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Life has deteriorated dramatically for children since hostilities broke out in Gaza. The number of children killed in July alone (36) is among the highest monthly child death tolls since the beginning of the Intifada in September 2000. While conditions have long been precarious in Gaza, the current escalation of violence is debilitating the Strip. Children are living in an environment of extraordinary violence and insecurity. Caregivers report signs of acute distress among children. Children are afraid to play outdoors and have suffered from being confined to their homes during a summer with few opportunities for outdoor activities. UNICEF-supported psychosocial counseling teams are responding to a substantial increase in the number of requests for assistance. With little or no access in and out of Gaza, the strip is cut off economically from the outside world. This not only creates shortages of food and fuel but amplifies already high poverty levels. Electricity is scarce and unreliable, significantly impacting all aspects of daily life. Stocks of essential medicines are at critical levels, and health facilities are struggling to provide adequate care. The spread of communicable disease remains a potent threat. These new challenges arise in a social-economic context wherein most government employees, including workers in the health, education and social sector, have received little pay for six months. ISSUES Health and Nutrition Gaza's health system has been hit hard by water and electricity rationing resulting from the current crisis. All hospitals and half of primary health care (PHC) facilities now run on generators, substantially increasing maintenance, fuel costs and the risk of wastage. Maintaining the integrity of the vaccine cold chain system has been a challenge; vaccines have had to be repeatedly relocated to health sites equipped with reliable power sources. Added costs for fuel, generators and maintenance will significantly hike the Ministry of Health's (MoH) budget over the coming months. Central stocks of essential drugs, infection-control disposable supplies and equipment were already low prior to the crisis and are now at critical levels. At end-July, there was less than one month's supply for 80 of the 437 items on the essential drugs list, and less than three months' for another 80 drugs. Health facilities need to immediately replenish disposables. The shortages hurt health care delivery in Primary Health Care and neonatal units, as well as mobile health clinics that reach isolated areas. Child nutritional status is threatened by household poverty and availability, quality and diversity of food products. Flour and sugar are in short supply, and prices are 15% and 33% higher, respectively, than in January 2006. Food safety is an issue because electricity shortages make it difficult to refrigerate. The proportion of stunted children is at 11% and the prevalence of anemia among pregnant women is now at 43%. Water and Sanitation Most of the 120 water wells, the 33 sewage pump stations and the 3 waste water treatment plants managed by the Coastal Municipalities Water Utility (CMWU) were powered through the power station destroyed by the Israeli Air Force on 28 June. Generators are being relied upon to power water wells and the pump stations. With 920,000 liters of fuel required each day for back-up generators to power regular water supplies, pump stations and wastewater treatment plants, long-term costs of fuel and maintenance are a major concern. The CMWU lacks the equipment and materials to repair pipe networks, as well as critical chemicals such as chlorine. A rotation mechanism is in place and access to water is restricted to a few hours per day. The lack of synchronization between water and electricity networks means that water is not being pumped to the highest floors, leaving health facilities, schools and families, particularly those with many young children, disabled or elderly members, without water or electricity. Communities living in areas prone to military incursions, especially in the South near Rafah and in the North, around Bet Lahia and Bet Hanoun, are regularly unable to access and maintain their wells. Disruptions in water and sanitation services have increased the risk of communicable disease. According to UNRWA surveillance data for Gaza, there was a 61.8% increase in the incidence of diarrhea between 10 and 16 July, compared with the same period last year, with the highest increase (122%) reported in the North. Electricity shortages also affect waste water treatment and disposal. None of the three treatment plants are functioning satisfactorily. CMWU's ability to conduct essential maintenance work on the North Gaza waste water treatment plant is restricted by recurrent shelling, exposing more than 10,000 people to the risk of non-treated waste water flooding. At times, raw sewage is being pumped directly into the sea. Municipalities have just received funds to begin processing solid waste that has accumulated in the streets, but the situation will remain a public health concern for weeks to come as the population is exposed to risks related to insects, rodents, polluted aquifers, the seashore and marine life. Child Protection and Adolescents The 36 children killed in Gaza in July is among the highest monthly child death tolls since the beginning of the Intifada. Exposure to unexploded ordnances, landmines and small arms increase the risk of death and injury, particularly along border lines and near former military and settlement areas. Caregivers say children are showing increasing signs of distress due to prolonged and extreme exposure to violence. UNICEF-supported child protection teams are