A/HRC/10/22 page 18 has been suspended since the closure of the central public health laboratory on 3 January 2009, thus seriously affecting an already deteriorating public health system. Additionally, the lack of access to clean water and the closure of waste water pumping stations has resulted in exposure to numerous diseases. Farmland and urban areas have been flooded with sewage, and the remains of a number of unrecovered bodies in advanced stages of decomposition has further exacerbated the grave risks to public health in the Gaza Strip. 58. The obstacles faced by humanitarian medical efforts have particularly affected the most vulnerable groups among the civilian population, namely children and women. The discontinuation of preventive health care, including vaccination of children, has further threatened the long-term health of the population in Gaza, rendering the population vulnerable to outbreaks of highly infectious diseases such as measles, polio and hepatitis.46 59. Mental health represents an integral part of the right to the highest attainable standard of health. The prolonged conflict, and in particular the latest offensive, has affected the psychosocial well-being of the population and has been particularly challenging for women, children and disabled persons. The state of mental health of the population in Gaza has also been evidenced by a dramatic increase in drug abuse, estimated to affect almost 10 per cent of the young population in the region. Signs of extreme psychosocial distress and related psychosocial conditions have also increased.47 60. The denial of access to medical treatment outside of the Gaza Strip for seriously ill Palestinian patients is a long-standing issue (see A/HRC/4/28/Add.1). There are indications of a worsening trend in the denial of access to health care, as evidenced by the decline in the percentage of requests approved for medical permits for patients referred for treatment outside of the Gaza Strip, from 80 per cent in 2007 to 66 per cent in the first half of 2008.46 61. The Special Rapporteur notes that under international humanitarian law, all medical personnel and facilities must be protected at all times.48 62. The Special Rapporteur strongly condemns the targeting of medical facilities and workers by Israeli forces. For example, 16 medical workers were killed and 25 injured while on duty. Furthermore, 15 hospitals, 43 primary health centres and 29 ambulances were destroyed. In early February 2009, only 44 of 56 primary health-care centres were functioning. Use of primary health-care facilities has significantly declined since the military offensive; WHO estimates that 40 per cent of chronically ill patients no longer turn to public health-care centres for care. 46 WHO, Health Situation in the Gaza Strip, 7 January 2009. 47 Integrated Regional Information Network, “Drug abuse on the rise in Gaza specialists”, 16 January 2009 at the website www.irinnews.org. 48 Fourth Geneva Convention, art. 20, and International Committee of the Red Cross study, rules 25, 28 and 29.