UNICEF witnesses cumulative effects of the conflict on health of Palestinian children

Palestinian boy standing against a pole watching the rubble left behind by Israeli bulldozers and tanks (Johannes Abeling)

New tensions and clashes with unprecedented levels of violence and destruction have erupted in OPT. The month of May has brought a significant further deterioration of the humanitarian situation, especially in Gaza and Rafah. Between 1 and 25 May 2004, incursions by the Israeli Defence Force (IDF) into Gaza resulted in over 40 casualties and the total demolition of 202 buildings. 2,733 people have lost their homes and their belongings during this period. Since September 2000, house demolitions by the IDF throughout Gaza have left 19,230 people homeless in the Gaza strip alone. Two thirds of this homeless population is from Rafah.

In various parts of Rafah, deliberate destruction of water and electricity infrastructure is threatening the health situation of the resident population in the absence of running water. The WHO warns of an acute threat of the outbreak and spreading of diseases in this context. Hundreds of homeless families and those fearing the destruction of their homes in the immediate future have sought refuge in several schools in Rafah. Sanitary conditions here are reportedly very poor and the risk of communicable diseases is rising from day to day. In addition to this, a long-term solution for resettling these families into new homes or temporary shelter is dim: the lack of adequate shelter is jeopardizing the right of children to education. The psychosocial impact of displacement and the loss of relatives on children is immense.

As seen in previous incursions, the access for humanitarian organizations to the most vulnerable has been denied or severely hampered by the IDF.

The worsening of the situation, especially provoked by new layers of closure, the progressing of the separation barrier as well as the renewed eruption of violence have led to the need of a fundamental review of the 2004 Consolidated Inter-Agency Appeal (CAP). The 2004 Mid Year Review (MYR) of the CAP paid tribute to the changed situation on the ground and has led to an even increased involvement of UNICEF in the areas of Health and Psychosocial care.

Although assistance provided under the CAP framework has helped to compensate for Palestinians’ inability to access basic services, the likelihood of further escalation of violence and the long-term consequences of closure, unemployment and disrupted education do appear to be exhausting Palestinians’ coping mechanisms.


Several studies completed during the last months show that we are witnessing now the beginning of cumulative effects of the conflict on the health and nutrition status of children. Beside the available data on iron-deficiency anaemia, data from a recent survey1 show that about 20% of the children under 5 have biochemical vitamin A deficiency, and additional 54% have “borderline” levels thus being at risk for vitamin A deficiency. This is due to the degradation of the existing preventive services for micronutrient supplementation, as well as to poor nutrition practices. With about half of the population being food insecure2, the nutrition patterns have been disrupted, with important effects on children’s well-being. Also, one of the most successful public health interventions - the immunization - is affected by the consequences of the conflict. Indeed, although more than 90% of children aged 18 - 30 months have received the measles and MMR vaccine, less than two thirds of them have the effective antibody protection against the measles, one of the children killer diseases3.

Also, during the Rafah siege, more than 45 new babies were born in houses, far from minimal obstetric and newborn care facilities. During the same events, and following the house demolition, the access to safe water has been considerably disrupted, with potential implications for the epidemic status. The overall population affected by the disruption of the health and water facilities is around 100,000, of which about half are children. Among the four MoH clinics, one has been considerably damaged (reduction of about 20% of capacity following damages as well as additional compression of the care capacity due to the rearrangements for trauma care). The full picture of the impact of the incursion is under assessment by the UN Agencies - OCHA, UNRWA, UNICEF, WHO, ICRC, PRCS.


A decade of effort to improve education of young people in OPT is under serious threat. Imposed mobility restrictions undermine the basic right of all Palestinian children to access education. On any given day, one third of all school-aged children are struggling to the classroom through checkpoints, earth mounts, bars and trenches. The number of schooldays lost can only be roughly estimated, but it is important to point-out, that teachers are facing the same or even worse problems in reaching school as their pupils do, and frequent losses of classes are due to the inability of teachers to reach school.


Ongoing violence, movement restrictions and a general lack of perspective in people’s lives are eroding the population’s coping mechanisms, gradually weakening children’s and adults potential for resiliency and increasing the risk for deep, long-term impact on their psychosocial well-being. Therefore, although the majority of Palestinian children have been showing great resiliency so far, psychosocial professionals working with children in the most exposed places report increasing difficulties among children to invest themselves in school and to plan for the future. In the Psychosocial Assessment published in 2003, nine out of ten parents interviewed reported signs of distress amongst their children, ranging from nightmares and bed wetting, to increased aggressiveness and hyperactivity, as well as a decrease in attention span and concentration capacity. As constant pressure on families is maintained, parents find it increasingly difficult to provide appropriate support to their children. Children’s opportunities for recreation, socialization and participation continue to be drastically reduced by the conflict and related restrictions of movement. Approximately half of the children interviewed in the Psychosocial Assessment claimed that they no longer spend time on extra-curricular activities (such as sports, playing outdoors or reading and writing).


