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Improving Newborn Health in Countries Exposed to Political Violence: An Assessment of the Availability, Accessibility, and Distribution of Neonatal Health Services at Palestinian Hospitals

Authors Massad S, Tucktuck M, Dar Khawaja R, Dalloul H, Abu Saman K, Salman R, Kafri R, Khammash H

Received 2 July 2020

Accepted for publication 18 August 2020

Published 13 November 2020 Volume 2020:13 Pages 1551—1562


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Salwa Massad,1 Marina Tucktuck,2 Ranin Dar Khawaja,3,4 Hadil Dalloul,1 Khalid Abu Saman,1 Rand Salman,1 Rawan Kafri,1 Hatem Khammash5,6

1Research Unit, Palestinian National Institute of Public Health, Ramallah, Palestine; 2School of Medicine, St. George’s University, Grenada, West Indies; 3Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss THP), Basel, Switzerland; 4Faculty of Medicine, University of Basel, Basel, Switzerland; 5Neonatology Department, Makassed Hospital, Jerusalem, Palestine; 6Pediatric Department, Al-Quds University, Jerusalem, Palestine

Correspondence: Salwa Massad
Research Unit, Palestinian National Institute of Public Health, Ministry of Health Building, 1st Floor, Qadora Street, Ramallah, Palestine
Tel +970 2 296 6842/7
Fax +970 2 296 6852

Introduction: Geopolitical segregation of Palestine has left a fragile healthcare system with an unequal distribution of services. Data from the Gaza Strip reflect an increase in infant mortality that coincided with a significant increase in neonatal mortality (12.0 to 20.3 per 1000 live births).
Objective: A baseline study was carried out to evaluate available resources in neonatal units throughout Palestine.
Study Design: A cross-sectional, hospital-based study was conducted in 2017 using the World Health Organization’s “Hospital care for mothers and newborn babies: quality assessment and improvement tool.” Data on the main indicators were updated in 2018.
Results: There were 38 neonatal units in Palestine: 27 in the West Bank, 3 in East Jerusalem, and 8 in the Gaza Strip. There was an uneven geographic distribution of incubators in relation to population and births that was more marked in the Gaza Strip; 79% of the neonatal units and 75% of the incubators were in the West Bank. While almost all hospitals with neonatal units accepted very and extremely low birth weight and admitted out-born neonatal cases, there was a shortage in the availability of incubators with humidifiers, high-frequency oscillatory ventilation, mechanical ventilators with humidifiers and isolation wards. There was also a considerable shortage in neonatologists, neonatal nurses, and pediatric subspecialties.
Conclusion: Almost all the neonatal units accepted extremely low birth weight neonatal cases despite not being ready to receive these newborns due to considerable shortages in human resources, equipment, drugs, and essential blood tests, as well as frequent disruptions in the availability of based amenities. Together, these factors contribute to the burden of providing quality care to newborns, which is further exacerbated by the lack of referral guidelines and challenges to timely referrals resulting from Israeli measures. Ultimately, this contributes to suboptimal care for neonates and negatively impacts future health outcomes.

Keywords: neonatal services, Palestine, assessment, hospitals

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