Action by Churches Together (ACT)
Appeal - Palestinian Territories
Emergency relief for victims of conflict: MEPL-12
Appeal Target: US $771,010
Geneva,  17 October 2001


The continuing emergency situation in the Palestinian Territories/Israel
is now over one year old.  The situation is characterized by increasing
violence, worsening economic conditions and a general deterioration of
Palestinian society.  As of 22 August 2001 there were over 800
Palestinians who had been killed and approximately 11,000 who had been
injured.  Around 50% of the Palestinian population of the West Bank and
Gaza are unemployed and living below the poverty line.

The ongoing Israeli closure has made the overall role of the Lutheran
World Federation (LWF) even more important in providing health and
humanitarian services to the refugees and the increasing number of
unemployed.

This appeal provides for the continued emergency response by Augusta
Victoria Hospital, the provision of primary care and home care services in
the villages through the Village Health Clinics Team and a program that
will increase work opportunities through job creation at the LWF in
Jerusalem.

Please note that LWF has, according to plan, completed their program under
the MEPL-11 appeal that ends on 31 December 2001.  MEPL-12 will duly be
revised to accommodate projects for The Middle East Council of
Church/Department of Service to Palestine Refugees (MECC/DSPR)  and the
International Orthodox Christian Charities (IOCC).

Project Completion Date:  30 September 2002


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

                                        US$
Total Appeal Target(s)                771,010
Less: Pledges/Contr. Recd.                  0
Balance Requested from ACT Network    771,010


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



BACKGROUND

The continuing emergency situation in the Palestinian Territories is now
over one year old.  The situation is characterized by increasing violence,
worsening economic conditions and a general deterioration of Palestinian
society.  As of 22 August 2001 there were over 800 Palestinians who had
been killed and approximately 11,000 who had been injured.  Around 50% of
the Palestinian population of the West Bank and Gaza are unemployed and
living below the poverty line.

The ongoing Israeli closure has made the overall role of the Lutheran
World Federation (LWF) even more important in providing health and
humanitarian services to the refugees and the increasing number of
unemployed.

This appeal provides for the continued emergency response by Augusta
Victoria Hospital, the provision of primary care and home care services in
the villages through the Village Health Clinics Team and program that will
increase work opportunities through job creation at the LWF in Jerusalem.

Through this appeal, AVH will continue to provide care to victims of the
violence and respond to the medical care needs on the West Bank.  It will
bring emergency relief to areas of violence, and will increase the
capability of the Hospital to handle emergency trauma in the conflict.

The Village Health Clinics (VHC's) program will continue to care for
patients in their homes through the Home Care Program and will strengthen
its primary care training programs in the villages.  Also, because of the
increasing inaccessibility of the villages, the VHC Team needs to have
additional transportation.  The bottom of the existing van has been ripped
apart on two different occasions because the only access is through rough
Palestinian bypass roads that are not passable with the existing
transport.  When the VHC Team isn't able to reach the clinic, many of the
villages are left with no accessible health services.

The Lutheran World Federation has been distributing some food, blankets,
quilts and school kits to the needy in West Bank villages and in Gaza.
Although this is needed, a greater need is to provide employment for
Palestinians through job creation.  The heads of families would much
rather maintain their dignity and earn wages rather than receive handouts.
Grounds upgrading and building repairs are the primary focus of this
program and the LWF will focus on programs for Palestinians in Jerusalem
to primarily refurbish community buildings.



REQUESTING ACT MEMBER INFORMATION

The Lutheran World Federation, Augusta Victoria Hospital (LWF-AVH)



IMPLEMENTING ACT MEMBER & PARTNER INFORMATION

The Lutheran World Federation, 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 past year, the Hospital has responded to
critical emergency situations that resulted from the Israeli/Palestinian
conflict.  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.

This new ACT Appeal anticipates the continuation of the Palestinian
Intifada.  A recent poll in the Palestinian Territories and Israel showed
that the general perception of both populations is that there is no way to
end this conflict in the near future.  It is not likely that the Israelis
will open up Palestine and give back the Occupied Territories, and it is
not likely that the Palestinians will give up their struggle.  So, it
appears that the programs operated by the LWF-Jerusalem will continue to
operate on an emergency basis for the foreseeable future.  ACT has had a
significant impact on the ability of the LWF Jerusalem to provide
emergency health services.

Since the second Intifada started on the 29 September 2000, more than 800
Palestinians have been killed.  Many more were injured and estimates are
that until now 1,500 people have sustained injuries which will leave them
permanently disabled.  4,000 buildings are reported to be damaged, trees
uprooted and agricultural land bulldozed.  Internal closures divide the
West Bank into 64 clusters and the Gaza Strip into 3 clusters.  External
closures continue to seal off the West Bank and Gaza Strip from the rest
of the world.

