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Oslo agreement was signed in 1993 between the Palestinians and the Israelis as a gesture of hope for the autonomy of the Palestinians on their lands. Palestinians lands was divided into three administrative regions: Areas A, B, and C. These divisions were signed as a temporary transitional period of 5 years, during which the transfer of control over areas C and B to the Palestinian National Authority, was not implemented until the time of writing this research. This work aims to shed light on the impact of the geopolitical division on the possibility of exploiting renewable energy resources on C areas, and the role of that in achieving the Palestinian vision of reducing total dependency on the Israeli side as a net importer of Energy. To conclude, 96% of the total potential of solar energy is in West Bank, while Gaza has only 163 MW. Area C obsesses over 62% of solar energy potential, while about 75% of the potential in area (A + B) is upon the roof tops. It is expected, 98% of the total renewable energy potential is solar energy potential. Only 0.12% of the total A and B lands are suitable for producing solar electricity.

Traditional communities have wide knowledge and experience of wild plants as natural resources that have historically been important for food, medicine, spiritual and hygienic uses. These communiti...

The radiographer is one of the most important and needful components of the workforce in the health care system. This study aimed to investigate the prevalence of depressive symptoms and explore its associated risk factors among radiographers working in the West Bank hospitals. A cross-sectional design was used for the study. Beck's depression inventory-II Arabic version was administered to respondents and Statistical Package of the Social Sciences (SPSS v 21) was used for the data analysis. The prevalence of depressive symptoms among radiographers was (66.9%). The results showed a significant association between gender and depression; men were at higher odds of having higher depression categories as than women by 9.6 times (95% CI 3.65-22.4). In addition, radiographers who had no children were at higher odds to report higher depression categories than radiographers who had from one to more than five children by 8.9 times (95% CI 1.55- 52.02). In addition, the results showed that the radiographers who had bachelor degree were at higher odds of having higher depression categories than diploma and master or more radiographers by 2.4 times (95% CI 1.04-5.78). To work in private hospitals had lower odds of having higher depression categories than radiographers who work in government hospitals by 0.24 times (95% CI 0.17-0.51). The results showed a significant association between monthly salary and depression categories; radiographers who took monthly salary 1000-1199$ were at higher odds of having higher depression categories than radiographers who took more than 2000US $ by 2.5 times (95% CI 1.24-5.33). The radiographers who smoke were at higher odds of having higher depression categories than radiographers who did not smoke by 2 times (95% CI 1.08-4.18). Other variables showed no significant association with depression categories among radiographers. Depressive symptoms among radiographers were found to be prevalent. Gender, number of children, education level, monthly salary, smoking cigarettes, work experience, and working sector were associated with the generation of depressive symptoms.

In settler colonial settings, agriculture is a means of reclaiming territorial sovereignty and indigenous identity. Turning attention to the Jewish settlers in the West Bank and their multiple uses and abuses of organic farming, this article explores epistemic and political spatial operations on the colonial frontier. Applying a relational conceptualization of three spatial modalities—soil, territory, and land—we explore the ways in which these modalities serve as political apparatuses: Soil designates the romantic perception of cultivable space, territory is concerned with borders and political sovereignty, and land is seen as a space of economic value and as a means of production. While agriculture is a well-known instrument of expansion and dispossession, organic farming contributes to the colonial operation by binding together affective attachment to the place, and new economic singularity in relation to environmental and ethical claims. We argue that organic farming practices converge claims for local authenticity, spatial appropriation, and high economic values that are embedded in what we term the colonial quality turn. Ultimately, organic farming in the West Bank normalizes the inherent violence of the colonial project and strengthens the settlers’ claim for political privilege.

PURPOSE: Cataract surgery, quantity and quality, is an indicator of ophthalmic care. A comprehensive assessment of cataract surgical services has never been carried out in Palestine, including West Bank, Gaza Strip and East Jerusalem. The objective of this study was to estimate the cataract surgical rate in 2015 to and to explore the modes of payment and referral systems. METHODS: A cross-sectional study conducted between June and August 2016. Medical Directors from Cataract Surgical Centres in Palestine were interviewed using a structured questionnaire to extract data on cataract output and surgical techniques. Additionally, data were collected on modes of payment for cataract services. The cataract surgical rate was calculated by dividing the total cataract output in 2015 by the estimated population of Palestine in millions. RESULTS: In 2015, 9908 cataract surgeries were carried out in 22 centres. The cataract surgical rate was 2,117 operations per million population. Phacoemulsification was the most common technique (73.4%), however in government centres 67% were performed by extracapsular cataract extraction.In the Gaza Strip, 56.6% of cataract surgeries were operated at government centres, and 42.8% were operated at NGO centres while in West Bank, only 12% of cataract surgeries were operated at government centres, with two-thirds of cataracts diagnosed at governmental centres being referred to private and NGO centres. Seventy eight percent of cataract surgeries were funded by insurance, of which the government insurance scheme contributed 65%. CONCLUSION: The cataract surgical rate in Palestine falls short of the required WHO target. The majority of cataract surgeries are funded by insurance.

