Stalled decline in infant mortality among Palestine refugees in the Gaza Strip since 2006

Abstract

BackgroundThe United Nations Relief and Works Agency for Palestine refugees in the Near East (UNRWA) has periodically estimated infant mortality rates (IMR) among Palestine refugees in the Gaza Strip (Gaza). These surveys have recorded a decline from 127 per 1000 live births in 1960 to 20.2 in 2006. Thereafter, a survey revealed an IMR of 22.4 in 2011. Alerted by these findings, a follow up survey was conducted in 2015 to further assess the trend of IMR.MethodsWe used the same preceding-birth technique as in previous surveys to estimate IMR and neonatal mortality rate (NMR) per 1000 live births. All multiparous mothers who came to the 22 UNRWA health centers to register their last-born child for immunization were asked if their preceding child was alive or dead. We based our target sample size on the previous IMR of 22.4 and we interviewed 3126 mothers from September to November 2015.FindingsThe third survey estimated mortality rates in 2013. The IMR was 22.7 (95% CI 17.2–28.1) per 1000 live births. IMR did not decline since the estimated IMR of 20.2 (15.3–25.1) per 1000 live births in 2006 and 22.4 (16.4–28.3) per 1000 live births in 2011. NMR was 16.1 (11.6–20.7) per 1000 live births, which was not statistically significantly different from 2006 (12.1 (8.7–16.4)), and was lower than in 2011 (20.3 (15.3–26.2)).ConclusionThe estimated mortality rate in infants of Palestine refugees in Gaza has not declined since 2006. The stagnation of infant mortality rates indicates that further efforts are needed to investigate causes for this stagnation and ways of addressing the potentially preventable causes among Palestine refugee children in Gaza.

Reconstruction under siege: the Gaza Strip since 2007

“…Second, unmet basic needs in Gaza are widespread, with a poverty rate of 53 per cent in 2017 (PCBS, 2018), and high food insecurity: in excess of 80 per cent of Gazans are dependent on food aid (Lim, 2014). Welfare has declined over the course of the 12-year-long siege, as indicated by maternal mortality increasing from 20.2 deaths per 1,000 live births in 2008 to 22.4 in 2013 (van den Berg et al, 2015). A major humanitarian response has been in continuous operation for decades, and the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) in particular has enabled Gazans to survive.…”

“…A closer inspection of sector-specific reconstruction shows that no progress was made with respect to the most heavily damaged infrastructure in many sectors. For instance, while 10 of 12 hospitals were repaired, the two worst affected faced severe difficulties owing to the unavailability of materials (UNDP, 2010). Similarly, only 17.5 per cent of the total damage in the education sector was repaired within one year (see Table 1).…”

“…Similarly, only 17.5 per cent of the total damage in the education sector was repaired within one year (see Table 1). While four of eight damaged universities were fixed in full, only USD 1.82 million was invested in rebuilding the Islamic University of Gaza, which was by far the worst affected, when USD 14.98 million was needed to rebuild completely (UNDP, 2010). In both sectors, the procurement of local materials was sufficient to rehabilitate lightly damaged infrastructure but insufficient for large-scale, complex reconstruction projects requiring a much greater quantity and range of resources than were available under siege.…”

“…75.6 per cent of all affected households had carried out at least partial repairs after one year, but the majority of them had suffered minor damage; 37.2 per cent were fully repaired and 43.3 per cent were partially repaired. 26.84 per cent of households that sustained major damage were fully repaired and 74.85 per cent partially repaired (UNDP, 2010). By contrast, no totally destroyed houses were fully or even partially rebuilt by reconstruction agencies.…”

“…Emphasis on humanitarian assistance in the Consolidated Appeals Process-the key instrument of the humanitarian sector for coordination, strategic planning, and programming-incentivised civil society organisations to prioritise short-term emergency programming, further perpetuating the neglect of long-term recovery needs (Qarmout and Béland, 2012). Reconstruction was largely funded by Arab and Islamic donors that worked around the no-contact policy (UNDP, 2010).…”