Posted on 14 April 2020

COVID-19 Emergency Situation Report 4 (7 – 13 April 2020)

Highlights

  • Second fatality recorded in the oPt.
  • Undocumented COVID-19 cases in East Jerusalem of increasing concern.
  • The Inter-Agency Response Plan for the COVID-19 crisis, over 80 per cent funded, is currently under revision to include critical emerging needs.

284 17,329 58 US$34 M
Confirmed COVID cases People tested for COVID-19 Quarantine and treatment centres request for Inter-Agency Response Plan

Situation Overview

As of 14 April, a total of 284 Palestinians are confirmed to have COVID-19 in the oPt, 271 in the West Bank (excluding East Jerusalem Palestinians), and 13 in the Gaza Strip, with 58 of these recovering. A 55-year-old man died on 10 April, bringing to two the total number of fatalities, both in the West Bank. The current number of people detected positive for COVID-19 in the oPt, especially in Gaza, remains low relative to other countries, but this may reflect the limited testing capacity. Of increasing concern is the lack of information regarding cases in East Jerusalem, as these are not covered by the Palestinian Ministry of Health (MoH) and are not disaggregated in the overall figures by the Israeli authorities.

The Government of Palestine is leading the efforts to contain the outbreak in coordination with the Israeli authorities and international actors, primarily the World Health Organization (WHO). In early March it declared a State of Emergency, which has been extended through to 4 May. 

The capacity of the Palestinian health system to cope with an expected increase in caseload remains severely impaired by longstanding challenges and critical shortages, particularly in Gaza. The most needed items are currently in short supply due to the unprecedented global demand, including personal protective equipment (PPE) kits and supplies to conduct COVID-19 tests. Hospitals across the oPt also face shortages of specialized staff in intensive care units. The imminent influx of up to four thousand Palestinians into Gaza via the Rafah Crossing, who have been unable to return from Egypt until now, will place additional strain on testing capacities and quarantine facilities in Gaza. 

The negative impact of movement restrictions, growing unemployment and the closure of schools on the most vulnerable Palestinians is of increasing concern. Reports from service providers indicate that domestic violence affecting women and children is on the rise. The Palestinian Ministry of Social Development (MoSD) estimates that at least 53,000 families across the oPt have fallen into poverty in recent weeks, due to the loss of a source of income. The UN Special Coordinator, Nikolay Mladenov, has also warned of the socio-economic consequences of the crisis on the already-weakened Palestinian economy, with revenues from trade, tourism and transfers declining to their lowest levels in the last two decades, and has reiterated a called for strong international donor support.

West Bank

Strict movement restrictions and social distancing measures remain in place. Currently, there are sixteen official quarantine centres and fourteen unofficial quarantine and medical facilities across the West Bank, where people who have COVID-19 are hosted, with additional community-based centres being established in refugee camps. The authorities have reported an acute shortage of medical equipment and supplies, including testing kits, as well as trained personnel. 

Concerns regarding the return of tens of thousands of Palestinian workers employed in Israel and the related risk of a spread of the virus have diminished somewhat, with the Palestinian Prime Minister announcing that there is ongoing cooperation with the Israeli authorities to handle the return of the workers in a coordinated and measured manner, while ensuring their health and security. The majority have remained in Israel during the ongoing Jewish Passover holiday, as the Israeli authorities maintained the validity of their work permits. Those who did return were monitored and registered by the Palestinian authorities and supplied with health information materials and instructions for home quarantine. Concerns persist regarding the difficulty of imposing the mandatory 14-day home quarantine and other measures on unauthorized workers, who have returned from Israel by sneaking through openings in the Barrier. 

The access of patients from the remainder of the West Bank referred to hospitals in East Jerusalem and Israel remained limited to emergency cases and cancer patients. The East Jerusalem Hospital Network has announced that all of their six facilities are preparing to deal with cases of COVID-19 that require clinical care, with 50 beds assigned for COVID-19 patients in Makassed and St. Joseph, and the other hospitals ready to support the network with medical and nursing staff. The hospitals continue to suffer from chronic underfunding, which hinders the provision of medical drugs and treatment: a contribution of 95 million Euros have been received from the European Union to help address urgent funding requirements.

