ReliefWeb

Highlights

• On 22 March, the Palestinian Authority imposed a curfew in the West Bank for 14 days, obliging people to stay at home, except for the purchase of food and medicine, or in case of emergency.

• First two COVID-19 cases detected in Gaza; 1,400 people held in 21 quarantine centers across the Strip in precarious conditions.

• The COVID-19 Inter-agency Response Plan for the coming three months, is less than 23 per cent funded.

Situation Overview

On 5 March 2020, the Palestinian Prime Minister declared a State of Emergency across the occupied Palestinian territory (oPt) in order to contain the spread of COVID-19, after the first cases were confirmed in Bethlehem city. This followed a World Health Organization (WHO) announcement on 30 January of a “public health emergency of international concern”, which was upgraded on 11 March to a “global pandemic”.

As of 23 March, a total of 59 cases have been detected in the oPt, 57 in the West Bank and two in the Gaza Strip. Of the West Bank cases, some 70 per cent are in Bethlehem’s urban area, and nearly 20 percent in the Ramallah governorate (figures exclude confirmed cases in Israeli settlements, which are dealt with by Israel). According to the Palestinian Ministry of Health (MoH), all cases are either asymptomatic or show mild symptoms, and 17 cases have recovered.

West Bank

Incoming travelers from Jordan, as well as people who were exposed to confirmed cases, were initially sent to home quarantine for 14 days, and, from 22 March, to isolation in medical centers in their areas of residence. The number of quarantined people is currently estimated at over 9,900. Confirmed cases of COVID-19 are being referred to two health facilities, in Jericho (the Military Academy) and Turmusayya village in Ramallah (the Hugo Chavez Hospital).

The Palestinian Authority (PA) has been gradually scaling up access restrictions and social isolation measures across the West Bank, including a suspension of all educational activities, a prohibition on public gatherings, a closure of the Bethlehem urban area, and a halt in Palestinian employment in Israeli settlements (the latter measure has been largely unenforced). These measures escalated on 22 March, when the PA announced a comprehensive curfew for 14 days, which obliges people to stay at home, except for the purchase of food and medicine, or in case of emergencies. Public services will be further reduced. As part of the COVID-19 response, the MoH, with UNICEF, WHO and the private sector, activated its risk communication plan, which aims at disseminating public health awareness messages and addressing uncertainty and misinformation.

The Israeli authorities have progressively limited the number of Palestinian workers allowed into Israel. On 22 March, both authorities agreed that Palestinians who intend to keep working in Israel, will be provided with accommodation by their employers and must stay in Israel for at least one month. The Israeli authorities also prohibited the entry of East Jerusalem Palestinians, as well as all residents of Israel, into areas A and B of the West Bank. The access of patients referred to hospitals in East Jerusalem and Israel has been limited to emergency cases and cancer patients. So far, no special restrictions have been placed on East Jerusalem residents, including those who reside beyond the Barrier. The functioning of the commercial crossings with Israel continue without change.

Gaza Strip

Since 15 March, all incoming travelers from Egypt and Israel have been sent to isolation for 14 days to one of 21 compulsory quarantine facilities set up in health facilities or schools, with some 1,400 people currently accommodated there. Additionally, over 2,000 people who entered Gaza prior to 15 March are currently in home quarantine. A field hospital has been established in Rafah to isolate and treat confirmed cases of COVID-19, with the first two cases detected in Gaza on 21 March.

As in the West Bank, all educational institutions have been closed since 6 March. However, other aspects of daily life, including commerce and services, had been less restricted until 22 March, when the de-facto authorities ordered a closure of wedding halls, weekly markets, restaurants and cafes; restrictions were imposed on the holding of public events and Friday prayers.

The Israeli-controlled Erez crossing has been largely shut down since 12 March for most permit holders, including over 5,000 laborers and traders with permits. The exit of patients referred to hospitals in East Jerusalem and Israel has been limited to emergency cases and cancer patients. The functioning of the Kerem Shalom commercial crossing with Israel and the Rafah crossing with Egypt continues without change.

The exit of people from Gaza to Egypt via the Rafah crossing has been halted by the Egyptian authorities as of 15 March; since 23 March, entry of people to Gaza has been suspended. Import of goods via this crossing continues.

Main concerns and priority needs Although the current number of detected cases remains relatively low, the capacity of the Palestinian health system to cope with an expected increase in COVID-19 cases is severely impaired by longstanding challenges and critical shortages. The situation is particularly severe in the Gaza Strip, where the health system has been undermined by the longstanding Israeli blockade, the internal Palestinian divide, a chronic power deficit and shortages in specialized staff, drugs and equipment.

As elsewhere, the most vulnerable groups, who may require intensive medical, are the elderly and those suffering from hypertension, lung conditions, kidney failure, cardiovascular diseases and diabetes. People living in overcrowded conditions, particularly in refugee camps and densely-populated, poor areas of Gaza and the West Bank, face a higher risk of contagion due to the precarious sanitation systems, including substandard and irregular water supply and shared latrines (more under Shelter Cluster section).

The most urgent items currently in short supply and which are needed to contain the spread of the epidemic and reduce potential mortality among vulnerable groups include: personal protective equipment (PPE) kits and other essential supplies for infection prevention and control; equipment, disposables and drugs for the treatment of respiratory distress; ventilators, cardio-monitors, emergency carts and portable X-Ray machines; and equipment to conduct COVID-19 tests. Hospitals across the oPt have shortages of specialized staff in intensive care units and the laboratory infrastructure urgently requires upgrade to conform with strict biosafety standards, while laboratory staff in Gaza suffer from significant gaps in training and specialized skills. In addition, new stringent national and international travel restrictions pose problems in adequately deploying emergency staff (more under Health Cluster section).

