Adolescent access to health services in fragile and conflict-affected contexts: The case of the Gaza Strip

Abstract

Background Enjoyment of physical and mental health is not only recognized as a human right but also as an integral part of development, as reflected in Sustainable Development Goal 3 – to ensure healthy lives and promote well-being for all at all ages. The rapid physical and psychosocial changes that take place during adolescence have a strong influence on the rest of a person’s life course, so investments in adolescent health services constitute a unique opportunity to reap inter-generational dividends. Yet the evidence base on adolescents’ access to health services, particularly in conflict-affected contexts, remains thin. This article explores adolescents’ access to health services in the Gaza Strip, and their experiences and perceptions of those services. Methods The article draws on mixed methods research in the Gaza Strip conducted in 2016 and 2017 as part of the Gender and Adolescence: Global Evidence research programme. Data were collected from 240 male and female adolescents combining in-depth interviews, focus group discussions and a tablet-based survey. This study also draws on a participatory action pilot project engaging 12 boys and 23 adolescent girls aged 15–19 years old. Results The findings underscore that gender norms—especially those pertaining to adolescent girls’ sexual purity––shape adolescent health in multiple ways. Girls face increasing restrictions on their mobility, leaving them with limited opportunities for leisure or exercise, socializing with peers or seeking health services and information. Adolescent boys in Gaza do not face the same restrictions, but given the multiple political, economic and familial stressors, they are at high risk of substance abuse including smoking and involvement in peer violence. Moreover, our findings suggest that a range of socioeconomic, cultural and structural barriers prevent adolescents in Gaza from accessing quality and appropriate health care. Study participants cited the main challenges being an absence of preventive adolescent health initiatives and limited information on sexual and reproductive health, as well as drug shortages, high treatment costs, and inappropriate interactions with service providers. Conclusions The article highlights the importance of designing and implementing conflict-sensitive and age- and gender-appropriate adolescent services and information and promoting preventive services targeted at adolescents.

How Can “Community Voices” from Qualitative Research Illuminate Our Understanding of the Implementation of the SDGs? A Scoping Review

“…Reading these papers together as a "body of literature" affords powerful insights into how communities are navigating challenges and barriers, often with few external resources but with their own "everyday ingenuities" [35]. The papers captured and shared a wide range of voices in the form of vivid quotes, from the 14-year-old girl from the Gaza Strip who described her marriage as "suffocation" [14] to the worker from Ghizou, China who wryly observed "If you don't have money don't take the bus. It's humiliating to be thrown off" [46] (p. 193).…”

“…Not surprisingly, many research participants reported difficulties in accessing health care, including financial barriers, drug shortages and lack of transport [8][9][10][11][12][13]. Six studies also cited shortages of health-care workers and unfriendly interactions with health-care providers as barriers to accessing health care [11,[14][15][16][17][18]. Masong et al [19] found that marginalised community members experienced a lack of trust in government-backed schistosomiasis treatment and prevention programmes, a further barrier to accessing health care and achieving SGD 3.8 ("access to quality essential health-care services").…”

The hypertension cascade of care in the midst of conflict: the case of the Gaza Strip

“…However, expropriation of land has created a condition of dispossession that has further compromised Palestinians’ abilities to withstand the deliberate de-development strategy pursued by Israel, through punitive economic and military policies. Israel still has overall sovereignty of Gaza, controlling its borders, economy, movement of goods and people, electricity, communications, and security—the key aspects of Palestinians’ lives [ 4 ].…”

“…Nearly 40% of total health expenditure in Gaza is out-of-pocket [ 8 ]. Despite that health insurance coverage is widespread (more than 90% of households), still it does not meet people’s needs; few medicines are covered by insurance (if available at all), and there are limited specialist services and long waiting lists [ 4 ]. While people are ordinarily able to access basic health services, access becomes challenging during renewed outbreaks of conflict, and access to advanced services outside Gaza (such as radiotherapy, advanced cardiac and neurosurgery) remains limited [ 4 ].…”

“…Despite that health insurance coverage is widespread (more than 90% of households), still it does not meet people’s needs; few medicines are covered by insurance (if available at all), and there are limited specialist services and long waiting lists [ 4 ]. While people are ordinarily able to access basic health services, access becomes challenging during renewed outbreaks of conflict, and access to advanced services outside Gaza (such as radiotherapy, advanced cardiac and neurosurgery) remains limited [ 4 ]. Despite the limited available resources, inefficiencies in the health care system are still common and resources are unnecessarily wasted due to duplication, fragmentation and ineffective coordination including weak referral systems among service providers [ 8 ].…”