key: cord-0975833-wahtij3e authors: Musalam, Alaa M. A.; Abunamous, Raed E. S.; El‐Ashgar, Nizam M.; Alhana, Ahmed S. title: Emergency management to avoid the spread of the COVID‐19 pandemic in Gaza Strip date: 2021-06-04 journal: Int J Health Plann Manage DOI: 10.1002/hpm.3260 sha: 212af8ce5d134cf2a31a2dc8937872ce46727c06 doc_id: 975833 cord_uid: wahtij3e Gaza Strip is exposed to the danger of the novel coronavirus pandemic ‘nCOVID‐19’ spread, which exacerbates the crises severity on this besieged area since 2007. This study aims to identify the preventive actions during the action effectiveness implemented by the Central Emergency Committee and the Ministry of Health to reduce the coronavirus spread in Gaza Strip. The researchers have followed the descriptive and the analytical methodology of the purposive sample responses data from the preventive medicine workers, the security team, and the members of the Central Emergency Committee.The most important results of the study showed that targeted peoples have been reexamined several times to ensure that they are recovered from the disease with an average of 81.0%. The reliability and accuracy of the detection tests of the coronavirus disease were of an average of 79.33%. In addition, the results demonstrate the existence of a strong correlation between the preventive action taken by the Central Emergency Committee and the effectiveness of the procedures to prevent the coronavirus pandemic. Also, the study shows a statistical significance effect at the level of significance (α ≤ 0.05) regarding the prevention procedures from the coronavirus pandemic and the effectiveness of the procedures. � PCR examination is performed for all inmates in the quarantine facilities on the fourth day. � The positive cases after examination are immediately transferred to the isolation hospital for the treatment of corona. � Reexamination is performed again on the 20th day since the beginning of the quarantine. Then, the quarantines are removed if the results are negative with the recommendation of staying at home. � Contacts of returnees from abroad are compulsory quarantined for confirmed cases for a period of 21 days from the date of contact. The PCR examination is performed on the fourth day of contact. The examination is repeated on the 20th day since the beginning of the quarantine and if the examination is not available the quarantine continues to 28 days. The number of quarantined people who came from abroad in the quarantine centres in Gaza Strip reached 569, distributed over all the quarantine centres 8 until 9/6/2020. Then, after the infection spread within the community in the Gaza Strip, the Central Emergency Committee implemented the following measures: -Home isolation for the injured and the families of the injured. -Close residential areas where the disease is spreading. -Curfews imposed on all citizens on Friday and Saturday. -Transferring dangerous cases to the European Hospital in Rafah. Many countries have taken decisions to close the borders, suspend flights and examine the returnees of citizens before integrating with the populations to prevent the spread of the novel coronavirus within societies. In addition, they have taken closure measures in gathering places such as markets, squares and worship places. 9 In the case of the Palestinians living in what is described as the largest open prison in the world, preventive measures and containment of COVID-19 will be very difficult, especially as the epidemic has reached Gaza Strip from the returnees from abroad. Since 2007, Israel has imposed a land, air and sea blockade on two million Palestinians in Gaza Strip, 1.4 million of them are refugees, which made them susceptible to overcrowding in one of the most densely populated areas in the world. 10 Therefore, discovering one infected case with coronavirus within the population in Gaza Strip will be catastrophic on the huge population density in a small geographical area such as Gaza Strip. F I G U R E 2 This shows the Emergency Committee procedures for dealing with returnees from abroad 8 Emerging infectious diseases such as nCOVID-19 require rapid responses from the Ministry of Health besides the community awareness about the seriousness of the epidemic, the epidemiological surveillance, the development of strategies to contain the coronavirus spread efficiently and the decreasing of the burden associated with this disease. 11 The main factors that contribute to the spread of the new coronavirus infection in the Gaza Strip include: -Great overcrowding in a small area. -The siege imposed on the Gaza Strip. -Lack of medical capabilities. -Overcrowding of refugee camps in the Gaza Strip. According to an interview with the coordinator of the emergency operations room in the Gaza Strip, Salah (2020) as well as with the director of public relations in the Ministry of Health, Abu Namous (2020) to obtain information about the capabilities of the Ministry of Health to confront coronavirus they explained that: -Allocating 30 quarantine centres for those coming from the Rafah and Beit Hanoun crossings as a precaution until 25/8/2020, then, the policy of home isolation became effective in quarantine operations. -Coronavirus examinations