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Delivery Systems for Substance Abuse Treatment: Gaza and the West Bank (Palestine Territory)

Delivery Systems for Substance Abuse Treatment: Gaza and the West Bank (Palestine Territory) . Mohammed Afifi, M.D., M.Sc. Substance Abuse Research Cenetr Istanbul, Turkey September 2005. The West Bank and Gaza Strip.

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Delivery Systems for Substance Abuse Treatment: Gaza and the West Bank (Palestine Territory)

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  1. Delivery Systems for Substance Abuse Treatment:Gaza and the West Bank(Palestine Territory) Mohammed Afifi, M.D., M.Sc. Substance Abuse Research Cenetr Istanbul, Turkey September 2005 Substance Abuse Research Center

  2. The West Bank and Gaza Strip • The West Bank: On the west side of the Jordan River. Its area is 3000 Sq.km (10 towns, 430 villages, and 18 refugee camps). Around 20% of it is occupied by Israeli settlements. • The Gaza Strip: On the East Cost of the Mediterranean. Its area is 362 Sq.Km (4 towns, 14 villages, and 8 refugee camps). Around 30% of it is occupied by Israeli settlements. Substance Abuse Research Center

  3. Detailed Maps of Gaza Strip and the West Bank Substance Abuse Research Center

  4. IntroductionPopulation (2003) • Estimated Population is 3.7 millions (36.7% in Gaza Strip, and 63.3 in the West Bank). • Density Rate in Gaza Strip in (3806 person /Sq.Km –area is 360 sq.km.), while the West Bank is 408 person /Sq.Km. area is 5800 sq.km. • The refugees make up 56% in Gaza Strip, and 44% of the West Bank Populations. • Un-employment: 31%, and 64.9% of families has an income of average 2 USD per day (Poverty line). Substance Abuse Research Center

  5. IntroductionPopulation: some indices (2003) • Birth rate: 27.2 per thousand, and fertility rate of 3.89 • 46% of population under 15 years • Infant Mortality: 24 per thousand • Life expectancy: males 70.7, females 72.3 • Education: below age 34years; 10.7% had university degree, and 12.5% completed high school, (1996). • Median age at first marriage is 18 years for females and 23 years for males. Substance Abuse Research Center

  6. Major Religions Muslims = majority (70-95%) Christians = (5-30%) Languages: Mother Tongue: Arabic Ethnic Groups Mainly Caucasians Substance Abuse Research Center

  7. Economy • Labor Force 602,000 • Unemployment Rate 31% • Major Industries: Light industries, food processing, consumer goods. • Agriculture products: Fruits, vegetables, poultry, dairy products and fish. Substance Abuse Research Center

  8. Nature of Substance Abuse Problems(No national figures) • Tobacco H. schools 7-18% Universities 9-50% • Alcohol H. schools 0.3-1.6% Universities 3-4% • Heroin/Cocaine H. schools 0.8-1.6% Universities 0.8-2.9% • Marijuana H. schools 1.1-3% Universities 1.2-4.6% • Ecstasy Lifetime ? Substance Abuse Research Center

  9. Nature of Substance Abuse Problems Continued • Meth/Amphetamine Lifetime ? • Inhalants H. schools 2.6-4.6% Universities 2.4-4.7% • Prescription Drugs H. schools 2.5-4.6% Universities 3.3-4.5% Substance Abuse Research Center

  10. Systems to Monitor and Estimate Substance Use Disorders • No national system • Reports of ANGA office (police) • SARC “Early alarming system for drug misuse among youth” in development stage through MERC grant (Joint project). Substance Abuse Research Center

  11. Nature of Substance Abuse Problems • Drug injection is a moderate problem especially with heroin, cocaine, and morphine derivative (pethedine). • Clean needles are available (not free) Substance Abuse Research Center

  12. Substance Abuse Related Problems • Living with HIV/AIDS 55 cases • HIV/AIDS related deaths 25 cases • The most urgent substance related problems include: hepatitis, co-morbid disorders and adolescent drug use. Substance Abuse Research Center

  13. Available Substance Abuse Treatment • Inpatient Detox – available only in one center in Jerusalem • Outpatient Detox –few clinics depending on doctor experience. • Physician Counseling: Assumed Yes, Practically- Rarely. • Methadone – not available • Buprenorphine – only occasionally • Outpatient Counseling: Yes, not specific for Drugs • Residential Rehabilitation – only in one center in Jerusalem • Therapeutic Communities – not available • Treatment for Women- not available • Treatment in Jail- only emergency (planned one clinic in Gaza). • Psychotherapy – available in few places (not properly trained) • Other pharmacotherapies, including antabuse, naltrexone, acamprosate and nicotine replacement (only occasionally). Substance Abuse Research Center

  14. Funding for Treatment • Self Paid 5-10% • Private Insurance 0% • State or Government: 90% (through gov. hospitals and community mental clinics Substance Abuse Research Center

  15. Treatment System • Substance abuse treatment in Palestine needs to be build from scratch: • Providing treatment facilities • Jailhouse treatment services • Adopting proper treatment protocols • Training health teams for proper protocols • Reduce the legal sanctions for use • Make treatment available for all Substance Abuse Research Center

  16. Unique Challenges • Establishing treatment facilities • Adopting, dissemination and implementation of available, effective treatment interventions • Limiting the impact of HIV and hepatitis Substance Abuse Research Center

  17. Substance Abuse Research Center

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