Despite severe limitations in access across the West Bank and Gaza, UNICEF through its six Zonal Offices was able to provide an ongoing flow of assistance and assessment of the situation in areas specifically affected by conflict and violence. On top of that, UNICEF was able to re-deploy international staff from the Jerusalem Office to Zonal Offices where the need for a quick and targeted intervention arose in the wake of unrest, violence and devastation.

In the case of the disasters which took place in Gaza during the month of May, UNICEF was amongst the first agencies to send International staff on an assessment mission into the still sealed-off areas around Rafah. A quick supply of emergency supplies followed, either airlifted from the logistics hub in Copenhagen or purchased locally.


In the past 6 months, UNICEF’s interventions have addressed the most critical services for children - immunization (procurement of all vaccines and vaccine-related supplies for the routine immunization services for all Palestinian children, including the school immunization programmes, preparation for a nation-wide immunization campaign), integrated management of childhood illnesses, nutrition (development of a Nutrition-Awareness Raising Campaign aiming to develop appropriate feeding and nutrition practices, with a special focus on iron-deficiency anaemia), and early childhood care for development.

As part of the relief and recovery response in Rafah area, UNICEF, in its capacity of lead agency for health coordination in Rafah will continue supporting the District health directorate in developing and implementing the recovery plan. At operational level UNICEF plans to equip a health clinic and a maternity unit in Rafah district as part of the plan for upgrading the services. UNICEF is also providing water purification supplies and Oral rehydration salts for the prevention and control of diarrhoeal diseases.


In 2003, UNICEF, in partnership with teachers, parents, local TV stations and the Ministry of Education district directorate, developed a distance learning/Remedial Education project in Jenin, Nablus, Tulkarem, Rafah and Hebron where more than 90 percent of the students have experienced significant difficulty accessing their schools due to closure and the dangers of the journey to and from school. In response, the local community has mobilized its own educational resources, parents, and teachers, to continue providing education in spite of tight closures and curfews. By building on the existing community structures, resources and initiatives, this model has proved very successful in rapidly mobilising the local community to provide high quality distance education. In order to enable more affected children to continue their educational activities and maintain a high level of educational attainment the project is currently being expanded to more schools affected by closures. This effort will be complemented by training teachers to maximize the limited time they have with students and to reduce the impact of the conflict on their students’ learning achievement. UNICEF is currently developing mechanisms for quick delivery of teaching materials, tools for needs assessment, community participation and teacher training and evaluation.

Since January 2004 many of the currently being implemented activities have been accelerated. Lack of funding has nevertheless prevented implementation of other aspects of the response plan, including after school community activities, the development of self-learning materials, and mine risk education. Under funding and access problems also prevent implementation of UNFPA psycho-social counselling for Palestinian students.


In preparing for potential emergencies, UNICEF has set up psychosocial teams of professionals across OPT, that act as focal points for referral and mechanisms for peer support. The teams are ready to be mobilized to provide support in cases of emergency, for example following incursions, house demolitions or any other act of violence. Team members receive training on detection of psychosocial distress, referral and care, with a special focus on crisis interventions. Two teams are already functioning (Jenin and Tulkarm) and five additional ones, including three in the Gaza strip, are in the process of being established.

UNICEF is working closely with municipalities and communities at the local level to provide children with opportunities to play, interact with peer and participate constructively in their communities, for example, through the setting up of safe play areas or youth clubs. Five safe play areas, including a playground and weekly activities, are currently being set up in areas most affected by the conflict. Children are participating fully in the design of the areas and activities.

As a complementary effort to these interventions at community level, UNICEF is working at the national level with the Palestinian Authority on the creation of a national psychosocial system, including the development of psychosocial policy, law, professional standards, national capacity building plan and monitoring system.

Following the massive psychosocial impact of the recent clashes in Rafah, UNICEF is presently developing a psychosocial component for the Summer Camps, which will offer children and adolescents the possibility to deal with the trauma experienced during the incursions.