Objective. Older men and women have higher risk of fall due to various factors. Among Palestinian older adults fall history yet to be studied in terms of prevalence and correlates. The primary objective of this study is to determine the prevalence of fall and the differences between fallers and non-fallers among a group of Palestinian older living in rural areas in Southern West Bank region of Hebron. Methods. The study included 142 participants from two villages: Se’ar and Bani Na’em, Hebron governance. Demographic variables and fall history was collected. Anthropometric measurement were used to assess nutritional status; physical function was assessed. Geriatric scale for depression and Montreal cognitive assessment test. Results. 51.7% of study participants were females, the mean age 69.5 5.7 years old. Positive fall history was present among 11.7% mostly females. Significant relationship was found between fall and larger waist and hip circumference, cognitive impairment, higher level of dependency and slower performance in time up and go (TUG) p < 0.05. Conclusions. Fall history has considerable prevalence among the study sample and it is correlated with nutritional status, cognitive and physical function.

Nosocomial infection (hospital-acquired infections) is considered a significant concern for the global health care system. The present study aims to assess radiographers' overall knowledge about nosocomial infection control practices (ICP) in southern West Bank hospitals. A descriptive cross-sectional self-administered questionnaire was conducted. The assessment questions' primary scope was intended to evaluate the overall knowledge of the participated radiographer about ICP and was accomplished in three phases; assess the general knowledge of nosocomial infection, knowledge in the primary infection prevention standards, and knowledge of ICP in the radiology department. The final data analysis was performed by Statistical Package for Social Sciences (SPSS), and it included 40 radiographers from private and public hospitals. For the first phase, the participants' main knowledge score was 62.0%; the second phase's main knowledge score was 68.4%, whereas the third phase's main knowledge score was 77.8%. The mean overall awareness was 70.09%, which translated as a moderate awareness. The study also assessed the overall knowledge of the participated radiographer in accordance with participants characteristics; the study indicates no correlation between the awareness of radiographers in nosocomial infection due to the gender, age, and working experience of the radiographers (p = .850, p = .581, p = .038, respectively), while it shows a statistically significant difference in radiographers with long working experiences (62.5%) compared with (37.5%) among radiographers with relatively shorter experiences (p = .038) which reflects that radiographers with longer working experience have more awareness of the ICP.

Limited water resources are among the main obstacles to development in Palestine. This research investigates farmers’ perceptions and willingness to use treated wastewater (TWW) for irrigation. Des...

Vitamin D and vitamin B12 deficiencies are major public health problems; they may result from inappropriate low exposure to sunlight, autoimmune diseases or diminished intake. These two deficiencies have been extensively studied globally: causes, e"ects, treatment, as well as epidemiology. In Palestine the epidemiology of vitamin D and vitamin B12 deficiencies has not been addressed. This study was undertaken to determine the prevalence of vitamin D and vitamin B12 deficiencies in patients reporting to the West Bank (WB) governmental hospitals in the period between January 2015 and December 2018. It is a retrospective cross-sectional study for the data collected from medical records of patients tested for these deficiencies in 12 WB governmental hospitals for the three years period. Out of 30890 patients tested for vitamin D levels, 88% had insu!cient vitamin D levels (< 30 ng/ml), whereas out of 43532 patients tested for vitamin B12, 19% had insu!cient vitamin B12 levels (< 203 pg/ml). The percentage of patients with insu!cient vitamin D levels is alarming. The percentage of patients with insu!cient vitamin B12 levels falls within ranges reported by other studies in various countries. In conclusion, this study revealed an alarmingly high percentage (88%) of vitamin D deficiency below the reference su!ciency level among patients suspected to have such a deficiency. Around one fifth of the patients tested for vitamin B12 had insu!cient levels. Because testing for vitamin D is costly, we suggest, that medical suspicion of vitamin D deficiency would be adequate to initiate treatment to alleviate the expense, especially in high-risk groups such as elderly women. Future studies have to address major risk factors contributing to these deficiencies that are specific to our community.

Palestine currently suffers a serious shortage in crucial energy supplies. Nearly 90% of electricity needs come directly from Israel, or through Palestinian electricity distribution companies. This...

In this article, I investigate three public transit-centered Palestinian political actions in the West Bank and argue that the activists’ framing choices facilitate particular forms of global solidarity. The bus-centered political actions I examine are the Palestinian Freedom Rides of 2011, the Freedom Bus of 2014, and the bus sabotage of 2013. I demonstrate that the activists and participants in each of these cases dexterously move among a collection of terminological frames, invoking racial segregation, racism, and apartheid alongside occupation and colonialism. This rhetorical movement parallels the physical movement that the bus enables and represents. In turn, both forms of movement carry Palestinian political messages beyond the Israeli enclosures in order to connect with diverse solidarity audiences and educate them about Palestinian experiences of im/mobilization.

Drawing on fieldwork in the West Bank (2007–2016) with engineers building sewage infrastructures for the would-be Palestinian state, I make a three-pronged argument. First, I argue that “failure to build” is its own thick, disorienting, and molasses-like condition. It is also “choppy”: it has a disjointed, jerky, quality that is inconstant and unsettling as if one is at sea without a lifeboat. It is limited neither to short-term, tactical governance—a governmentality looking to survive in the short term—nor to strategically planning for the future. It combines the durability of the temporary with the fragility of the future. Second, I propose that the failure-to-build temporality is structured by and structures the intersection of two phenomena: nonsovereignty, for example but not only in settler colonialism or war, and particular environmentalist logics. Failure to build takes on its moral valence from the way those who rule Palestinian life—Israel, international donors, and the Palestinian Authority—determine the environmental standards for Palestinian infrastructures. For these actors, the environment is a singular entity “shared” across political borders. It requires expertise Palestinians are repeatedly suspected of lacking, partly because they lack a state and experience running their own infrastructures. Failure to build thus works circularly in relation to nonsovereignty. The more nonsovereign communities “fail to build,” the more those who govern them can claim the right to control what and how they build. Third, I argue that waste infrastructures such as landfills, incinerators, and sewage treatment plants are particularly susceptible to a failure-to-build temporality because of their association with environmental harm.

