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UNITED
NATIONS
E

        Economic and Social Council
A/48/183/Add.1
E/1993/74/Add.1

21 December 1993

GENERAL ASSEMBLY ECONOMIC AND SOCIAL COUNCIL
Forty-eighth session Substantive session of 1993
Item 12 of the preliminary list* Item 4 (b) of the provisional
REPORT OF THE ECONOMIC AND SOCIAL agenda
COUNCIL COORDINATION QUESTIONS:
IMPLEMENTATION OF THE
DECLARATION ON THE GRANTING
OF INDEPENDENCE TO COLONIAL
COUNTRIES AND PEOPLES BY
THE SPECIALIZED AGENCIES
AND THE INTERNATIONAL
INSTITUTIONS ASSOCIATED
WITH THE UNITED NATIONS

Assistance to the Palestinian people

Report of the Secretary-General

Addendum


CONTENTS

Paragraphs Page

II. REPLIES FROM THE UNITED NATIONS SYSTEM ............... 1 - 60 3

A. United Nations ................................... 1 - 40 3

6. Department of Political Affairs of the
Secretariat .................................. 1 3

7. Department of Economic and Social Development
of the Secretariat ........................... 2 3

8. United Nations Environment Programme ......... 3 - 22 3

9. United Nations Relief and Works Agency for
Palestine Refugees in the Near East ......... 23 - 38 7

10. World Food Programme ........................ 39 - 40 10

B. Specialized agencies ............................. 41 - 60 11

4. Food and Agriculture Organization of the
United Nations .............................. 41 - 45 11

5. United Nations Educational, Scientific and
Cultural Organization ....................... 46 - 47 11

6. World Health Organization ................... 48 - 60 12


II. REPLIES FROM THE UNITED NATIONS SYSTEM


A. United Nations

6. Department of Political Affairs of the Secretariat

1. In response to paragraph 10 of General Assembly resolution 47/170, the Committee on the Exercise of the Inalienable Rights of the Palestinian People convened a seminar on assistance to the Palestinian people as part of its programme of work for 1993. The seminar was held at the headquarters of the United Nations Educational, Scientific and Cultural Organization (UNESCO) in Paris from 26 to 29 April 1993, with the participation of United Nations bodies and agencies involved in projects in the occupied Palestinian territory, donor countries, regional organizations, intergovernmental and non-governmental organizations active in the field, as well as Palestinian and other experts. The report of the seminar has been transmitted to the Secretary-General by the Chairman of the Committee in a letter dated 10 May 1993 (A/48/168-E/1993/62 and Corr.1).


7. Department of Economic and Social Development of the
Secretariat

2. The work of the former Department in relation to assistance to the Palestinian people has been focused to a large extent on development planning. At the invitation of the United Nations Development Programme (UNDP), the Department participated in the independent mission for the review of the UNDP programme in the occupied Palestinian territories. The planning adviser of the Department was one of three professionals on a team led by Ambassador Robert J. van Schaik (Netherlands), which gathered data and evaluated the UNDP programme in the occupied territories from 10 to 31 October 1992. The mission recommended, among other things, that UNDP should assist Palestinian efforts to draw up an initial development plan, as well as sector plans based on it.

8. United Nations Environment Programme

3. The activities of the United Nations Environment Programme (UNEP) in assistance to the Palestinian people can be subdivided into three categories.

(a) Activities implemented directly by UNEP

Environmental situation in the occupied Palestinian territories

4. In 1987, the Governing Council of UNEP adopted decision 14/11, entitled "The environmental situation in the occupied Palestinian and other Arab territories", requesting the Executive Director, within the mandate of UNEP, to provide, within available resources, assistance to the Palestinian people and particularly to the municipalities of the occupied Palestinian territories. This was to be done in collaboration with UNDP and in coordination with the Palestine Liberation Organization (PLO), in order to help them protect and improve their environment in the occupied Palestinian territories. The Council also requested the Executive Director to report to the Council at its fifteenth session on the environmental situation and the implementation of the decision.

