Improving the resilience and responsiveness of the palestinian population most vulnerable to the humanitarian crisis in Gaza and the West Bank At Médicos del Mundo

1. INTRODUCTION

1.1 JUSTIFICATION AND RATIONALE FOR THE EVALUATION

The carrying out of a final evaluation finds its legal framework in section VI. 4 Evaluations of the Resolution of 24 March 2009 and 31 October 2011 of the Presidency of the Spanish Agency for International Cooperation, approving the rules for the management, monitoring and justification of NGDO projects and agreements and development cooperation actions subsidised to non-governmental development organisations.

The project under evaluation received a grant of €600,000 from AECID in the 2022 call for proposals.

The reasons for carrying out a final evaluation are, firstly, to comply with the requirements of the international cooperation grant financed by AECID where an evaluation is foreseen for reasons of transparency and accountability.

Secondly, the value that Médicos del Mundo attaches to carrying out evaluations of interventions, considering that the results of these evaluations represent a very valuable working tool, with a view to:

• To increase the quality of support for the fulfilment of the organisation’s mission.
• Increasing transparency with regard to the populations we work with, the local authorities, the national authorities and the associative level of the managing organisation Médicos del Mundo (MdM).
• Broaden the organisation’s learning and share it among projects and local partners by identifying value-added practices.

For this reason, Médicos del Mundo has a Monitoring and Evaluation Unit which is responsible for following up on the evaluations carried out in the different projects implemented, ensuring that the lessons learnt are fed back into future projects.

1.2 SPECIFIC OBJECTIVES OF THE EVALUATION

The final external evaluation of this project is a commitment acquired with the AECID following the grant awarded for the implementation of the aforementioned project, within the framework of the monitoring and justification regulations set out in the regulatory bases of the AECID Call for Proposals. Thus, this evaluation represents the last milestone marking the end of the project’s implementation, with the main purpose of globally evaluating the development and achievement of the results obtained in relation to the specific objectives and the components of the intervention for the improvement of the processes and, on the other hand, specifically, to analyse the relevance and effectiveness of the actions implemented as well as the capacity for improvement and adaptation according to the findings produced in previous evaluations.

All the lessons learnt will be compiled to guide Médicos del Mundo’s future interventions in Palestine. This, in turn, will provide a clear understanding of the level of involvement of the various actors involved in the intervention, the integration of human rights, gender, environmental and anthropological approaches, as well as the accountability process employed, and will help to improve decision-making in future interventions.

The evaluation will generate recommendations that identify concrete actions that Médicos del Mundo should take to strengthen its operations in order to ensure the most timely, effective and efficient response possible in future interventions in Palestine, paying particular interest and attention to the degree of achievement of the expected results, coordination, quality, relevance and impact of the actions implemented so far.

1.3 TYPE OF EVALUATION

This is a final external evaluation of the above-mentioned project.

1.4 EVALUATION USE AND EXPECTATIONS

The evaluation will have a dual use:

• On the one hand, to be accountable to donors through an external opinion on the impact of the project.
• Furthermore, a list of conclusions and recommendations to improve the implementation, quality and relevance of Médicos del Mundo’s future interventions is expected.

The Evaluation Report will be of use for:

• The staff of the project’s funding bodies: AECID.
• Médicos del Mundo technical staff and volunteers at HQ and in the field.

1. PURPOSE AND BACKGROUND OF THE INTERVENTION

2.1 INTERVENTION LOGIC

The AECID project 2022/ACHU/000242, “Improving the resilience and response capacity of the most vulnerable Palestinian population to the humanitarian crisis in Gaza and the West Bank” is implemented with the local organisations Aisha, Ein Sultan, Juzoor and the Ministry of Health and Ministry of Education.

The total amount of the project is €660,000, of which €600,000 corresponds to the grant from the Spanish Agency for International Development Cooperation (AECID). The project started on 7 September 2022 and is scheduled to end on 6 September 2024.

