1. Gaza, Sept. 2005 Substance Abuse Research Center 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

2. Gaza, Sept. 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.

3. Gaza, Sept. 2005 Substance Abuse Research Center 3 Detailed Maps of Gaza Strip and the West Bank

4. Gaza, Sept. 2005 Substance Abuse Research Center 4 Introduction Population (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).

5. Gaza, Sept. 2005 Substance Abuse Research Center 5 Introduction Population: 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.

6. Gaza, Sept. 2005 Substance Abuse Research Center 6 Major Religions Major Religions Muslims = majority (70-95%) Christians = (5-30%) Languages: Mother Tongue: Arabic Ethnic Groups Mainly Caucasians

7. Gaza, Sept. 2005 Substance Abuse Research Center 7 Economy  Labor Force602,000  Unemployment Rate31%  Major Industries: Light industries, food processing, consumer goods.  Agriculture products:F ruits, vegetables, poultry, dairy products and fish.

8. Gaza, Sept. 2005 Substance Abuse Research Center 8 Nature of Substance Abuse Problems (No national figures)  Tobacco H. schools 7-18% Universities 9-50%  AlcoholH. schools 0.3-1.6% Universities 3-4%  Heroin/Cocaine H. schools 0.8-1.6% Universities 0.8-2.9%  MarijuanaH. schools 1.1-3% Universities 1.2-4.6%  EcstasyLifetime ?

9. Gaza, Sept. 2005 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%

10. Gaza, Sept. 2005 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).

11. Gaza, Sept. 2005 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)

12. Gaza, Sept. 2005 Substance Abuse Research Center 12 Substance Abuse Related Problems  Living with HIV/AIDS55 cases  HIV/AIDS related deaths25 cases  The most urgent substance related problems include: hepatitis, co-morbid disorders and adolescent drug use.

13. Gaza, Sept. 2005 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).

14. Gaza, Sept. 2005 Substance Abuse Research Center 14 Funding for Treatment  Self Paid5-10%  Private Insurance0%  State or Government: 90% (through gov. hospitals and community mental clinics

15. Gaza, Sept. 2005 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

16. Gaza, Sept. 2005 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

17. Gaza, Sept. 2005 Substance Abuse Research Center 17