5. The Executive Director recruited an experienced consultant who was familiar with the occupied territories to carry out a preliminary assessment of the environmental situation in the occupied Palestinian territories. The consultant was admitted to Israel in January 1989 as a private tourist. In that capacity, the consultant was unable to have access to information, nor was he able to corroborate it. The Executive Director submitted the findings and conclusions of the consultant in his report to the Governing Council at its fifteenth session.

6. In 1989, the Governing Council adopted decision 15/8, in which it considered that the report of the Executive Director was inadequate and that it must be updated and the information it contained corroborated. This further required the formation of a group of consultants specializing in environmental problems, with a mandate to prepare a comprehensive report on the environmental situation in the occupied Palestinian and other Arab territories, making use of relevant data and information from sources provided by the population of the territories, as well as by the States and regional and international organizations concerned. The Council also requested the Executive Director to submit to the Council at its sixteenth session a comprehensive report based on the findings reached by the group of consultants.

7. The Executive Director recruited a group of experienced consultants specializing in environmental problems, with a mandate to prepare a comprehensive report on the environmental situation in the occupied territories. The group was unable to visit the occupied territories, but was able to collect information and data from a wide range of sources that appeared to be reasonably authoritative. The findings of the group were submitted by the Executive Director to the Governing Council at its sixteenth session.

8. The report referred to the difficulty of obtaining relevant data since most of the published information on the occupied territories tended to be concerned with political, historical and juridical aspects of the question, and rarely contained sound environmental data.

9. In 1991, the Governing Council adopted decision 16/13, entitled "The environmental situation in the occupied Palestinian and other Arab territories", requesting the Executive Director, among other things, to take measures and action in halting the environmental deterioration in the occupied Palestinian and Arab territories. The Council further requested the Executive Director to complete an up-to-date database of information on the environment in the occupied Palestinian and other Arab territories and to report the progress to the Council at its seventeenth session.

(i) Availability of environmental data

10. To implement this decision, a mission was sent to Egypt, the Syrian Arab Republic, Jordan and to PLO headquarters in Tunisia. Again, the mission was not able to visit the occupied Palestinian territories.

11. The objectives of the mission were to identify and compile information on the availability of existing environmental data for the occupied Palestinian and Arab territories and to provide guidelines for the establishment of an environmental information system.

12. A questionnaire was developed at UNEP headquarters and distributed to organizations and persons visited during the mission. This questionnaire was used to locate and identify the availability of environmental data. The mission succeeded in visiting 5 organizations in Egypt, 9 in the Syrian Arab Republic, 29 in Jordan and 3 departments at PLO headquarters at Tunis. The mission also visited headquarters of the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) at Vienna. The organizations visited included governmental, non-governmental and United Nations organizations, as well as Palestinian sources.

(ii) Conclusion and recommendations
13. Once the data had been collected and analysed, it was concluded that environmental data for the occupied Palestinian territories were scattered among a large number of sources and in various formats, scales, geographic projection and different time-frames. However, data were sufficient for preliminary assessment of the state of the environment and the changes that had occurred since 1967.

14. The mission recommended that the establishment of environmental information systems for the occupied Palestinian territories was a necessary first step for the assessment of the environmental situation. The mission also recommended that an environmental information system be established at an institution in the occupied Palestinian territories, preferably in the West Bank with a sub-centre in Gaza, with technical, financial and training support provided to the institution operating the system. The establishment of a back-up system was also suggested.

15. The report of the mission and its findings and recommendations were discussed at the seventeenth session of the Governing Council of UNEP on 21 May 1993 (see A/48/25). The Governing Council expressed its concern over the deterioration of the environmental conditions in the occupied Palestinian and other Arab territories, and stressed the need for protecting their environment and their natural resources; welcomed the contents of the Executive Director's report, commended the cooperation extended by most of the parties concerned to the United Nations team in preparing the study, and requested the Executive Director to implement the recommendations contained in it. The Council requested the Executive Director to complete and update the report on the state of the environment in the occupied Palestinian and other Arab territories and to submit it to the Council at its eighteenth session; and also requested the Executive Director to provide the necessary technical assistance in Palestinian institutional and self-capacity-building in the field of the environment, including training in the relevant necessary fields.