The Palestinian civilian population continues to suffer the consequences of the Israeli occupation and the intra-Palestinian division between Fatah and Hamas. The lack of political progress in the Middle East Peace Process, the failure of Israel as an occupying power to comply with its obligations (IHL), combined with the physical and political fragmentation of the territory have resulted in a protracted protection crisis with severe humanitarian consequences, according to the Inform 2022 risk index Palestine presented at the time of formulation an overall medium risk of 4.5 with a high risk >5 in three of the index dimensions: risk and exposure to personal harm from conflict and violence, population vulnerability and institutional response capacity.

This situation has increased markedly since the events in Palestine on 7 October 2023 summarised below:

• On 7 October 2023, armed groups in Gaza launched an offensive against Israel, through the firing of explosive rockets and militant raids on communities and military installations near the Gaza Strip, killing soldiers and civilians and taking hostages that they carried into the Strip. In response, the Israeli government launched a military operation in Gaza with the stated aim of ending Hamas and freeing Israeli hostages held in Gaza.
• From 7 October to 12 June, according to the Gaza Ministry of Health, 37,202 Palestinians have been killed, including at least 7,797 children and 4,959 women, and approximately 84,932 injured, and 1.7 million displaced. The number of fatalities recorded in Gaza during the first 15 days of hostilities was more than double the total number of fatalities during the 50-day escalation of hostilities in 2014 (2,251 Palestinian fatalities).
• These events have not only had an impact on Gaza, but in the West Bank, increased vulnerability and exposure to personal harm from conflict and violence (including Area C, East Jerusalem and H24) is subject to an increasingly coercive environment generated by the ongoing occupation and the continued expansion of Israeli settlements, with the resulting displacement of the Palestinian population, who are exposed to demolitions and settler violence.
• The situation is therefore constantly deteriorating, resulting in a very fragile health system that has struggled to cope with the recent Covid outbreak19 , along with the collapse of other critical services, degraded infrastructure, lack of electricity, unemployment, restrictions on movement, and the constant possibility of escalation of the conflict.

The overall objective of this project was to “Contribute to improving humanitarian response and respect for IHL and IHRL in Gaza West Bank and E1” and the specific objective was to “Strengthen MHPSS capacities in emergencies in Gaza and MHPSS humanitarian response in the West Bank”. This was initially intended to be achieved through 4 outcomes, which had to be reformulated and expanded to 5 in response to the sudden onset emergency following the events of 7 October:

• R1: Improved capacity of child and youth MHPSS health service providers in Gaza
• R2: Increased resilience and responsiveness to crisis and continued stress in Gaza
• R3: Improved MHPSS response for the affected and most vulnerable population in the West Bank and E1
• R4: Improved sensitivity of society and political actors to IHL violations
• R5: Capacity building of primary health care facilities to respond to medical and trauma emergencies

With these objectives in mind, an 18-month intervention was designed, which due to the events following the IDF invasion of Gaza has been increased to 24 months.

Across the board, the project has promoted the humanitarian principles of equity, participation, do no harm, and the use of available resources and capacities. It has also promoted the protection and conservation of the environment through the rational use of available resources.

2.2 TARGET GROUP OF THE INTERVENTION

HNO 2022 identified 1.8 million people targeted for protection, 64% in Gaza and 36% in communities affected by displacement risk in the West Bank and E1, with physical and psychological well-being as a priority.

Therefore, the target group for the intervention was minors with suspected and/or diagnosed mental health problems in the prioritised areas. Given the situation in the Gaza Strip, the entire population of minors in a situation of vulnerability was considered. On the other hand, although there is no official record, the CSMCs reported that more than twice as many men and boys are treated as girls and women, therefore, it was established as a priority to focus activities on these differences in order to balance access to professional help and overcome stigma. Likewise, during the identification period, it was established that the selection of the indirect target population would be carried out by the existing referral mechanism, following the following criteria: Under 18 years of age and Existence of suspected mental health problems.

In addition, it was agreed that, together with AISHA, direct psychosocial care would be provided to 100 women survivors of gender-based violence, 80 women cancer patients and awareness campaigns would target 100,000 people in the 5 governorates of Gaza where the project is being implemented.

