495	27,800	65	US$42.4 M
People with COVID-19	Samples tested for COVID-19	Quarantine and treatment centres	request for Inter-Agency Response Plan

* Detailed maps of quarantine facilities in the West Bank and Gaza Strip are available at OCHA’s website

Situation Overview

An additional 46 Palestinians were confirmed to have contracted COVID-19 in the oPt during the reporting period, including 33 in East Jerusalem, 11 in the reminder of the West Bank and two in the Gaza Strip, with no new deaths recorded.[1] This brings to 495, the total number of cases across the oPt as of 28 April, of whom four have died and at least 95 have recovered. The relatively large increase in caseload in East Jerusalem is attributed to the increase in the volume of samples tested, following the Israeli authorities’ establishment of new testing facilities in the Palestinian areas of the city over the past two weeks (currently ten facilities).

According to the Palestinian Ministry of Health (MoH), since the onset of the pandemic, nearly 28,000 laboratory samples have been tested and approximately 13,000 Palestinians are in quarantine at home, or in designated facilities for monitoring purposes.

Addressing the critical gaps in supplies needed to contain and manage the pandemic remains the main priority of the MoH and the humanitarian community. The main items required include testing kits, personal protective equipment (PPE), ventilators and essential Intensive Care Unit (ICU) equipment (see detailed table below). These gaps are the result of the fragile situation of the Palestinian health system, even before the crisis, exacerbated by global shortages since then.

The Palestinian Ministry of Education announced that schools will not reopen during the current academic year, which ends on 23 May; however, the next academic year is expected to start one month earlier. The 12th grade exam, the Tawjihi, will take place from 30 May onwards.

Following last week’s announcement by both the Palestinian and Israeli authorities about the relaxation of certain restrictions, economic activity has increased during the reporting period, particularly in the West Bank, including East Jerusalem. However, the socio-economic impact of the pandemic in the oPt is of increasing concern.

The World Bank estimates that due to the reduced demand caused by job losses and salary cuts the Palestinian economy will shrink in 2020 between 2.6 to 7.6 per cent compared to 2019, depending on the length of the restrictive measures. Moreover, the Palestinian Authority’s fiscal deficit as a result of the decline in revenues, along with the increase in expenditures to confront the pandemic, may reach up to US$2 billion. The UN Special Coordinator, Nikolay Mladenov, warned the Security Council that “if current trends continue, the damage to the economy risks the very existence of the Palestinian Authority.”

West Bank

In the context of the relaxation measures announced a week ago, factories have been permitted to re-open with 50 per cent of their workforce, craftsman shops (garages, blacksmiths, furniture stores) were allowed to open three days a week, and retail stores only on Fridays. While movement restrictions between localities and social distancing measures remain in force, anecdotal information indicates a general loosening in the public’s adherence to, and enforcement of, regulations by the authorities.

To prevent gatherings and potential spread of the virus on the occasion of the month of Ramadan, which started on 23 April, the Palestinian Authority has imposed a daily curfew from 19.00 until the following morning, which has been largely enforced.

In East Jerusalem, only two hospitals (Al Makassed and Augusta Victoria) are currently prepared to receive COVID-19 patients. WHO is coordinating with the East Jerusalem Hospital Network to address the most pressing needs of these and other hospitals. However, most Palestinians in the city can also receive treatment at Israeli hospitals.

To prevent contagion, Palestinian security forces, along with local emergency committees, have scaled up efforts to halt the daily commuting of workers between the West Bank and Israel. Those who were intercepted at checkpoints have been registered by the Palestinian authorities and instructed to home quarantine for 21 days; reportedly, in many cases their work permits and magnetic cards have been confiscated. However, due to the multiple openings in the West Bank Barrier and the limited capacity of the Palestinian authorities, the movement of workers back and forth has reportedly continued on a significant scale.

Restrictions imposed by the Israeli authorities on the movement of Palestinians residing in the closed area behind the Barrier (the ‘Seam Zone’) to the rest of the West Bank have been relaxed during the reporting period. However, access of farmers to their lands in the area remains heavily restricted due to the revocation of permits and the non-opening of agricultural gates.