(b) Activities implemented in cooperation with other United Nations organizations

(i) Training course on water supply, sanitation and health for environmental health officers working with Palestinian people

16. This project was funded by UNEP and implemented by the World Health Organization Eastern Mediterranean Regional Office (WHO/EMRO) through its Regional Centre for Environmental Health Activities (CEHA) at Amman. The 25-month project started in 1989 and ended in 1991. It facilitated training in the control of pollution and environmentally sound management of environmentally related diseases and aimed to control such diseases more effectively in refugee camps and settlements. Over the long term, this training is expected to improve drinking-water supplies, sanitation and food hygiene, especially with regard to controlling diarrhoea and other water-borne diseases among refugees. This project was implemented in close collaboration with UNRWA.

17. The output of this project included the training of 36 environmental health officers from the five UNRWA fields of operation in Jordan, the Syrian Arab Republic, Lebanon, the West Bank and Gaza. A training manual on water supply and sanitation for health in refugee camps was developed and was published and distributed in Arabic and English.

(ii) Promotion of Environmental Health and Manpower Development in Palestinian Refugee Camps

18. On the basis of further evaluations of UNRWA's needs, it was recommended that a comprehensive manpower development programme for all 100 environmental health officers of UNRWA should be carried out. A new project, that could be classified as phase II of the original project, is being implemented by WHO/CEHA and funded by UNEP. Its objective is to facilitate training in pollution control and sound management of vector-borne and parasitic diseases. The long-term objective is to improve drinking-water supply, sanitation and food hygiene, so as to contribute to the control of diarrhoeal and other water-borne diseases in Palestinian refugee camps.

19. The first stage of the workplan for the project is the training of senior sanitarians and area sanitation officers in two workshops. The second stage is to hold two sequential training sessions for field sanitation officers in each of the five UNRWA fields.

(c) Activities implemented in cooperation with other organizations

20. At its twentieth meeting, held at Istanbul in August 1991, the Islamic Conference of Foreign Ministers requested the Islamic Foundation for Science, Technology and Development (IFSTAD) to prepare and submit a report on the environmental problems of the occupied Palestinian and other Arab territories to the Conference at its next meeting.

21. In September 1991, a joint programming session between the Organization of the Islamic Conference (OIC) and UNEP was held at Jeddah. In that meeting, OIC/IFSTAD and the UNEP Regional Office for West Asia were designated as focal points for the two organizations for activities relating to environmental issues. One item in the memorandum of understanding between the two organizations calls for the preparation of a joint report on the environmental problems of the occupied Palestinian and other Arab territories. The UNEP Regional Office recruited a consultant to gather all the information available and to prepare the draft report. Despite the scarcity of information available, the consultant was able to collect enough data for the joint OIC/IFSTAD and UNEP report, which will be submitted to the Islamic Conference of Foreign Ministers at its twenty-first meeting, in 1993.

22. UNEP participated in the multilateral discussions of the Middle East Peace Process - Working Group on Environment, which was held in Tokyo on 24 and 25 May 1993.


9. United Nations Relief and Works Agency for Palestine
Refugees in the Near East

(a) Introduction

23. In 1993, UNRWA is continuing to provide education, health, relief and social services and other humanitarian assistance to more than 2.7 million Palestine refugees in its five fields of operation, namely Jordan, Lebanon, the Syrian Arab Republic and the occupied territory of the West Bank and Gaza Strip. In addition, emergency measures are being carried out in Lebanon and the West Bank and Gaza Strip. A full account of UNRWA's activities can be found in the annual reports of the Commissioner-General to the General Assembly.

24. An indication of the level of UNRWA assistance to the Palestine refugees is provided by the budget figures. In the biennium 1992-1993, the Agency's regular budget is approximately $572 million. The emergency measures in Lebanon and the occupied territory are planned to continue at a cost of $40 million. In addition to the regular and emergency budgets, about $40 million has been pledged or received since 1988 on the expanded programme of assistance referred to below. UNRWA employs approximately 20,000 staff, the vast majority of whom are themselves Palestine refugees, and is thus one of the largest employers in the Middle East.

