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Dear Supporter,

I write to you from Gaza City six months after the end of Israel's assault on Gaza.

During the attacks it gave us a huge boost knowing that people in the United Kingdomwere sensitive to and aware of the tragic events unfolding. I would like to be able to saythat things are better and that the situation has improved, however it would simply notbe true. For many Palestinians in Gaza there is precious little hope. Families are still livingin the rubble of their destroyed homes, and they lack physical security: we are in constantfear of renewed attacks.

The Zeitoun area, in the eastern area of Gaza City, was particularly badly hit and remainsa zone of destruction, resembling something that comes out of a bad dream. Manyfamilies' homes look exactly as they did six months ago, children are returning fromschool to houses of rubble, with only planks of wood and plastic sheeting sheltering themfrom the wind and dust.

The Samouni family was devastated by the attacks. Thirty members of the same familywere killed in one day, with twenty more severely injured. I met with and heard theterrible stories of many of the surviving members living in the rubble as MAP distributedits hygiene and nutritional kits. Sadly the Samouni family's story is not so rare, manyfamilies lost fathers, mothers, children, brothers and sisters.

In this issue of Witness you will learn more about the ongoing challenges impacting onthe health of Palestinian families living in the occupied Palestinian territory and in thedevastated refugee camp of Nahr al-Bared in Lebanon.

Knowing that you are supporting us means a lot to our team here. I also know that itmeans a lot to the people of Gaza to know that they have not been forgotten.

Nawraz Abu LibdehMedical Aid for Palestinians Gaza April 2009

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Ü 1, 417 Palestinians were killed including 313 children and 116 Women1

Ü There were an estimated 2,300 Israeli airstrikes2

Ü 1,872 children and 800 women injured in the attacks3

Ü 8,000 homes were completely destroyed4

Ü 33,767 families had their houses damaged5

Ü 200,000 people were displaced, among them 112,000 children6

Ü 98% of the Palestinian children in Gaza Strip are sufferingpsychological traumas and feel unsafe7

On the 27th of December Israel launched 'Operation: Cast Lead'on the Gaza Strip, home to 1.5 million Palestinians. The attackslasted for 22 days – 8 days of airstrikes followed by 14 days ofcombined attacks by air, land and sea.

“People call this placea prison; it is not aprison because aprison in WesternEurope would be muchbetter in terms ofconditions than here”.John Ging (UNRWA)March 09

IMPACT OF THE WAR ON GAZA

1 WHO Specialized Health Mission to the Gaza strip, May 2009 2 Oxfam3 WHO Specialized Health Mission to the Gaza strip, May 20094 Oxfam Rebuilding Gaza: putting people before politics, June 2009 5 Oxfam Rebuilding Gaza: putting people before politics, June 20096 Al Mezan Centre for Human Rights – “Cast Lead Offensive in Numbers”, 2009 7 Gaza Community Mental Health Programme – “Death anxiety, PTSD, Trauma, grief, and

mental health of Palestinians victims of War on Gaza”, 2009

The most serious health needs for Palestinianrefugees in Lebanon are of those living in the devastated refugee camp of Nahr al-Bared.Located on the outskirts of Tripoli in the northof Lebanon, 82% of camp buildings in Nahr al-Bared were demolished and tens ofthousands of refugees were displaced due to the fighting in 2007.

With camp reconstruction proceeding at a snail's pace,one of MAP's projects is addressing the health needsof vulnerable young mothers. This is done on the basisof an integrated care model including healtheducation, health promotion, home-based support andaccess to professional clinical services.

MAP knows that improving a child's chance ofsurvival, health and development, particularly forchildren at risk, born either premature or with adisability, is dependent on the quality of theinteraction between the parent and child. Whilerefugees remain displaced in temporary housing, thereis a continued negative impact on their health.Frequent bouts of illness, watery and bloody diarrhoea,viral hepatitis, fevers and intestinal infestations alllimit children's opportunities to explore and learn, thisduring a period in early childhood is critical fordeveloping basic intellectual and social skills.

