Newborn health and survival in the occupied palestinian territories: A case study

Mohammad Howard-Azzeh, Nadia Akseer, Mahdis Kamali, Nour Bakhache, Zulfiqar A. Bhutta

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


In an effort to quantify gains in child survival in the West Bank and Gaza (i.e., the Occupied Palestinian Territories [OPT]), and to explore success factors and opportunities for the Sustainable Development Goal (SDG) era, this chapter examines the following: 1) levels and trends in newborn survival and stillbirths, 2) major causes of newborn death, 3) coverage and equality in essential maternal and newborn health interventions, and 4) social and contextual factors including female empowerment, conflict, state governance, health financing, and health systems and policies in the OPT. Although newborn deaths and stillbirths have decreased notably in the OPT across the Millennium Development Goal era (MDG), the OPT continues to have higher neonatal mortality when compared to its culturally similar neighboring countries (Jordan, Lebanon, and Syria). Whilst information on the exact causes of neonatal death is unavailable, the major causes of neonatal death in general are largely preventable with proven cost-effective interventions. Our analysis of life-saving interventions across the continuum of care found high coverage (>90%) in antenatal care, skilled birth attendance and postnatal care in the OPT. Suboptimal levels of coverage were noted for contraceptive use and early initiation/exclusive breastfeeding, while prevalence of caesarean section births was high. Moreover, access to improved drinking water sources in the Gaza Strip was alarmingly low (~10%). Differences according to wealth quintile, maternal education, subnational region in the OPT, and area of residence (urban, rural, or refugee camp) were minimal, except across the different governorates which varied according to indicator, governorates in Gaza typically performed poorer than those in West Bank. Evidence suggests that social determinants such as empowerment of females may be poor in the OPT; efforts to improve this should be encouraged to promote health care seeking behavior and utilization of public health services among girls and women. Governance in the OPT remains unstable and deficiencies may be detrimental to attaining the peace and security needed to maintain sound health care systems - a focus on achieving stable and effective governance in the OPT is paramount. Out-of-pocket expenditures for health are high (~40%) in the OPT and should be reduced to encourage affordable health care for vulnerable and impoverished civilians. Effective policies and strategies to improve health and survival of women and children have been adopted and endorsed in the OPT, although information on their implementation is limited. OPT appears to be adequately stocked in health workers while a shortage in neonatologists has been noted. The current state of health care provision is largely dependent on external funding and operational support, thus long-term sustainable strategizing for human resource staffing is required in the OPT. To successfully reduce preventable fetal and newborn deaths, Palestinian and international organizations must focus on increasing the allocation of resources into examining and implementing specific programmes for advancements in maternal and neonatal health. Though progress has been made in the OPT, much remains to be done. Chronic instability and conflict has an adverse impact on all aspects of the health care continuum in the OPT, particularly in areas of Gaza which has been most affected by conflict. For long-term and consistent improvement in maternal and neonatal health, it is critical that the state government, civil society and international community maximize efforts in restoring peace and stability in the OPT.

Original languageEnglish
Title of host publicationNeonatal and Perinatal Mortality
Subtitle of host publicationGlobal Challenges, Risk Factors and Interventions
PublisherNova Science Publishers, Inc.
Number of pages20
ISBN (Electronic)9781536105742
ISBN (Print)9781536105629
Publication statusPublished - 1 Jan 2017


  • Health
  • Interventions
  • Mortality
  • Newborn
  • Occupied palestinian territories


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