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Basic data (1991 unless otherwise stated)
The situation of children and women
49. The total Palestinian population is estimated at 3.8 million, fewer than 45 per cent of whom live in the West Bank and Gaza. There is high annual population growth, with a young age structure. In contrast with the West Bank, which has a large rural population, most groups of Palestinians are highly urbanized. In Jordan, Lebanon and the Syrian Arab Republic, more than 60 per cent of registered Palestinians live in refugee camps and underserved squatter areas. Greater Gaza City is, by far, the largest urban area in the occupied territories.
50. Palestinians have been affected severely by poor economic and living conditions. As a result of civil strife in Lebanon, economic recession in Jordan and a weakened economy of the occupied territories, currencies lost a substantial portion of their international values, the cost of living increased substantially and unemployment climbed to over 30 per cent. The Gulf crisis worsened the economic situation of many Palestinian families who relied heavily on economic activities linked with the Gulf countries; more than 25,000 workers from the Gulf returned to the occupied territories in 1991. Daily power cuts in Lebanon led to poor water supply. Although 98 per cent of Palestinian shelters have private latrines, there is serious lack of appropriate sewerage systems in all the camps. Overcrowded and unsanitary conditions have turned the displacement camps into slums.
51. The infant and under-five mortality rates fall in the range of 42 to 53 and 55 to 64 per 1,000 live births, respectively, the rates being somewhat higher in squatter communities and overcrowded areas. The major causes of infant mortality are low birth weight/prematurity, congenital malformations, gastroenteritis and ARI. Diarrhoeal diseases and ARI are the leading causes of death among children under five years of age. Registered Palestinians are provided with PHC services through a network of health centres and MCH centres run by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA). Palestinians also benefit from the services of hospitals and dispensaries run by the Palestinian Red Crescent Society (PRCS), mainly inside the camps. In addition to UNRWA and PRCS, several Palestinian philanthropic associations, international NGOs and private physicians provide health services. While immunization coverage is over 85 per cent for all antigens and ORT is commonly used, services provided by NGOs and the private sector usually do not focus on prevention and are of uneven quality. Misuse of antibiotics for treating diarrhoea and ARI is common.
52. Little is known about birth practices and service quality. The proportion of births by trained attendants ranges from 50 per cent in camps in Jordan to 80 per cent in Gaza. Data on the maternal mortality rate vary from zero for registered pregnant women, who are under UNRWA supervision in Lebanon, to 93 per 100,000 live births in the Syrian Arab Republic. Among the major causes are haemorrhaging, pre-eclampsia and womb lacerations.
53. The enrolment rate of Palestinian children is above 90 per cent in primary school, with no significant gender bias. Secondary school enrolment, however, shows a lower enrolment of girls than boys. The UNRWA school system provides primary and preparatory education for the majority of registered Palestinian children. The primary school drop-out rate may reach 30 per cent. In the occupied territories, overcrowded classes, ill-equipped schools, under-trained teachers and extended school closures since the onset of the intifadah have limited the quality of education. The modest coverage and quality of pre-school education provided by NGOs and limited stimulation opportunities for young children in their communities and homes are major concerns.
54. The responsibilities of Palestinian women differ from those of women in many other Arab societies owing to the unique nature of life in refugee communities and in camps. The high value placed on education and the need for women to head households in the absence of adult males because of education, employment or military obligations promote women's participation in family and community decision-making.
55. During the intifadah, there were many casualties, particularly children who require physiotherapeutic and psychotherapeutic care. In addition, the suspension of sports, educational and cultural clubs and community-based activities has reduced substantially non-formal learning opportunities for children and young people in the occupied territories.
Review of programme cooperation
56. A mid-term review of the UNICEF-assisted programme for Palestinians in the Syrian Arab Republic was held in May 1993. The lessons learned highlighted recommendations to (a) retain the priorities of the programme; (b) ensure that national efforts to achieve global mid- and end-decade goals include the Palestinian community; (c) strengthen programmatic links with Palestinian NGOs and grass-roots organizations; (d) expand UNICEF cooperation in experience exchange and in cooperation between UNRWA and the Ministries of Health and Education; (e) focus early childhood development activities on empowering parents and other caregivers with essential knowledge; and (f) strengthen cooperation between the Palestinian programmes in the Syrian Arab Republic and those in Jordan, Lebanon and the West Bank and Gaza.
57. A review of programme implementation for Palestinians in Lebanon is planned for early 1994. Among lessons learned are that the programme should place emphasis on building the capacity of Palestinian counterpart NGOs; empowering communities, families and women with basic skills and knowledge for better living; promoting social mobilization; and developing comprehensive monitoring and reporting systems. Since registered Palestinians are reasonably well covered by UNRWA services, UNICEF should focus on those living outside camps who are not reached by either government or UNRWA assistance.