Nonhuman bodies in many sizes and diverse social roles are central to Israel’s control mechanism in the Occupied West Bank. Delving into the agricultural record of the Israeli Civil Administration, I ask how the Israeli system of control operates through animal bodies. What does a bureaucratic record so invested in monitoring animals’ production, treatment, disease, and death tell about the potential disruption of power? Through a political ecology of human–animal entanglement, I argue that nonhuman bodies both reproduce human colonial relations and allow their constant interruption. Nonhumans challenge the power regime through their unpredictable mobility as well as in their role as both objects of a political economy and subjects of potential agricultural diseases, ecological risks, or public health threats. Breaking from contemporary multispecies scholarly literature’s focus on endangered species and relations of care, I place nonhuman bodies as actors of international-interspecies relations in colonial conditions and point to nonhumans, which are here to stay in the climate change era. By doing so, I reflect on the continuous significance of nonhuman bodies to the operation of power in the “borderlands” of Israel/Palestine and beyond.

BACKGROUND Acne vulgaris (AV) is a common dermatological disease affecting almost 85% of teenagers. Patients with AV usually present at community pharmacies during the early stages of their disease. AIM The aim of this study was to assess community pharmacists' knowledge, attitudes, and practice toward AV management in West Bank in Palestine. METHODS This study was a cross-sectional questionnaire-based study. The questionnaire included four sections: 1) demographic, 2) knowledge, 3) attitude and practice items related causes, and 4) treatment options and counseling during management of patients with AV. A convenience sampling method was implemented in this study. Parametric and non-parametric tests were used to compare different issues as appropriate. P

This paper offers a field tested community environmental policing model to address the pressing environmental management challenges of reducing e-waste burning in informal e-waste hubs, and enforcement against informal polluting industries more broadly. This is based on our intervention to reduce e-waste burning in a substantial informal e-waste hub in the West Bank, Palestine, a 45 km2 region in which an estimated 5–10 metric tonnes of cables are burnt daily, causing serious environmental and public health consequences. In analogous e-waste hubs in the global South, environmental management solutions have focused on economically attractive alternatives to replace cable burning or policies that integrate informal recyclers with formal e-waste management systems—achieving little success. Our paper describes a two-pronged intervention in Palestine’s e-waste hub, which reduced e-waste burning by 80% through a combination of economically competitive cable grinding services and an “active” community environmental policing initiative that lowered barriers to and successfully advocated for governmental policing of e-waste burning. Our discussion of this intervention addresses the community environmental policing literature, which has documented few successes stories of real improvements to the enforcement of environmental violations. We argue that existing strategies have relied on “passive” approaches comprised of monitoring and reporting environmental violations to advocate for change. Our strategy offers a template to improve outcomes through a more “active” approach, moving from monitoring environmental violations through understanding the rationale and dynamics of violators, identifying environmental policing barriers, and implementing a feasible and persuasive strategy to overcome them.

The wind resource assessment in Palestine is one of the main issues necessary for achieving our renewable energy target in Palestine by 2025. In this paper, wind energy potential assessment of West Bank was investigated, focus on wind site assessment of using small wind turbine in different cities in West Bank. A wide variety of data types and analysis techniques will be presented, were utilized in performing the national wind energy assessments. Most of the data used in the assessments were collected at anemometer 10m heights and locations that chosen for wind energy assessment purposes, and many of these have been located in areas chosen by energy research centre thought to have high wind resource. The techno-economic analysis of collected wind data at different cities in West Bank also will be presented.Keywords: Wind resources assessment; Wind power density; Techno-economic Analysis.JEL Classification: Q4DOI: https://doi.org/10.32479/ijeep.8067

Background Testing by pharmacogenomics (PGx) aims to reduce the side-effects of medicines and to optimize therapy. Aim To ascertain the knowledge and attitudes towards PGx among pharmacy students in Jordan and West Bank of Palestine (WBP). Methods This cross-sectional study focused on pharmacy students from five universities in Jordan and WBP. Students were asked to answer an online survey comprising 30-closed ended questions measuring the knowledge and attitudes towards PGx. Results The total number of respondents to the questionnaire was 466. Most (96.1%) respondents knew that genetic variations can affect the drug response. Most students stated that the total number of lectures mentioning PGx was fewer than three. Most (>80%) respondents answered that they knew that human genetics can affect the response, inter-individual variation, and ethnic variations in the drug response. However, their knowledge about US Food and Drug Administration recommendations regarding PGx testing of commonly used drugs was weak. Also, 60.3% of respondents stated that the information they received about PGx was insufficient. Most (>92.7%) students wished to know more about PGx and believed that PGx is helpful in choosing the appropriate drug. Conclusion Pharmacy students had fair knowledge and good attitudes towards PGx. These factors could aid application of PGx in clinical practice in Jordan and WBP.