25. The Israeli-ordered closure of the Gaza Strip on 30 March and the West Bank on 31 March 1993 had a large impact on UNRWA services and on overall socio-economic conditions of Palestinians in the occupied territory. The closure divided the occupied territory into four isolated regions: the northern West Bank, East Jerusalem, the southern West Bank and the Gaza Strip. Special permits were required for entry into Jerusalem and Israel, including travel between the West Bank and Gaza and within the West Bank itself, with no exceptions. This resulted in the severe disruption in the daily life of Palestinians, caused unemployment to rise to over 50 per cent and negatively affected commerce, medical care, education and access to services, including those of UNRWA.

(b) Education

26. The objective of the Agency's education programme is to provide, within the framework of the host countries' prescribed school curricula, general education at the elementary and preparatory levels, teacher and higher education, and vocational and technical education for Palestine refugees, in accordance with their education needs, identity and cultural heritage. The programme operates with technical assistance from the United Nations Educational, Scientific and Cultural Organization (UNESCO). In the 1992/93 school year, the Agency has more than 392,000 pupils enrolled in 641 schools staffed by over 11,400 teachers and is providing training for more than 5,200 vocational and teacher trainees in its eight training centres.

27. Schools and training centres in the occupied territory are presently open but, throughout the intifadah, education has been severely disrupted by strikes, curfews, disturbances and closure orders imposed by the Israeli authorities. For example, UNRWA vocational training in the Gaza Strip has lost almost 50 per cent of teaching time in the 1992/93 school year, owing primarily to military-ordered closures. Since the Israeli authorities closed the occupied territory in late March, students from Gaza and the southern part of the West Bank have been unable to attend vocational and teacher training courses at UNRWA centres located north of Jerusalem. After many years of disruption, most schools in Lebanon are now operating relatively normally.

(c) Health

28. The UNRWA health programme comprises medical care and health protection and promotion delivered through 118 health centres and points, environmental health services in camps and distribution of food supplements to vulnerable women and children. The Agency's health protection and promotion activities focus particularly upon health care, including disease control and maternal and child health care. Mental health projects have been established in the West Bank and Gaza Strip. Medical care also comprises a number of specialist clinics, including, inter alia, dental care, hypertension diabetes, respiratory diseases, cardiovascular diseases and obstetrics and gynaecology. A physiotherapy programme is run in conjunction with the United Nations Children's Fund (UNICEF) in six clinics in Gaza and five in the West Bank.

29. In 1992, there were over 6 million patient visits to clinics Agency-wide. Hospitalization costs are covered through a reimbursement scheme whereby UNRWA covers the majority of costs; UNRWA also directly finances beds in non-governmental organization hospitals in the occupied territory and Lebanon. The health programme operates with technical assistance from the World Health Organization (WHO).

30. In addition to these services, the UNRWA health programme is focusing on the expansion of family planning in the context of maternal health, reducing doctor/patient ratios in health centres to a manageable level and the expansion of consultative mechanisms to enhance Palestinian participation in the establishment of health care priorities. As part of the latter, UNRWA is supporting a project effort to explore the needs of a future health insurance scheme for the occupied territory. A top priority in terms of external funding is given to environmental health and, in particular, to planning and first stage implementation of master plans for sewage disposal and safe water supply in the occupied territory and Lebanon. UNRWA is continuing with its project for constructing, equipping and commissioning a 232-bed hospital in the Gaza Strip at a cost of $35 million, $20 million of which represents capital cost and $15 million operating costs for the first three years.

(d) Relief and social services

31. The relief and social services programme provides support to those Palestine refugees who suffer the greatest socio-economic disadvantages and its purpose is to facilitate their self-reliance. The programme consists of assistance to special hardship cases, social case work, self-support projects and related skill training, women's programmes, rehabilitation of the disabled and assistance to refugees in emergency situations.

32. These activities are continuing in 1993. The ongoing deterioration of the socio-economic situation in the UNRWA area of operations is putting increasing pressure on the special hardship programme. As at March 1993, 180,000 persons, or about 7 per cent of the Palestine refugee population Agency-wide, were registered as special hardship cases. Emphasis continues to be placed on setting up small group enterprises to provide employment, especially for women from special hardship families and the disabled. The community-based rehabilitation programme for the disabled has further expanded, particularly in the occupied territory, where projects are being developed aimed at the vocational rehabilitation of the disabled, in particular former bread-winners injured during the intifadah. The number of women's programme centres in all fields has increased to 68.