58. Since 1980, in the West Bank and Gaza, UNICEF has supported immunization, CDD, ECD and water supply and sanitation services. UNICEF responded to the intifadah with a joint UNRWA/UNICEF emergency physiotherapy programme which, by 1991, had treated more than 5,000 casualties. The cooperation of 1992-1994 strengthened the capacity of health and education institutions to address problems resulting from physical and psychological trauma through three components: (a) strengthening local PHC organizations through training and cooperation in universal child immunization, nutrition, ARI, CDD and maternal health; (b) upgrading the education system through teacher training, development of remedial education, self-learning and active learning packages and resource centres, and strategies to bring educational and child development messages into the home and the community; and (c) supporting the childhood disability and rehabilitation programme previously mentioned. Emergency physiotherapy services as well as psychological services for traumatized children are being strengthened.
Recommended programme cooperation
59. Recent developments, which culminated in the Declaration of Principles of 13 September 1993, have had a direct effect on the cooperation programmes for Palestinians. The joint United Nations Development Programme (UNDP)/UNRWA/UNICEF project for youth in the occupied territories became a stepping-stone for much broader cooperation among the three bodies. At the request of the Secretary-General, a high-level task force from those organizations submitted a joint paper for the first year of the transition period requesting $138 million, which was the basis of the United Nations appeal in early October 1993. That paper was broadened for the Consultative Group meeting of December 1993 in Paris chaired by the World Bank. It outlined a framework of assistance for the first two years of the transition period. Simultaneously, UNICEF held consultations which strongly favoured harmonizing the programme cycles for Palestinians. As a result, UNICEF is submitting short-duration recommendations for Palestinians in the occupied territories, Lebanon and the Syrian Arab Republic for the period ending in 1995. That submission is an integral part of the joint United Nations paper. UNICEF will, subject to Executive Board approval, also abbreviate the cycle of the programme for Palestinians in Jordan approved by the Executive Board in 1993 for the period 1994-1997 so that it, too, becomes fully synchronized with the proposed programmes for Palestinians.
60. UNICEF will cooperate with various institutions. The Palestinian Economic Council for Development and Reconstruction will be the focal point for the ratification and implementation of the Convention on the Rights of the Child, the finalization of the national programme of action and the development and review of the programme framework. In the Syrian Arab Republic, the General Organization for Palestinian Arab Refugees (GOPAR) is currently the government agency responsible for overseeing the administrative and civil status needs of Palestinians. The Palestinian Red Crescent Society will be the counterpart body for health, with UNRWA maintaining the operation of its health delivery units. UNRWA is at present the main body responsible for public sector education. Other organizations with areas of interest to UNICEF are expected to emerge soon. An important UNICEF role will be in strengthening the capacities of active Palestinian NGOs, which currently manage community development, income-generating activities, adult literacy, health and young child-care services with minimal support. Coordination among these groups is not yet strong, and there are gaps in service coverage.
Recommended programme cooperation for Palestinians in Lebanon, 1995
61. This short-duration submission will expand on the objectives of the current (1992-1994) programme for Palestinians in Lebanon and contribute to achieving the mid-decade goals. It is based on a strong commitment of all partners to global priorities and strategies for the 1990s. The 1995 programme will be implemented to be responsive to a changing situation of Palestinians in the region as a whole. Thus UNICEF support will respond to priority needs in cooperation with UNRWA, PRCS and a network of Palestinian philanthropic associations and international NGOs.
62. The overall goal of the programme is to improve the quality of life of Palestinian children and women in Lebanon. The programme comprises four components: health; early childhood development; women in development; and water supply and sanitation. Advocacy, planning, monitoring and evaluation will form integral parts of each component. The common aim is to build on past experience and empower local associations and communities to meet the physical, emotional and socio-psychological needs of their children.
63. The programme strategy will emphasize the strengthening of partnerships with local and international NGOs and government institutions. Hence, a high priority will be inter-agency cooperation through policy dialogue and information analysis. Community empowerment and national capacity-building through strengthening of data reporting systems will continue to be major elements of programme strategy.
64. Health objectives include (a) virtual elimination of neonatal tetanus, elimination of poliomyelitis and reduction of measles mortality by 95 per cent and morbidity by 90 per cent; (b) sustained vaccination coverage by all six antigens of more than 90 per cent of all infants, and 90 per cent coverage of all women of child-bearing age with tetanus toxoid; (c) sustained 95 per cent coverage of mothers with regular antenatal and post-natal care; (d) increased ORT use to 90 per cent; and (e) sustained universal availability of iodized salt. The programme will comprise EPI, CDD, child nutrition, safe motherhood and screening and treatment of childhood disabilities. To achieve those objectives, the programme will target the known causes of maternal and child mortality and morbidity.
