Background: Chronic diseases are considered the greatest public health concern globally, and contributor to a large burden of disease in developed world, and increasing rapidly in developing countries as well as Palestine. Where, Palestineis experiencing an epidemiological transition and a rapid increasing burden of chronic diseases as a consequence of rapid modifications in people behaviors. The Global Burden of Disease (GBD) project has made possible a new methodological approach and conceptual framework to estimate the burden of diseases and other health problems in populations everywhere nationally and globally.

Objective: We quantify the burden of chronic diseases using disability – adjusted life years (DALYs) for 2010 in the Palestinian healthcare sector.

Methodology: In this study, we adapted Global Burdenof Diseases (GBD) methodology for measuring the burden of chronic diseases in the main two entities of Palestinian territories, using Disability-Adjusted Life Years (DALYs) measurement. The measurement tools and their standards templates were specially designed for assessing the burden of disease, developed by the World Health Organization (WHO) to estimate and quantify the burden of chronic diseases. The study used secondary data extracted from multiple sources including Ministry of Health (MOH) materials and annual reports about chronic diseases mortalities registered in 2010 and also data about chronic diseases morbidity collected by Palestinian Central Bureau of Statistics (PCBS) Demographic & Health Survey data 2010 (DHS) performed in the West Bank and Gaza Strip.

Results: In 2010, DALYS lost due to selected chronic diseases in the current study were estimated as (60/1000 DALYs) in the West Bank while (57/1000 DALYs) in GazaStrip respectively, considering that each one DALY is thought of as one lost year of ideal healthy life. Ischemic heart disease(IHD) and hypertension contributed to the highest proportion of DALYs among males and females in 2010 in the West Bankand Gaza strip followed with cancer (lung cancer in males vs.breast cancer in females) and then respiratory disease (COPD) with small difference in rank order. There also were sex and region differences. Heart diseases specifically Ischemic heart disease (IHD) also continued to rank highly as a cause of both YLLs and mortality, followed by cancer among Palestinian populations in both the West Bank and Gaza strip for both sexes in 2010, indicating the major causes of chronic diseases burden in Palestine in 2010.

Conclusion: Our study demonstrates that heart diseases followed with cancer remains the major chronic diseases burden in the Palestinian healthcare sector in the Palestinian territories in both Gaza strip and West bank. Our study recommends that further studies using more recent data are important and needed. Additionally, our study findings indicate the need for basic intervention to tackle these burdens. In general, attention has to be increasingly paid to chronic non communicable diseases (NCDs) in the Palestinian territories.

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 (X-2) was used. The significance level was derived at p < 0.05. The data were analyzed by IBM SPSS software, version 23.

Results: Males (75.5%) have experienced more war-related injuries than females (24.5%), constituting a male: female ratio of 3.1: 1. Almost half (49.5%) of the injured victims were of the age group 20-39, followed by children and adolescents (< 20 years), accounting for 31.4%. More than half of victims were single (53.6%), 44.3% were married and the rest were widowed or divorced. The overall number of injuries was 6.4 per 1000 population, though it varied among regions. North Gaza reported the highest number of injuries (9.0) and Rafah the lowest (4.7) per 1000 population. Blast and explosion were found to be the most common causes of war injuries (72.9%). The highest proportion of injuries were reported in the upper body. Multiple body shrapnel wounds and burns (39.3%) were most frequent. Other types of injuries were multiple organ injury (24.3%), fractures (13.6%), internal organ injury and bleeding (9.8%), amputation (4.5%), abrasions / lacerations and contusions (4.8%), vision or hearing loss or both (1.9%) and respiratory problems (1.9%). The highest percentage of injuries were classified as mild (46.9%), and the rest ranged from moderate-to-severe. Almost 26% of individuals had sustained disability, and most of them had physical/motor impairment.

Conclusion: War-related injuries constitute a major problem to public health discipline and clinical medicine as well. A better surveillance system using ICD codes, and development of a comprehensive electronic data network are necessary to make future research easier and more timely.

Background: 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 subthemes 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.

BACKGROUND: Improving access to optimal quality of care is a core priority and ambitious health policy goal in spite of impediments, threats and challenges in Palestine. Understanding the factors that may impede quality of care is essential in developing an effective healthcare intervention for patient with non-communicable disease (NCD) or war-injured survivors. METHODS: Qualitative interviews were performed using a purposive sampling strategy of 18 political-key informants, 10 patients with NCD and 7 war-injured survivors from different health facilities in Gaza Strip. A semi-structured interview guide was developed for data collection. The interviews were audio recorded and transcribed verbatim. Important field notes of the individual interviews were also reported. Thematic-driven analytic approach was used to identify key themes and patterns. RESULTS: From the policy maker's perspective, the following important barriers to accessing optimal healthcare for patients with NCD or war-injured survivors' treatment were identified; 1) organizational/structural 2) availability 3) communication 4) personnel/lack of staff 5) financial and political barriers. Patient with NCD or war-injury had similar experiences of barriers as the policy makers. In addition, they also identified socioeconomic, physical and psychological barriers for accessing optimal healthcare and treatment. CONCLUSIONS: The main perceived barriers explored through this study will be very interesting and useful if they are considered seriously and handled carefully, in order to ensure efficient, productive, cost-effective intervention and delivery of a high-standard quality of care and better disease management.