The ‘From Emergency Food Security to Durable Livelihoods: Building Resilience in the Occupied Palestinian Territories’ project was implemented in the West Bank, in the Occupied Palestinian Territory, between November 2015 and January 2018 by Oxfam, together with two partners: the Land Research Centre (LRC) and the Palestinian Livestock Development Centre (PLDC). The project, funded by the Belgian Cooperation, through Oxfam Italy, focused on improving protection around three key areas at community level to build resilience: supporting animal health, rehabilitating protected rangelands and strengthening community-based legal protection mechanisms. The combination of these key areas is the focus of this Effectiveness Review: the evaluation assesses the impact of this cross-sectorial approach on the resilience capacities of male and female members of Bedouin communities in the West Bank, at risk of displacement. It combines a quantitative quasi-experimental design with a questionnaire with community leaders. Find out more by reading the full report now.

Israeli airstrikes in the Palestinian territory of Gaza have damaged six hospitals, nine primary health care centres, and a desalination plant that supplies clean water to 250 000 people, the United Nations has reported.1 Gaza’s main covid-19 laboratory and the Palestinian Ministry of Health offices have also been hit,2 and at least two prominent doctors, the internal medicine consultant Ayman Abu Alouf, who was leading the covid-19 team at Al Shifa hospital, and the health ministry neurologist Moeen Al-Aloul, have been killed. The latest escalation in violence was the result of unrest in the West Bank, as pro-settler organisations have been attempting to force Palestinian families from their homes in the Sheikh Jarrah neighbourhood of East Jerusalem, in a move that the United Nations warned could amount to “war crimes.”3 Since the unrest began on 7 May at least 212 Palestinians, including 61 children, have been killed in …

The aim of the study is to explore and determine the factors influencing household expenditure on electricity in Palestine for 2011, using the OLS method in data analysis, and using the logarithmic model. The effect of the number of dwelling rooms, number of bedrooms, income, number of family members, and goods and services on household electricity expenditure. The study found that the number of rooms in the dwelling, number of bedrooms, income, number of family members, total expenditure on goods and services were all statistically significant and positively associated with spending on electricity. The study showed that the urban areas are the most spending on electricity, and according to the region, the study showed that the central areas of the West Bank is the most spending on electricity, while it was found that the housing used in the construction of external walls concrete, the least expenditure on electricity.Keywords: Household electricity, Expenditure on electricity, Electricity in Palestine.JEL Classifications: B22, C21, C51, Q43, P21DOI: https://doi.org/10.32479/ijeep.8035

To investigate both caries prevalence and clinical consequences experienced by deprived children in the West Bank, using a child-centred approach. Children were invited by their social workers to attend free dental screening sessions held across clinics in the north of the West Bank. Data were collected using the dmft/DMFT and pufa/PUFA indices. Dental pain was reported by children using the Wong-Baker FACES® pain scale. Data were analysed using SPSS Version 22.0. Data were collected for 177 children aged 4 to 18 years. Caries prevalence was 95.5% with only eight children presenting clinically caries-free. The sample had a dmft of 3.88, and DMFT of 3.44. The Care Index was calculated at 0.1 (mft/dmft). Clinical consequences of caries were identified in 64% of the sample, with a mean pufa score of 2.12, and a PUFA score of 0.55. Dental pain was experienced by 45% of children. Deprived children living in the West Bank experience high levels of untreated dental caries, with significant clinical consequences and self-reported pain.

Background We aimed to investigate the molecular basis of β-Thalassemia intermedia (TI) in the West Bank region and its management practices. Methods This was a case series multi-center study and included 51 cases of TI. DNA sequencing was used to analyze β-globin gene mutations. Common α-globin gene mutations were screened by Gap-PCR (−α3.7, −α4.2, −-MED, αααanti3.7) or DNA sequencing (α2-IVS II 5 nt del). XmnI -158 C > T polymorphisms of Gγ-globin gene was determined by RFLP-PCR. Results Seven β-globin gene mutations were observed, namely IVS-I -6 C > T, IVS-I-110 G > A, IVS-II-1 G > A, IVS-I-1 G > A, Codon 37 Trp > Stop, beta − 101 and IVS-II-848 C > A. Ten genotypes were observed. Homozygosity for IVS-I-6 accounted for the majority of TI cases with a frequency of 74.5%. The second common β-globin gene genotype was homozygote IVS-I-110 G > A (5.8%) and homozygote IVS-II-1 G > A (5.8%). The remaining seven genotypes were each detected in about 2% of patients. α-Thalassemia mutations were seen in five patients (9.8%), and included (−α3.7, αααanti3.7 and α2-IVSII-5 nt del). XmnI polymorphism was observed in four patients (7.8%), three homozygotes and one heterozygote. Conclusions Homozygosity for the mild β-globin gene IVS-I-6 allele was the major contributing factor for the TI phenotype among the study subjects. The role of XmnI SNP and α-thalassemia mutations in ameliorating the TI phenotype was observed in few patients for each factor. The beta − 101 C > T mutation was diagnosed in one patient in homozygote state for the first time in Palestine.