were conducted for returnees from the Gaza Strip crossings, where the infectious cases were isolated for 21 days in quarantine places, they were not allowed to enter the Gaza Strip area except after making sure that they are not carrying the infection. -On 25/8/2020 and after the coronavirus spread in the community of the Gaza Strip, the number of tests for detection of the infected cases increased. -The Ministry of Health conducts 1,000 to 6,000 coronavirus examinations daily, which lead to a severe decrease in the available laboratory materials required for these tests. -According to the examination results, it was observed that the highest number of injuries in 2020 was on 15/12/ 2020, as the percentage of the confirmed infected samples reached 45% of the examined samples. -The number of coronavirus infected cases that admitted daily in the European Hospital ranges between 30 and 40, while the hospital capacity is 300 beds, 200 of them are fully used in the intensive care unit. 12 -The clinical capacity assigned for coronavirus patients in the Gaza Strip is 800 beds distributed between the European Hospital in Rafah and in other hospitals in Gaza Strip (Al-Aqsa Hospital, Al-Indonesian Hospital, Nasser Hospital and Al Shifa Hospital). -There are 21 health care centres distributed geographically across the Gaza Strip that prepared to take samples for coronavirus testing. This study was designed for: 1. Contributing to the evaluation of the Central Emergency Committee procedures to limit the spread of the coronavirus in Gaza Strip. 2. Helping the emergency operation planners in preparing plans that manage the emergency work to limit the spread of infectious diseases. Furthermore, one of the study problems is to identify obstacles that the Central Emergency Committee faces to reduce the spread of infection of the coronavirus in residential communities. The study problem can be formulated in the following question: How effective are the emergency measures done by the Central Emergency Committee to reduce the spread of the coronavirus in Gaza Strip? The researchers followed the descriptive and analytical method in the analysis of the data collected from respondents using the questionnaire tool that targeted the Central Emergency Committee, the purposive sample of preventive medicine workers, and the security team responsible for protecting and transporting the returnees and quarantined people in addition to analysis the Ministry of Health and the Gaza Central Emergency Committee reports. The objectives of the study are: 1. Identifying the procedures of the Ministry of Health to limit the spread of the coronavirus in Gaza Strip. This study was applied to the preventive medicine workers, who have a relationship with operations to reduce the spread of the coronavirus in Gaza Strip including the security team in the Ministry of Interior, the Central Emergency Committee, Medical Personnel, and preventive medicine in the quarantine facilities. The study was conducted during the time period April, May and June of 2020. The study population consists of all workers in the Central Emergency Committee, the Preventive Medicine Committee and the Ministry of Interior especially the worker in the emergency operations, in addition to specialized researchers. A purposive sample of 70 respondents was taken, the questionnaire was distributed to all members of the study sample, and the number of questionnaires retrieved was 65. After examining the questionnaires, five questionnaires were excluded due to the failure to fulfil the conditions required to answer the questionnaire, and thus the number of the questionnaires analysed was 60. Table 1 shows the characteristics of the study sample, the frequency, and the percentage of each variable in the sample. In addition, 'others' means the specialized researchers from the senior-level management in the Ministry of Health and the Central Operations Room. MUSALAM ET AL. The main tool of the study was the questionnaire which prepared as follows: 1. A preliminary questionnaire was prepared and designed by researchers for use in collecting data and information. 2. An initial field test study has conducted for the questionnaire and it has modified appropriately. 3. The questionnaire has distributed to all individuals of the sample to collect the data for the study. The questionnaire was divided into two parts as follows: The first part contains the personal information of the study sample. The second part contains three fields that address the procedures of the emergency management to avoid the spread of the coronavirus pandemic in Gaza Strip as follows: The first field addresses the procedures of the Ministry of Health, it consists of 12 paragraphs. The second field addresses the procedures of the Central Emergency Committee, it consists of 16 paragraphs. The third field addresses the effectiveness of procedures to prevent the coronavirus pandemic, it consists of 15 paragraphs. Each paragraph was answered according to 5-point Likert scale, as shown in Table 2 . The sincerity of the structural consistency of the study fields is given in Table 3 . Table 3 shows the correlation coefficients between the rates of each field of the study with the overall rate