In response to a petition to the Israeli Supreme Court, as of 14 April, the Israeli authorities have committed to opening health clinics and coronavirus testing centres for the estimated 150,000 Palestinians living in East Jerusalem neighbourhoods beyond the Barrier.

Since the beginning of the crisis the Israeli authorities have largely frozen the demolition of inhabited homes but continued targeting livelihood and service-related structures, with one recorded during the reporting period, adding strain to already vulnerable communities. Previous weeks also witnessed a surge in attacks by Israeli settlers, as well as incidents raising concern about excessive use of force by Israeli soldiers.

Gaza Strip

As of 13 April, only 2,106 people have been tested for COVID-19 in Gaza, including some conducted in the West Bank or in Israel due to lack of capacity. The health authorities in Gaza continue to appeal for more support to procure additional testing kits, with some people waiting to be released from quarantine pending testing. The number of people in 18 active designated quarantine sites, including health facilities, schools and hotels, has dropped to 623, on the conclusion of their 21-day mandatory quarantine period. All non-emergency surgeries have been suspended and primary healthcare is restricted to 14 centres, which provide essential services only. 

Access for Palestinians from Gaza to the outside world via the two passenger crossings with Israel and Egypt remains severely constrained. The Israeli-controlled Erez crossing has been largely shut down since 12 March for most permit holders and is functioning on a further reduced scale during the Passover holiday. As in the West Bank, the exit of patients has been limited to emergency cases and cancer patients. Exit to Egypt via the Rafah crossing has been halted by the Egyptian authorities, as of 15 March. 

Regarding entry into Gaza via the Rafah crossing, which is set to open for four days from 13 to 16 April, the Hamas authorities have requested Palestinians who are currently in Egypt, to register through an online platform, so that they can prepare for quarantine on their return. According to MoSD in Gaza, over 4,000 people have already registered, with the most vulnerable prioritized. On 13 April, 127 persons crossed, with hundreds expected in the following days. Medical staff have been sent to the crossing to identify people with medical issues and move them to specific facilities reserved for people with health issues. The newly opened Palestine-Turkey Friendship Hospital in Gaza City has a capacity of 320 places to receive medical cases and their companions for quarantine purposes.

The movement of goods from Israel and Egypt has continued as previously, including the entry of restricted (“dual use”) items via the Israeli-controlled Kerem Shalom Crossing. The latter is expected to continue operating over the Passover holiday at a reduced capacity. The Government of Israel has offered to expedite approvals for items needed in relation to the COVID-19 response.

Inter-Agency Response Plan – Funding Status

No additional contributions to the oPt Inter-Agency Response Plan for COVID-19 were announced during the reporting period. Overall, since its launch on 27 March, around US$ 28 million have been raised for its implementation, covering 81.5 per cent of the amount requested ($34.7 million).[1] The interventions proposed by the Health Cluster, which account for more than half of the total request, are over 90 per cent funded.

Roughly half of the contributions received so far entailed the reprogramming of funds previously allocated or pledged for other interventions, including nearly $7.76 million by the European Union (ECHO) and $5.16 million by the oPt Humanitarian Fund (HF). It should be noted that these funding tables capture all resources mobilised in response to the COVID19 Crisis including those for activities beyond the Inter-Agency Response Plan.

The Plan is intended to cover 90 days following its launch. The key objectives of the plan are to support Government efforts to prevent further transmission of the virus in the oPt; provide adequate care for patients and their families; and mitigate the worst effects of the pandemic. 

The Inter-Agency Response Plan is currently being updated, focusing on the most vulnerable communities in light of the prolonged shutdown on most forms of economic activity, in addition to supporting quarantine centres and the East Jerusalem Hospital Network.