65. Assistance for the expanded programme on immunization will help to sustain vaccination coverage of 90 per cent or greater of infants and women of child-bearing age. UNICEF will continue to provide vaccines, syringes, needles and cold-chain equipment to UNRWA service units and to PRCS and Medical Aid to Palestinians (MAP) clinics. Special attention will be given to the improvement of the disease surveillance system, maintaining effective cold-chain operations and strengthened social mobilization to sustain public awareness and support of UCI.
66. The control of diarrhoeal diseases project will continue to address diarrhoea-related morbidity and mortality among children under five years old through wide promotion of ORT in all PHC facilities and in families. Increased attention will also be given to the prevention of diarrhoea through the promotion of breast-feeding, continuous feeding during diarrhoea episodes and appropriate personal hygiene and sanitation. As a result, close linkages will be forged with the water supply and sanitation project. UNICEF support will include the provision of ORS sachets, as well as the production of promotional and educational materials using Facts for Life messages.
67. The focus in nutrition will be on capacity-building in nutrition education for preventive measures related to infant and child feeding practices, the elimination of vitamin A deficiency, the reduction of anaemia and the eventual elimination of iodine deficiency disorders. UNICEF will provide growth charts to all PHC facilities and support the training of health workers. Community-based meetings will help to educate and empower families to address the range of issues contributing to malnutrition and micronutrient deficiencies.
68. The safe motherhood project will train health workers and traditional birth attendants, with a strong focus on the pregnancy risk factors and approaches to prevent them, and on clean and safe deliveries. The project will support the upgrading of prenatal and post-natal care in PRCS and MAP facilities. In coordination with UNRWA, PRCS and MAP, workshops will be conducted for mothers in camps and displacement centres to improve their knowledge and practices in child growth promotion, personal hygiene, maternal nutrition, breast-feeding, immunization and safe motherhood.
69. In areas of childhood disability and rehabilitation, UNICEF support will focus on helping children and their families prevent and cope with physical disability and psychological trauma. In conjunction with local and international NGOs, UNICEF will help to develop and promote systems for the prevention and early detection of childhood disabilities, which will be established within the PHC structure, in kindergartens and in primary schools. These agencies will also provide counselling for traumatized children and help to empower families and communities to care for their own children. In this context, UNICEF will support the training of teachers, health staff and parents in the care and counselling of children with disabilities and those experiencing trauma.
Early childhood development
70. The main objective of the ECD programme is to help children realize their cognitive, emotional and psycho-social development. UNICEF will support the inclusion of child-centred, play-oriented learning and early child stimulation methodologies into pre-school education services and home settings. The physical upgrading of kindergartens through the establishment of children's libraries and playgrounds also will be supported. The programme will continue its close linkage with the Lebanese Education for Peace programme, which will provide for the participation of Palestinian children in all of its activities.
71. UNICEF will collaborate with UNRWA in the development of new teaching methodologies, new diagnostic testing and a remedial education structure and will involve teachers, students and parents in efforts to improve the quality of primary education. A pilot project at Burj el-Barajneh for lower-elementary-level students with learning problems will be evaluated to serve as a reference for expansion of coverage.
Women in development
72. This programme will provide women with wider education and vocational skills to empower them to participate more widely in economic life. UNICEF will continue to support small-scale, cooperative income-generating and marketing activities for Palestinian families, especially for female-headed households. UNICEF will support family agricultural activities, which have the potential to achieve family nutritional security. All activities will be implemented in collaboration with Palestinian NGOs, which will sponsor participating families. A monitoring system for income-generation and marketing activities will be established to help strengthen the viability of programme objectives. The promotion of effective, local strategies to increase adult literacy among the Palestinian population, especially women, will be pursued by developing and disseminating sound models for literacy activities. Priority health and nutrition education messages will be incorporated into literacy materials.
Water supply and sanitation
73. This programme seeks to improve the quality and quantity of drinking water, promote healthy sanitary practices in displacement centres and achieve and sustain access to an average of 40 litres of water per person per day. The strategy is to organize community-managed water supply and sanitation schemes. Appropriate information materials using Facts for Life messages will be disseminated to raise public awareness of proper practices for sanitation and safe disposal of human waste.
74. Monitoring and evaluation will be integral parts of this programme. Support will be provided to establish more detailed and up-to-date baseline data, to monitor trends and to serve as the basis for the evaluation of the programme and planning for the next programme of cooperation.