In the West Bank, on the other hand, the target population consisted of the total population of the intervention communities, 105,667 people whose identification was based on the

WBPC vulnerability profile (Jericho and E1) expanded with focus groups and interviews in the new intervention communities (Ramallah). It was initially planned to provide direct assistance to 1386 people, mainly women and children, victims of both community and OCHA critical incident alerts.

But following the escalation of violence from 7 October and the request for reformulation of the project, which has included a new outcome to respond to the emergency situation, the entire population of the Gaza Strip affected by the conflict has been added as the project’s target population, whose health and mental health needs will be addressed.

In general terms, we can speak of two target groups present in the project:

On the one hand, those sectors of the population affected by the humanitarian crisis with the greatest vulnerabilities, such as the displaced population, families, unaccompanied minors (MENA), women, pregnant women, the elderly and people with disabilities, have been direct subjects of rights.

On the other hand, local staff (health, social, educational, displaced workers) who are part of the response to care for people affected by the humanitarian crisis and who have received training in the area of Mental Health and Psychosocial Support as well as psychosocial care to improve their own capacity to manage stress in their response tasks have been considered indirect subjects of law.

It is important to highlight that the target groups have been part of the definition of needs, as well as of the selection criteria at the time of the formulation of the project and during its implementation, their opinion has been taken into account, with what has been collected through the complaints and suggestions mechanism put in place.

1. ACTORS INVOLVED

The main actors involved in this intervention have been:

• In the West Bank, implementation has been straightforward.
• In Gaza, the Ministry of Health is the duty bearer and responsible for the provision of specialised health care services and is the main provider of MHPSS services through Community Mental Health Centres and school health teams.
• In Gaza also, the Ministry of Education is responsible for detecting and addressing psychosocial mental health conditions of students through guidance staff and Central Guidance Units.
• Local partner AISHA carried out the provision of individual and family psychological services to women survivors of GBV as well as to women chronically ill with cancer.
• The local social enterprise Ein Sultan Provision has been responsible for providing psychosocial support sessions to displaced Gazan workers in Jericho through a service contract.
• The local partner, Juzoor, has trained Ministry of Health primary health care staff in the West Bank in the provision of emergency and trauma care and has been in charge of health care at medical points set up in shelters in the Gaza Strip.

The actors involved in the evaluation will be the following:

• Evaluation management unit: Médicos del Mundo also acts as the evaluation management unit, in charge of validating and supervising the quality of the process, drafting the ToR, recruiting the evaluation team, publishing and disseminating the results. This unit is made up of the Emergency Unit Coordination (HQ), the Emergency Project Technician (HQ) and the Monitoring and Evaluation Unit (HQ).

The Evaluation Monitoring Committee will be composed of:

• On the part of MdM: the Emergency Projects Technician, Coordination of the Emergency Unit and the Monitoring and Evaluation Unit (HQ).
• On the part of the evaluating entity, the person(s) designated in the contract.
• On the part of AECID, the reference person(s)

Additionally:

• MdM technical staff will provide the evaluation team with information on the evaluated project.
• The field team will facilitate interviews and meetings as necessary with local stakeholders and partners.

1. SCOPE OF THE EVALUATION

4.1 DIMENSIONS OF THE INTERVENTION TO BE EVALUATED (PROJECT, PROGRAMME) GEOGRAPHIC, INSTITUTIONAL, TEMPORAL, AND THEMATIC OR SECTORAL

At the sectoral level, the intervention impacts on the health sector, prioritising Primary Health Care and Mental Health and Psychosocial Support and Gender.

At the programmatic level, the object of the evaluation will be the project 2022/ACHU/000242 “Improving the resilience and response capacity of the most vulnerable Palestinian population to the humanitarian crisis in Gaza and the West Bank”.

At the temporal level, the evaluation corresponds to the period from the beginning of the project until the end of the implementation period, namely from 07/09/2022 to 06/09/2024.

The geographical scope will coincide with the geographical scope of activities in both the Gaza Strip and the West Bank.