The 2017 West Bank Municipal elections were framed by locally based non-governmental organisations and the Palestinian Authorities – albeit to a lesser extent – in terms of the desirability of increasing female participation in them in two particular ways: participation as representatives and participation as voters. Both aspects of participation were supported by extensive radio campaigns conducted by locally based non-governmental organisations. The effectiveness of these campaigns and the approaches used form the basis of this article. Using a mixed-methods approach consisting of both quantitative and qualitative data, it concludes that radio has endemic socio-technical advantages for reaching women, particularly in conflict-affected areas, and that broadcasting content aimed at women by women is essential in terms of increasing their representation and voting.

Objectives Worldwide, hemodialysis (HD) patients are increasing every year, including Palestine. Dialysis fluid contamination due to the use of unpurified water is a common problem worldwide. Chemical and microbiological contaminants in the dialysis fluid could cross the dialyzer membrane and cause harm to dialysis patients. The objectives of this study were to evaluate the water quality used in centers in the West Bank, Palestine. The outcomes of this study will reflect the water purification system situation and come up with valuable recommendations to health decision makers. Study design This is a laboratory-based study that covered all dialysis centers in the West Bank, Palestine. Methods Water samples were collected from all dialysis centers, and the samples were tested chemically and microbiologically according to the standard international and pharmacopeial methods. Results The results showed that the water quality in most dialysis centers did not comply with the minimum requirements of HD water. Microbiological contamination was detected in 12.5% of the dialysis centers. The test for chloride failed in 87% of the dialysis centers. Moreover, tests for conductivity, total organic carbon (TOC), and lead were not within the allowed limits in all the dialysis centers. Conclusions Our study revealed evidence of chemical and bacterial contamination in the dialysis centers in Palestine. The outcomes of this study showed an urgent need for immediate steps to be taken by the concerned authorities to improve the water quality used in Palestinian HD centers.

In the past, Agriculture has played an important role in the life of Palestinians. It was the cultural and traditional livelihood in Palestine. It was also a prevailing economic activity for the majority of the Palestinians, a source of pride, and a significant key for their survival in the economic hardships. However, the importance of agriculture has declined recently due to the economic transformation in the West Bank. For this reason, this article focuses on the importance of the agriculture sector within the West Bank in the last century, and discusses the economic transformation in the Palestinian economy. It concludes that economy in the West Bank has gone through different phases which led to the negligence towards agriculture, and to the decline in its importance as a livelihood activity. It also concludes that the Palestinian economy has been significantly affected by the political changes in the West Bank. These changes have led to an economic transformation from agriculture to services sector. Furthermore, agriculture was the prevailing economic activity in Palestine, but it has collapsed slowly, and also lost its cultural and traditional importance due to the modern Palestinians concentration on relaxing, comfortable, and higher-earning jobs. In addition, the article concludes that the Israeli limitations and obstacles that are imposed on the Palestinians in the West Bank threat the agriculture sector and limit its performance in food security and labor force. This leads the Palestinian economy to be susceptible to any internal and external shocks and political instability.

This exploratory study introduces a human security framework to examine the challenges that journalists face from daily professional and societal constraints and pressures when attempting to fulfill their role to inform the public in areas of conflict. The research focuses on the influences on Palestinian journalists in one of the most challenging regions in the world for independently reporting the news. Our framework includes seven dimensions of human security: personal, organizational, community/societal, economic, political, geographic, and infrastructural. Our study found that the Palestinian media are military targets, and journalists face direct and indirect censorship by the Israeli government as well as the Palestinian Authority and Hamas. Although we have adapted this framework for the Palestinian case in particular, the spheres of these influences on human security would likely pertain to other insecure situations for journalists. Applying this framework to journalism studies could open new avenues of academic discovery to analyze human security beyond violence, safety, and risk. Our main contribution, we suggest, is building out a human security framework for academic journalism studies in contested, conflict-prone, and post-conflict areas around the world.

Background The structure, function, and capacity of the health care system in the Occupied Palestinian Territories (OPT) had been largely shaped by the complex political history of the country. Since the establishment of the Palestinian Authority in 1994, the reform efforts were subsidized much by the international aids to rebuild the country’s institutional capacity. No previous studies have provided a realistic evaluation of Palestinian achievements in the conduct of public healthcare, we examine the relative productive efficiency of public hospitals (their managers’ success in the usage of resources) during 2010–2015 within West Bank and Jordan. Then, we estimate the efficiency of policies within which managers operate (the program efficiency) across the two countries. Methods We employ the Data Envelopment Analysis (DEA) models to distinguish between within-country managerial efficiencies and public policy “program” efficiencies across the two countries. The study follows two key steps, the first step evaluates managerial efficiencies and explores trends in performance within each country. Then, we examine the program efficiencies across the two countries. Results Public hospitals improved their year-specific overall efficiency from 75 to 80% in the West Bank and from 78 to 86% in Jordan in 2010 and 2015 respectively. Changes in efficiency are driven by scale effects in West Bank and by managerial enhancements in Jordan. Program efficiency in West Bank outperformed Jordan during 2010–2012, there was no significant difference in mean program efficiencies between the two countries during 2013–2015. Conclusions This work addresses a gap in the DEA literature by empirically investigating the efficiency of public hospitals as distinct from program efficiency in a developing country, namely, Palestine. Findings stimulate hospital managers to enhance potential improvements, policymakers to allocate resources, and international donors to focus on the right adoption of new technology to get better benefits from their considerable investments in public hospitals.