The Village Health Clinics continue 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 critical need.

The catchment area for the VHC's continues to be the western border area
of Ramallah, north of Jerusalem.  These services, offered at 5 clinics,
are available to a population of 40,000.  The West Bank population is very
vulnerable to economic instability.  Due to the inaccessibility to jobs in
Israel, and to the closures as a result of the Israeli/Palestinian
conflict, families whose wage earners are mostly manual workers and who
rely on daily paid labor on farms, factories and building sites in Israel
for their income, are becoming poorer and poorer.

The VHC's provide primary health care to this population: including
mothers and child care, detection and management of chronic illness,
particularly Diabetes Mellitus, Hypertension and Coronary Heart Disease,
as well as treating seasonal acute illness.

These services have been badly affected due to the Israeli/Palestinian
conflict.  Access to the villages has been severely disrupted due to
roadblocks, closures and violent clashes, which have endangered the safety
of the Medical Team as well: the Team has had to take circuitous routes to
get to the villages.  Some roads are in very poor condition and the
average length of time to get to villages now takes twice to three times
as long.  Nevertheless, with a diminished team the VHC's have managed to
maintain services to a besieged community and to bring medical services to
homebound patients as well as to the villages.  These services include:


Home Care to Disabled and terminally patients:  A project which has now
expanded to all five of the LWF Village Health Clinics.

Post Natal Care:  Care given to women for the first 40 days following
delivery.

Health Education:  Providing an intensive, year long instruction course in
sanitation, well baby care, first aid, etc.



Focus on Women:  Through co-operation with other NGO's and institutions,
the following are offered to women:

Osteoporosis :  including Prevention and Treatment

Breast Cancer :  Detection and Management

Sexually Transmitted Diseases :  Prevention and Treatment


The Lutheran World Federation Village Health Clinics also contract with
the Palestinian Health Authority, including primary health care and
laboratory tests.

The LWF will implement a jobs creation program that will serve both
Palestinian men and women who are supporting their families.  The existing
emergency and political situations have increased poverty and unemployment
and this program will create a number of jobs that will provide
Palestinians with needed income.  This program is a direct response to a
growing socio-economical issue caused by the emergency.

When the LWF-Jerusalem is able to fund this program, it is anticipated
that there will be the opportunity to collaborate with other NGO's to
provide jobs that serve the community.  Some jobs will be created through
the LWF and its programs, but other opportunities will also be explored.
There are many community buildings and grounds that need to be repaired
and upgraded.

AVH provides emergency services and emergency standby services whenever
there appears to be the possibility of injuries coming to the Hospital.
The Hospital sends medical transport and physicians and nurses to trouble
spots in and around Jerusalem.  At the same time, AVH keeps 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 and continuing relevance.  Since the Refugees
and others who need medical treatment often cannot come to AVH, the
Hospital continues to go to the patients.

Because of the increased numbers of trauma patients, AVH is moving forward
with increasing the medical capacity to deal with these patients.  A full
time Emergency Room (ER) physician to co-ordinate treatment of patients in
the Hospital Emergency Room, to direct the emergency team response to
offsite locations and to implement treatment programs in emergency
orthopedics and neuro-surgery is needed.  When ambulances bring trauma
patients to AVH they are usually complex cases and need to be treated
on-site.  During times when large numbers of patients are being treated,
it is not good patient care to have to re-transport the patient to another
facility that is already very busy with other patients.

The VHC's 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, now can take two to two and half hours each way.
This has significantly increase personnel time on the road and the overall
costs of this program.  The roads to some of these villages are so bad
that a "normal" vehicle is not able to use them.

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 coordinating its resources with the VHC Team
and available medical transport to pick up chronic patients (dialysis)
from outlying areas.  Because of the difficulties in accessing the
villages and patients using regular roads in the West Bank, a 4-wheel
drive vehicle for use by the LWF programs is included in this ACT proposal
to transport staff on the rough bypass roads.  Also, laboratory equipment
(a cell counter) and an ultrasound are needed for the clinics.  Many
pregnant women come to the clinics and additional diagnostic equipment is
very much needed.  Again, these women do not have easy access to any other
doctors.  Also, the laboratory equipment is needed for patients who cannot
go elsewhere for these tests.