Citing the lack of building permits, the Israeli authorities demolished or seized another eight Palestinian-owned structures in Area C of the West Bank. All but one of the targeted structures were donor-funded assistance, including a mobile home near Jericho, as a result of which, a family of eight was displaced. The Humanitarian Coordinator, Jamie McGoldrick, called on the Israeli authorities to stop demolitions, particularly during the COVID-19 crisis and the month of Ramadan. Also of concern is the ongoing surge in attacks by Israeli settlers, which since the start of the pandemic have increased by about 80 per cent compared with the first two months of the year.

Gaza Strip

As of 27 April, the de-facto authorities have authorized the reopening of restaurants, hotels and tourist facilities for indoor service across Gaza, subject to the abidance of hygiene and physical distancing measures. In conjunction with the absence of restrictions on movement between localities within Gaza and the low number of detected cases, this has resulted in a further increase in public activity, particularly at night hours, following the end of the daily Ramadan fast. The closure of schools and mosques, as well as the ban on public gatherings continues.

Despite the low number of confirmed COVID-19 cases in Gaza, WHO is encouraging people to adhere to the recommended measures, including physical distancing and personal hygiene measures. In cooperation with UNICEF, WHO continues efforts to procure essential ICU and ventilator equipment through global supply mechanisms although there are considerable delays in delivery dates due to global demands.

There has been no significant change in the number of people staying in 26 quarantine centres, including health facilities, schools and hotels, which remains at around 2,000. The Rafah Crossing with Egypt remained closed in both directions and 87 people returned to Gaza through the Erez Crossing. The movement of goods from Israel and Egypt has continued as previously, including the entry of restricted (“dual use”) items via the Israeli-controlled Kerem Shalom Crossing.   In Gaza city, the municipality announced a reduction in the frequency of some services, including solid waste collection, due to the decline in revenues.

Inter-Agency Response Plan – Funding Status

A revision of the COVID-19 Inter-Agency Response Plan for the oPt, originally launched on 26 March, was released on 25 April. This main goal remains to support the efforts led by the Government of Palestine to contain the pandemic and mitigate its impact through the end of June 2020. The updated requirement is $42.4 million, an increase from the $34 million originally requested. The additional $7 million is to provide support to quarantine centers in Gaza and the West Bank; multi-sectoral efforts in East Jerusalem; and safety net support for most vulnerable communities.   The largest components are public health interventions, 45 per cent of the appeal ($19.1 million), and food security, at 28 per cent ($11.8 million).

So far, $13.3 million, or 31 per cent of the amount requested, has been raised. As detailed below, donors have contributed another $16.7 million for a range of interventions related to COVID-19, but not included in the response Inter-Agency Response Plan, bringing overall contributions to $30 million.

COVID-19 response funding in the oPt

Total Funding for COVID-19 Response by Donors (in US$)

* Attribution to the Inter-Agency COVID-19 Response Plane under verification.

Total funding for COVID-19 response by cluster (in Million US$)

Essential items required to respond to the COVID-19 crisis

Coordination

The Inter-Agency COVID-19 Task Force led by the Humanitarian/Resident Coordinator (HC/RC), as well as the Inter-Cluster Coordination Group (ICCG), continue regularly meetings to follow up on the implementation of the Inter-Agency Response Plan. The HC/RC also informs the Palestinian authorities about the essential movements required by humanitarian and development staff during this period of enhanced movement restrictions, while following the already adopted Standard Operation Procedures. Where necessary, coordination with the Israeli authorities is also conducted to ensure the safe movement of staff.

As part of the Risk Communication and Community Engagement (RCCE) plan, WHO is releasing guidance to civil and religious authorities, regarding traditional religious practices observed during Ramadan.  There is concern that too rapid a relaxation of measures could trigger additional spikes in cases.

UNICEF is also taking the lead in coordinating and centralizing the procurement of medical supplies and equipment.  Additionally, the World Food Programme (WFP) has set up a logistics working group to support humanitarian partners in providing key supply chains, reducing duplication and increasing cost efficiency. Logistics services will be provided by air and sea, through Ben-Gurion Airport and Ashdod Port.

