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Background War-related injury is a growing clinical and public health concern in occupied Palestinian territory, especially in the Gaza Strip. However, little research has been done into the quality of care and management of war injuries in public hospitals. We explored the perceptions of health-care workers about these factors in Palestinian health-care facilities in Gaza. Methods This was a qualitative descriptive study. Data were obtained in four focus group discussions attended at public health facilities by 30 purposively selected health-care providers, comprising 14 head surgeons, and 16 head nurses, aged 38–55 years. A semi-structured topic guide was developed by the authors for the study based on earliest literature, and was critically reviewed by a panel of experts to ensure the trustworthiness of the qualitative guide and to minimise complexity and enhance clarity of the questions for participants. Audio recordings of discussions were transcribed verbatim, translated, and analysed with a thematic analysis approach. The study was approved by the Palestinian Health Research Council and facilitated by the Ministry of Health. Findings A consensus was expressed that, despite some positive aspects in the system, fundamental changes and essential improvements were needed to advance the care and facilitation of war injury management. Some respondents had serious concerns about the health-care system, suggesting that it needs to be comprehensively rebuilt. Unanimous views were expressed about the important barriers to effective management and quality of care: shortages of resources, medicines, and funding; underuse or absence of specific and unified clinical practice guidelines; no official commitment by the Ministry of Health to adopt updated clinical guidelines; few incentives and poor motivation, poor communications; blockade and siege; division of health systems in the country; overcrowding of patients with war injuries in hospitals with limited capacity; spreading of infection due to poor cleanliness; shortages in fuel and power supply; and low wages, which negatively affected staff motivation. Respondents also reported inadequate sharing of care and cooperation between different health-care facilities. Interpretation The perceptions about barriers to management of war injuries and the quality of care provided were similar across Palestinian health-care facilities in the Gaza strip. Our findings suggest that fundamental changes and comprehensive reform of the health-care system are needed to make the care of patients with war injuries more effective and efficient. One of the important strengths of this study is that it addressed the perspective and opinions of different key health professionals, which made it possible gain deeper and better understanding of how war injuries are managed in the Palestinian health system. In addition, the outcomes of the study were based on diverse information. However, the analysis of the qualitative data may represent challenges, and be more complicated and time consuming than a quantitative approach. Funding None.

Marwan Mosleh, 1, 2 Yousef Aljeesh, 3 Koustuv Dalal, 1, 4 Charli Eriksson, 5 Heidi Carlerby, 1 Eija Viitasara 1 1Department of Health Sciences (HLV), Public Health Science, Mid Sweden University, Sundsvall, Sweden; 2Ministry of Health, Gaza, Palestine; 3International Public Health Medicine, Islamic University, Gaza, Palestine; 4Department of Epidemiology, Biostatistics, and EBM; Faculty of Medicine and Health Care, Al-Farabi Kazakh National University, Almaty, Kazakhstan; 5Department of Public Health, Stockholm University, Stockholm, SwedenCorrespondence: Marwan Mosleh Tel +970599859122Email Marwan.mosleh@miun.seBackground: Palestine, like other low-income countries, is confronting an increasing epidemic of non-communicable disease (NCD) and trend of war injury. The management of health problems often presents a critical challenge to the Palestinian health system (PHS). Understanding the perceptions of healthcare providers is essential in exploring the gaps in the health system to develop an effective healthcare intervention. Unfortunately, health research on management of NCD and war injury has largely been neglected and received little attention. Therefore, the study aimed to explore the perspectives of healthcare providers regarding NCD and war injury management in the PHS in the Gaza Strip.Methods: A qualitative study approach was used, based on four focus group discussions (FGDs) involving a purposive sampling strategy of 30 healthcare providers from three main public hospitals in Gaza Strip. A semi-structured topic guide was used, and the focus group interviews data were analyzed using manifest content analysis. The study was approved by the Palestinian Health Research Council (PHRC) for ethics approval.Results: From the healthcare providers perspective, four main themes and several sub-themes have emerged from the descriptive manifest content analysis: functioning of healthcare system; system-related challenges; patients-related challenges; strategies and actions to navigating the challenges and improving care. Informants frequently discussed that despite some positive aspects in the system, fundamental changes and significant improvements are needed. Some expressed serious concerns that the healthcare system needs complete rebuilding to facilitate the management of NCD and war-related injury. They perceived important barriers to effective management of NCD and war injury such as poor hospital infrastructure and logistics, shortage of micro and sub-specialities and essential resources. Participants also expressed a dilemma and troubles in communication and interactions, especially during emergencies or crises. The informants stressed the unused of updated clinical management guidelines. There was a consensus regarding poor shared-care/task sharing, partnership, and cooperation among healthcare facilities.Conclusion: Our findings suggest that fundamental changes and significant reforms are needed in the health system to make healthcare services more effective, timely, and efficient. The study disclosed the non-use of clinical guidelines as well as suboptimal sectorial task-sharing among different stakeholders and healthcare providers. A clear and comprehensive healthcare policy considering the gaps in the system must be adopted for the improvement and development of care in the PHS.Keywords: NCD, management, Palestinian health system, perception, war injury