reporting a large increase in the number of requests for assistance. The psychosocial centre in Khan Yunis listed seven cases in May; 45 cases in June; 166 cases in July, and 214 as of 20 August. Higher stress levels among children are driving negative behaviors that affect family and social life. Stress also undermines children's ability to concentrate and learn, thus jeopardizing their education. A high proportion of adolescents are two or three levels below their normal grade, and end up dropping out of school: girls for early marriages, and boys to join the unskilled labor force. Adolescents frequently in the direct line of violence have the most need for opportunities to acquire skills that will enable them to develop into productive citizens. Families are afraid of allowing children outdoors due to the level of violence. At one UNICEF-supported safe play area in Rafah, for example, only half the number of children were attending in July. The MoEHE and NGOs also express concern about the idea of gathering children and adolescents in one place, as this may further expose them to shelling or shooting. Of the 60 camps planned this summer in Gaza, (compared to 200 in previous years), only 10 are taking place. Moreover, youth clubs that cater to the large, vulnerable and volatile adolescent population, generally lack funding, and are poorly managed and equipped. Education Education quality continues to be a major challenge. Schools lack basic materials, and few teachers have the skills set needed to create child-friendly learning environments. Most teacher training programmes have been put on hold or cancelled because of funding restrictions. Levels of violence in schools are rising, along with drop out rates, particularly for older children. Outside classrooms, students have few opportunities for sports and recreation. During this summer many activities were cancelled due to the non-availability of funds for the schools and it has been a challenge for schools recruiting volunteers to organize children's activities in schools and communities. Most teachers have received little or no pay for half a year. Although school fees have been reduced from US$11 to US$5, many families will struggle to pay for uniforms, supplies, transportation and other needs when schools re-open in September. UNICEF Action in Gaza UNICEF's work in Gaza is based on its 2006-2007 Country Programme, dedicated to realizing Palestinian child rights to survival, development, protection and participation; as well by the Consolidated Appeals Process (CAP), which focuses mainly on humanitarian interventions based on the joint UN Needs Assessment Framework. Activities are carefully coordinated with UN agencies and relevant NGOs. Health UNICEF provides all vaccines for children in Gaza, including Haemophilus influenzae type B (HiB), which protects children from pneumonia and meningitis. UNICEF, in coordination with other partners, is supplying essential drugs and disposables for PHC clinics and neonatal wards of government hospitals. UNICEF's contribution covers needs for six months. Given the importance of ensuring a reliable source of power for the vaccine cold chain system during times of limited or no electricity, UNICEF is providing eight generators to PHC clinics and five to the Palestinian Red Crescent Society. In addition UNICEF supports the maintenance of the cold chain system. Because deaths among children occur most frequently among newborns, government hospitals will be upgraded with basic supplies, equipment, and health staff will receive training. Fifty-six PHC facilities have already been upgraded with equipment, and the staff running these facilities will now receive training on Integrated Management of Childhood Illnesses. Given the risks to public health posed by the electricity and water shortages, some 40 health educators from North Gaza, the middle area and Gaza City have been trained on food and water preservation and environmental health. They have begun conducting awareness-raising sessions through clinics and CBOs. A training programme for MoH and Ministry of National Economy staff on implementing, monitoring and testing of salt iodization and flour fortification processes has taken place, and an awareness-raising campaign is planned. Water and Sanitation UNICEF's work in the water and sanitation sector has been significantly scaled up in response to the current crisis. To respond to immediate needs, five 5,000-liter water tankers have been procured for the Coastal Municipalities Water Utility to reach neighborhoods with severed water networks. UNICEF is also supporting establishing five water wells in Gaza city, Khan Yunis and in the middle area to serve needy communities. To ensure continuous monitoring of water quality, UNICEF has procured 25 water testing kits for use by municipalities and MoH. More than 570 UNICEF family water kits (for 10 families each) have been distributed to affected communities and 667 have been pre-positioned with local authorities and other partners. Some 300 family hygiene and 700 baby hygiene kits have been pre-positioned or distributed to families affected by, or displaced due to military incursions. Education Part of UNICEF's emergency response has included supporting recreational activities that contribute to the overall educational achievements of children. In partnership with NGOs and MoEHE, 36 centres have been open 4 days a week in the mornings, each attracting around 100 students between 6 and 12 years old on a daily basis. Activities include singing, dancing, role-playing and other hands-on activities. The children benefiting live in some of the hardest-hit areas in Gaza, and are most in need of outlets for their stress, fear and frustration. Going