4. 2. KEY QUESTIONS, SPECIFIC EVALUATION OBJECTIVES AND EVALUATION CRITERIA

Below is a summary table of the scope of this final evaluation in relation to evaluation questions and analysis criteria and specific objectives at intensive and extensive level:

EVALUATION CRITERION

KEY QUESTIONS

RELEVANCE

• Does the intervention correspond to the priorities and needs of the rights-bearing population, in particular women?
• Have existing gender policies been analysed and included in the project?
• Are there levels of exchange with different local organisations to ensure the relevance of the activities to be developed?
• Have any of the proposed activities had to be modified or eliminated because they did not take into account the context of the place?

EFFECTIVENESS

• Have all expected results been achieved in the implementation of the project?
• Have other unintended effects been achieved?
• What factors have contributed positively to the achievement of results, or what factors have contributed negatively to the failure to achieve the expected results?
• Were the training contents and methodologies implemented adequate considering the specific needs of people with disabilities?

EFFICIENCY

• Has the transformation of resources into results been efficient?
• Have the budgets and timelines initially set out in the document been respected?

ABILITY TO ADAPT AND IMPROVE

• To what extent has the project been adapted to the situation following the events of 7 October?

1. METHODOLOGY AND WORK PLAN

5.1 METHODOLOGY AND TECHNIQUES REQUIRED

The person(s) carrying out the assessment is expected to

• Review the questions posed, as well as the criteria chosen.
• Develop tools for data collection and processing.
• Return preliminary results to the agencies involved in the intervention.

Through:

• Review and analysis of the documentation related to the project.
• The fieldwork proposal should consider the collection of information through technological tools that allow for remote communication.

5.2 DEADLINES

The work will be divided into a desk phase, field work and feedback:

• Cabinet phase: duration of approximately two weeks.
• Remote fieldwork: duration of approximately three weeks.
• Preliminary return to MoM. December 2024
• Delivery of the draft Final Report. January 2025
• Delivery of the final version of the Final Report with the comments of the Monitoring Committee: February 2025

5.3 CONDITIONS OF THE EVALUATION

• The consultant will be paid only on the basis of the amount defined and granted in his/her contract with Médecins du Monde.
• The responsibility for paying income tax and National Insurance contributions rests with the consultant and Médicos del Mundo will not make any deductions from the fee for these liabilities.
• The consultant will have his/her own necessary equipment (laptop, etc.).
• The consultant will work remotely in the case of Gaza-related activities and in the case of the West Bank, if the security situation permits, may be face-to-face.
• The consultant will pay the costs of the support staff necessary to carry out the study (translator, etc.).
• The consultancy will be supported by the Médicos del Mundo team from the field and from the HQ in Madrid.

1. DOCUMENTS AND SOURCES OF INFORMATION

Documents and sources of information to which the evaluation team will have access.

SOURCES OF INFORMATION

CONTENTS

LOCATION

Partnership agreements between NGOs and financiers

• Terms and scope of agreements and grants.
• Budgetary framework of the project
• MdM HQ

Formulations, reformulations and annexes

• Project structure, timeline and results.
• Details of the context, indicators and sources of information of the intervention area
• MdM HQ

Projects prior to the development of this project

• History of MdM
• MdM HQ

Diagnostic or feasibility studies related to the intervention

• Sources of information on the health situation and context of the intervention area.
• MdM HQ

Strategic Plan MoM

• Positioning and strategies for the associative development of MoM and its projects and actions.
  It includes the key lines of intervention of MdM/FM both in the field and in Spain.
• MdM HQ

Monitoring reports

• It records the development and progress of the main aspects of the project based on its initial formulation.
• MdM HQ

Own records, reports or reports of public bodies, policies and strategic plans

• Statistics and reports that contextualise actions and provide information, as sources of verification
• Field

Gender, Environmental, SMAPS, Anthropological, Human Rights, Sexual Abuse and Harassment Policies and Protocols of MoM.

