Purpose Cataract surgery, quantity and quality, is an indicator of ophthalmic care. A comprehensive assessment of cataract surgical services has never been carried out in Palestine, including West Bank, Gaza Strip and East Jerusalem. The objective of this study was to estimate the cataract surgical rate in 2015 to and to explore the modes of payment and referral systems.Methods A cross-sectional study conducted between June and August 2016. Medical Directors from Cataract Surgical Centres in Palestine were interviewed using a structured questionnaire to extract data on cataract output and surgical techniques. Additionally, data were collected on modes of payment for cataract services. The cataract surgical rate was calculated by dividing the total cataract output in 2015 by the estimated population of Palestine in millions.Results In 2015, 9908 cataract surgeries were carried out in 22 centres. The cataract surgical rate was 2,117 operations per million population. Phacoemulsification was the most common technique (73.4%), however in government centres 67% were performed by extracapsular cataract extraction.In the Gaza Strip, 56.6% of cataract surgeries were operated at government centres, and 42.8% were operated at NGO centres while in West Bank, only 12% of cataract surgeries were operated at government centres, with two-thirds of cataracts diagnosed at governmental centres being referred to private and NGO centres. Seventy eight percent of cataract surgeries were funded by insurance, of which the government insurance scheme contributed 65%.Conclusion The cataract surgical rate in Palestine falls short of the required WHO target. The majority of cataract surgeries are funded by insurance.
The Calais 'jungle'The Calais 'jungle' is a shocking indictment of governmental policy towards refugees in 2016. 1 Medical assistance to the inhabitants of the unofficial refugee camp, many of whom are unaccompanied children, is at best scanty and uncoordinated.Most of the refugees live in deplorable conditions under tarpaulin sheets on the former dumping sites, which are also home to sizeable rat populations.Many sleep close to the ground and are forced to endure squalid toilet facilities.Some suffer with infectious diseases such as malaria and tuberculosis, and are in need of urgent medical treatment.They are exposed to assault, ethnic and police violence, sexual exploitation, infectious disease, and psychological illness.Non-governmental organisations (NGOs), for example MSF, and local charities such as the Salam Association are on hand to provide a level of primary care, yet what is needed is an orchestrated medical campaign to include screening for infectious disease and even secondary care for certain cases.We contend that a joint Franco-British programme is needed urgently to augment public and environmental health measures in the refugee camps around Calais and to liaise with the NGOs already in operation there.The British and French Armed Forces benefit from unparalleled resources to provide medical aid in adverse situations -both contributed admirably to containing the recent Ebola epidemic in West Africa -and have a history of collaboration.Could we invite their respective medical services, with their wealth of experience, staff, and supplies, to become fully engaged in assessing and addressing the refugees' health needs in the camps?In these days of extreme global inequality, a compassionate governmental response could powerfully counter the narrative of violence we appear to have grown accustomed to.
Eye health is an integral part of well-being that may be at increased risk when health service delivery is affected by sudden-onset disasters, complex humanitarian events, or conflict in resource-scarce environments. This study proposes a design plan for a mobile eye hospital to support health systems between the initial emergency response and recovery of health infrastructure in resource-scarce environments of low- and middle-income countries. The facility benefits from high mobility and modularity, it can be assembled and operated by minimal personnel, and easily expanded as necessary. It has capacity to host high-volume ophthalmological services without the logistical complexity of large-scale emergency medical team responses or military operations. The design provides a medium-term service that can either operate from a fixed location or be redeployed in-country with ease. Mobile eye hospitals may provide a useful facility for local governments suffering damaged health systems, or as a way to complement current eye health provision. The design may also be used by charitable nongovernmental organizations during an initial emergency response, with the ability to quickly deploy to a target location and establish eye services.
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