To ensure both success and sustainability, MAP'sproject utilises community-based health initiativesdirected at pregnant women and infants. One of the core components – a community outreachnursing team comprising of midwives and nurses – is successfully working from a well-resourced clinic which provides adequate space for the variety of activities.

Dr Ali Dakwar, MAP's project co-ordinator, is based inthe clinic together with a part-time paediatrician, anadministrator and ancillary staff. Dr Ali told MAP howthe midwives work alongside MAP's communitymothers scheme to “promote a sustainable approachto health through education and empowermentcombating the effects of child stunting. In particularnutritional courses are critically important inprotecting the health of the next generation".

Newborn paediatric care is also available in the clinic.The team is providing coverage which currently standsat just over 50% of the patients accessing UNservices. Between January and April 2009 the projectstaff have carried out 947 home visits to 442 families.

HELPING FAMILIES IN NAHRAL-BARED CAMP, LEBANON

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Some of the key outcomes of this project's workto date include:

n Managing and containing nutritional deficienciesand anaemia, which are wide spread amongpregnant and post-natal mothers.

n Safe motherhood practices are being embedded in the community. This has required a capacity-building approach which has involved cooperationwith other NGOs in the field.

n Maternal and child health are supported throughhome nursing interventions and support.

n The nutritional status of children at risk and theirfamilies is being improved through currentpromotion of exclusive breastfeeding. Thisrequires continued training and support of staff.

Mothers explained how home visits were welcomeand that they appreciated advice and the time takenper visit. Housing is the current priority for families aswell as an expansion of services offered at the clinicto include facilities for the delivery of babies.

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However, one of the critical issues for people referred has been the delay in the reconstruction ofNahr al-Bared camp. There is the widespread viewthat the temporary shelters will become permanenthomes. There was almost unanimous criticism of these 'temporary' shelters, described as grosslyinadequate and inhumane, which include convertedshipping containers that are unbearably hot in thesummer months.

Clearly the main determinants of refugee health in Nahr al-Bared camp will require longer termimprovements in housing and environmentinfrastructure. Put simply while refugees continue the ongoing struggle to rebuild their lives whilstsurviving in temporary housing, their health will be at serious risk.

With the world's attention focused on Gaza, thesituation for Palestinian families living in the rubble of Nahr al-Bared is often forgotten. MAP will continueto work in Nahr al-Bared to protect the health ofvulnerable young mothers and their newborn children.

To learn more about MAP's projects in Lebanon visit: www.map-uk.org/regions/lebanon/

Ramadan, the Islamic holy month, will start inAugust. During this special month Muslims fastthroughout the sunlight hours, and alter eatingpatterns especially for staple food items such asbread, nuts, fruit, and cheese which provide importantnutrients to maintain good health. These food itemsare normally expensive and with greater demandover Ramadan, prices increase and place animpossible economic burden on family households ofvery limited or no income. Considering the highlevels of food insecurity in Gaza, and that mostfamilies are reliant on food aid, the need for foodassistance during Ramadan for the most vulnerablefamilies is of particular importance. In the aftermathof the war on Gaza, and with the ongoing blockade,MAP will be increasing the number of familiesreceiving support with food parcels during Ramadan.

MAP met with long-term supporter Haleem Kherallah, who was born in Gaza, todiscuss what Ramadan means to Palestiniansliving there.

“Ramadan is an incredibly special month forPalestinian families. The whole pace of life slowsdown and you spend lots of time with your familyand loved ones.

The days start early, and the whole family wakes up at around 4am. If they're not woken by the call to prayer then they will be woken by aneighbourhood drummer who makes the rounds!After a light breakfast before dawn we go to work,leaving early at 2pm to return home. Then we're offto the market with the children to buy food, it is aspecial feast and families across generations cometogether in one room.