of the questionnaire paragraphs. The total rate shows that the outlined correlation coefficients are indicative at the significance level of 0.05, where the probability value of each field is less than 0.05 and the calculated r-value is greater than the tabular r-value which equals 0.361. The r tabular value is at the significance level of 0.05 and the degree of freedom '28' equals 0.361. The researchers used the Alpha Cronbach13 method to measure the stability of the questionnaire 13 as a second method for measuring stability. It is shown that the stability coefficients are high, as the stability factor for all paragraphs of the questionnaire reached 0.884, which is greater than the standard 0.70. To achieve the targets of the study and to analyse the collected data, several appropriate statistical methods were used via the Statistical Package for Social Science (SPSS). The following is a set of statistical methods used in data analysis: To be consistent with the questionnaire paragraph content, the sample responding average must be greater than 60% and the mean is greater than the neutral average (3); otherwise, the paragraph is not positive which means that the sample members are not consistent with its content. The main question is 'how effective are the prevention measures implemented by the Central Emergency Committee to limit the spread of the coronavirus in Gaza Strip at the level of significance (α ≤ 0.05)'. The results of the respondents answers are given in Table 4 , which summarized as follows: These results related deeply to the Ministry of Health action as shown in The proportional average 84%-100% 68%-84% 52%-68% 36%-52% 20%-36% T A B L E 3 the correlation coefficient between the rate of each field of the study and the overall average of the questionnaire items The results of the respondents answers are given in Table 5 , which summarized as follows: The Figure 3 . The effectiveness of the measures taken by the Central Emergency Committee to limit the spread of the coronavirus in the Gaza Strip The order The prorated average The quarantine areas are field hospitals equipped with all the equipment and supplies for the purpose of countering this virus. In addition, there is a possibility of using them as fast-setting field hospitals in far places, where it is possible to provide these field hospitals with the clean and safe solar energy systems. 16 The lowest paragraphs were 'there is financial and medical support and medical supplies provided by the Table 5 shows that the average of all paragraphs of the second field (Central Emergency Committee procedures) is 3.81 which is greater than the neutral average value '3'. The standard deviation is 0.54, the prorated average is 76.10% and it is greater than the neutral prorated average '60%'. This indicates that the procedures of the Central Emergency Committee to limit the spread of coronavirus in Gaza Strip were highly effective at the level of significance (α ≤ 0.05). The results of the respondents answers are given in Table 6 , which summarized as follows: Table 6 illustrates the results of the effectiveness of the measures to prevent the coronavirus pandemic. The The lowest paragraphs are 'the discovery of infected cases with coronavirus of whom recovered from the virus in the period of the quarantine' with a prorated average of 29.67%, and 'There have been returnees escape from the quarantine centres' with a prorated average of 32.33%. There was only one case of escape, and he was caught within hours. After the medical examination, it was free from the coronavirus. 19 Therefore, it is important to raise the awareness level of the citizens and the workers in the quarantine facilities about the serious danger of the coronavirus prevalence within societies and how dangerous it will be if the virus transmitted from the returnees to the residents. 20 The effectiveness of preventive measures to limit the spread of the coronavirus in Gaza Strip The order Table 6 shows that the average of the third field (the effectiveness of coronavirus pandemic prevention measures) is 3.05 which is greater than the neutral prorated average '3'. The standard deviation is 0.39 and the prorated average equals 60.98% which is greater than the neutral prorated average '60%'. This indicates that the effectiveness of the coronavirus pandemic prevention measures was medium at the significance level (α ≤ 0.05) In general, as shown in Table 7 it turns out that the average of all the questionnaire paragraphs (43) in the three fields is 3.44, which is greater than the neutral average value '3'. The standard deviation is 0.32, the prorated average equals 68.68% and it is greater than the neutral prorated average '60%'. This indicates that the preventive procedures effectiveness taken by the Central Emergency Committee and the Ministry of Health to reduce the spread of the coronavirus in Gaza Strip was significant at the level of significance (α ≤ 0.05). There is no statistically significant relationship at the significance level (α ≤ 0.05) between the preventive measures taken by the Ministry of Health and the effectiveness of the measures to prevent the coronavirus pandemic. The Pearson test was used to find the relationship between the preventive