Palestinian National Authority

• On Oct. 17, 2023, news broke that at least 500 patients, staff and people seeking shelter from Israeli bombs had been killed in an explosion at a hospital, according to health authorities in the Hamas-run enclave.
• It amounts to a devastating loss of life during a campaign of bombing that has not spared the frail or sick.
• Insufficiently and poorly resourced for decades, doctors and hospitals also had to contend with the devastating effects of a 16-year blockade imposed by Israel, in part with coordination with Egypt.

A system completely overwhelmed

• Hospitals in Gaza are completely overwhelmed.
• They are seeing around 1,000 new patients per day, in a health system with only 2,500 hospital beds for a population of over 2 million people.
• People maimed in the bombing are being treated for horrific injuries without basics such as gauze dressings, antiseptic, IV bags and painkillers.
• The U.N. estimates this fuel will run out any day due to a complete siege placed on Gaza by Israel.

A century of underfunding

• But Gaza’s health care system was already under stress before the latest bombardment.
• In fact, policies that stretch back decades have left it unable to meet even the basic health needs of Gaza’s residents, let alone respond to the ongoing humanitarian catastrophe.
• What each have had in common is that, from my perspective as a global health expert, they invested little in Palestinian health.
• For periods of the 20th century, the health priorities of successive governing bodies appeared focused more on reducing the spread of communicable disease to protect foreigners interacting with the native Palestinian population.

Dying before they can leave

• Since then, chronic underfunding of public hospitals has meant that Palestinians in Gaza have remained reliant on outside money and nongovernmental organizations for essential health services.
• During the passage of the Oslo Accords in the mid-1990s, the Palestinian Authority was established to administer services in the occupied territories.
• The Palestinian Authority received a significant influx of humanitarian aid as it took on civil responsibilities, including health.
• As a result, health indicators for Palestinians, including life expectancy and immunization rates, started to improve in the late 1990s.

Gaza health services after the siege

• This vulnerable health system is now facing unprecedented challenges, staffed by health professionals who have committed to stay with their patients even under hospital evacuation orders and at risk of death.
• It is uncertain what the health system of Gaza will look like in the future.
• Already at least 28 doctors and other health workers have been killed in Gaza, with ambulances and a number of hospitals rendered useless by the bombs.

• Setmelanotide has been available through a similar program for patients in France with Bardet-Biedl syndrome (BBS) since July 2022.
• Rhythm estimates there are approximately 500-2,000 patients living with hypothalamic obesity in France, with approximately 50 to 200 new cases each year.
• In the United States, the Company estimates the prevalence in hypothalamic obesity to be approximately 5,000-10,000 patients with an annual incidence of approximately 500 new patients.
• “This AP1 addresses a significant unmet need for patients with severe obesity and hyperphagia, two hallmark symptoms of hypothalamic obesity, for the first time.”

• On May 15, 2023, the United Nations will stage a high-level special meeting to commemorate the 75th anniversary of the Nakba – the mass displacement of around 750,000 Palestinians from their homeland in 1948.
• It is the first time that the international body has commemorated the date, which organizers said serves “as a reminder of the historic injustice suffered by the Palestinian people.” Not everyone is behind the U.N.‘s marking of the day, however.
• The United States and the United Kingdom were among the countries that voted against the commemoration.
• For decades, Palestinians struggled for international recognition of the Nakba in the face of a narrative that minimized their plight.

What is the Nakba?

• From the early 1900s, increasing numbers of Zionists – Jewish nationalists – emigrated from Russia and other parts of Europe to Palestine, seeking to escape antisemitism.
• Many of these settlers also sought to establish Jewish sovereignty in a land that had long been inhabited by Muslims, Christians, Jews and others.
• As a result of Zionist settlement, thousands of peasants were forced off land they had lived on for generations.
• Well-trained Zionist militias attacked Palestinians in areas that had been designated as part of the proposed Jewish state.
• By the end of the Arab-Israeli war in 1949, an estimated 750,000 Palestinians had either fled or had been expelled from their homes.

The battle over the Nakba narrative

• One reason for this was the 1958 bestselling novel “Exodus” and the 1960 blockbuster film of the same name.
• Attempts to commemorate the Nakba have long been rooted in a counternarrative that connects Palestinian culture and society to their pre-1948 hometowns and villages.
• While some African American groups in the U.S. also backed the Palestinian cause, in much of the West the Nakba remained largely unknown.
• That same year, Palestinian Authority President Yasser Arafat also made official what had long been unofficial: May 15 was declared Nakba Day.
• Then in 2011, the Israeli parliament passed a “Nakba Law,” authorizing the government to withdraw funding from civil society groups that commemorate the Nakba.
• Last year, German courts upheld the Berlin police’s decision to cancel several planned Nakba Day protests in that city.

• Reimbursement was granted by the National Authority of Medicines and Health Products (INFARMED) with no change to the current label.
• The Companys primary product ILUVIEN is a sustained release intravitreal implant injected into the back of the eye.
• The non-infectious uveitis affecting the posterior segment indication for ILUVIEN was launched in Germany and the U.K. in late 2019, Belgium in 2021 and Spain and Italy in 2022.
• Alimera cautions investors not to rely too heavily on the forward-looking statements Alimera makes or that are made on its behalf.