Pharmacists are unable to supply essential common medications in Gaza, exacerbating loss of life among older people and those who are chronically ill, representatives of the Union of Palestinian Pharmaceutical Manufacturers (UPPM) have told The Pharmacist.

A latest statement from the World Health Organization (WHO) described the health and humanitarian situation in the area as ‘inhumane’.

WHO Director-General Tedros Adhanom Ghebreyesus told press yesterday that, along with its partners, the WHO had carried out ‘several emergency missions’ to Nasser Medical Complex in Southern Gaza over the last three days, but many sick and injured patients and several healthcare staff remain.

‘Much of the territory has been destroyed, more than 29,000 people are dead, many more are missing, presumed dead and many, many more are injured,’ he added.

Representatives at the UPPM told The Pharmacist this month that major pharmaceutical manufacturing sites supplying Gaza’s medicines have been destroyed and looted, and that ‘over 90%’ of the community pharmacy network in Gaza had also been destroyed.

Aid to the area through the Rafah crossing has been able to meet just 3% of the need, the UPPM said, meaning that more than 350,000 chronically ill patients are not receiving their medications.

In addition to antibiotics, analgesics and anaesthetics, essential medicines for kidney patients are running out, added the UPPM.

And ‘many pregnant women’ are experiencing miscarriages due to a lack of blood-thinning medication to prevent blood clots, as well as a lack of vitamins and supplements.

Ouf Awadallah, UPPM chief executive told The Pharmacist: 'Medicines are only found in hospitals, covering less than 20% of Gaza's pharmaceutical needs. Individuals struggle to obtain even basic medications such as pain relievers and antibiotics, exacerbating the challenges of managing chronic diseases.'

In addition to the death toll caused by air strikes, ‘severe shortages of [the] essential drug list’ are causing deaths among those whose conditions would ordinarily be managed by medication, Dr Amjed Dawahidy, a UPPM representative currently in Gaza, told The Pharmacist.

‘We lose our grandfathers and grandmothers and a lot of our chronic patients and kidney failure [patients]’, he said.

‘The situation at the north Gaza strip is very bad and every day we lose elderly people.

‘Thank God I am not pregnant during war.’

‘We are [dying] in front of the health care workers and they [are] unable to do anything,’ he added.

He also shared photographs and videos of healthcare workers tending to wounded adults and children in makeshift hospitals. The UPPM has said pain relief and essential medication is hard to source.

Oksana Pyzik, senior teaching fellow and global engagement lead at the University College London School of Pharmacy, told The Pharmacist that ‘getting medical supplies into the occupied territory from donors is the biggest challenge, rather than supply or funding itself’.

Ms Pyzik has supported a European-wide initiative to send and distribute medicines to Ukraine.

But she said that in Gaza, the situation was different.

‘Of course, any pharmacy initiative that helps fundraise for medicines would be helpful but again logistically these medicines would need to be procured in the Middle Eastern region and then make it across the border which requires higher level diplomacy to let aid trucks into Gaza,’ she told The Pharmacist.

The WHO is allowed to distribute medical supplies through locally employed staff, and has spent over $37,550,000 on ‘the procurement and distribution of essential health-related supplies and commodities’ to health facilities in the Gaza strip, according to a recent report.

But earlier this month, WHO representative Dr Rik Peeperkorn said in a statement that ‘repeated access restrictions and denials continue to obstruct the delivery of crucially needed humanitarian aid to the people of Gaza’.

‘WHO and the [United Nations] are ready to deliver, but we need sustained access and safety guarantees. Without these, humanitarian operations, already struggling to stay afloat, could grind to a halt,’ he said.

Since November to 9 February, around 40% of WHO missions to the north had been facilitated, while the rest ‘have been denied, impeded, or postponed’, and around 45% had been facilitated to the south, he added.

‘Even if an immediate ceasefire is not reached, humanitarian corridors are urgently needed to continue providing vital aid,’ Dr Peeperkorn said.

The United Nations Relief and Works Agency for Palestinian Refugees in the Near East (UNWRA) was last month able to receive eleven different vaccinations, both refrigerated and freezer stored, from UNICEF for its health centres, it said.

Between 3 January and 3 February, over 22,300 children were vaccinated against diseases such as measles, mumps and rubella, and others, while on 17 February, an additional 878 children were vaccinated, UNWRA said.

But in an update provided yesterday, the UNWRA said that just seven out of its 23 health facilities across Gaza are currently operational.

And the WHO director-general noted yesterday that the World Food Programme ‘cannot get into northern Gaza with supplies’, while severe malnutrition has ‘shot up’ since the war started, from under 1% to more than 15% in some areas.

International medical aid organisation Médecins Sans Frontières / Doctors Without Borders (MSF) has said: ‘Four months of war has destroyed and damaged homes and civilian infrastructure, including water and health care facilities.’

It warned earlier this month that ‘extensive damage to pipes as well as sanitation infrastructure’ was ‘creating a disaster and making the risk of [disease] outbreaks imminent’.

According to UNICEF, ‘at least half of the water and sanitation facilities in Gaza have been destroyed or damaged’, while the UNWRA suggested  ‘around 70% of the population in Gaza is drinking salinized and contaminated water’, MSF said.