Background War-related injury is a major public health concern, and a leading cause of mortality, morbidity, and disability globally, particularly in low and middle-income countries such as Palestine. Little is known about the burden of war-related injury in the Palestinian context. The objective of this study was to characterize the incidence and pattern of injuries, associated with war in Gaza Strip, from July 8 to August 26, 2014. Methods This was a descriptive study based on an injury registry at hospital facilities in the Gaza Strip. A total of 420 victims records from 2014 Gaza war injuries were randomly selected, proportionate to the size of the study population estimated across five Gaza governorates. Simple descriptive statistics were calculated to explore the frequency and percentage distribution of study variables and injury data. A chi-square test (X2) was used. The significance level was derived at p

Anaemia in pregnancy is the most common public health concern in both developed and developing worlds like Palestine. Little is known about this significant health issue. Therefore, the purpose of this study was to investigate the perception, opinions and attitudes of anaemia among refugees pregnant women in Gaza strip. A cross-sectional study was employed among a random sample of 164 women or subjects, with a response rate of 81%. The survey was conducted at UNRWA antenatal health centers at refugee camps in Gaza strip. The study was approved by United Nations Relief and Work Agency (UNRWA) health department. The study elucidated that a higher rate of women were knowledgeable and had ideas on anaemia, however, some women had inadequate knowledge on anaemia during pregnancy. There were a concern and misconception regarding some issues on anaemia such as; lack of knowledge on the effect of drinking tea on iron absorption; and on the side effects of iron pills during pregnancy. Highly positive opinions and attitudes toward anaemia were observed in most women. The study found that a high proportion of women were dissatisfied with the volume of health education sessions on anaemia at UNRWA antenatal health centers and many women had not attended or joined such sessions. In general, the study declined to find a significant differences regarding anaemia between women with and those without health education sessions on anaemia. Finally, the study suggests that, an effective and a clear health education strategy is needed in order to improve women perceptions, awareness, opinions and attitudes regarding anaemia in Palestine. Further researches are important and needed in this scope.

Background Chronic diseases are the greatest public health concern worldwide, contribute to a large burden of disease in the developed world, and are increasing rapidly in prevalence in developing countries. The aim of this study was to quantify the burden of reported chronic diseases in the occupied Palestinian territory. Methods We used the global burden of disease (GBD) approach and its templates to quantify disability-adjusted life years (DALYs). To estimate years of life lost, we used mortality data from Ministry of Health materials, and we used local morbidity data from the Palestinian Central Bureau of Statistics (heath survey 2010) to estimate years lived with disability. The study was approved by the Palestinian Health Research Council. Findings In 2010, DALYS lost due to selected chronic diseases were estimated as 60 per 1000 DALYs in the West Bank and 57 per 1000 DALYs in Gaza Strip, with each DALY defined as 1 year of optimum healthy life lost. Ischaemic heart disease and hypertension contributed the highest proportion of DALYs in men and women in 2010, followed by lung cancer in men and breast cancer in women. Respiratory disease also contributed a high proportion of DALYs, with a small difference in rank between the Gaza Strip and West Bank. Cancer was ranked the third largest contributor and respiratory disease the fourth largest contributor to DALYs in the Gaza Strip, whereas respiratory disease was the third and cancer the fourth largest contributors to DALYs in the West Bank. We also found differences by sex and region. Heart disease and cancer continued to rank highly as causes of years of life lost in the West Bank and Gaza Strip for both sexes in 2010, indicating the major causes of chronic disease burden in the occupied Palestinian territory in 2010. Interpretation The burden of chronic disease is increasing substantially in the occupied Palestinian territory, and interventions are needed to tackle these burdens. Further studies using recent data and increasing attention to chronic non-communicable diseases are needed in the occupied Palestinian territories. Funding None.