Inter-Agency Response Plan funding received by sector (in Million US$)

 

Inter-agency COVID-19 Response PLAN

Inter-Agency Response Plan funding received by sector

Cluster Request US$ Received US$ Rate of funding
Health 19,468,000 17,732,000 91.1
Protection 550,000 373,000 67.8
WASH 5,785,000 3,285,000 56.8
Shelter 3,440,000 3,448,500 100.2
Education 1,132,000 660,000 58.3
Food Security 4,300,000 2,771,500 64.5
Total 34,675,000 28,270,000 81.5

Inter-Agency Response Plan funding received by donor

Donor Amount in US$ Type of contribution
Kuwait 9,000,000 New
Canada 2,810,000 New
Education Cannot Wait 250,000 New
OPT Humanitarian Fund  1,000,000 New
DFID 500,000 New
Ireland 138,000 New
WHO HQ 120,000 New
CERF 300,000 New
ECHO 7,760,000 Reprogrammed
OPT Humanitarian Fund  5,160,000 Reprogrammed
Education Cannot Wait 310,000 Reprogrammed
DFID 500,000 Reprogrammed
UNICEF 367,000 Reprogrammed
Oxfam 60,000 Reprogrammed

Coordination

The Inter-Agency COVID-19 Task Force led by the Humanitarian/Resident Coordinator (HC/RC), as well as the Inter-Cluster Coordination Group (ICCG), continue regularly meetings to follow up on the implementation of the Inter-Agency Response Plan. The HC/RC also informs the Palestinian authorities about essential movements required by humanitarian and development staff during this period of enhanced movement restrictions, while following the previously adopted Standard Operation Procedures. Where necessary, coordination with the Israeli authorities is also conducted to ensure the safe movement of staff.

As part of the Inter-Agency Response Plan, UNICEF and WHO, with the support of the HCT’s Advocacy Working Group and UN Communications Group, are implementing a Risk Communication and Community Engagement (RCCE) plan. With the support of over 20 Health Cluster partners, NGOs and INGOs messages have been disseminated across various channels and via social media for the fourth week in a row, reaching tens of thousands of people and vulnerable communities across the oPt.

UNICEF are also taking the lead in coordinating and centralizing the procurement of medical supplies and equipment.  Additionally, the World Food Programme (WFP) has set up a logistics working group to support humanitarian partners in providing key supply chains, reducing duplication and increasing cost efficiency. Logistics services will be provided by air and sea, through Ben-Gurion Airport and Ashdod Port. 

Strong cooperation efforts continue between the GoP and Israel in response COVID-19. This cooperation includes material support.  The Israeli authorities delivered to the West Bank and the Gaza Strip 2,850 testing kits, 2,000 gloves, 1,000 masks, 100 litres of sanitizer and 200 protective suits, as well as coordinated the entry of 10,000 testing kits through the Ben Gurion airport.

Needs, responses and constraints by cluster

[For a detailed list of activities by cluster please refer to the annex in the full report]

Health

Needs overview

The key priorities for the Health Cluster remain:

  • Enhancing capacity to identify, trace and isolate cases, with a critical need to expand laboratory capacity to test for timely detection; 
  • Protecting health care workers by training and providing additional personal protective equipment (PPE); 
  • Ensuring proper case management of people who contracted COVID-19; and 
  • Raising awareness about COVID-19 risk and preventive measures.

As part of these priorities, there is an increasing need to support the quarantine centres in the West Bank and Gaza, upscale activities in East Jerusalem, and engage civil society and national NGOs to sustain critical health services.

Response overview

The Health Cluster, including its members and observers, remain committed to reinforcing a comprehensive, multi-sectoral response to the outbreak of COVID-19, while continuing principled programme delivery and provision of life-saving assistance. All related activities are directed at supporting the measures taken by the Palestinian authorities led by the Ministry of Health (MoH), which is leading the response to the crisis.