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As a child I remember never wanting Ramadan tofinish. Despite the difficulties of fasting the eveningswere always filled with celebration. I would beshowered with kisses from aunties I hadn't seensmile for months, and as to get angry is to break fastI could never get in trouble! Even bed time rules wererelaxed as the family gathered round to watch thespecial Ramadan soap operas.

Today, living in London it is hard to enjoy Ramadanwithout thinking of the suffering of those Palestiniansstruggling to live with dignity in Gaza. Despite the

horrors of the recent attacks, Ramadan allows peopleto come together in family solidarity which is strongerthan any occupation.

I continue to support MAP's annual programme todistribute food parcels to the poorest families in Gaza– families who for much of the year have littleguarantee of clean water and are blockaded fromreceiving many different types of food”.

MAP was a recent co-signatory to a letter signed by38 aid agencies protesting the two year blockade ofGaza. For more visit www.map-uk.org/news

RAMADAN IN GAZAINTERVIEW WITH HALEEM KHERALLAH

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Suhair holds her young sons close as they bothwriggle in her arms. 'My two boys cannot walkalone, and they both have problems speaking',she says. 'It is a difficult situation.'

Six year old Sharif and his five year old brother Ahmedboth have cerebral palsy. The brothers need twenty fourhour care, including intensive physiotherapy tomaximise their movements and help them remain asphysically able as possible. Their mother Suhair liveswith her husband and her nine children in animpoverished area of Rafah city, in the southern GazaStrip. Until April last year, Suhair was struggling to cope with her sons' complex needs, but now she hasfound support through an innovative local associationthat teaches physiotherapy skills to mothers of disabled children in Rafah so they in turn can supporttheir own children.

The Ameera Association was set up by a local womanfrom Rafah, Akhlam Ferwinaa, in response to the needsof her own physically disabled daughter. With thesupport of MAP, Akhlam and her team are now training240 mothers of disabled children in Rafah to administerdaily physiotherapy to their children.

'This project is vital because instead of working short-term with the children, we are giving long term supportto their mothers who learn how to support their ownchildren', says Akhlam. 'We have a lot of mothers onthe waiting list to join our project.'

Suhair and her sons joined the Ameera Associationphysiotherapy project last year, and attendphysiotherapy training sessions twice a week, plusspeech therapy sessions. One of the association projectworkers also visits them at home on a regular basis foradditional support. 'I can now do all the physiotherapyfor my two boys myself', says Suhair. 'We also learnother practical skills – how to toilet our children, andnew ways to play with them.' She says both her sonsare now more physically mobile, and that attendingspeech therapy sessions has made a huge difference totheir communication skills. 'Ahmed only used to say'Baba' ('Daddy') but I've learnt to encourage them torepeat words after me - and now he says everything!'

Whilst Israel maintains its blockade and closure of theGaza Strip, resources for disabled children like Sharifand Ahmed continue to be absolutely minimal, whichplaces more strain on their families. For their mother

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Suhair, one of the most important things about theAmeera Association project is the social support shereceives both from the workers and other local motherswho have disabled children. 'It is really good toexchange experiences with other mothers like me' she

says. 'We have taken our children out together to thebeach, and I'm not shy to take my boys out now. We'vebeen going to the Ameera Association for a year, and ithas made a real difference to all three of us.'

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A family in Gaza sitamongst the rubble of their home.© Maan Images / Hatem Omar

MAP’s Rapid ResponseProgramme providednutritional & hygienesupport to children under5, families with childrenand young adults withdisabilities.

51,000 vulnerableresidents of Gazabenefitted from the kits at a time of critical need.

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As the bombs fell on Gaza, Tamara Ben-Halim, atwenty-three year old student from London, joined the millions in the UK whowatched on in horror and disbelief.

Much closer to the events was Tamara's mother Lubna,who was in Jordan and described to MAP "the torrentof disbelief, anger and helplessness at the daily sightsof murdered families, the high number of children inthe victims. An overwhelming state of stupor engulfedthe people in what was an undeclared public wake”.