Needs, responses and constraints by cluster

[For a detailed list of activities by cluster please refer to the annex in the full report]

Health

Needs overview

There is currently no specific treatment for COVID-19. Consequently, the most effective approach to protect the population is containment, with a focus an early testing of all suspected cases, isolation and treatment of confirmed cases, and contact tracing and quarantine arrangements. This must be complemented by primary and community-based health initiatives, focused on the prevention and promotion of effective protection measures (hand hygiene, physical distancing, etc.). Additionally, efforts must continue to scale up hospital preparedness and treatment capacity to manage an increase in demand for hospital-based patient care.

As part of these priorities, there is an increasing need to mobilize further resources to provide adequate training for all staff working in health facilities, including on clinical case management protocols and infection prevention and control policies. Additionally, local procurement should be emphasised wherever possible, while maintaining quality control. There is a need for a healthcare strategy that maximizes available resources and minimizes the consumption of materials currently in global shortage.

Currently, the health services in the oPt are being confronted with an increased demand generated by the COVID-19 outbreak. Therefore, responding exclusively to COVID-19 cases, without considering how the delivery of essential health care services will be maintained across the continuum of care, comes with several risks.

To minimize this risk, it is essential to give equal priority to the continuation of essential health care services in the oPt, including primary healthcare services; sexual and reproductive and maternal health services; continuation of critical inpatient services (i.e. dialysis); management of acute episodes of chronic conditions; trauma services; services for people with disabilities; and time sensitive surgeries.

Response overview

The Health Cluster remains committed to reinforcing a comprehensive, multi-sectoral response to the outbreak, while continuing principled programme delivery and the provision of life-saving assistance. All related activities are directed at supporting the measures taken by the Palestinian authorities, led by the Ministry of Health (MoH).

Interventions have strengthened the MoH’s capacity to early detect and respond to the outbreak and prevent further transmission. Mental Health and Psychosocial Support (MHPSS) activities are an integral part of these interventions. Efforts have been also invested in coordinating and streamlining the work of various partners with the authorities.

Some of the Health Clusters achievement to date include:

• All essential primary healthcare centres established early triage mechanisms, including UNRWA’s 22 primary healthcare centres in the Gaza Strip, and 43 in the West Bank. 
• With support from WHO, the MoH established rapid response teams in each governorate, while contact tracing is underway. 
• Over 4,430 full PPE kits, 227,000 face masks, 88,507 gowns, 1,585,640 gloves, 2,000 head covers, 5,000 over-shoe covers, were distributed to MoH, NGO service providers, and vulnerable members of the community in the West Bank and the Gaza Strip. 
• Cluster partners provided the MoH with testing kits (an estimated 6,000 tests), swabs for the collection of samples and other laboratory supplies required for COVID-19 testing.

Gaps, challenges and constraints

Efforts to address needs related to the quarantine sites faced various challenges, including a local, regional and global shortage of laboratory supplies for COVID-19 testing, as well as shortages of some essential case management equipment, particularly for critical cases and Infection and Protection Control supplies. These shortages are delaying delivery of such items to the oPt, especially in the Gaza Strip, and impacting on testing. The lockdown of ministries, such as the Ministry of Finance, further complicates the processing of financial procedures like VAT exemption, and the transport of items through borders.

All major providers (MOH, UNRWA, NGOs) have scaled down sexual and reproductive health services as a result of the COVID-19 outbreak, leading to an increased risk of disability and death amongst women, girls and new-borns; a drop in pregnant women attending facilities; a lack of resources to conduct home/mobile clinic visits; and a general shortage of medical supplies, including PPE.

Access to vulnerable communities was curtailed over the past few weeks, with key health service providers being denied or delayed in providing essential primary health care services to parts of the West Bank. This is particularly detrimental when partners are the only service provider for the vulnerable communities.

Protection

Needs overview

Data from Gender-Based Violence (GBV) helplines suggest an increase in abuse and violence, specifically domestic violence against women, and physical abuse by parents against adolescent boys and young men. The number of cases of women whose lives are under threat has increased compared to previous weeks, as reported by Protection partners.

Widespread job losses affecting income and livelihoods are placing significant pressures on families, pushing vulnerable families into further poverty and contributing to the increase in abuse and violence. Protection partners report increased tension among vulnerable households since their ability to work in Israeli settlements ended, as well as increase in negative coping strategies, including child labour and early marriage.