Interventions have strengthened the MoH’s capacity to early detect and respond to the current COVID-19 outbreak and prevent further transmission of the virus. Mental Health and Psychosocial Support (MHPSS) activities are an integral part of these interventions. Efforts have been also invested to coordinate and streamline the work of different partners with the authorities. 

As knowledge about the virus increases, resources are being re-targeted to support the most effective public health interventions, with an emphasis on the most vulnerable.

Gaps, challenges and constraints

Enhanced movement restrictions and an increasing number of healthcare staff placed under quarantine have posed significant operational constraints. In the West Bank, services at two mobile clinics in Bethlehem and Jericho operated by MAP-UK and PMRS have been halted, and a Polish mission of health experts could not be deployed. In Gaza, MSF France have stopped their services at the osteomyelitis treatment centre and UNRWA’s 22 health clinics have had to reduce their services. Also in Gaza, WHO’s efforts to support the establishment of a centralized ambulance dispatch centre have been delayed due to the restrictions imposed by Israeli authorities on the entry of essential supplies, such a centralized centre is essential to manage the COVID-19 response effectively. 

The most urgent gaps in terms of supplies and capacity across the oPt include: 800,000 full PPE kits; 20,000 COVID-19 test kits; 200 ventilated beds; 114 laboratory reagents; 600 doctors and 2,000 nurses at hospitals; 15 rapid response teams (one per governorate); and 50 types of essential drugs and 16 types of disposables.

Protection

Needs overview

Across the oPt, there is an urgent need to provide adequate training on detection and referral of gender-based violence (GBV) and child protection cases to frontline staff at new quarantine sites. Unofficial quarantine sites recently opened in the West Bank lack basic monitoring and accountability systems, as well as recreational spaces for children, private breastfeeding spaces, female hygiene kits and adequate WASH facilities. 

Reports from the southern West Bank indicate increased stigmatization of people tested positive, or suspected of COVID 19, in the form of rumours and verbal attacks online, triggering the need for additional psychosocial support.

Service providers report an increasing demand for psychosocial assistance due to domestic violence against women and children, amid a chronic lack of safe places and recreational areas. The rise in domestic violence is attributed to fear and anxiety stemming from the situation, including economic stress and overcrowded households.

In the Gaza Strip, 40 women and 37 children were recently released from prisons run by the local authorities, raising concern about the potentially hostile environment they may face in their communities.  Of additional concern, are the range of health measures put in place by the Israeli authorities in relation to Palestinians in Israeli prisons, the non-release of Palestinian detainees to reduce crowding in prisons and restrictions on the detainees’ ability to contact family and lawyers. 

Ongoing search and arrest operations by Israeli security forces (ISF) in the West Bank, including East Jerusalem, also raise concerns due to the inconsistent protection measures adopted during these operations to avoid spreading infection. Similar concerns about a spread of the virus exist in relation to the spike in settler violence witnessed in previous weeks. The withdrawal of most international protective presence from sensitive areas has exacerbated the vulnerability of Palestinians to settler violence.

Response overview

All protection partners have continued adapting their response to the operational constraints by using alternative methods of service delivery: scaling up remote psychosocial consultations; expanding toll-free helpline services; rolling-out awareness campaigns; and requesting movement authorization in emergency cases.

The Protection Cluster is supporting implementation of a project to facilitate access of women and children in quarantine centres, and after returning home, to GBV and mental health and psychosocial support services, including training of frontline staff at the quarantine sites.

GBV and child protection partners have continued conducting daily phone calls to female and juvenile detainees, who have been released on home leave, for referrals and reintegration support.  Across the West Bank, organizations have continued providing psychosocial support to hundreds of families affected by stress.

Gaps, challenges and constraints

Efforts to address needs related to the quarantine sites has faced various challenges, including limited access to the sites and a lack of accurate and timely information provided by the authorities. This has undermined the ability of partners to monitor possible stigma and safety issues by people being released. Protection training of frontline staff at these sites is also challenged by the compulsory health-based rotation cycle of staff. Although remote support to people facing stigma is ongoing, it is not as effective as face-to-face interactions, and additional specialized training to involved staff is required.