• MoM positioning and strategies on gender, environmental, MHPSS, Anthropological, Human Rights, Sexual Abuse and Harassment and their implementation in projects.
• MdM HQ

Basis for justification and evaluation of the AECID

• Criteria to be met for external evaluations set by the AECID.
• MdM HQ and AECID

In addition to these documents, the evaluation team, once the contractual relationship has been established, may request any other documentation it deems appropriate for a full understanding of the project and its degree of realisation.

1. STRUCTURE AND PRESENTATION OF THE EVALUATION REPORT

7.1 EXPECTED OUTPUTS

• Draft Final Report: should contain the key aspects of the evaluation carried out and a first assessment of the questions and criteria raised. Médicos del Mundo will make comments on this draft in order to reach a consensus. This process may generate more than one version of the draft report.
• Final Report. Final document that must respond to all the questions raised following the format indicated in section 7.2.
• Final Report Presentations: a presentation of the results will be made on dates to be agreed.

The evaluation will give rise to a report, written in Spanish or English, of a maximum length of 60 pages, annexes not included. This shall be accompanied by an executive summary, of a maximum of 5 pages, which shall appear at the beginning of the report. Finally, a summary of the evaluation must be submitted following the format established by the OECD DAC for the inventory of OECD evaluations.

7.2 REPORT FORMAT

The format of the report mentioned below will therefore be strictly adhered to:

1. Cover page:

• Title of the evaluation report: (operation, local organisation, partner, country, sector(s) of cooperation)
• Evaluation period;
• Name of the evaluator;
• Express mention that the report has been prepared at the request of MdM in the framework of a project financed by AECID, and that the comments contained therein reflect only the opinion of the evaluator.

2. Table of contents.

3. Summary:

• -Name of the local partner organisations.
• Objective of the operation under assessment.
• Title of the operation.
• Operating Contract Number.
• Country/ies of operation.
• Duration of the operation.
• Purpose and duration of the evaluation.
• Method used: documents analysed, interview schedule, etc.;
• Main conclusions and recommendations in order of priority
• (maximum 5 pages)

The main body of the report shall be structured in accordance with the specific objectives formulated in point 5.

• 4.1 Executive summary
• 4.2 Introduction
  • Background and Objective of the evaluation.
  • Main questions and value criteria: definition.
• 4.3 Summary description of the intervention evaluated;
• 4.4 Methodology used in the evaluation
  • Methodology and techniques applied.
  • Conditions and limits of the study carried out.

5. Analysis of the collected information and evidence in relation to the previously established questions. Interpretation of the evidence in relation to the stated evaluation questions.

6. Conclusions of the evaluation in relation to the established evaluation criteria.

7. Lessons learned from the overall findings that indicate good practice and that can be extrapolated and fed back into the actions of the intervention being implemented or for future interventions, as appropriate.

8. Recommendations resulting from the evaluation classified according to the criteria chosen by the evaluation team

9. Annexes to include:

• ToR.
• Work plan, composition and mission description.
• Methodology proposed, techniques and sources used to gather information
• Documentary review: list of secondary sources used.
• Interviews: list of informants, interview script, transcripts and notes.
• Surveys: models, raw data collected and statistical analysis.
• Allegations and comments from different stakeholders on the draft report if deemed relevant, especially if there are disagreements and they have not been reflected in the body of the report (see premise of accountability).
• Summary of the evaluation (CAD24 model).

After its submission in electronic format and once approved, the team will deliver 2 paper copies of the final version of the Final Report, with the document in electronic format.

1. EVALUATION TEAM

The profile of the person(s) carrying out the assessment should take into account the following:

• A minimum of 3 years’ experience in evaluation and similar technical assistance is required, especially in the field of humanitarian action and emergency response and evaluation methodologies.
• Fluency in English is required and fluency in Arabic and Spanish is an asset.
• A specialist profile in social sciences and knowledge of health as well as gender would be an asset.
• Not having maintained an employment relationship with the entity receiving the grant (MoM) or with its counterpart, at least during the two years prior to the proposal to contract them to carry out the evaluation, nor having been involved in the design, management or implementation of the intervention to be evaluated.

