Following an initial exploratory mission in January 2024, Dr Pierre Catoire and Dr Mehdi El Melali led an initial training mission in emergency ultrasound in May 2024.
Here’s their experience.
What is the situation in the West Bank?
Mehdi El Melali : Palestine is divided into two territories: the Gaza Strip to the east and the West Bank to the west. The West Bank, with around 3 million inhabitants, is subdivided into several zones (A, B and C). These zones reflect the degree of control exercised by the Palestinian government over security and the management of medical services.
Zones A and B are fragments of territory surrounded by zone C, which is under Israeli control. This makes movement difficult, as trade between these zones passes through Israeli checkpoints, slowing down the movement of goods and people. This chronic situation, which has been going on for years, has become even worse since 7 October 2023.
How did your fact-finding mission go last January?
M.E. M. : In January 2024, we decided to focus our mission on the West Bank, as access to Gaza was impossible. We were surprised by the scale of the difficulties there. Our aim was to assess local needs and meet local and international humanitarian actors, as well as representatives of the Palestinian Authority.
We noted an increase in the number of checkpoints controlled by the Israeli army, making movement limited and dangerous. This situation has contributed to more than 450 deaths linked to the clashes since 7 October.
How good is the health system in Palestine?
M.E. M. : The standard of medical care in Palestine is very high, comparable to that in France, and in some areas even higher, thanks to international influence. Despite the difficult context, they have shown a remarkable organisational will.
However, they lack the resources to cope with the Israeli authorities’ blocking of logistical convoys and the restricted mobility of medical staff.
What needs have been identified?
M.E. M. : We have identified five main needs, with the help of Palestinians who know their health system well. Firstly, emergency ultrasound, in which Mehad has a great deal of expertise. Then there’s the management of emergency deliveries, training in war surgery, support for the mobile clinics that are currently at a standstill, and finally, logistical support for the supply of medical equipment and medicines.
Why did you choose emergency ultrasound training as a priority?
Pierre Catoire : Ultimately, in the spectrum of training, emergency ultrasound is what’s missing. In fact, clinical ultrasound is fairly new.
For patients in conflict situations who are exposed to particular types of trauma, emergency ultrasound enables us to determine whether the patient is stable, stabilised or unstable, so that we can guide the surgeon.
Our aim is to train clinicians to perform abdominal and thoracic ultrasound scans in less than three minutes, which is the standard required to obtain our certification.
How did you develop this training?
P.C. : This course has been developed in partnership with the Palestinian Ministry of Health. Our aim is to provide healthcare professionals with key skills and preserve their capacity for continuous learning. Our programme is not an isolated course, but the start of a continuous learning process in ultrasound, adapted to the logistical constraints of the region.
Where have you been involved?
P.C. : With the support of the Palestinian Ministry of Health, we have rolled out this training throughout the West Bank, particularly in Hebron, Bethlehem, Jericho, Tulkarem, Jenin, Nablus, Selfit and Ramallah. These towns were chosen according to the needs identified by the Ministry.
What are the results of this first phase?
P.C. : We launched an evaluation process on the first day of training. All the participants were certified, mastering abdominal and thoracic ultrasound in less than three minutes. We organised twelve training sessions, with an average of ten participants per session. The feedback was very positive, with a satisfaction score of 9/10 and 100% recommendations. In the future, we want to develop the training of trainers to increase the number of sessions and extend the training to obstetrics.
