It has been a year since the fighting between the Palestinian armed group Hamas and the Israeli military intensified. While there are still no signs of a conclusion, JICA continues to provide support for the serious humanitarian crisis in the Gaza Strip, making use of the knowledge of the International Emergency Relief Team. What kind of support is being provided remotely from Japan? We interviewed some members of the JICA relief team.
Rafah refugee camp in the southern Gaza Strip after Israeli airstrikes
Photo: Anas-Mohammed / Shutterstock.com
Like a “living hell,” Gaza’s humanitarian crisis is unimaginable.
On October 7, 2023, Hamas, an armed group that effectively controls the Gaza Strip in the Palestinian territories, launched a large-scale attack on Israel. The Israeli side then responded with heavy air strikes, and even now, a year later, there are no signs that the situation is under control amid the intertwining historical and geopolitical factors that have been at play.
According to the Ministry of Health in the Gaza Strip, more than 41,000 Palestinians in the Strip have been killed and 96,000 injured in the fighting. Sixty percent of the buildings have been damaged, and more than half of the hospitals are completely inoperable. Many residents are still suffering from hunger and infectious diseases due to inadequate delivery of humanitarian aid such as food, water, fuel, and medical care due to the closure of checkpoints. The UN Secretary-General GRETES has warned that Gaza is experiencing an unimaginable humanitarian crisis and that “the population is in a hellhole.
Government shelter in Rafah, southern Gaza Strip, where large numbers of Palestinians are displaced.
Photo: Anas-Mohammed / Shutterstock.com
WHO request for support through Japan-led data management approach
In the Gaza Strip, about 17 national and international emergency medical teams, including the International Red Cross, are engaged in frantic medical activities. At first, however, the harsh environment with inadequate internet and food supply prevented information sharing, and no one was able to obtain accurate information on the distribution of patients, their conditions, and medical needs, as well as a complete picture of the situation. Then, on October 13, the World Health Organization (WHO) requested the data management expertise of Japan’s Japan Disaster Relief (JDR) team.
The JDR medical team is developing a simple and efficient method of consolidating information by organizing the minimum reporting items necessary to determine the condition and number of patients to be treated by the emergency medical team during a disaster and by standardizing the format of medical records and daily medical reports, inspired by the support for the 2017 typhoon disaster in the Philippines The method is being developed by the National Institute of Health (NIH). This method “visualizes” the activities of emergency medical teams working in disaster-stricken areas, and is one of the important materials for administrative officials who are not experts in disaster medicine to understand the current situation in disaster-stricken areas and make appropriate decisions.
This method was officially adopted by WHO as an international standard called MDS (Minimum Data Set), and has since been used in the cyclone disaster in Mozambique, the earthquake disaster in Turkey, and countries affected by the conflict in Ukraine, gaining worldwide recognition. The JDR medical team’s experience in data management and the relationship of trust it has built with the WHO led to this request for support.
Japan Disaster Relief Team (JDR) is a Japanese relief team dispatched at the request of the government of a disaster-stricken country or an international organization to assist in the aftermath of a disaster that has occurred overseas. The JDR consists of five teams, including a medical team and a rescue team, and JICA serves as the secretariat. JICA has deployed 168 times to date, including to the Philippines in 2013, Nepal in 2015, and Turkey in 2023, etc. The JDR Law stipulates that JICA deploys for natural disasters and cannot provide direct assistance for conflict-induced disasters. However, JICA provides assistance to humanitarian crises to the fullest extent possible through the framework of technical and financial cooperation, and as part of this cooperation, JICA has begun to draw on JDR’s experience. The assistance to Gaza is the second case of non-disaster relief following the assistance to Moldova (Ukraine crisis-affected country).
It consists of 50 items, including information on the emergency medical team, the date, time, and location of the treatment, the patient’s age and gender, and the presence of infectious and non-infectious diseases.
Unify and standardize items to make data aggregation and analysis more efficient and faster
Remote support with team members from all over Japan working together
Since there are restrictions on the movement of people and goods within the Gaza Strip, and security considerations make it extremely difficult for JICA personnel to enter the area, we had no choice but to provide assistance remotely this time.
When we first started providing remote assistance, we did not have a system in place for local emergency medical teams to report their medical data, so we had to start by setting up a reporting system and other foundations for assistance. Soichiro Kai, a physician in the Emergency Department of the Hyogo Prefecture Disaster Medical Center, who has been involved in the Gaza support project since its inception and is also responsible for coordinating with the World Health Organization (WHO), explains, “We had to start by setting up a reporting system and other foundations for support.
Patient age and gender, where they were brought, severity and site of injury, presence of infection or pregnancy, increase or decrease in the number of patients–the list goes on and on. To get a complete picture of the medical situation in the Gaza Strip, 50 items based on the MDS must be reported daily in data to the local emergency medical team, but at the beginning of the project, we were unable to collect such information.
Soichiro Kai, M.D.
Deputy Director of the Emergency Department of the Hyogo Disaster Medical Center, and Executive Director of the NPO “Humanitarian Medical Assistance Association for Disaster Relief (HuMA)”, he has been involved in disaster relief and support systems in Japan and abroad, including the Great East Japan Earthquake, with the JDR Medical Team and the Disaster Medical Assistance Team (DMAT) operating in Japan. He has also participated in JICA projects to develop disaster medical systems in Latin America and the ASEAN region.