1. PREMISES FOR EVALUATION, AUTHORSHIP AND PUBLICATION

• Anonymity and confidentiality. – The assessment should respect the right of individuals to provide information while ensuring their anonymity and confidentiality.
• Responsibility. – Any disagreement or difference of opinion that may arise between team members or between team members and project managers regarding the findings and/or recommendations should be mentioned in the report. Any assertions should be upheld by the team, or the disagreement should be recorded.
• Completeness. – It is the evaluators’ responsibility to highlight issues not specifically mentioned in the terms of reference if this is necessary to obtain a more complete analysis of the intervention.
• Independence. – The evaluation team must guarantee its independence from the intervention being evaluated, not being linked to its management or to any element of it.
• Incidents. – In the event of the appearance of problems in any other phase of the evaluation, these must be communicated immediately to MdM. Otherwise, the existence of such problems may in no case be used to justify the non-achievement of the results established by the organisation in the terms of reference.
• Validation of information. – It is the responsibility of the evaluation team to ensure the accuracy of the information gathered for reporting purposes, and they are ultimately responsible for the information presented in the Evaluation Report.
• Authorship and disclosure rights. – It is clarified that all rights of authorship rest with the entity contracting the evaluation. Dissemination of the information collected, and the Final Report is the prerogative of Médecins du Monde. However, AECID reserves the right to reproduce, distribute or publicly communicate the evaluation report without the need for prior agreement with this entity, when this is required for the correct development of administrative procedures, and will do so with prior authorisation from this entity, when required for other reasons.
• Penalties. – In the event of delay in the delivery of reports or in the event that the quality of the reports delivered is manifestly inferior to what was agreed, the full payment of those previously agreed shall not be made.

1. DEADLINES FOR CARRYING OUT THE EVALUATION

• Receipt of offers by Médecins du Monde: until 31 July 2024 at 23:59 Spanish time by email to evaluacion@medicosdelmundo.org and miriam.montero@medicosdelmundo.org.
• Evaluation of the bids and communication of the selected proposal on 5 August.
• Signing of the contract: Once AECID validation has been received.
• Planned start of evaluation work: October 2024 or upon completion of the implementation of the Convention.

The maximum budget for the evaluation will be €9,500 including taxes, which should include all costs such as accommodation and internal travel and travel for the desk phase as well as translation of the document into Spanish if necessary.

11. PRESENTATION OF THE TENDER AND EVALUATION CRITERIA

Technical proposals must respect the following characteristics in order to be submitted:

• 1-Cover page where indicated:
  • Name of company or evaluator (self-employed)
  • Title of the evaluation (Final evaluation and title of the agreement)
  • Contact details of the company or individual evaluator (self-employed)
• 2-Technical offer including:
  • Detailed CV of the company (if applicable)
  • Detailed CVs of the members of the tendering company’s evaluation team (if any)
  • Detailed CV of the individual evaluator (if applicable)
• 3-Working methodology
  • Proposed evaluation methodology to include an evaluation matrix
• 4-Work plan
• 5-Estimated budget for the realisation of the evaluation including all the expenses derived from the realisation of the evaluation and proposed method of payment, in the form of a proforma invoice.

The evaluation criteria for the bids received will be as follows:

CRITERIA

CRITERIA VALUE

FACTORS

VALUE FACTORS

Experience

professional of the person or team

40%

Experience in similar technical assistance.

20%

Experience in the context

20%

Academic profile of the person or team

25%

Training in emergencies and humanitarian action

10%

Training in anthropology

5%

Gender training

5%

Human Rights Training

5%

Quality and value

technician of the offer

35%

Value added to the ToR objectives

20%

Value added to the methodology proposed in the ToR

15%

Médicos del Mundo promotes equal opportunities for all people and establishes positive action measures for those who, due to functional diversity or social and/or cultural exclusion, belong to groups that are under-represented in the positions offered. Therefore, no candidate with a valid profile will be rejected because of functional diversity or cultural or social exclusion due to birth, ethnicity, race, sex, gender or any other personal, social or cultural condition or circumstance.