Action by Churches Together (ACT)
Appeal - Palestinian Territories
Emergency Relief for Victims of Conflict - MEPL-11
Appeal Target: US$ 241, 027
Geneva,  7 March 2001


The casualty toll in the Palestinian territories is increasing as the
on-going violence dominates the lives of the civilian population. Besides
this, restricted freedom of movement and loss of jobs are only
contributing to a rapid economic decline that is pushing larger sectors of
the population below the poverty line.

The most vulnerable group, however, remain refugees in Gaza and the West
Bank.

ACT member the Lutheran World Federation (LWF) through the Augusta
Victoria Hospital (AVH) in Jerusalem and the Village Health Clinics (VHC),
wishes to continue providing emergency medical assistance to the civilian
victims of the conflict.  Having successfully completed their program
under the current appeal for Israel/Palestine, MEPL-01 that ends on 31
March 2001, it is important to keep the momentum in delivering essential
assistance to the most vulnerable of the affected.

The LWF proposal comprises the following elements:
  Provision of emergency care
  Emergency and surgery units
  Easier access to health services for refugees
  Services to homebound patients
  Provision of patients pick-up service

Project Completion Date: 30 September 2001


Summary of Appeal Targets, Pledges/Contributions Received and Balance
Requested

                                            US$
Total Appeal Target(s)                  241,027
Less: Pledges/Contr. Recd.                    0
Balance Requested from ACT Network      241,027




Ms. Genevieve Jacques		Thor-Arne Prois		Rev. Rudolf Hinz
Director			ACT Coordinator		Director
WCC/Cluster on Relations				LWF/World Service



REQUESTING ACT MEMBER

Lutheran World Federation (LWF)



IMPLEMENTING ACT MEMBER AND PARTNER INFORMATION

The Lutheran World Federation (LWF), through the Augusta Victoria Hospital
(LWF-AVH) and Village Health Clinics (LWF-VHC) in Jerusalem, has been
providing health care services to refugees and other Palestinians for the
past fifty years.  During this time, the Hospital has responded to
critical emergency situations as they have occurred between the Israelis
and the Palestinians.  The Hospital has an emergency response capability
including an Emergency Room, Medical and Nursing Staff and inpatient and
Outpatient care facilities.  AVH serves all patients regardless of race,
gender, religious belief, nationality, ethnic origin or political
persuasion.

The Village Health Clinics continue to try to overcome the West Bank
closure on a daily basis to bring Primary Care and Home Care services to
villages and individuals that cannot access health services from any other
source.  Most of the home care patients are either handicapped or
terminally ill and use the VHC services for nursing care, family training,
pain control and medication.  This is a very critical need.

This program anticipates the continuation of the Palestinian Intifada and
that Jerusalem will be a focal point for conflicts relating to unresolved
contentions such as the Right of Return, continuing construction of
Israeli settlements, status of Jerusalem, etc.




DESCRIPTION OF EMERGENCY SITUATION

Since the beginning of the Palestinian "Al-Aqsa" Intifada, which started
on 29 September 2000, light and heavy weaponry from land, air and sea have
been used in the conflict, resulting in hundreds having been killed, as
well as thousands injured and disabled.  Hundreds of houses have been
demolished and huge areas of agricultural land bulldozed.  In addition,
three million Palestinians have been living under siege, which isolates
Palestinian communities from each other and prevents people from receiving
food, medical care and other basic needs.  Closing borders and the
Palestinian airport in Gaza, has cut Palestinians off from the outside
world.  As a result, unemployment and poverty rates have increased
dramatically in the Palestinian areas.  Israel controls sources of water,
electricity and fuel, and have recently prohibited fuel supplies from
getting into the Gaza Strip.

AVH has continued to provide emergency services and emergency standby
services whenever there appears to be the possibility of injuries coming
to the Hospital.  The Hospital sends medical transport, physicians and
nurses to trouble spots in and around Jerusalem.  At the same time, AVH
has medical personnel at the Hospital and allocates emergency areas and
operating room capacity to serve patients that come to the Hospital.  
This has increased the operating expenses at AVH because of the overtime
paid to staff and the reduction in access to clinic and operating rooms.

