk’ and in need of admission to NICUs. Prematurity, birth asphyxia (a lack of oxygen and blood flow to the brain during birth), and sepsis are clearly identified as the leading causes of unacceptable high morbidity and mortality in those NICUs. We continue to complement and coordinate this work with our key partners in Gaza including the MoH, World Health Organization (WHO), United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA).
During my latest visit to Gaza we delivered Neonatal Life Support (NLS), Neonatal Safe Transfer (NST) and Neonatal In-Service Training (NIST) workshops to healthcare professionals involved in providing neonatal care.
The Neonatal In-Service Training (NIST) programme has recently been developed following a recommendation which emerged from the NLS service evaluation undertaken in 2017 and the endorsement and support from the MoH and Gaza Neonatal Network (GNN). NIST has two parts to complement each other: Firstly, we provide an outreach training which is delivered by a visiting team led by myself and working with the local hospitals, neonatal units and maternity services’ managers and staff to evaluate and develop the local system and processes required for the delivery of safe and high quality services for neonatal emergencies and resuscitation. Secondly, we are developing and starting the process for a sustainable, local neonatal life support training programme by developing local capacity and providing appropriate training equipment and necessary material. During the same visits, we also aim to review the local neonatal infection prevention and control processes and ROP prevention and screening programme.
We regularly evaluate our work to assess our achievements to date and priorities for the next phase of the projects, and share this information with current/potential donors and other stakeholders. It is clear from the evaluation and feedback that the core components of MAP’s neonatal care support programme in Gaza are hugely valued by all those involved in neonatal services including the nurses, doctors and our partners (particularly the MoH, WHO and UNICEF), and that these activities have had a significant and positive impact on neonatal morbidity and mortality.
With so many factors in Gaza leading to worsening health outcome and indicators despite the ever-increasing efforts of all stakeholders, it is hard to accurately quantify the impact of MAP’s work in this arena. Nevertheless, if MAP was to stop or reduce support at this time or in the future a significant gaping hole would be created that simply couldn’t be filled by others, and this will be reflected on the survival of the vulnerable new-borns and negatively impact the outcome of neonatal services.
Dr Ezzedin Gouta, Consultant Paediatrician, Foundation Training Programme Director, Barnsley, South Yorkshire, UK, and MAP Trustee.
Please donate today, to help MAP ensure that new-borns in Gaza receive the care and support they need and they have a better chance of survival.