In some communities, as a result of disruptions in vocational training, remedial classes and interventions, working and out-of-school children suffer increased risk of exploitation, neglect and abuse. Additionally, children released from juvenile institutions are at risk of re-offending, while children in protective care risk being sent back to families where there was previous violence.

There is a general lack of information about COVID-19 in Area C, particularly in the Jordan Valley. Municipalities and village councils in Area C, in particular Ein al Beida, Bardala and Fasayil village, are requesting recreational kits for children to mitigate increased cyberbullying, as children are spending more time on their phones.

Due to disruptions of schools, there is an increased risk for children, living near/in areas close to military sites, particularly in Palestinian Bedouin and herder communities in the north and central West Bank, to be exposed to Explosive Remnants of War (ERM).

Response overview

The Protection Cluster adjusted its COVID-19 response plan priorities based on new and emerging needs identified by partners, focusing on the most vulnerable individuals and households. Cluster, GBV and MHPSS partners will continue to initiate alternative phone and online activities to ensure continuity of critical protection services and referral pathways, with an increased focus on disability and supporting those with a chronically ill family member, persons with disabilities and the elderly. People with seeing, hearing or mobility issues are already experiencing difficulties in accessing services and information, as services are suspended while they seek to protect themselves from COVID-19. Partners will adopt strategies to reach this vulnerable population through reinforced referral pathways; targeted assistance (e.g. assistive devices); comprehensive dissemination of critical information; material support to mitigate heightened protection risks; and legal action.

During the reporting period, partners reached people remotely for individual counselling and structured group activities, including persons in quarantine sites in the Gaza Strip. Legal Task Force (LTF) members continued requests to the West Bank Military Commander and Israeli Police, seeking enforcement of containment measures in settlements and outposts and enhanced protection from settler violence to prevent spread of COVID-19.

Gaps, challenges and constraints

Limited access to reliable data from quarantine sites in the West Bank is making the identification of needs and ways to respond difficult. There is an ongoing lack of a clear and consistent approach to services, including psychosocial support for Palestinian communities in East Jerusalem, particularly those located behind the Barrier (notably Kfar Aqab, Shu’fat Camp, and Qalandiya).

Throughout the oPt, partners report facing financial constraints to meet increasing need for MHPSS and PPE supplies for community members involved in distribution and home visits. MHPSS counsellors report shortages of electronic devices to facilitate sessions, leaving vulnerable households disproportionally challenged to participate in online activities. The absence of an international protective presence and continuing settler violence is of additional concern.

Education

Needs overview

On 21 April, the Ministry of Education (MoE) announced that the official twelfth grade exams, the Tawjihi, will be conducted as planned on 30 May.  Grades 1-11 will continue utilizing distance learning resources through the end of the academic year (23 May). The Ministry plans to start the next year academic year one month earlier to compensate for lost time.

Since the closure of education facilities in early March, 1.43 million children across the oPt need to access distant learning and receive age appropriate, awareness-raising messages around COVID-19. In isolated and poor areas, 360,000 children without internet connections need home-based learning materials and support.

Continued age-appropriate, awareness-raising messages to 1.43 million children and their families around COVID-19 is needed, in addition to hygiene-related preventive measures and continuity of learning at home.

3,037 schools are in need of cleaning and disinfecting in preparation for re-opening, as well as an adequate supply of cleaning and disinfecting materials while closed. Specifically, the MoE in Gaza is in need of stationary and infection control measures to safely conduct the Tawjihi exam.

215,000 children and their caregivers, and 3,000 teachers are in need of psychosocial support through innovative approaches, utilizing social media and phone calls.

Latrines in 402 schools need urgent rehabilitation and new clean drinking water points are needed in 134 schools.

Response overview

Education Cluster partners have developed interventions to address the needs set out in the MoE Response Plan for COVID-19. As the Tawjihi exam, will be conducted on 30 May, the Education Cluster will work with the MoE to ensure the protection of students during the exams. This will include opening more examination centres to reduce the number of students per centre, as well as applying all relevant infection control measures for school environments recommended by WHO and UNICEF. Main achievements to date include:

• The mobilization of US$2.5 million for the MoE COVID-19 response plan, which is currently 40 per cent funded;
• Started the procurement of 2,000 cleaning and disinfecting kits for MoE schools;
• Technically and financially supported about 100,000 children to access various MoE e-learning platforms. 
• Supported the provision of remote MHPSS support to children and their families in coordination with Child Protection partners.