Education

Needs overview

The main needs and priorities in the Education Cluster include:

  • Following the closure of education facilities in early March, 1.43 million children across the oPt need to continue distant learning and receive age appropriate, awareness-raising messages around COVID 19.
  • In isolated and poor areas, 360,000 children without internet connections need home-based learning materials and support. 
  • Psychosocial support to 215,000 children and their caregivers and 3,000 teachers through innovative approaches utilizing social media and phone calls is needed.
  • A total of 5,000 schools and kindergartens (KGs) need cleaning and disinfecting in preparation for the re-opening of schools, while 402 schools need rehabilitation of latrines, and 134 schools require new clean drinking-water points.

Response overview

Education Cluster partners have developed interventions to address the needs set out in the Ministry of Education’s (MoE) Response Plan for COVID-19. Main achievements to date include:

  • The mobilization of US$2.5 million for the MoE COVID-19 response plan, which is currently 40 per cent funded;
  • Started the procurement of 1,800 cleaning and disinfecting kits for MoE schools;
  • Supported, technically and financially, the access of about 100,000 children to various MoE e-learning platforms. 
  • Supported the provision of remote MHPSS support to children and their families in coordination with Child Protection partners.

Gaps, challenges and constraints

The scale and nature of this crisis is beyond the existing preparedness plans and capacities of MoE and cluster partners. This includes the lack of platforms for distance learning prior to the emergency, and lack of consensus between MoE in Ramallah and Gaza over the content of the e-learning platform. This has been compounded by the limited internet connectivity available in certain communities and households. The MoE and cluster partners are also not operating at full capacity due to the movement restrictions as well as quarantine measures. Finally, there are funding gaps for the rehabilitation of emergency WASH facilities at schools.

Shelter

Needs overview

In the Gaza Strip, people hosted in quarantine centres for the 21 mandatory days need various individual hygiene kits, sterilizing items and non-food items (NFI), such as mattresses, blankets, pillows and mats. Most of these items must be periodically redistributed for incoming people. There are currently 38 facilities identified for potential use as quarantine centres, with a capacity to host up to 5,000 individuals. The highest occupancy rate was reached by mid-March, where around 1,900 people were accommodated in 26 centres, declining to some 630 by 12 April. Numbers are expected to rise again over the coming week, following the reopening of the Rafah crossing for the return of a few thousand people from Egypt.  

Also in Gaza, an assessment by the Ministry of Housing and Public Works identified 9,500 dilapidated or substandard homes. The most vulnerable among those, urgently need proper hygienic and disinfection materials, as well as awareness materials concerning hygienic practices and mitigation measures. 

In the West Bank, the main concern has been the expected return of Palestinian workers employed in Israel, who might be sent to quarantine facilities. The current capacity of identified centres is 5,000 individuals, who will need similar NFI kits to those in Gaza. 

An assessment conducted by an NGO of 198 vulnerable communities in Area C found that over half of the residents cannot afford the basic hygienic and cleaning materials to combat COVID-19.

Response overview

The Shelter Cluster response seeks to improve the capacity and resilience of vulnerable individuals and households to reduce the spread of the pandemic.  In Gaza, partners have continued to aid 20 quarantine centres, including NFIs, hygiene and female dignity kits, and cleaning supplies. In the West Bank, one partner distributed 61 tents (originally meant to respond to demolitions) to be used as pre-screening facilities at hospitals and clinics. Across the oPt, around 11,000 hygiene and cleaning materials were distributed to vulnerable families, including via different institutions and village councils.

Gaps, challenges and constraints

A main constraint is the lack of quality, household disaggregated information on needs, to accurately target interventions, compounded by the movement restrictions that impede access to the most vulnerable households and communities.