Another major response to the crisis has been the implementation of a "go
and serve" program.  Since many of the refugees and other Palestinians
cannot access Jerusalem, AVH has coordinated with UNRWA to send doctors
and nurses to the Refugee Camp clinics and to supply needed specialists to
the UNRWA hospital in the north.  By matching the AVH medical and nursing
staff resources with the area of need for the Refugee Camps, AVH has been
able to utilize West Bank staff that live near to the clinics as well as
the Hospital that needs additional support.  This does not generate
patient income for the AVH and increases staff expense.  It is, however, a
program that has increasing relevance.

Since the Refugees and others who need medical treatment often cannot come
to AVH, the Hospital is going to the patients.  AVH is also proposing to
provide transportation for the chronically/seriously ill patients who
cannot access or have a difficult time accessing AVH services (e.g.
pediatric Dialysis patients).  A transport van will provide this service
when necessary and provide medical transport to the refugee and village
clinics.

The VHC continue to provide health services in the villages to the West of
Ramallah.  The primary difficulty is the access to the clinics and to the
home care patients that rely on this medical team.  A trip that normally
took one hour, can now take two to two and half hours each way.  This has
significantly increased personnel time on the road and the overall costs
of this program.

Access to essential medical treatment and medicines continues to be
difficult as the Israelis have blockaded the West Bank and Gaza.  Augusta
Victoria Hospital has been co-ordinating its resources with the VHC Team
and available medical transport to pick up chronic patients (dialysis)
from outlying areas.



Location for Proposed Response:

One aspect of care at AVH at this time is providing emergency care for the
wounded and injured.  This care is provided on site during emergencies
(for instance, at Al-Aqsa Mosque on Fridays).  Emergency treatment and
surgery are provided as well as inpatient intensive and general hospital
care.  As the crisis continues, patients who would normally come to the
Hospital for their care (dialysis, etc.) have difficulties in accessing
Jerusalem, due to lack of transport and military closures.  The
checkpoints and roadblocks are very strict and travelling around them
takes hours.  This creates problems for patients that are also referred to
the Hospital for non-emergency treatment.  Many of these patients simply
do not come while others with chronic illness only manage to access the
Hospital with great difficulty.  Another aspect is that AVH and VHC health
services are being provided where they are needed, in the Refugee Camps
and in the West Bank villages.  This has expanded the access to medical
services which are needed in this crisis.  This has also helped to
alleviate some of the issues from chronic patients and other patients that
need to have access to specialists.



GOALS & OBJECTIVES

The goal is to continue to provide emergency and health services to the
wounded and injured in this current conflict as well as to provide health
services to treat patients that normally need primary care and specialty
services, but do not have access during the crisis period.


Objectives

Provision of emergency care to the critically wounded.

Maintain the emergency and surgery units in a state of readiness.

Provide access to health services for refugees and other West Bank
Palestinians.

Provide services to housebound patients as well as other patients needing
regular medical treatment who do not have access to these services.

Provide kidney dialysis treatments for the increased number of kidney
failure patients who are being treated at AVH.

Provide patient pick up from the West Bank for serious, chronic cases
(i.e. Pediatric Dialysis patients) also transportation of staff to refugee
and village clinics.



TARGETTED BENEFICIARIES

Although the majority of the injured are young men, older men, women and
children have also been wounded or injured in this conflict and been
treated at AVH.  There are approximately 180,000 Palestinians in Jerusalem
and over 2 million in the West Bank.  The beneficiaries will ultimately be
those who are in need of care at AVH, in the Refugee Camps or in the
Palestinian villages that are served.  The ACT funding will help to assure
that AVH and the VHC have the wherewithal to provide that care where it is
needed.


Criteria for Beneficiary Selection:

All patients who are wounded or injured or in need of care along with
patients who cannot access medical care will be treated.  The basic
criteria is the need for medical care.



PROPOSED EMERGENCY ASSISTANCE & IMPLEMENTATION

This proposal is to continue to provide medical assistance to those
patients needing emergency and inpatient treatment at Augusta Victoria
hospital and to assist in the programs to "go and serve' in the Refugee
camps and villages.  This medical assistance includes all the Hospital
services, including, but not limited to, emergency preparedness, primary
care, dialysis, home care, intensive care, surgery, diagnostics,
medication, physician and nursing care and general inpatient care.  This
assistance will pay for the cost of emergency preparedness at AVH as well
as all pre-hospitalization emergency treatment both at the site of the
emergency and in the AVH treatment areas.

