Ensuring access to health in Gaza Overall Operational objective is to ensure the ongoing provision of Emergency Medical Services and rehabilitation services to the people in Gaza, and strengthen the capacity of PRCS in delivering these services. Since the start of the mass demonstrations end of March 2018, the number of emergency cases supported by PRCS increased by almost 60% (more than 12,000 cases) and it has also led to a rise in the number of cases requiring long-term home visits and follow-up. The additional geographical locations covered by PRCS due to the opening of 4 emergency response stations along the border, have increased the burden on medical stocks, overstretched the fuel budget for ambulances, and enlarged the number of volunteers and staff needed to cover the emergency medical posts. The steep rise of fuel prices has overstretched the fuel budget for the EMS stations and hospitals at the same time, as these centers increasingly rely on generator systems in order to operate.  

Since March 2018, the consumption of medical disposables and supplies has grown substantially in order to provide life-saving services for the individuals injured during the ongoing demonstrations. At the same time, maintaining the current level and quality of EMS operations and rehabilitation services is faced with major financial challenges as funding is diminishing due to a combination of reasons:

•	The 13 year blockade has eroded the capacity for health service delivery in Gaza. There is a chronic shortage in medicine and supplies in Gaza. About two-thirds of major medical supplies are depleted from the warehouses of Governmental and non-governmental health services providers. The restriction on movement of goods and services has negatively impacted the availability of medical supplies in the local market, thus requiring their external procurement and transport to the Gaza at an extra cost to PRCS and often late delivery of supplies to the service centers. 
•	The necessity to increase the number of teams and working shifts has led to an increase of PRCS’ operational costs. Damage to the fleet ensuing from constant mobilization, resulting in frequent and costly repair and maintenance, and the need for frequent fleet replacement. Both spare parts and vehicles meeting the national specifications for ambulances are hard to find in the Gaza Strip.
•	In hospital emergency and surgical wards, PRCS provides services to all victims who need it regardless of their economic status. Very often PRCS is not compensated for its services provided to impoverished victims and affected areas. Not only are the injured high in numbers, but serious injuries and amputations are frequent, which necessitate a long-term follow up. Due to the ongoing demonstrations service providers face a rise in the need for medical rehabilitation services. With the destruction of Al-Wafa Hospital during the 2014 war, Al-Amal rehabilitation center in Khan Younis is the sole medical rehabilitation department in the Gaza Strip with only 46 beds.
•	The continued closure and restrictions on movement of people outside of Gaza for over 13 years, has limited the opportunities for PRCS staff and volunteers in participating in training and capacity building programs.
•	The reduction of US funding for UNRWA and a diversion of donor funds from Gaza Strip to other humanitarian crises in the region, and a cut in ICRC’s contribution to PRCS services for 2019 which mostly affects the EMS services. The operational strategy is articulated through the following objectives:

1.	Ensure crisis-affected individuals and communities in Gaza have continuous access to (pre-hospital) emergency medical services at all times.
2.	Ensure that PRCS EMT staff and volunteers have increased their capacities in providing emergency medical services to people affected by the ongoing crisis in Gaza.
3.	Ensure that the capacities of PRCS hospitals to provide medical and rehabilitation services to conflict-affected individuals with injuries and disabilities are increased. Palestinian Red Crescent Society and Netherlands Red Cross Society Gaza