measures taken by the Ministry of Health and the effectiveness of the procedures to prevent the coronavirus pandemic at a significant level α ¼ 0:05. The results in Table 8 show that the coefficient of relationship value is 0.661, and the probability value is 0.000, which is less than 0.05. This indicates a big significant relationship between the preventive measures taken by the Ministry The Pearson test was used to find the relationship between the preventive measures taken by the Central Emergency Committee and the effectiveness of the procedures to prevent the novel coronavirus pandemic at the level of significance and the results are shown in Table 9 . The correlation coefficient value is 0.835, and the probability value is 0.000, which is less than 0.05. This indicates a strong relationship between the preventive measures taken by the Central Emergency Committee and the effectiveness of the coronavirus prevention procedures at the level of significance. Is that there is a statistically significant impact at the level of significance (α ≤ 0.05) of the coronavirus pandemic prevention measures and the effectiveness of the coronavirus virus prevention measures. Multi-linear regression analysis was used to identify the effect of the independent variables (Ministry of Health procedures and Central Emergency Committee procedures) on the dependent variable (effectiveness of coronavirus pandemic prevention measures). It has been found from the results given in Table 10 The novel coronavirus 'COVID-19' will continue spreading in the world nations because of the humans need to travel and move across borders. Therefore, it is important to work on reducing it by using all medical and administrative means and preventing returnees from abroad from reaching residential T A B L E 9 The correlation coefficient between the prevention measures taken by the Central Emergency Committee and the effectiveness of the measures to prevent the coronavirus pandemic at the level of significance (α ≤ 0.05) The effectiveness of the coronavirus prevention procedures The Central Emergency Committee procedures The correlation coefficient 0.835** Probability value 0.000 The sample size 60 areas before making sure that they are not infected with the coronavirus, so we recommend the following: � Achieving complete control of all international terminals to prevent infection from outside reaching the housing estates. � Working to prevent the mass gatherings in parks and beaches and impose fines on violators. � Requesting international bodies to increase the financial funding allocated to support the efforts of the Central Emergency Committee in Gaza strip in the response phase and the recovery phase from the effect of the novel coronavirus. � Increasing inter-agency coordination with the Ministry of Health in Ramallah to combat the coronavirus pandemic, away from political conflicts. � Enhancing effective community participation in educating the Palestinian community about the seriousness of the outbreak of the novel coronavirus and work to prevent it. A Study Reveals that Coronavirus Had Spread Around the World by Late Corona Emerging Virus meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novelcoronavirus-(2019-ncov) COVID-19) Strategic Preparedness and Response Plan: Accelerating Readiness in the Eastern Mediterranean Region WHO. Gaza has not Started the Coronavirus Curve, but Spread is Only a Matter of Time. 2020 Summary of Covid 19 (Coronavirus) Status in Palestine Daily Report for COVID 19 Virus We need compassionate leadership management based on evidence to defeat COVID-19 Structural Violence in the Era of a New Pandemic: The Case of the Gaza Strip COVID-19 pandemic: what can the West learn from the East? Understanding a Widely Misunderstood Statistic: Cronbach's Alpha. Paper presented at Southwestern Educational Research Association (SERA) Conference Warnings of the collapse of Gaza hospitals after being overcrowded with severe Corona injuries Epidemiology, Clinical Manifestation, and Characteristic of Coronavirus Covid-19 in Palestine and Regional Areas Building 500 Rooms for the Quarantine Hospital in Gaza Within Days A proposal to establish a field hospital with isolation units in the emerging Coronavirus crisis. ARID Sheltering and quarantine measures for risks that threaten the village of Umm al-Nasr, Gaza Strip Management of infections in critically ill returning travellers in the intensive care unit-I: considerations on infection control and transmission of resistance Awareness and Preparedness of Hospital Staff against Novel Coronavirus (COVID-2019): A Global Survey-Study Protocol. 2020. How to cite this article We would like to thank the Ministry of Health in Gaza, as well as the Ministry of the Interior and the Central Emergency Committee in the Gaza Strip for helping us to accomplish this scientific article. Not applicable. All authors contributed to the idea of this work and all have co-written the manuscript. All authors approved the final version of the manuscript. Research funding is provided by researchers only. Data available on request from the authors. The data that support the findings of this study are available from the corresponding author upon reasonable request.