(e) Extraordinary measures

33. In response to the additional needs created by the intifadah and the Israeli countermeasures, UNRWA introduced a programme of extraordinary measures, which began in early 1988 and has continued until the present. The large number of casualties resulting from the intifadah has led to a considerable expansion of the emergency medical programme. These measures are continuing in 1993, with nine clinics open 24 hours a day and five clinics open in two shifts in the Gaza Strip, while a number of clinics also run double shifts in the West Bank. Additional medical supplies and equipment, including ambulances for the evacuation of casualties, have been purchased and the payment of hospital costs and subsidies has been increased.

34. Welfare services have been expanded to assist the families of those killed, disabled or detained and to cope with the far-reaching socio-economic effects of the intifadah. Additional food is being provided to needy people in both the West Bank and the Gaza Strip, and needy families have received cash grants. The Israeli-ordered closure of the occupied territory in late March 1993 led to a sharp increase in unemployment and socio-economic hardship. UNRWA responded to the new and urgent needs created by the closure with emergency food distribution to 120,000 families in the Gaza Strip and 39,000 in the West Bank.

35. An important element of the Agency's extraordinary measures in the occupied territory is the programme of general assistance and protection. The major component of this programme is the placing of 12 international staff members in the West Bank and 9 in the Gaza Strip as refugee affairs officers. These staff members facilitate Agency operation in the difficult prevailing circumstances and assist the refugee population in their day-to-day life. The refugee affairs officers help by their presence to lower tensions, especially during confrontations with the security forces, and to prevent maltreatment of the refugees, in particular vulnerable groups such as women and children.

36. The situation prevailing in Lebanon has required the Agency to carry out programmes of emergency and extraordinary measures for a number of years. In 1993, while the overall situation continues to improve, many of these measures are still needed by Palestine refugees and include, inter alia, distribution of foodstuffs, cash assistance to the most needy and assistance to displaced persons.

(f) Expanded programme of assistance

37. In 1988, UNRWA launched an expanded programme of assistance, consisting of approximately 200 projects to improve living conditions and infrastructure in the camps in the occupied territory. The programme was subsequently extended to the Agency's other fields. Approximately $40 million had been received or pledged by early 1993 of a target amount of $65 million. A high priority in the expanded programme of assistance is to ensure that refugees living in the 27 camps of the West Bank and the Gaza Strip have decent shelter and a sanitary environment. Accordingly, substantial efforts are being made in repairing and constructing refugee shelters and in upgrading the standards of rehabilitation. The Agency has also continued to improve camp infrastructure and primary health care facilities, including construction and equipment of additional health centres, internal sewage systems and integration of camp water and sewage schemes into municipal and regional systems. In early 1993, a study was completed on strategic actions for development of the environmental health sector in the Gaza Strip.

38. Following the war in the Persian Gulf, as part of its efforts to relieve unemployment and the stagnant economy of the occupied territory and assist Palestinians suffering economic dislocation in Jordan and Lebanon, UNRWA implemented a new income-generating and job-creation scheme through the establishment of revolving loan funds. Individuals as well as cooperatives, partnerships and other types of groups are eligible to apply for loans. In the Gaza Strip, where the programme was first implemented, loans totalling more than $1.9 million have been disbursed; in the West Bank, over $560,000 of loans has been approved. In Lebanon, a total of $82,000 and in Jordan $158,000 in loans has been disbursed.

10. World Food Programme

39. Regarding the provision of food assistance to the Palestinian people, WFP supported a food-aided project for vulnerable groups and hospital patients worth about $1 million, which terminated in April 1992. Since then WFP has been in contact with both UNDP, Jerusalem and the Israeli authorities for an extension of the project. But despite those efforts, the Israeli Civil Administration has not yet agreed and WFP has been unable to deliver food assistance in the occupied Palestinian territories since April 1992.