back to school in September is critical to bringing normalcy back to children's lives. UNICEF, in cooperation with other UN agencies, is supporting the MoEHE in a Back-to-School campaign that starts in September and runs for the entire school year. The aim is to bring students and teachers back into a quality learning environment and ensure that children continue learning throughout the school year. The following supplies have been or are about to be distributed as part of the campaign: - 30,000 school uniforms - 100,000 school bags with a full complement of stationary and supplies - 500 math teaching kits, and 500 science teaching kits - 1200 recreational kits and school-in-a-box kits - 60,000 copybooks and stationary supplies for schools - 50,000 remedial worksheets - 45 sports equipment kits A social advocacy campaign to galvanize support for education within communities was launched in mid-August. Main elements include focus groups across all districts, TV and radio public service announcements, SMS messages, and media outreach. As part of the Child Friendly Schools initiative, training is ongoing for teachers and administrators on more interactive and stimulating teaching methods. This year 25 schools will also receive a broad package of learning and recreational material. To support capacity building for teachers who have little or no training, the MoEHE Gaza Teacher Education Centre will be upgraded with library books, computers and other equipment before the end of the year. Child Protection UNICEF supports five child protection teams (about 20 people each) that offer group counseling and as well as home visits / individual counseling for children in acute distress, or immediately after the occurrence of violent events. They reach approximately 8,000 children and 4,000 caregivers on a monthly basis. Approximately 4-5% of the children seen in group counseling are referred for in-depth counseling. To address higher demand, and to complement the work of the psychosocial teams, a toll-free line, 13 outreach and three socio-legal defense centres have been set up to provide counseling and referrals. The latter received 111 cases in July and 287 in August 2006. Some 100 indoor recreational kits pre-positioned with counterparts have been distributed to children confined to their homes because of violence. Throughout August, daily summer festivals provide 25,000 children with opportunities to vent stress and engage with their peers in sports, artistic and cultural activities. Mine risk education, undertaken with the Palestinian Red Crescent Society (PRCS), has reached more than 2,000 children and 1,000 parents per week since May 2006. Around 600 more children are reached with MRE printed materials each day in five summer camps. MRE songs produced by UNICEF and the PRCS were aired for 45 minutes on a local youth radio channel. Recognizing the role children play in their own protection and in raising awareness amongst their peers, UNICEF supported training on child rights and protection for groups of children in each of the five districts. Each group will design an advocacy campaign around an issue related to violence against children, and implement within their communities over the course of the school year. Adolescents Structured activities organized in 15 safe play areas in some of Gaza's most deprived or violent districts draw around 6,000 participants each month, providing much needed outlets for stress and frustration. Art supplies and sports equipment have been provided to each of the sites. Around 510 indoor recreational kits including art supplies, stationary and sports equipment have been distributed to families in high risk areas, enabling about 2,000 children and adolescents to play at home safely. Another 100 kits are pre-positioned with counterparts. Fifteen university students have received training on peer support. It is expected that these students will work with 6,600 adolescents directly affected by the conflict over five months, under the supervision of professionals. UNICEF is helping to build the capacities of six youth clubs as a way of helping address the limited opportunities for recreation and interaction available to adolescents. Life skills training was provided to 119 adolescents and 48 members of management committees set up to oversee activities. Committee members received additional training on computers and management. The youth clubs will be accessible to approximately 12,000 children and adolescents. UNICEF is setting up two adolescent-friendly learning spaces to offer non-formal learning opportunities to youngsters at risk of, or who have already dropped out of school. The spaces will include a wide range of recreational materials, along with books, computers, and a literacy program. Staff will receive extensive training. Around 800 adolescents are expected to benefit directly; the spaces will be accessible to approximately 10,000 children. BUDGET UNICEF has an integrated programme for West Bank and Gaza. The table below illustrates the work we implement in Gaza as a proportion of the integrated programme, covering both emergency and regular resources UNICEF's 2006 CAP or emergency requirement is US$22.7 million, of which US$13.8 million (60%) is directed towards Gaza. In addition, regular programme funds for West Bank and Gaza amount to US$ 11.5 million, of which US$4.3 million (40%) is for Gaza. As of 25 August, some US$ 10.8 million had been received for the CAP appeal and some US$ 6.4 million for the UNICEF Regular Programme. Accordingly, using the above formula, some US$ 9.1 million would be available for action in Gaza or 50% of total needs. Approximately US$4.2 million is in the pipeline for the CAP, but has not yet been confirmed. [ReliefWeb]