Advances in early diagnosis, treatment, and postoperative care have resulted in increased survival rates among children with congenital heart disease (CHD). Research focus has shifted from survival to long-term follow-up, well-being, daily life experiences, and psychosocial consequences. This study explored the everyday experiences of children with CHD and of their parents living in the Palestinian West Bank. Interviews with nine children aged 8 to 18 years with CHD and nine parents were analyzed using content analysis. The overall theme that emerged was facing and managing challenges, consisting of four themes: sociocultural burden and finding comfort, physical and external limitations, self-perception and concerns about not standing out, and limitations in access to health care due to the political situation. To provide optimum care for children with CHD and their parents, health care providers and policy makers must understand the negative consequences associated with sociocultural conditions and beliefs about chronic illness.

Background Pain continues to be a prevalent yet undertreated problem among cancer patients. Achieving adequate control of cancer pain is influenced by physicians’ knowledge and practices, which have been found to be inadequate by many studies. In this study, we aimed to examine knowledge and practices, as well as perceived barriers relating to the management of cancer pain among Palestinian physicians. Methods This cross-sectional study took place at eight hospitals in the northern West Bank in Palestine. A questionnaire was developed and distributed to physicians who were responsible for the care of cancer patients. The questionnaire assessed knowledge, perceived barriers, assessment practices, pain documentation, and delaying processes relating to cancer pain management (CPM). Results In total, we analysed 109 questionnaires. The mean age of the participants was 32.3 ± 7.0 years and 73.4% had less than 10 years of professional experience. After analysing the data, we found physicians’ knowledge to be inadequate, with a mean knowledge score of 6.2 ± 1.9 out of 14. The barriers that were perceived by the highest percentages of physicians to affect CPM were inadequate pain assessment (89%), insufficient experience (79.8%), and insufficient knowledge (76.1%), all of which are staff-related. However, 65% reported assessing pain on every round and 70% asked about all items related to the nature of pain. Finally, obtaining opioids from the pharmacy was the most recognized delaying step in CPM. Conclusions Despite reporting good practices, physicians showed substantial knowledge deficits regarding CPM. Besides, many barriers appear to impede effective CPM. Therefore, appropriate educational programmes and policy changes are recommended in order to improve professional performance as well as patient care.

BackgroundBrucellosis in Palestine continues to be a significant public health problem due to its impact on the human health, as a result of the high prevalence level of infection in livestock especially in sheep and goats. The purpose of this research was to investigate the epidemiology of human brucellosis in the West Bank over the past 20 years with a focus on recent trends in disease incidence from 2010 through 2020. MethodsWe conducted a long-term descriptive epidemiological study based on the Palestinian Ministry of Health records on human brucellosis from 2000-2020.ResultsThe total number of cases reported in this period was 7935 patients and the average annual incidence rate (AAIR) was 9.4 cases/105 population. Hebron was the most endemic among all studied governorates.The AAIR ranged from 17.9 in 2000 to 15.7 cases/105 population in 2020. The AAIR markedly decreased from 17.9 in 2000, to 2.9 cases/ 105 populations in 2012. A dramatic increase in human cases started from 2013 onwards to mark a peak in 2016. Higher incidence was reported in male (57.1%) and among the age group 11-20 years (29%). A higher number of cases was reported during April, May and June with the highest peak recorded in May, and subsequently exhibiting a gradual decline during autumn and winter. 2850 (62.7%) patients reported contact with animals which included 1783 (62.6%) patients who had contact with sheep, 819 (28.7%) with goats, and 248 (8.7%) with cattle.Moreover, (37.2%) of the patients reported raw milk consumption and (80.9%) reported white cheese consumption. Approximately (30%) had at least one infected household member. Diagnosis was based on the clinical picture and confirmed by laboratory tests. Patients were treated with a combination of Streptomycin and Tetracycline, or Tetracycline and Rifampicin. ConclusionsThe incidence of human brucellosis in the West Bank has markedly increased in recent years. This dramatic increase is linked to the impaired control and surveillance of the disease. Mass vaccination, regular screenings of animals for brucellosis, continuous outreach campaigns on raising public health awareness, monitoring milk and homemade dairy products pose some recommended precautionary measures of coping with the epidemic.

Delirium is a critical issue in the intensive care unit (ICU), and the correct diagnosis and treatment of this disorder by the ICU team are doubtful on many occasions due to a lack of information. This research is intended to test the awareness and control of ICU delirium by the ICU nurses. A nonexperimental, quantitative, descriptive, cross-sectional study was conducted using a previously adopted and translated to Arabic and validated questionnaire. The sample include nurses who work in ICUs of 10 Palestinian hospitals (private and public) located in the West Bank and Jerusalem participated in this study; each gave consent to be part of this study. Approval was received from the Palestinian Ministry of Health and the Ethical Committee at Birzeit University. Version 19 of the Social Sciences Statistical Package (SPSS) software was used to analyze the data. The results showed that ICU nurses hold moderate to low levels of knowledge and lack of adequate clinical experience to handle delirium. Delirium is a common complication in the ICU that increases morbidity and mortality and increases the length of ICU stay, therefore the cost of health care rise and the quality of life is decreased. In clinical practice, there are no assessment guidelines and protocols for patients with delirium.