This assistance also covers the additional cost of sending staff to
Refugee camps and villages which need AVH and VHC resources.  This
includes primary care and specialty medical services both in the clinics
and in other West Bank Hospitals.  The LWF Jerusalem has medical resources
that can be of service in the West Bank but without the ability to send
these staff, there are patients that will not receive care.


Implementation

Since these programs are already operational, they will continue to be
functional as long as there are casualties and needs that AVH and the VHC
can meet in the Refugee Camps or the West Bank.  Clinical support by AVH
and the VHC for the clinics and the hospitals on the West Bank needs to be
continued and expanded because these patients cannot get to health
services.  Financial viability is a need in order to provide continuity to
these programs.


Transition from the Emergency

ACT funding will help to maintain special services during the present
emergency.  Once there is peace, the Hospital and VHC will transition back
to their normal program of providing care for the Refugees and other
patients.



ADMINISTRATION, FINANCE, MONITORING & REPORTING

Administration

Augusta Victoria Hospital and the Village Health Clinics are fully
functional and staffed to provide inpatient, outpatient and emergency
care.  The Chief Executive Officer (LWF Representative) is responsible for
the overall operation of the Hospital and the Village Health Clinics.  
The Chief of Operations is responsible for the administrative function,
and the Chief of Clinical Services is responsible for the medical
functions of the Hospital.  The Medical Director of the Village Health
Clinic coordinates these activities.


Finance Management and Control

The Hospital and the Village Health Clinics are served by a fully staffed
professional financial department.  Each year a certified auditing firm
audits the programs, including all donations.  All money received by AVH
and the VHC is accounted for and used for the purposes for which it is
designated.  Standard, acceptable accounting practices are in place and
reviewed during the annual audit.

ACT Funds will be accounted for as a separate grant and will be part of
the annual audit.


Monitoring and Reporting

ACT Funds are identified for their specific purpose.  The LWF-Jerusalem
Accounting Department will be responsible for the receipt of funds,
monitoring and assuring that these funds are used properly and that there
is proper documentation.  The Chief Finance Officer is responsible for the
overall monitoring and financial reporting on these ACT Funds.

LWF will report separately on funds used for this emergency.  It will
adhere to the ACT Reporting Guidelines and will give updates periodically
during this time of crisis.



IMPLEMENTATION TIMETABLE

The emergency care and the "go and serve" treatment of patients has
already commenced and this ACT request will cover costs that will allow
these programs to continue to serve these patients (emergency, homebound,
dialysis, refugees, etc.) both in Jerusalem and on the West Bank.  The
period of implementation will depend on the situation in this conflict,
which may last several months.  However, for purposes of planning the
expected date of completion has been reset at September 30, 2001.



CO-ORDINATION

LWF-Jerusalem coordinates the AVH efforts through the East Jerusalem
Hospital Forum (EJHF), (the EJHF is the five hospitals in East Jerusalem),
the Palestinian Ministry of Health and other emergency service providers
who assist the injured during the violence.  The VHC co-ordinate their
activities with the Palestinian Authority primary care network and other
primary care providers on the West Bank.

The East Jerusalem hospitals co-ordinate resources and patient allocation
during emergencies.  As patients are being medically assessed, they are
sent to the hospital that can best treat that patient's injury (i.e.
kidney injury patients come to AVH, eye patients go to St John's
Ophthalmic Hospital, etc.).  As this crisis continues, the providers of
health services are getting better at understanding each other's
capabilities and at coordinating their activities.  In addition, the LWF
is working with DSPR which is another ACT partner in the Jerusalem area to
assure the appropriate co-ordination of activities.



BUDGET


ESTIMATED EXPENDITURE - AUGUSTA VICTORIA HOSPITAL
Description	Type of	No of	Unit Cost	Budget
	Unit	Units	US$	US$

Additional staffing (4 days/month) including field teams (5 days/month)
for 6 months.