Water, Sanitation and Hygiene

Needs overview

The main needs identified by the WASH cluster include:

  • Increased demand for drinking water and hygiene kits in quarantine centres;
  • Limited capacity of some local councils in the West Bank to conduct regular cleaning and sanitization of community public facilities, according to a recent assessment;
  • Limited ability of vulnerable households to adopt the required hygiene practices, due lack of access to hygiene materials.

Response overview

During the reporting period, eight WASH cluster partners implemented interventions, reaching around 23,000 individuals. Partners were able to distribute 711 household hygiene kits, support quarantine centres in Gaza with 14,420 bottles of water and cleaning materials, along with hygiene and protection materials for health workers.  

The Palestinian Water Authority has developed its national COVID-19 response plan. The plan includes emergency interventions to ensure the regularity of access to water and sanitation services across the oPt. In Gaza, the main water utility, in coordination with the International Committee of the Red Cross and the Norwegian Refugee Council, supported water service providers with essential sanitization and protection materials.

Targeted individuals and institutions improved their hygiene levels thanks to the provision of hygiene items and sanitizers, as well as protective materials for health workers. Water service providers have managed to maintain regular levels of supply in the West Bank and Gaza. Current support to the quarantine centres improves their capacity to ensure safe, dignified, and healthy habits for the people who need to quarantine.

Gaps, challenges and constraints

The main challenges identified by the WASH Cluster include:

  • Restrictions on movement in the West Bank affecting the capacity of contractors to deliver hygiene, cleaning and protection materials to the targeted communities and households; 
  • Shortage of some hygiene materials in the market, especially those imported;
  • Limited data regarding people in home quarantine and potential quarantine centres in the West Bank, as well as limited needs assessments of the quarantine centres in Gaza;
  • Local authorities in Gaza not allowing partners to conduct any post-distribution monitoring in the targeted quarantine centres.

Food Security 

Needs overview

The pandemic has already had severe socio-economic consequences, which are expected to increase in the coming weeks, with direct consequences on food security. The Ministry of Social Development (MoSD) estimates that at least 53,000 families across the oPt have fallen into poverty in recent weeks following the loss of a source of income in the context of the COVID-19 restrictions.  

Agricultural livelihoods have been particularly impacted. The medical herb market in the Jordan Valley has been significantly disrupted and while the harvest season has already begun, farmers have not been able to export their produce. In the Tubas governorate, only two certificates of origin (needed to transport produce) were issued during the past 10 days, compared to around 50 for the same period last year. The livestock market in the northern West Bank is currently closed and herders are struggling to sell their lambs, with prices declining due to low demand. In Gaza, the prices of vegetables sold in Israel, West Bank and Jordan have been reduced, while farmers are struggling to acquire agricultural inputs and fodders.

Response overview

During the reporting period, partners in the Food Security Sector have continued distributing food parcels to poor families, including through safe home deliveries in the Gaza Strip, and providing hot meals and fresh fruit to persons in quarantine centres. 

In the West Bank, the MoSD, in partnership with local councils, charitable societies and Zakat committees, has begun tracking and assessing newly poor families, towards a possible distribution of cash and food assistance by the end of April. Across the oPt, the MoSD, in partnership with Food Security Sector partners, has conducted a rapid survey to monitor the availability of food and other basic items in the market. 

In the West Bank, the Ministry of Agriculture (MoA) began distributing one million seedlings for home gardens through local NGOs. Additionally, food security partners have engaged in various initiatives to help herders, particularly in the Jordan Valley, to market their products. In Gaza, the MoA is about to start the distribution of fodder and fertilizers for farmers and poultry (broilers) breeders with total value of US$1 million.

Gaps, challenges and constraints

In addition to the mobility restrictions affecting all partners, the delivery of cash assistance has been disrupted, as banks have stopped receiving clients face-to-face. Moreover, Cash-for-Work (CfW) interventions are also impacted as many skilled and unskilled jobs come to a halt, although some education and other organizations began implementing a work-at-home modality.


[1] A previously reported higher rate of funding was due to the misattribution of part of one contribution to the Plan.