40. However, following the recent contacts among WFP senior staff, the Special Representative of the UNDP Administrator and the Palestinian authorities on the occasion of a seminar on assistance to the Palestinian people, which took place at the end of April 1993 at UNESCO headquarters in Paris, the need for urgent humanitarian food assistance for the population in the Gaza Strip, in particular, was raised in the light of the severe disruption of Palestinian economic life following the Israeli closure of the borders in March. A WFP mission is being fielded to ascertain these needs, pending final concurrence of the Israeli Civil Administration, through UNDP, to provide further WFP food assistance.
B. Specialized agencies

4. Food and Agriculture Organization of the United Nations

41. At its twenty-sixth session in November 1991, the FAO Conference reviewed the recommendations of the FAO mission fielded to the occupied Palestinian territory from 23 August to 6 September 1991 and invited the Director-General to formulate projects and activities to implement the recommendations of the mission and the conclusions of the Conference.

42. In response to that request, FAO and the Economic and Social Commission for Western Asia (ESCWA) fielded a joint project identification/formulation mission to the occupied territory, from 10 February to 2 March 1993, in order to prepare a concise plan of action for the rehabilitation of the agricultural sector, to make recommendations for the development of the institutional structure for servicing the agricultural sector and to prepare priority project documents.

43. In the political climate obtaining in the occupied territory and, given the weakness of the agricultural institutions, particularly the absence of coordinated sectoral planning, as well as the risk involved in new investments, the mission concluded that no firm course of action for agricultural rehabilitation could be realistically recommended.

44. The mission was nevertheless able to identify priority issues central to the rehabilitation process for which some immediate action was required. These included, inter alia, the need for land reclamation in the West Bank, the need for rehabilitation of village roads, water resources development, livestock development, agricultural planning, agricultural marketing and applied research and extension.

45. Draft project documents for those areas have been prepared with a view to submission by ESCWA to potential donors for purposes of resource mobilization.


5. United Nations Educational, Scientific and
Cultural Organization

(a) United Nations European Seminar on Assistance to the Palestinian People

46. In response to the request addressed to him by the Chairman of the Committee on the Inalienable Rights of the Palestinian People, the Director-General agreed to host the above-mentioned seminar, organized by the Committee, at UNESCO headquarters from 26 to 29 April 1993. UNESCO participated in the work of the seminar and, inter alia, submitted a document on its activities on behalf of the Palestinian people.

(b) UNESCO action

47. In accordance with decision 4.3.1 adopted by the Executive Board at its one hundred and thirty-ninth session, the Director-General on 22 January 1993 addressed a circular letter to member States, international organizations and various sources of funding asking them for voluntary contributions to cover the deficit in the operating budgets of the Palestinian universities resulting from the prolonged closure of those institutions and the current situation. The scope of that appeal was as broad as those launched by the Director-General on 27 April 1988 and 8 December 1986 requesting that scholarships should be granted to students in the occupied territories and that of 7 September 1990 requesting that research and training fellowships should be awarded to Palestinian assistant lecturers in various scientific and technical fields. The Director-General also concluded a cooperation agreement with the PEACE (Palestinian European Academic Co-operation in Europe) programme, following which UNESCO granted this programme a subsidy of $16,000 in December 1992. In addition, under the Participation Programme for 1992-1993, Palestine received financial assistance amounting, in February 1993, to $93,000.

6. World Health Organization

(a) General considerations

48. As a result of a number of World Health Assembly resolutions, a special technical support programme to improve the health conditions of the Palestinian people was initiated in January 1990. It aims at providing the Palestinians with the means of attaining a level of health that would permit them to lead a healthier and more productive life. While real and lasting peace requires a political solution, it is still important for WHO to be fully engaged in the effort to attain health for all in the area, contributing to and promoting the socio-economic development that is an important element in assuring a peaceful settlement of the Palestine question.

49. Through the opportunity provided by the Middle East Peace Conference and subsequent events, it is important to anticipate the effect the peace process may have on the Palestinian people and their health in future. It is now time to plan ahead, preparing the Palestinians to build up their health system.

50. In this spirit, WHO launched an appeal to the international donor community in October 1992, proposing an initial plan for two years. It advocated a three-pronged approach to assist the establishment and implementation of measures for assumption of responsibility for health services by a higher council for health. Through the Council, assistance to Palestinian health institutions in the occupied Arab territories would be provided and managerial and financial problems that face these institutions would be tackled. Finally, the appeal aimed at promoting regional health cooperation once the political climate so permitted.