The coordination headquarters set up by the affected country is supposed to be in charge of compiling medical examination data for the emergency medical team, but the Gaza Strip, which is not an independent state, has a different premise. In addition, the strict entry restrictions and lack of Internet access in the area made communication difficult. From December to January, a total of eight JDR medical team members arrived in Cairo in relay, speaking directly with WHO staff and support teams from various countries entering and leaving Gaza to share the importance of the report. The necessary data items were adjusted and the foundation for remote support was set. Considering the harsh conditions in the area, we started with “Ultra MDS” reporting with a minimum of 9 items out of 50, and gradually increased the number of items such as the number of injuries and diseases in the area and information on infectious diseases.
Although I am not directly responsible for providing medical care to the victims of the disaster, I feel that I have a very important responsibility to connect the reports submitted by the emergency medical teams that are risking their lives in the field to WHO,” says Hanako Ogawa, who has nearly 20 years of experience as a nurse. I feel that I have a very important responsibility to connect the reports submitted by the emergency medical teams in the field to WHO. She is currently studying public health in a master’s program at Hiroshima University Graduate School, while working as the head of the Data Entry Team, which corrects and enters MDS reports sent from the field into a prescribed format.
Hanako Ogawa, Nurse
Currently enrolled in a master’s course (public health) at Hiroshima University Graduate School. After the Great Hanshin-Awaji Earthquake, she decided to become a disaster medical worker and has been involved in disaster relief both in Japan and abroad as a nurse. As a member of the JDR medical team, she has been dispatched to the Philippines, Nepal, Mozambique, and Turkey. She was also involved in data management during the Turkey earthquake.
Survey team briefing emergency medical teams entering Gaza on how to report data in the MDS
Reports received from the field cannot be tabulated as is because some items are missing, some do not follow the prescribed format, and some are handwritten, so it is necessary to re-enter the data according to the MDS form. In addition to the Data Entry Team, there is also a Double Check Team that double-checks the entered data, a System Management Team that develops and operates data aggregation programs and ensures data consistency, and a Communication Team that communicates with WHO and other organizations. The team consists of up to 19 members in various regions of Japan, who work day and night in support activities.
Hideki Tanaka, head of the System Management Team, is the representative of an IT consulting firm and is involved in providing support. I am not a medical professional, so what I can do is limited, but if there is anything I can do, I would like to be involved.
All JDR team members are supporting the relief efforts in addition to their own work and studies. There is a seven-hour time difference with Gaza, and data is sent to us by 9:00 p.m. (Japan time) every day, so some of the work is done late at night. The data compiled by the team is used in the Situation Report released by WHO every Monday to provide detailed information on the medical situation in Gaza.
Hideki Tanaka, Engineer
IT consultant and representative of Prime Integration, LLC. He has been involved in the development of J-SPEED, the Japanese version of the Philippines’ SPEED medical daily reporting method, which is the original version of MDS, and also developed a data collection and tabulation program during the assistance to the conflict-affected country in Ukraine (Moldova).
Some of the data compiled by JDR and submitted weekly to WHO is available on the web.
The JICA logo appears on the dashboard of the website (image: capture of the “Gaza Strip: Emergency Medical Teams Coordination Cell” screen on the website).
From the data maintained by JDR, a report was prepared by WHO to estimate the rehabilitation needs of the patients.
The report finds that about 25% (22,500) of all injured people have suffered a limb injury, limb resection, head or spinal cord injury, or burn injury and have acute and ongoing rehabilitation needs (image from WHO report “Estimating Trauma Rehabilitation Needs in Gaza using Injury Data from Emergency Medical Teams” cover)
Each of us has our own thoughts and common wishes for Gaza support
From the beginning of our support, we have been concerned about the high percentage of children with injuries and illnesses*. I don’t think all the medical data is attributable to the conflict, but the most painful thing for me is that the data shows the deep suffering of the children,” said Tanaka.
- 20% of injured and ill persons are under 5 years old as of July 2024
In the free-text column of the reports sent to us by the emergency medical teams, they frequently describe the harsh conditions in the conflict zone, such as, “Yesterday there was a bombing and many wounded and sick people were brought in,” or “We are short of supplies and daily provision of medical care is difficult.” There are also teams that report daily that they are safe. We are keenly aware of the reality that local people are continuing their activities under harsh conditions,” says Ogawa.
In the daily reports, the number of fatalities is usually in the double digits or higher. In Japan, these numbers are only possible due to large-scale traffic accidents. We can only provide support in the form of data management, but we continue to provide assistance with the hope that the local emergency medical teams will be able to reduce their workload and spend that time resting and sleeping, which will benefit the Gaza Strip in total,” said Kai.
While the future of natural disaster relief can be seen after a few months or so, the future of conflict relief like this one cannot be seen until the conflict is over. We hope that the conflict will end as soon as possible. With the same wish in mind, the three members of the team and other members of the International Emergency Relief Team continue to support the medical field in Gaza.
© Source JICA
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