The increasing need for poverty alleviation though is becoming a major
focus for the Palestinian community.  The LWF in Jerusalem is proposing to
start a program which will employ Palestinians who support their families.
The scope of this program envisions up to 2,450 days of work at 100 NIS
(approximately US$ 24) per day.  This jobs creation program will paint,
fix up, terrace, clean up, repair and help the LWF and other NGO's in East
Jerusalem and the West Bank.



Location for Proposed Response

An important aspect of care at AVH at this time is continuing to provide
emergency care for the wounded and injured.  This care is provided on site
during emergencies in Jerusalem and in the West Bank when it is feasible.
Emergency treatment and surgery are provided as well as inpatient
intensive and general hospital care at AVH.

As the crisis continues, Palestinian 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
Israeli Military are continuing to create access problems for both staff
and patients.  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 of this appeal is that it supports AVH and VHC providing
health services 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 specialty physicians.



GOALS & OBJECTIVES:

The main goal is to continue to provide emergency and health services to
the wounded and injured in the current conflict a 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.

The second goal is to implement a program of jobs creation to help
alleviate poverty.

Goal 1 - provision of emergency and health services to the wounded and
injured in the current conflict

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.

Maintain the financial viability of the Augusta Victoria Hospital and the
LWF Village Health Clinics.

Provide services to homebound 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.



Goal 2 - to create jobs in order to help unemployed Palestinian population

Objectives:

Provide means for unemployed Palestinians to earn a daily income.

Create jobs that help to keep Palestinians in Jerusalem and to reduce out
migration.

Alleviate poverty for up to 40 Palestinian families (240 persons).




TARGETTED BENEFICIARIES

Number and type of 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 300,000 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's have the wherewithal to provide that care where it
is needed.

The jobs creation project focuses on unemployed Palestinians.  It is
anticipated that there will be a minimum of 40 families (average at least
6 members per family) who will benefit.  These families in turn buy goods
and services which in turn support the Palestinian community.  There will
be at least 240 direct beneficiaries with a positive effect on many more
Palestinians.


Criteria for Beneficiary Selection

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

Unemployed Palestinians whose families are in financial need are eligible
for the jobs creation program.




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.  Without the ability to send
these staff, there are patients that will not receive care.

This proposal also covers the emergency jobs creation assistance to repair
and upgrade community buildings.


Implementation

Since the healthcare programs are already operational, they will continue
to be functional as long as there are casualties and needs that AVH and
the VHC's can meet in the Refugee Camps or in 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 of these programs is a
prerequisite in order to provide continuity to these programs.

The jobs creation program is being piloted (implemented) with a small
donor grant at the present time.  This program can be expanded under the
supervision of the LWF.  Projects are being identified that are
appropriate for this type of effort.


Transition from the Emergency:

The 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.

At the end of the emergency, normal employment opportunities will again
become available for Palestinians.  The jobs creation program will phase
out.



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 jobs creation effort would become an active program of the LWF
in Jerusalem.  The LWF Representative is responsible for these programs.
The Chief of Executive Officer is responsible for the overall Hospital
function, and is assisted by the Chief of Clinical Services.  The Medical
Director of the Village Health Clinic coordinates these activities for the
VHC program.


Finance Management and Control

The LWF in Jerusalem is served by a fully staffed professional financial
department.  Each year a certified auditing firm audits the programs,
including all donations.  All money received by the LWF programs including
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 years. However, for purposes of planning the
expected date of completion for this ACT Appeal has been reset at
September 30, 2002.



COORDINATION

AVH coordinates efforts through its membership in the East Jerusalem
Hospital Forum (EJHF), (the EJHF consists of the six hospitals in East
Jerusalem), the Palestinian Ministry of Health and other emergency service
providers who assist the injured during the violence.  The VHC's
coordinate their activities with the Palestinian Authority primary care
network and other primary care providers on the West Bank.

The East Jerusalem hospitals coordinate resources and patient allocation
during emergencies through their regular meetings in the Forum.  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.  This may be one positive aspect of this situation.

In addition, the LWF is working with DSPR which is another ACT partner in
the Jerusalem area to assure the appropriate coordination of activities.