Gaps, challenges and constraints

The scale and nature of this crisis is beyond that anticipated in existing preparedness plans and the capacities of MoE and cluster partners. This includes the lack of platforms for distance learning prior to the emergency, and a lack of consensus between MoE in Ramallah and Gaza over the content of the e-learning platform. This has been compounded by the limited internet connectivity in certain communities and households. The MoE and cluster partners are also not operating at full capacity, due to movement restrictions and quarantine measures. Finally, there are funding gaps for the rehabilitation of emergency WASH facilities at schools.

Shelter

Needs overview

In the Gaza Strip, people hosted in quarantine centres for the 21 mandatory days need various individual hygiene kits, sterilizing items and non-food items (NFI), such as mattresses, blankets, pillows and mats. Most of these items must be periodically redistributed for incoming people. There are currently 38 facilities identified for potential use as quarantine centres, with a capacity to host up to 5,000 individuals. Of these, 26 are active with a total number of 1,967 quarantined individuals. The numbers are expected to rise again if Rafah crossing is reopened during the coming days.

Additionally, in Gaza, a previous assessment by the Ministry of Public Works and Housing has identified 9,500 dilapidated or substandard homes. The most vulnerable urgently need proper hygienic and disinfection materials, as well as awareness materials concerning hygienic practices and mitigation measures.

In the West Bank, the main concern remains the expected return of Palestinian workers employed in Israel, who require quarantine facilities. The current capacity of identified centres is 5,000 individuals, who will need NFI kits similar to those in Gaza. Also, many requests were made of Cluster partners to set-up pre-screening and registration facilities for the workers at crossings and at the entrances to Palestinian towns, in addition to one infrared thermometer for each location and consumable protective materials (gloves, masks, hand sanitizers) for the municipality teams who carry out the initial testing and registration at each crossing.

An assessment conducted by an NGO of 198 vulnerable communities in Area C found that over half of the residents could not afford the basic hygiene and cleaning materials to combat COVID-19.

Response overview

The Shelter Cluster response seeks to improve the capacity and resilience of vulnerable individuals and households to reduce the spread of the pandemic. In Gaza, partners have continued to aid quarantine centres, with necessary support including NFIs, hygiene and female dignity kits, and cleaning supplies with over 6,000 bedding sets provided to quarantine centres. In the West Bank, 80 tents (originally intended to respond to demolitions) were distributed for use as pre-screening and registration facilities at hospitals, clinics, crossings and town entrances. Across the oPt, around 13,000 hygiene and cleaning materials were distributed to vulnerable families via different institutions and village councils, as well as educational materials and awareness flyers, as part of the RCCE campaign.

Gaps, challenges and constraints

A main constraint is the lack of quality, household disaggregated information on needs, to accurately target interventions, compounded by the movement restrictions that impede access to the most vulnerable households and communities. The lack of accurate information about the quarantine facilities needs in the West Bank impede the Cluster’s ability to mobilize the required NFI materials support.

Cluster members reported that there is a shortage of sterilizing materials on the local market in Gaza, and that the available quantities do not comply with technical specifications.

Water, Sanitation and Hygiene

Needs overview

During the reporting period, WASH Cluster Partners reached more than 14,800 people. In coordination with the Palestinian Water Authority (PWA) and service providers, the Cluster is closely monitoring access to WASH services to ensure that the required levels of water and sanitation are not being affected by the COVID-19 outbreak.

Community committees and local councils in the most vulnerable areas in East Jerusalem and Area C are reporting shortages of cleaning and sanitizing materials which effect their ability to continue environmental cleaning and sanitizing campaigns in these communities.

At least half of the WASH service providers in the southern West Bank reported that they do not have the capacity to raise public awareness about proper hygiene practices in the context of the combat against COVID-19.

Some neighbourhoods in East Jerusalem reported lack of proper collection and disposal of medical waste.

Increased unemployment in the Gaza Strip and the West Bank, including East Jerusalem, is limiting many vulnerable families’ access to hygiene and cleaning materials and tools.