51. Improvement of health care and health status in the occupied Arab territories is essential in view of the precarious health conditions prevailing there, which continue to give serious cause for concern. The realities of the situation, and the effects of the intifadah and countermeasures, have produced extraordinary economic and social conditions that seriously affect many aspects of people's lives. The effect of a quarter century of conflict, displacement and occupation, and the repercussions of the Gulf crisis have combined to make the health conditions deteriorate more rapidly in the past two years than at any time since the matter was brought to the attention of the World Health Assembly. The poor conditions are likely to continue if the will to tackle the problem does not prevail.

(b) Special technical support programme

52. During the period under review the WHO special technical support programme to improve the health conditions of the Palestinian people provided the support described below. As reported to the forty-fifth World Health Assembly, the steering committees of the two collaborating centres in Ramallah were to close the centres down as at 31 December 1991; WHO continued to cooperate with the Gaza centre through funding from the special technical support programme. It is in the process of finalizing two studies: the first on strengthening health education for pregnant women, the second on hospital discharge system in operation in the Gaza Strip.

53. WHO cooperated with the Union of Palestinian Medical Relief Committees in completing a study of rural health centres and services in the occupied Arab territories. The purpose of this study is to locate the infrastructure, analyse the services it offers and establish how this infrastructure could form the backbone of a cohesive primary health care system.

54. Work financed by WHO to remodel a maternity wing in the Red Crescent Society hospital in Jerusalem was completed late in 1992, enabling the hospital to install a lift and remodel a building for use in providing care services for mothers and children in East Jerusalem.

55. WHO transferred to UNRWA responsibility for the mental health programme established by the special technical programme in 1991 to cope with increased trauma in children and their mothers. Surveys indicated an increase in the incidence of psychiatric illnesses in this population group due to intifadah-related arrests and detention of young people and their parents. While the impact is difficult to quantify scientifically at present, the mental health programme offers treatment to alleviate the harrowing effect of trauma related to imprisonment and arrest or deportation of a family member in children or in mothers who have to withstand the stress of caring for their families in such a difficult environment.

56. The programme will finance a one-year study in collaboration with the Palestinian Research Centre in Jerusalem aimed at achieving a better accounting system for hospitalization costs by analysing costs per bed, which would constitute a reliable basis of information, as recommended by the two international consultants contracted by UNRWA to study the possibilities for starting a health insurance scheme in the occupied Arab territories.

57. A protocol for a brucellosis survey in humans and animals is being established with the WHO Veterinary Public Health Unit to define the extent of the brucellosis problem in humans and animals, assess the impact of the disease on the economy, conduct a cost-benefit analysis for brucellosis control, assess the current reporting systems on zoonoses in humans and animals and propose a model for effective surveillance. It is hoped that the financing of the survey can be assured. It will draw on the expertise of local veterinary officers and short-term consultants from the Veterinary Public Health Unit and the Division of Field Epidemiology in the Centers for Disease Control, Atlanta, Georgia, United States of America.

58. The WHO Health Coordinator in the occupied Arab territories has maintained and further developed cooperation with international and non-governmental organizations operating in the territories. Discussions were maintained with Palestinian scientists and physicians, local health department officials, and representatives of the Commission of the European Communities, the World Bank and other bodies. Cooperation mainly focused on the development of joint action and the exploring of possible sources of financial support for the special technical support programme.

59. In response to resolution WHA45.26 and the historic opportunity offered by the negotiations that are now under way for a peaceful settlement in the Middle East, WHO worked with Harvard University's Institute for Social and Economic Policy in the Middle East in the formulation of strategies for the development of plans to enhance the participation of the Palestinians during the transition period in deciding on measures affecting their health and for the promotion of broader regional cooperation in health matters once the political circumstances make it possible.

60. Work in the implementation of the strategies is not proceeding further, owing to lack of funds from the international donor community. During the period under review two donations were received, totalling some $230,000, from Italy and Belgium in response to an appeal for $3.5 million. The cost of 1992 operations amounted to approximately $400,000.
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