The closure of schools, limitations on access to work places, and the imposition of quarantine and curfew, particularly in overcrowded households, alongside general uncertainty, are expected to increase mental and psychosocial distress, particularly among children, as well gender-based violence. These concerns are particularly magnified in the Gaza context, given the impact of the blockade, three major escalation of hostilities and, most recently, the effect of the high casualty toll from the “Great March of Return”. At the same time, the provision of social services has been severely curtailed due to the access and other restrictions imposed. The implementation of alternative modalities for the delivery of Mental Health and Psychosocial Support Services (MHPSS) to cover the increasing caseload is urgently needed (more under Protection and Education Cluster sections).

The economic impact of the crisis has so far been limited mainly to the workers who have lost their income from jobs in Israel, as well as some businesses in the West Bank, particularly in Bethlehem city, which were forced to shut down. However, in the West Bank, in particular, the volume of people affected by the loss of income is expected to increase soon, following the tightening of restrictions and its impact on all sectors of economic activity (including services, manufacturing, construction and transportation).

In Gaza, the initial macro-economic impact of COVID-19 has been limited. However, the impact of long-term disruptions in Gaza raises serious concerns, given the already-dire economic situation there, with unemployment at almost 43 per cent in the last quarter of 2019, youth unemployment at 64 per cent, and some 53 per cent of the population living below the US$4.6 poverty line (more under Food Security Sector section).

Inter-agency response plan and humanitarian operations

Under the direction of the UN Resident and Humanitarian Coordinator (HC/RC), UN agencies and NGOs have developed and begun implementing a range of interventions to support the Palestinian authorities’ efforts.

At the heart of these interventions is the Health Cluster COVID-19 Interagency Response Plan. The Plan details initial priority actions, critical over the next three months, to address immediate shortages and capacity gaps in the health system, while enhancing preparedness efforts by the MoH for a worst-case scenario. This initial plan aims to stop further transmission of the virus; to provide adequate care for affected patients and support to their families; and to mitigate the impact of the epidemic (including through MHPSS). The Plan also includes a communications component, involving the dissemination of health advice, to mobilize the community and combat rumors and misinformation (For more about specific activities see Health and Protection Cluster sections below).

The plan in its current form seeks to mobilize for US$ 6.5 million to support these efforts. The funding requirement across sectors is likely to increase significantly due to the scale of the pandemic and the progressive expansion of the response to critical elements of different sectors.

Of the total appeal, less than $1.5 million has been raised so far, including $1 million allocated from the oPt Humanitarian Fund, $120,000 by WHO corporate funds and $367,000 reallocated from UNICEF’s budget (see also Funding matrix at the bottom of the report).

Activities covered by the plan are supplemented by additional interventions addressing other aspects of the crisis and carried out by partners in the areas of food security, shelter and non-food items, protection, education and water, sanitation and hygiene (WASH) (more in the Cluster response sections).

Additionally, UNRWA has launched a separate Flash Appeal, seeking $14 million to cover COVID-19 related interventions across its five areas of operation (Lebanon, Jordan, Syria, Gaza and West Bank), also for the coming 90 days. Proposed activities include preparedness and response measures at UNRWA health and education facilities, and coverage of health expenditures for vulnerable populations.

Humanitarian partners are making efforts to maintain critical components of regular programmes and health partners continue to scale up responses. In addition, food distribution, protection, WASH and responses to both demolition and settler violence incidents continue. Due to tightened access restrictions, humanitarian partners have had to prioritized urgent humanitarian interventions only.

Following the initial release of the Health Cluster plan, partners are working across the board to identify broader support requirements in the coming 90 days, which should be launched in the coming day, while the Palestinian authorities develop their own integrated plan for response.

Coordination

Since the start of the crisis, the Palestinian and Israel authorities have maintained a close, unprecedented cooperation on efforts aimed at containing the epidemic. Representatives from both ministries of health, as well as from Israel’s Coordinator for Government Activities in the Territories (COGAT) have been meeting on a regular basis to agree on matters of mutual concern, such the understandings concerning Palestinian workers employed in Israel. As part of this efforts, COGAT is facilitating four trainings for Palestinian medical teams, while the Israeli MoH donated over 1,000 testing kits and thousands of PPEs to the West Bank and Gaza. Despite longstanding tensions and disputes, there has been also continuous cooperation and coordination between the Ramallah-based Palestinian Authority and the Gaza-based Hamas authorities, around efforts to address the current crisis.

Under the auspices of the HC/RC, an inter-agency Covid-19 Task Force has been established which meets several times a week, to set policies and coordinate the response. The HC/RC is also convening a weekly general coordination meeting with a wider group of partners and an information meeting with donors.

The HC/RC and OCHA are also engaging on a regular basis with relevant Palestinian authorities, including the Prime Minister’s Office and Palestinian Civil Defense; and with Israeli authorities, including the COGAT and the National Emergency Management Agency (NEMA).

The Inter-Cluster Coordination Groups (ICCG), in both the West Bank and Gaza, are responsible for coordinating the implementation of the Task Team decisions and monitoring the impact of movement restrictions on regular humanitarian programming.

The HC/RC also informs the Palestinian authorities about essential movements required by humanitarian and development staff during this period of enhanced movement restrictions. Where necessary, coordination with the Israeli authorities is also conducted for safe movement in the West Bank. A Standard Operations Procedures (SOP) has been developed to guide agencies in identifying and submitting requests for essential staff movements.