Meanwhile back in London Tamara and her cousin Luludecided to transform their feelings of frustration andhelplessness by doing something positive to help. Luluhad a very personal connection to the unfoldingcarnage in Gaza: her parents are originally from thebeleaguered territory and she watched helplessly fromabroad. Tamara spent weeks during and after theassault working as a volunteer in MAP's London office,helping the team support the field offices in the WestBank and Gaza whose work was saving the lives andsafeguarding the health of thousands of Palestinians.

By February, Lulu and Tamara decided to raise £100,000to support MAP's work in Gaza. To do so the pairdecided to take on the challenge of cycling fromLondon to Paris, raising not only funds but alsospreading awareness of the critical situation in Gaza.

Tamara's mother spoke to MAP about herdaughter's challenge:

“When I learned that Tamara and some friends haddecided to form this charity cycle, I was needless to saythe happiest mum, who took great pride not only in herdaughter but in a whole inspiring generation who putwords into action, speaking volumes and reaching outto others who have been endlessly victimized. It isthrough such acts of altruism that one hopes that thedeaths of innocents will never be in vain".

Training has been no easy matter. Tamara could initiallybarely balance on a bike and suffers from mild asthma:her longest cycle previous to the Paris challenge wastwenty minutes long! However after hundreds ofspinning classes and hours of training at the gym,

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FAMILIES IN THE UK REACTTO EVENTS IN GAZA FUNDRAISING STORY

Tamara was ready to take on the 290 kilometre ride,the equivalent of over seven times the length of theentire Gaza Strip.

Through their tireless efforts, Tamara and her teamrecruited twenty-six cyclists to join them on the ride.Included in the team was renowned Israeli historian Avi Shlaim, author of 'The Iron Wall' and his wife Gwyn. Tamara told MAP that she hopes her efforts canbe replicated across the country; “the only way tocounter the frustration of witnessing such events is toget out and do something about it here that can effectreal change”.

To learn more about their cycle visit:www.cycling4gaza.com If you want to get involved and take part in fundraising for MAP, please contact our London office on 0207 226 4114 or email:info@map-uk.org

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March saw the launch of a special series onHealth in the Occupied Palestinian Territory inThe Lancet, one of the world's leading medicaljournals. This publication is the culmination of

over two years of work by Palestinian academicsand their international counterparts, and was ledby MAP's partner, the Institute of Community andPublic Health of Birzeit University.

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HEALTH IN THE OCCUPIEDPALESTINIAN TERRITORY by the current extraordinary circumstances of

occupation, siege and invasion.

The official launch, held at the Royal College ofPaediatrics and Child Health, brought together a widerange of international academics, health specialists andadvocates. Drawing together a diverse and internationalaudience from the health, development and politicalsectors, this conference considered the key issues facedby Palestinians in the region and how to take therecommendations of the Lancet series forward.

Building on this launch, MAP also held a conferenceentitled: Health under Occupation: Health Under Fire.With the series being published in the shadow ofIsrael's assault on Gaza, MAP's conference highlightedthe key findings of the Lancet series but also focused onmore recent health-related violations in Gaza.Physicians for Human Rights-Israel presented findingsincluding the targeting of medical personnel andequipment, while the World Health Organisationpresented their initial assessment of health needs forGaza after the conflict.

MAP will continue to support the capacity of localpartners to initiate such important research, and sustainthe momentum for policy change following the series.

The full text articles of the Lancet series on Health inthe Occupied Palestinian Territory are available onMAP's website at: www.map-uk.org/projects/

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As MAP wrote in the edition the health and welfare ofPalestinians within the occupied territory has beensecondary to powerful outside interests.