In highly water-poor areas, rooftop rainwater harvesting (RRWH) can be used for a self-sustaining and self-reliant domestic water supply. The designing of an optimal RRWH storage tank is a key parameter to implement a reliable RRWH system. In this study, the optimal size of RRWH storage tanks in the different West Bank governorates was estimated based on monthly (all governorates) and daily (i.e., Nablus) inflow (RRWH) and outflow (domestic water demand, DWD) data. In the estimation of RRWH, five rooftop areas varying between 100 m2 and 300 m2 were selected. Moreover, the reliability of the adopting RRWH system in the different West Bank governorates was tested. Two-time series scenarios were assumed: Scenario 1, S1 (12 months, annual) and scenario 2, S2 (8 months, rainy). As a result, reliable curves for preliminary estimation of optimal RRWH storage tanks for the different West Bank governorates were obtained. Results show that the required storage tank for S1 (annual) is more than that of the S2 (rainy) one. The required storage tank to fulfill DWD is based on the average rooftop area of 150 m2, the average family members of 4.8, and the average DWD of 90 L per capita per day (L/c/d) varies between (75 m3 to 136 m3) and (24 m3 to 84 m3) for S2 for the different West Bank governorates. Further, it is found that the optimal RRWH tank size for the 150 m2 rooftop ranges between 20 m3 (in Jericho) to 75 m3 (in Salfit and Nablus) and between 20 m3 (in Jericho) to 51 m3 (in Jerusalem) for S1 and S2 scenarios, respectively. Finally, results show that the implementation of an RRWH system for a rooftop area of 150 m2 and family members of 4.8 is reliable for all of the West Bank governorates except Jericho. Whereas, the reliability doesn’t exceed 19% for the two scenarios. However, the reduction of DWDv is highly affecting the reliability of adopting RRWH systems in Jericho (the least rainfall governorate). For instance, a family DWDv of 3.2 m3/month (25% of the average family DWDv in the West Bank) will increase the reliability at a rooftop area of 150 m2 to 51% and 76% for S1 and S2, respectively.

The availability of safe drinking water and the proper management of wastewater in healthcare facilities are important pillars for maintaining safety of workers, patients, and visitors and protecting human health and environment. Water and sanitation services at 495 healthcare facilities in the West Bank of Palestine are assessed using the results of PCBS and MoH (2014) survey study. Services are reassessed after the COVID-10 pandemic using personal interviews with experts from healthcare facilities, regulatory authorities, and service providers. The results show that 92.1% of healthcare facilities were connected to public water networks, 12.9% of them purchased water tanks, and 10.8% of them depended on harvested rainwater which may cause contamination and waterborne diseases. Regardless the source of freshwater, the water quality has to be regularly examined and compared to local guidelines and international standards for health promotion. Almost 63.4% of healthcare facilities were not connected to wastewater networks and used either tight or porous cesspits. Once these cesspits are filled off, wastewater is randomly disposed into nearby valleys causing adverse environmental impacts on air, water, and land resources. Medical wastewater of hazardous substances should be treated before discharged to wastewater networks. Experts assured that although heightened procedures have been made by service providers to curb the spread of the COVID-19 disease, yet, more consistent protocols and stringent procedures are crucial. There have not been any new directives or procedures regarding the management of water supplies and wastewater services in the healthcare facilities. Stakeholder collaboration can help prevent the COVID-19 disease.

Background Exposure to violence in youth may be associated with substance use and other adverse health effects. This study examined cigarette smoking in two middle-income areas with different levels and types of exposure to violence. Methods Association of exposure to verbal and physical violence with cigarette smoking in the West Bank oPt (2008) and in Jujuy Argentina (2006) was examined using cross-sectional surveys of 14 to 17-year old youth in 7th to 10th grade using probabilistic sampling. Results Violence exposure rates were more than double for Palestinian girls (99.6% vs. 41.2%) and boys (98.7% vs. 41.1%) compared with Argentinians. The rate of current cigarette smoking was significantly higher among Argentinian girls compared with Palestinian girls (33.1% vs. 7.1%, p Conclusion Findings highlight the importance of producing context and gender specific evidence from exposure to violence, to inform and increase the impact of targeted smoking prevention strategies.

Saliva is a biofluid that can easily be obtained and used for biomonitoring lead levels in occupationally and environmentally exposed individuals. The aims of this study were to determine salivary lead levels among workers in different industrial areas in the West Bank of Palestine and investigate the association between sociodemographic and occupational characteristics of the workers and their salivary lead levels. Salivary samples were obtained from workers in different industrial areas in metal-free polyethylene tubes. The samples were analyzed for their lead contents using a pre-validated inductively coupled plasma-mass spectrometric method. A total of 97 salivary samples were analyzed. The median salivary lead level was 1.84 μg/dL an IQR of 5.04 μg/dL. Salivary lead levels were significantly higher in workers who were 40 years and older (p value = 0.031), had 3 children or more (p value = 0.048), worked in repair workshops (p value = 0.012), worked in industrial areas for 20 years or more (p value = 0.048), did not consume fruits on regular basis (p value = 0.031), and smoked for 30 years or more (p value = 0.013). Multiple linear regression showed that smoking of 30 years old or more was a significant (p value