Response overview

During the reporting period, WASH Cluster partners conducted four rapid assessments regarding the WASH status in the most vulnerable areas. The assessments targeted quarantine centres in the West Bank, as well as the water service providers in the southern West Bank and East Jerusalem.

Seven WASH Cluster partners implemented various response interventions reaching around 14,852 individuals. Partners were able to distribute 1,290 household hygiene kits and 37 cesspit dislodges, and support quarantine centres in the Gaza Strip with the delivery of over 14,000 bottles of water, 300 dignity kits and provide 12 latrines with water tanks. With regards to RCCE, partners were able to conduct 790 awareness sessions at the household level, distribute 980 posters and disseminate materials via two radio spots in the Gaza Strip.

Targeted individuals and institutions improved their hygiene levels due to the provision of hygiene items and sanitizers, as well as protective materials for health workers. Current support to the quarantine centres improves their capacity to ensure safe, dignified, and healthy habits for those in quarantine. Lastly, water service providers have managed to maintain regular levels of supply in the West Bank and the Gaza Strip.

Gaps, challenges and constraints

The main challenges identified by the WASH Cluster include:

• Unclear division of responsibilities of PA bodies in Area C communities, which creates confusion for partners concerning who to coordinate with regarding WASH COVID-19 response activities. Some partners coordinate with Governorate offices and others with local councils. 
• PWA announced that water demand in Palestinian communities is expected to increase by more than 30 per cent in the coming weeks.

Food Security

Needs overview

The pandemic has already had severe socio-economic consequences, which are expected to increase in the coming weeks, with direct consequences on food security. New families have fallen into poverty following the loss of a source of income due to COVID-19 restrictions. The Ministry of Social Development (MoSD) expects that 100,000 families across the oPt will be added to the list of new poor families by the end of April.

Agricultural livelihoods have been particularly impacted. The low availability and high prices of fodder represent a constraint for Palestinian Bedouins and herders, especially as the grazing season is coming to an end. Prices for fertilizers and pesticides also increased during the last three weeks. Although fuel prices declined, it does not compensate for the price increase of major inputs costs.

The overall agriculture and food market continues its negative trajectory, triggered by low demand, due to low purchasing power, high inputs price, local market and export closures, and the interruption of traditional informal credit payment system in favour of cash upfront only payments.

The livestock sector in the West Bank is subject to a complete paralysis since the start of the COVID-19 crisis. According to the appeal recently launched by UAWC, there was a decline in the consumption of red meat by more than 15 per cent. In the Gaza Strip, prices of one-day-old chicks have significantly increased to nearly double the price, likely due to the increase in demand during Ramadan.

In the Gaza Strip, the Ministry of Labour (MoL) estimates that of 130,000 registered workers, around 38,000 of them need urgent humanitarian assistance based on poverty status and other socioeconomic conditions.

With the new arrivals to the Gaza Strip from Egypt, MoSD are concerned about the continuation of food assistance to people in quarantine facilities.

Response overview

Partners in the Food Security Sector have continued distributing food parcels to poor families, including agricultural commodities in the food parcels. Local NGOs in the West Bank started the process of distributing more than 60 tonnes of vegetables and five tonnes of dates, as direct support for poor farmers and families.

The Ministry of Agriculture (MoA) continued the distribution of around one million seedlings for home gardens through local NGOs, with around 90 per cent of the activities completed.

In Gaza, an additional 7,000 daily waged workers received cash assistance of US$100, as part of a grant by the de facto authorities to workers affected by the COVID-19 pandemic.

Responding to the COVID-19 impact on food security at a household level, WFP is assisting another 254 families (around 1,200 individuals) nominated by the MoSD, with cash-based assistance. The new families will receive temporary assistance for a period of three months.

Gaps, challenges and constraints

In addition to the mobility restrictions affecting all partners, the delivery of cash assistance has been disrupted, as banks have stopped receiving clients face-to-face. Moreover, Cash-for-Work (CfW) interventions are also impacted as many skilled and unskilled jobs come to a halt, although some education and other organizations began implementing a work-at-home modality.

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[1] The situation in East Jerusalem regarding COVID-19 is being managed by the Israeli authorities.