The series looked at the main determinants ofPalestinian health, the most powerful being the Stateof Israel, whose economic, political, military andterritorial superiority continue to be applied to bothGaza and the West Bank. However, the Lancet papersalso considered the lesser, yet significant, power thatinternationally-funded agencies can exert over thedirection of health development in the region; thecombined activities of such organisations, despite hugefinancial investment, can lack co-ordination andcoherence. Furthermore, the Palestinian Authority,which has lacked the ability to develop a coherenthealth system, has failed too often to rise aboveserving factional interests.

In this way, the series of articles describes the morecomplex background of a strangulated Palestinianeconomy, gross restrictions on ordinary movement anda pervasive environment of intimidation, uncertaintyand insecurity, in which attempts to establish acoherent health system are set to fail. The occupiedPalestinian territory is unique, not only for being underexternal military and economic control, but alsobecause of the 40 year duration of these circumstances.This series of Lancet articles illustrates the many waysin which the Palestinian right to health is compromised

their children. The hanger-like structure ischaracterised by a complete absence of actual people, instead automated metal controls theconveyor belt of humanity that slowly makes theirway through.

Once through the checkpoint, travelling around the West Bank is a sharp awakening to what anoccupation really looks like. The territory is a spiderweb of roadblocks, checkpoints and prohibited areas. Driving to visit a MAP project near Hebron I saw the Israeli military pull a teenager out of a public bus, where his permit papers werescrutinised in the shadow of fenced-off Israelisettlements that dominate the hilltops. Travelling near Jericho I saw whole communities of oncenomadic Bedouin struggle to get by in semi-permanent dilapidated housing.

Tragedies occur at these checkpoints. I heard thestory of Fawziya Qabb who died of a stroke inTulkarem last year when an ambulance wasprevented from travelling to her house. Her husbandspent twenty minutes trying to persuade the soldiersto let the ambulance through but to no avail.

MAP's new Programme Officer Libby Powellvisited the West Bank this June. In May theUnited Nations reported that in the West Bankapproximately 28 percent of the land over theyears has been declared as either closed militaryzones or nature reserves, where Palestinianaccess and use is either banned or restricted.

Libby spoke to Witness about her experiences of passing through the system of Israelicheckpoints that crisscross the occupied land:

As you arrive into Jerusalem you become veryaware of the system of segregation that exists.

There are different coloured number-plates signifyingwhich cars can go where, and as soon as you enterthe West Bank, the smooth paved roads are replacedby dusty potholed tracks.

My first experience of Qalandia checkpoint(controlling access between East Jerusalem and therest of the West Bank) was crowds of Palestiniansqueuing in the baking heat. Families were huddledtogether, some carrying an array of bags that wouldget trapped in the automated cattle grid gates thatwould close without notice, separating mothers from

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SPEAKING OUTLIBBY POWELL“RESTRICTING HEALTH IN THE WEST BANK”

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At a paediatric advanced lifesaving training session,where MAP works with the Royal College ofPaediatrics and Child Health and Juzoor in traininghealth practitioners in advanced lifesaving and neo-natal skills, I saw how MAP's projects have adaptedto the occupation. Living with ever-presentconstraints means 'satellite training' is crucial:training doctors and nurses who work in marginalisedareas that can gain confidence in treating caseslocally and not having to run the gauntlet of dailyhold-ups and humiliations that characterisetravelling through the West Bank.

To learn more about MAP's projects in the West Bankvisit http://www.map-uk.org/regions/opt/projects/

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Thank you from the entire team at MAP for yourgenerous support. With your help we were not onlyone of the first international aid agencies to respondto the recent war on Gaza, but we never lost sight of our long-term programmes helping to protectPalestinian peoples’ right to health in the oPt and Lebanon.

Our work would not be possible without you.

SPECIAL THANKS

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Registered Charity, Number 1045315.

33a Islington Park Street, London, N1 1QB

DONATIONHOTLINE020 7226 4114

Cover: Jabaliya Refugee Camp, © Maan Images

Donate online at www.map-uk.org