RESUMEN
BACKGROUND: The United Nations Relief and Work Agency for Palestine Refugees (UNRWA) is one of the main health-care providers in the Gaza Strip. It provides primary health services to approximately 1·3 million Palestine refugees, comprising approximately 76% of the population of the Gaza Strip. UNRWA has well-prepared emergency health plans that are based on previous conflict experiences. However, the Great March of Return (GMR) injuries that UNRWA has faced since Mar 31, 2018, are considered a new experience of emergency. GMR is a protest activity launched by Palestinians in the Gaza Strip to express their right to return to their homes, from which they were expelled in 1948. This study aimed to describe the GMR-related injury patterns in patients and the health services provided as a part of the UNRWA emergency response in Gaza. METHODS: This was a descriptive analysis of medical and data reports of patients who sought care at 22 UNRWA health centres in Gaza for GMR-related injuries between Mar 31 and Sept 30, 2018. Data were collected from each individual on first contact with their health-care provider. We analysed the data using SPSS version 21. The study protocol was approved by the Gaza Field Office, and each participant provided oral informed consent to disclose their medical data for analysis. FINDINGS: 2020 patients attended the 22 UNRWA health centres for GMR-related injuries during the study period. 18·9% (381) were below 18 years of age, and 94·9% (1916) were male. 10·0% (202 of 2020) of injuries were classified as severe, 54·2% (1095) as moderate, and 35·8% (723) as mild. The majority of injuries (86%; 1737 of 2020) were due to gunshots, and 14% (283) were due to other causes (such as gas inhalation, rubber bullets, burns, and falling down). 54% (1090 of 2020) received wound care and dressing, 20% (404), received medical treatment only, and 26% (526) received both medical treatment and wound care. 9% (169 of 2020) developed motor dysfunction or disability as a complication, and received rehabilitation physiotherapy at UNRWA health centres. In addition to injury treatment, all patients received psychological first aid according to UNRWA Mental Health and Psychosocial Support Services guidelines. Individual and group psychosocial support sessions and home visits were provided for injured individuals and their families as needed. The UNRWA Health Programme collaborated with partners (eg, the International Committee of the Red Cross and Médecins Sans Frontières) for hospital referral for patients with severe injuries who needed advanced treatment. INTERPRETATION: Given the unprecedented situation, UNRWA health centres responded positively and comprehensively to the GMR-related injuries, providing care and essential medical and psychosocial support. However, many patients will require long-term care owing to their injuries. Further consideration should be given to developing a more systemised response to such emergencies, and to the human resources that are needed to support health, physiotherapy, and rehabilitation in Gaza. FUNDING: None.
RESUMEN
BACKGROUND: To meet the emerging needs of the increasing numbers of patients with non-communicable diseases and to provide optimum care with optimum contact time and minimum waiting time, as stated in UNRWA guidelines, the mobile phone text messaging system was implemented in UNRWA centres to remind patients of upcoming appointments and to thereby improve the quality of care for vulnerable patients and regulate the work load in the clinics for non-communicable diseases. The aim of this study was to assess the causes for lack of adherence to the appointment system at UNRWA centres. METHODS: This descriptive cross-sectional study was done in the UNRWA's Khan Younis Health Centre (KYHC), which serves the same refugee population as other UNRWA health centres and follows the same guidelines with minimal variation. Data were collected through interviewer-administered questionnaires, with ten medical staff members involved in the appointment process and 50 patients with non-communicable diseases selected randomly from patients attending the KYHC. The text-message reminder intervention targeted 1000 patients with non-communicable diseases and consisted of an electronic message technique that was developed to remind patients about the day and time of upcoming appointments. Administrative approval was obtained from the chief of UNRWA health programme. Verbal consent was obtained from participants. We followed the Modified International Code of Ethics Principles (1975), known as the Declaration of Helsinki. FINDINGS: The main barrier to adherence to appointments in the clinic for non-communicable diseases was forgetting the appointment. Other factors were lack of awareness, clinic overcrowding, appointments that do not match the patient's preference, availability of other service providers, and financial issues. In March, 2016, after the completion of the intervention, the proportion of patients that adhered to their appointment by date and time was 76%, compared with about 45% in January and February, 2016 (p=0·013). INTERPRETATION: The text messaging reminder is a successful way of improving patient's adherence to appointments in UNRWA clinics for non-communicable diseases. The intervention should be continued and integrated in daily work. More financial resources are needed to support the text messaging reminder system. FUNDING: None.