Nurses 	Nurse	3	800	2,400
Resident doctors 	Doctor	2	1,200	2,400
Consultants	Consultant	3	2,666	8,000
Sub total				12,800


Field Team				
Nurses	Nurse	2	800	1,600
Doctor		1		1,600
Support				600
Sub total				3,800	
Medical supplies (see attached details) 			110,000

Operating Room
Nurses	Nurses	2	800	1,600
Technicians	Technicians	2	800	1,600
Anesthesia physician		1	2,067	2,067
Sub total				5,267

Transportation Cost 	Lump sum			2,160
Patient and staff transport van				29,500
Emergency crash cart				8,000
Sub total 				39,660
				
2nd: Emergency Go & Serve (Medical Field Relief)							
Nurses (5)	Month	6	5,000	30,000
Surgeon 	Month	6	2,000	12,000
Anesthesia physician	Month	6	2,583	15,500
Primary care doctor 	Month	6	2,000	12,000
Sub total 				69,500	
TOTAL ESTIMATED EXPENDITURE			241,027


Medical Supplies List






Appeal








Unit Price
Unit Price
Total Price
Total Price



in NIS
in USD
in NIS
in USD


Quantity
VAT incl.
VAT incl.
Vat incl.
Vat incl.

DRUGS






SURGISTRAIN GALLON
16
340.11
82.95
5,441.72
1,327.25

ENDOZUME HANDWASH GALLON
16
373.45
91.08
5,975.14
1,457.35

ENDOZUME MACHINE WASH GALLON
16
373.45
91.08
5,975.14
1,457.35

CLEXAN 40MG/0.4ML
120
30.08
7.34
3,609.26
880.31

FORMALIN 10% SOLUTION  /LITER
50
5.95
1.45
297.41
72.54

FUSID AMP
1500
2.59
0.63
3,885.57
947.70

INSURE LIQUID
200
9.50
2.32
1,899.61
463.32

OSMOLITE LIQUID
200
8.87
2.16
1,774.89
432.90

DIST WATER AMP
5500
0.72
0.18
3,957.53
965.25

DOPAMINE HCL 40 MG/ML AML AMP
100
9.07
2.21
906.63
221.13

PRESEPT 2.5GM
32
65.14
15.89
2,084.58
508.44

CIDEX 28DAYS  5LTR
4
65.14
15.89
260.57
63.55

ROCEPHIN I.V 1GM VIAL
400
86.35
21.06
34,538.40
8,424.00

FLAGYL I.V 500 MG 100ML BAG
1200
15.40
3.76
18,478.04
4,506.84

GLYCIN 1.5% BAG 3000 ML
96
46.19
11.27
4,434.56
1,081.60

SOLUMEDROL 500 MG VIAL
120
41.46
10.11
4,974.67
1,213.33

SLOW K TAB
1200
0.12
0.03
142.13
34.67

DIST WATER 1 LITER bT
1080
10.54
2.57
11,384.88
2,776.80

DOCARD AMP 200mg/ 5ML VIAL
600
0.64
0.16
383.76
93.60

GLUCOSE WATER 10% 500ML BAG
320
8.17
1.99
2,615.25
637.87

TELEBRIX 350 100ML
35
71.07
17.33
2,487.33
606.67

ULTRAVIST 370 50ML
45
167.01
40.73
7,515.30
1,833.00

VOLUMETRIC I.V SET 150ML
300
11.25
2.74
3,375.67
823.33

AMPROLENE AMP 1-20 PKT
2
3,407.77
831.16
6,815.54
1,662.33

RUFENAL SUPP ADULT
2000
1.22
0.30
2,439.96
595.11

Sub-Total




33,086.23








MEDICAL DISPOSABLES






STERILIZATION BAG 305-381mm
3000
1.01
0.25
3,022.11
737.10

STERILIZATION BAG 75-75 cm
3000
0.67
0.16
2,014.74
491.40

STERILIZATION BAG 90-90 cm
5000
1.10
0.27
5,516.55
1,345.50

KANGAROO FEEDING BAG
30
15.97
3.90
479.22
116.88

GRANUFLEX PATCHES 10-10cm PIECE 1-10PKT
6
473.80
115.56
2,842.80
693.37

SUCTION CATH G14
600
0.72
0.18
431.73
105.30

SUCTION CATH G10
600
0.72
0.18
431.73
105.30

SUCTION CATH G16
400
0.72
0.18
287.82
70.20

OXYGEN NASAL CANNULA G10
300
4.08
0.99
1,223.24
298.35

MESH 30-30CM
5
1,018.59
248.44
5,092.97
1,242.19

MESH 15-15CM
5
1,137.08
277.34
5,685.40
1,386.68

VELBAND COTTON 10 CM
48
2.69
0.66
