Global Background

The neonatal period, which spans the first 28 days of a newborn’s life, is considered an integral indicator of future child survival. The burden of neonatal mortality is most pronounced in low and middle-income countries, where 99% of neonatal deaths occur. 

Globally, approximately 2 million newborns die during the first 7 days of birth. In 2015, it was estimated that 5.9 million children under-five died, with a global mortality rate of 42.5/1000 live births, and a neonatal mortality rate (NMR) of 19/1000 live births.

Situation in Palestine

As a developing middle-income country, Palestine mirrors some of the same trends and challenges faced globally in neonatal health. According to the Ministry of Health (MoH) 2017 Annual Report, in 2016 there were 72,327 live births in the West Bank and 58,170 live births in the Gaza Strip. Additionally, in 2016 there were 1,793 referrals for neonatal services at an estimated cost of 34,996,588 ILS for incubators, not including surgeries.

Study Objective

Assess the availability, distribution and accessibility of neonatal health services at Palestinian hospitals in the West Bank (WB, including East Jerusalem (EJ)) and Gaza Strip (GS) to inform policy and aid organizations in filling the gap in neonatal services in Palestine.


Study Methodology 

The WHO tool “Hospital care for mothers and newborn babies: Quality assessment and improvement tool” was used to evaluate the quality of care at the hospital level, identify areas of improvement, and develop future action plans. All 63 hospitals providing delivery and neonatal care participated in the study.

Main Findings

There are a total of 38 neonatal units in Palestine, 35 of which provide delivery services. About 79% of neonatal units and 78% of incubators in Palestine are based in the West Bank, indicating that the number of incubators in Gaza is much lower than what is needed. Furthermore, not all facilities in Palestine are designed to effectively promote breastfeeding and parenteral feeding. 

There are only 10 neonatologists in Palestine, some of whom work on a part-time basis. Moreover, sub-specialty consultants in different medical and surgical areas can only be found at a few specific hospitals. In 2018, the number of practicing specialized neonatal nurses reached 86.

Basic amenities can only be found at 19 out of the 38 facilities, making the other 19 facilities unsuitable for the essential care of sick newborns.

Main Recommendations:

1. Build an effective referral system (regionalization)
2. Upgrade hospitals that provide neonatal services
3. Develop an effective transport system
4. Implement standards of care to all MoH neonatal care units as well as non-governmental units as part of licensing for services and referrals.
5. Regulate In Vitro Fertilization (IVF) centers for number of embryos to be transferred.