• Marwan Mosleh, Yousef Al Jeesh, Koustuv Dalal, Heidi Carlerby, and Eija Viitasara.
• Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden. Electronic address: marwanmoon@hotmail.com.
• Lancet. 2021 Jul 1; 398 Suppl 1: S37.

BackgroundWar-related injury is a growing clinical and public health concern in occupied Palestinian territory, especially in the Gaza Strip. However, little research has been done into the quality of care and management of war injuries in public hospitals. We explored the perceptions of health-care workers about these factors in Palestinian health-care facilities in Gaza.MethodsThis was a qualitative descriptive study. Data were obtained in four focus group discussions attended at public health facilities by 30 purposively selected health-care providers, comprising 14 head surgeons, and 16 head nurses, aged 38-55 years. A semi-structured topic guide was developed by the authors for the study based on earliest literature, and was critically reviewed by a panel of experts to ensure the trustworthiness of the qualitative guide and to minimise complexity and enhance clarity of the questions for participants. Audio recordings of discussions were transcribed verbatim, translated, and analysed with a thematic analysis approach. The study was approved by the Palestinian Health Research Council and facilitated by the Ministry of Health.FindingsA consensus was expressed that, despite some positive aspects in the system, fundamental changes and essential improvements were needed to advance the care and facilitation of war injury management. Some respondents had serious concerns about the health-care system, suggesting that it needs to be comprehensively rebuilt. Unanimous views were expressed about the important barriers to effective management and quality of care: shortages of resources, medicines, and funding; underuse or absence of specific and unified clinical practice guidelines; no official commitment by the Ministry of Health to adopt updated clinical guidelines; few incentives and poor motivation, poor communications; blockade and siege; division of health systems in the country; overcrowding of patients with war injuries in hospitals with limited capacity; spreading of infection due to poor cleanliness; shortages in fuel and power supply; and low wages, which negatively affected staff motivation. Respondents also reported inadequate sharing of care and cooperation between different health-care facilities.InterpretationThe perceptions about barriers to management of war injuries and the quality of care provided were similar across Palestinian health-care facilities in the Gaza strip. Our findings suggest that fundamental changes and comprehensive reform of the health-care system are needed to make the care of patients with war injuries more effective and efficient. One of the important strengths of this study is that it addressed the perspective and opinions of different key health professionals, which made it possible gain deeper and better understanding of how war injuries are managed in the Palestinian health system. In addition, the outcomes of the study were based on diverse information. However, the analysis of the qualitative data may represent challenges, and be more complicated and time consuming than a quantitative approach.FundingNone.Copyright © 2021 Elsevier Ltd. All rights reserved.

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