128.94
31.45

CHROMIC W4425
14
131.49
32.07
1,840.80
448.98

PROLENE W8626
20
245.17
59.80
4,903.49
1,195.97

PROLENE W626
3
253.47
61.82
760.42
185.47

PROLINE W742
10
131.49
32.07
1,314.86
320.70

SILK 327
10
104.24
25.42
1,042.39
254.24

VICRYL W9231
8
195.43
47.67
1,563.44
381.33

CHROMIC W435
4
137.39
33.51
549.54
134.04

SILK W586
4
88.84
21.67
355.36
86.67

PROLINE W621 STRAIGHT
4
163.96
39.99
655.85
159.96

PROLINE W538
10
163.43
39.86
1,634.34
398.62

LAPROTOMY SPONG 45-45
100
11.27
2.75
1,127.30
274.95

DOUBLE LUMAN CATH GDK-1120J
30
376.56
91.85
11,296.94
2,755.35

X-RAY FILM 20-25 cm IMMAGE
15
143.91
35.10
2,158.65
526.50

X-RAY FILM 35-35 cm
20
239.85
58.50
4,797.00
1,170.00

X-RAY FILM 24-30 cm
20
136.33
33.25
2,726.61
665.03

HIGH QUALITY PRONTING PAPAER UPP 110S
20
58.62
14.30
1,172.33
285.94

DEVELOPER
20
177.67
43.33
3,553.33
866.67

FIXER
20
94.76
23.11
1,895.11
462.22

BUBLE TUBE
60
88.95
21.70
5,337.11
1,301.73

DISP THICK NEEDLE G18-1.5
18000
0.10
0.02
1,790.88
436.80

Sub-Total




18,934.88








DIALYSIS SUPPLIES LIST






BICART ACID 5 LIT GALLON
1100
37.42
9.13
41,158.26
10,038.60

ALTRA FLUX 140 ( SURFLUX DIALYZER 140)
108
27.82
6.79
3,004.84
732.89

HEPARIN SODUIM
1000
16.19
3.95
16,189.88
3,948.75

DIALYZER CELL FB130T
120
72.91
17.78
8,749.73
2,134.08

DIALYZER SUREFLUX 150 E
144
110.33
26.91
15,887.66
3,875.04

DIALYZER SUREFLUX 50 E
144
56.12
13.69
8,081.99
1,971.22

DIALYZER CELL 90T
144
70.52
17.20
10,154.29
2,476.66

DIALYZER SURFLUX 110
72
72.67
17.73
5,232.57
1,276.24

HEMOPHAN DIALYZER GFS PLUS 16
80
72.91
17.78
5,833.15
1,422.72

BLOOD SET AK F5M87847
662
32.38
7.90
21,435.39
5,228.15

A LINE 5122 B6
350
45.57
11.12
15,950.03
3,890.25

V LINE 5107 X
414
45.57
11.12
18,866.60
4,601.61

BICART SODIUM POWDER
1100
35.98
8.78
39,575.25
9,652.50

DOUBLE LUMEN C.V.P HVVP0607
5
566.05
138.06
2,830.23
690.30

DUAL LUMEN CATH GDK510P
5
1,218.44
297.18
6,092.19
1,485.90

A.V FISTULA G16
400
3.50
0.85
1,400.72
341.64

A.V FISTULA G17
400
3.50
0.85
1,400.72
341.64

DUAL LUMEN CATH PEDIATRIC GMB7412
5
681.17
166.14
3,405.87
830.70

OPSITE 15-28
790
15.99
3.90
12,632.10
3,081.00

Sub-Total




58,019.87








Grand Total




110,040.98



- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Action by Churches Together (ACT) is a worldwide alliance of churches and
their related agencies, meeting human need through co-ordinated emergency
response.  The ACT Coordinating Office is based with the World Council of 
Churches (WCC) and the Lutheran World Federation (LWF) in Switzerland.
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   Ecumenical Centre                          Phone: ++41-22-791.60.33
   150, route de Ferney                         Fax: ++41-22-791.65.06
   P.O. Box 2100                             E-Mail: act@wcc-coe.org
   1211 Geneva 2                              Telex: 415 730 OIK CH
   Switzerland                                 http://www.act-intl.org




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