UNICEF has and will continue to advocate for the protection of all children in the midst of the current conflict. UNICEF’s advocacy efforts are aimed at the local, Israeli and international levels. At the local level, UNICEF continuously calls on the Palestinian Authority to improve the quality of services for children and to continuously strengthen their efforts in protecting children. At the Israeli level, UNICEF through bilateral meetings with key policy-makers, has called upon the Israeli Authorities to abide by its obligations to Convention on the Rights of the Child and the 4th Geneva Convention. At the international level, through various interviews, UNICEF was able to share its concerns about children in the midst of the current conflict and that children should not be targeted. Specific issues such as child detainees and the Rafah emergency were also highlighted in recent UNICEF interview with international media.


UNICEF joins its counterparts, the Palestine Authority, to express its deep appreciation for the generous contribution made by the donors. The contribution has not only helped the children and women survive under emergency situation, but also laid down some corner stones for the long term socio-economic development, from which children and women can benefit in the long run.

As part of the 2004 Consolidated Appeal for the OPT, UNICEF requested US$ 13.4 million to provide humanitarian relief to the affected children and women in the territory. To date, some US$ 1.9 million has been received.


Some of the activities requiring immediate support under the ongoing 2004 emergency programme are given below, by sector:

Health & Nutrition

  • IMCI - development of district training facilities and of the community component in, in relation with the integrated early childhood development strategy development (US$ 550,000);
  • Nutrition - development and implementation of flour fortification policy, to prevent micronutrient malnutrition and the troubles associated with the iron and vitamin A deficit (US$ 1,200,000;
  • Upgrade of maternal & child health services - to ensure the health needs in the areas isolated or closed (US$ 500,000);
  • Immunization programme (US$ 3,400,000)
  • Management Information system (US$ 42,000)
  • Support to Palestinian detainees (US$ 287,500)


  • Mine Risk Education in Summer Camps. Through extra-curriculum activities including the summer camp activities to provide mine risk education with locally developed materials or packages. The programme will be organized through hand-on or peer education and activity based (US$ 171,000)
  • Peer to Peer Education in utilizing Media. This is psychosocial education conducted between the adolescent group. Through watching special TV programme Alli Soutak and reading the articles in the Youth Times, the peers will help each other in overcoming the psychological stress generated from the living environment (US$168,000)
  • Reducing the Impact of Conflict in Learning intends to make the most effective and efficient use of potentially limited teacher/pupil contact hours and ensure a healthy psychological climate for children experiencing trauma. The project aims to support the new MOEHE Centre for Teacher Training. Such support will take the form of child-centred programme and materials development, standards setting for teacher qualification and capacity building (US$ 2,700,000).
  • Distance teaching - remedial education (US$ 1,300,000)

    Psychosocial support

  • Equip parents with basic skills on how to detect the first signs of distress among the children and how to provide them appropriate support (US$ 300,000) - parents play a crucial role in strengthening their children’s resiliency and providing them with a nurturing environment. In this respect, they need support in managing their own stress.
  • Establish 10 additional safe play areas for children in the areas most exposed to the conflict (US$ 420,000) - Opportunities for recreation, socialization and participation contribute to strengthen children’s resiliency. They are also an outlet to everyday stress and keep them away from dangerous conflict-related situations.
  • Set up 4 additional psychosocial teams across OPT (US$ 280,000) - existing teams have proven instrumental in providing emergency support to children affected by stressful experiences, such as house demolition, incursions or other violent events.
  • Peer to Peer psycho-social support (US$ 70,000)
  • Providing alternative media support as a way of outlet (US$ 40,000)
  • Establishment/reactivation of more Youth clubs (US$ 60,000)
  • Promoting life skills at schools and out of schools (summer camps) (US$ 260,000)


    1. MARAM - USAID , 2004;

  • FAO, WFP, USAID, EC, 2004
  • Survey conducted by MoH with UNICEF support, 2003.

    More Information

  • David S. Bassiouni, UNICEF OPT, Jerusalem, Tel: + 972 2 583 00 13, Fax: + 972 2 583 08 06, E-mail: dbassiouni@unicef.org; Olivier Degreef, UNICEF EMOPS, Geneva, Tel: + 41 22 9095655, Fax: + 41 22 909 5902, E-mail: odegreef@unicef.org; Dan Rohrmann, UNICEF PFO, New York, Tel: + 1 212 326 7009, Fax: + 1 212 326 7165, E-mail: drohrmann@unicef.org.

    Related Links

  • UN factsheet on children in the occupied Palestinian territories (PDF)
  • BY TOPIC: Children