BUDGET

ESTIMATED EXPENDITURE
AUGUSTA VICTORIA HOSPITAL (AVH)

Description	Type of	No of	Unit Cost	Budget	Budget
	Unit	Units	NIS	NIS	US$
Emergency Medical Personnel (assigned to "Go and Serve")
Staff Salaries and Support
General surgeon	Month	12	8,400.00	100,800	23,718
Pediatrician	Month	12	8,400.00	100,800	23,718
Nurse / midwife	Month	12	5,040.00	60,480	14,231
Registered nurses (3 persons)	Month	12	4,200.00	151,200	35,576
Description	Type of	No of	Unit Cost	Budget	Budget
	Unit	Units	NIS	NIS	US$
Support medical staff	Month	12	8,400.00	100,800	23,718
Head nurse - admin,
 supervision & coord	Month	12	5,026.00	60,312	14,191
Other Expenses
Transportation (12 months)	Km	12,480	1.05	13,104	3,083
Insurance (malpractice and other)	Lumpsum			55,440	13,045
Communications	Lumpsum			1,050	247
Stationery and office supplies	Lumpsum			2,100	494
Sub Total				646,086	152,020

Emergency Care of Injured Patients
Supplies and Care
Medical supplies	Various	Various		175,609	41,320
Medications	Various	Various		190,948	44,929
Dialysis equipment	Various	Various		305,441	71,868
Patient care days	Day	200	1,470.00	294,000	69,176
Emergency Room Staffing
Emergency room physician	Month	12	8,400.00	100,800	23,718
Orthopaedic surgeon	Month	12	7,350.00	88,200	20,753
Field Teams (5 days per month) - Additional Staff
Nurses (3 persons)	Month	12	997.50	35,910	8,449
Resident medical doctors (2)	Month	12	1,260.00	30,240	7,115
Medical support staff (2)	Month	12	840.00	20,160	4,744
Consultant medical doctors (3)	Month	12	2,799.30	100,775	23,712
Operating Room - Additional Staff
Nurses (2)	Month	12	997.50	23,940	5,633
Technicians (2)	Month	12	997.50	23,940	5,633
Anesthetist	Month	12	2,168.25	26,019	6,122
Other Costs
Medical supervision & coordination	Lumpsum			39,148	9,211
Insurance (malpractice and other)	Lumpsum			55,440	13,045
Communications	Lumpsum			1,050	247
Stationery and office supplies	Lumpsum			2,100	494
Sub Total				1,513,720	356,169

Transp costs of field teams	Lumpsum			18,900	4,447

Emergency Equipment
Monitors for operating room	Unit	2	42,000.00	84,000	19,765
Crash cart / defibrillator 	Unit	1	50,400.00	50,400	11,859
Sub Total				134,400	31,624


TOTAL EMERGENCY COSTS FOR AVH			2,313,106	544,260

VILLAGE HEALTH CLINICS (VHC)

Home Care Program
Medical supplies	Various	Various		75,600	17,788
Staff Salaries
Registered nurses (1.5 posts)	Month	12	4,200.00	75,600	17,788
Other Costs
Transportation	Km	17,280	1.05	18,144	4,269
Description	Type of	No of	Unit Cost	Budget	Budget
	Unit	Units	NIS	NIS	US$
Insurance (malpractice and other)	Lumpsum			27,720	6,522
Communications 	Lumpsum			1,050	247
Stationery and office supplies	Lumpsum			2,100	494
Medical supervision & coordination	Lumpsum			26,670	6,275
Sub total				226,884	53,384

Capital Equipment
Laboratory & ultrasound equipment	Lumpsum			126,000	29,647
Transport vehicle for the Village
Health Clinic program	Vehicle	1	130,200.00	130,200	30,635
Sub total				256,200	60,282


TOTAL VILLAGE HEALTH CLINICS (VHC)			483,084	113,667

JOB CREATION FOR UNEMPLOYED PALESTINIANS
Labor
Labor (10 persons)	Day	245	100.00	245,000	57,647
Tools and Supplies
Shovels, wheelbarrows, etc.)	Lumpsum			10,500	2,471
Stones for paths	Lumpsum			20,160	4,744
Tiles for indoor floor repairs	Lumpsum			25,200	5,929
Cement for wall & building repairs	Lumpsum			27,300	6,424
Concrete tiles for outdoor areas	Lumpsum			33,600	7,906
Paint central office & other bldings	Lumpsum			21,000	4,941
Dirt	Lumpsum			8,400	1,976
Plants	Lumpsum			8,400	1,976
Wood, bags, gloves, paint
brushes, etc.	Lumpsum			10,500	2,471
Masons/supervisors of construction
/repairs work (2 persons)	Month	12	2,213.00	53,112	12,497
Other Costs
Coordination	Lumpsum			6,300	1,482
Communications	Lumpsum			630	148
Stationery and office supplies	Lumpsum			420	99
Insurance	Lumpsum			10,080	2,372

TOTAL JOB CREATION FOR EMERGENCY			480,602	113,083

TOTAL ESTIMATED EXPENDITURE			3,276,792	771,010

Rate of Exchange
Budget : US$ 1 = NIS 4.250




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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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