BackgroundPediatric acute lymphoblastic leukemia (ALL) is the most prevalent type of cancer among children. This study was conducted to describe and correlate the clinical characteristics and outcomes of treatment of patients with pediatric ALL in the main referral hospital in Palestine. MethodsIn this single-center, retrospective, observational study, paper-based and electronic medical records of patients with pediatric ALL who received induction chemotherapy were reviewed. The sociodemographic variables, details of patient history, findings of physical examinations, daily progress notes, bone marrow biopsies, flow cytometry, and cytogenetics of patients were collected. ResultsComplete data of 69 patients were included in this analysis. The majority (79.7%) of the patients had B-ALL phenotype, 22 (31.9%) had abdominal pain, 37 (53.6%) had fever, 30 (43.5%) complained of bone pain, 50 (72.5%) had pallor, 9 (13.0%) had anorexia, 34 (49.3%) had hepatomegaly, 34 (49.3%) had splenomegaly, and 15 (21.7%) complained of bleeding symptoms. After induction chemotherapy, remission was experienced by the vast majority of the patients and 5 (7.2%) experienced relapse after receiving chemotherapy. The vast majority of the patients (96%) had CNS status 1, 1.4% had CNS status 2, and 2.9% had CNS status 3. Cytogenetics for patients with B-ALL phenotype indicated that 10 (18.2%) patients had t(12,21) translocation, 5 (9.1%) had hyperdiploidy, 4 (7.3%) had t(1,19) translocation, and 2 (3.6%) had t(9,22) translocation. The initial white blood cells (p value < 0.001), absolute neutrophils (p value = 0.011), and hemoglobin (p value < 0.001) were significantly lower for patients with B-cell ALL. Platelet counts were significantly lower (p value = 0.012) in patients with splenomegaly and those with bleeding symptoms (p value = 0.008). Presence of pollar was positively associated (p value = 0.035) with T-cell ALL. Presence of hepatomegaly was positively associated (p value < 0.001) with splenomegaly.Conclusion Overall, this study provides insights into the clinical characteristics and outcomes of induction chemotherapy in Palestinian patients with pediatric ALL. The characteristics of ALL among Palestinians were comparable to their peers in the region. The outcomes of induction chemotherapy were also comparable to other published data for ALL patients.

Recently, developing sustainable public transportation systems has been highlighted by decision makers and transportation agencies, due to the development of urban areas and the related environmental problems. Implementing new vehicle technologies has been introduced as an appropriate alternative to the conventional taxis. Hybrid electrical vehicles (HEVs) have been the potential candidates for replacing the conventional taxis, since they are more eco-friendly than conventional ones and even more reliable than electric vehicles (EVs) as a mode of public transportation. In this study, current and future environmental impact assessments have been determined for the taxi fleet in the West Bank, Palestine, and the implications of using new vehicle technologies (hybrid taxis) as a replacement of the conventional taxi fleet have been investigated. In order to perform this study, firstly, the data of the number of taxis for the period of 1994&ndash, 2018 have been collected and a prediction model for the future number of taxis has been developed. The expected total amounts of consumed fuels have been then estimated. Finally, the current and the future N2O and CO2, and emissions, have been estimated and the expected influences of hybrid taxis have been determined. The results of the analysis have concluded that replacing 50% of conventional taxis with a hybrid fleet could achieve 42.3% and 28% reductions in N2O and CO2, respectively, in the next 10 years. A 395% increase in CH4 could be obtained due to the higher amount of CH4 that is produced by the gasoline combustion compared to the diesel fuel, since hybrid vehicles have gasoline-based engines (GHG in terms of CO2-equivalent could be increased by 28.2%).

This study aimed to assess treatment satisfaction and its association with medication adherence among patients with diabetes.Participants in this study were outpatients at the governmental Primary Healthcare Unit in Ramallah. Adherence was measured with the 4-item Morisky Green-Levine (MGL) questionnaire, and treatment satisfaction with the Treatment Satisfaction Questionnaire for Medication version 1.4. Glycemic control was measured as the last value of an HbA1c test, with HbA1c ≤7 considered good.Of the participants, 220 (57.9%) were classified as having high adherence to their medications, and 160 (42.1%) as having low adherence. Regarding glycemic control, 174 (45.7%) of patients had good control, while 206 (54.2%) had poor control. Satisfaction with treatment effectiveness showed a significant mean difference with adherence level (78.61 vs. 74.2; p = 0.04). Glycemic controlled patients had a higher and significant adherence mean in the global satisfaction domain (69.19 vs. 62.08; p = 0.01). However, glycemic control level had no significant differences in means of effectiveness, side effects, and convenience domains (P = 0.31, 0.49, 0.37) respectively.Treatment satisfaction level is lower among low adherence and poor glycemic control. Addressing the specific needs of these patients might be effective in improving their satisfaction, thus having a positive influence on other clinical outcomes.

Collective action by farmers including the development of cooperatives is regarded as one of solutions to overcome low productivity. This study investigates the impact of agricultural cooperative on technical efficiency (TE) and total factor productivity (TFP) of olive farms in the West Bank of Palestine. Using cross-section data of olive-growing farms in Jenin governorate, we estimated a stochastic frontier production function with inefficiency components. TFP was also estimated by residual approach. We employed propensity score matching to reduce self-selection bias in becoming a member of the cooperative. Results suggest that cooperative membership has a positive impact on TE and TFP, as joining a cooperative raises the TE by 10.16 to 10.52 percentage points. We interpret access to credits, land and productive olive seedlings, and extension services provided by cooperatives are possible pathways that affect TE and TFP. Due to the existence of huge inefficiency and low land productivity of olive farms in Jenin, we imply participation in cooperatives is an effective strategy for them to catch up with productive farms in the Mediterranean region.