Cooperation with other organizations
75. Close cooperation with UNRWA and WHO will continue. UNICEF will also cooperate and coordinate with Palestinian philanthropic associations and those international NGOs that provide assistance to Palestinian children and women in Lebanon.
Recommended programme cooperation for Palestinians in the Syrian Arab Republic, 1995
76. The objectives of the 1995 programme will expand on those of the 1991-1994 programme. The broad objectives of the national programme of action provide the framework for UNICEF cooperation.
77. The health objectives are:
(a) To eliminate poliomyelitis, virtually eliminate neonatal tetanus and reduce the incidence of measles to near zero;
(b) To sustain immunization coverage of infants at more than 95 per cent for all antigens;
(c) To increase to 90 per cent the proportion of women of child-bearing age receiving at least two doses of tetanus toxoid vaccine;
(d) To reach 70 per cent of mothers and at least one health worker from each clinic with information on ARI case management and referral;
(e) To increase the use of ORT to 90 per cent;
(f) To reach 90 per cent of mothers with information on safe birth delivery;
(g) To achieve and sustain universal availability of iodized salt.
78. The programme consists of six components: EPI; CDD; control of ARI; safe motherhood; iodine deficiency disorders; and vitamin deficiency. The strategy is to sustain and improve past achievements through a strategy comprising capacity-building, community empowerment and service delivery.
79. As part of capacity-building efforts, UNICEF will continue to support in-service training of health staff of UNRWA and NGOs, the development of standardized treatment and care protocols and the improvement of reporting systems and baseline data. UNICEF will also continue to promote cooperation and exchange of experience between UNRWA and the Ministry of Health. In an effort to empower communities with critical life skills and knowledge, increased emphasis will be placed on a variety of social mobilization activities aimed at involving the mass media, women's leaders, schools, traditional birth attendants and local NGOs in community awareness-raising efforts. Support to service delivery will centre on strengthening the network of MCH services provided by UNRWA, GOPAR and Palestinian NGOs through the provision of essential materials and supplies. A stronger focus will be put on improving health services in unofficial camps, which are without access to UNRWA services.
80. Efforts to achieve the mid-decade goals within the Palestinian community in the Syrian Arab Republic are taking place largely within the context of broader national efforts. National programmes relating to the elimination of neonatal tetanus and poliomyelitis and the control of measles, launched in 1990, are being implemented in cooperation with UNRWA and thus include the refugee population. The universal access of Palestinians to radio and television should help national awareness-raising campaigns to promote ORT use among Palestinian households. The national Baby-Friendly Hospital Initiative launched in 1992 includes maternity facilities that are utilized by Palestinian women. Thus UNRWA health staff are included in in-service training on that initiative. A recently launched project on the national control of iodine deficiency disorders, involving the iodization of salt and provision of oil capsules in high-risk areas, covers the Palestinian community. A national study on the incidence of vitamin A deficiency scheduled for 1994 will also cover the Palestinian community.
Women and early childhood development
81. The primary objective of the programme is to develop community-based initiatives that will help women and children to achieve their potential. Increased efforts are being made so that women's development and ECD activities are linked and mutually supportive, wherever possible.
82. Early childhood development will increasingly emphasize strategies for empowering mothers and other caregivers within the home with the key knowledge and skills they need for guiding early childhood growth and development. UNICEF will also continue to mobilize the numerous NGOs and community groups involved in ECD as a network and provide support for that network to expand the coverage and improve the quality of centres. Promoting the involvement of women and women's organizations in the network will be a high priority.
83. Women's development efforts will continue to centre on expanding income-generating opportunities for women, especially for female heads of household. UNICEF will seek to foster more community support through extensive advocacy and more mobilization of community groups, which could lead to income-generating activities for women. Combining income-generating activities with broader training in a range of basic life skills and knowledge, including key ECD skills needed by Palestinian women in their daily lives, will be a challenge.
Cooperation with other United Nations organizations
84. Close cooperation will be maintained with UNRWA and WHO in the development and implementation of programmes for Palestinians in the Syrian Arab Republic. Cooperation will be strengthened with the United Nations Population Fund in safe motherhood and with UNDP and the United Nations Development Fund for Women in women's development. Representatives of United Nations organizations will meet on a regular basis to exchange experiences and to coordinate activities. A strategy paper for cooperation in the Syrian Arab Republic is expected to be completed by the end of 1994. The programme cycles of the United Nations organizations will be synchronized starting in 1996.
Recommended programme cooperation for Palestinians in the West Bank and Gaza, 1994-1995
85. To formulate a social policy for the occupied territories and develop effective and sustainable services for Palestinian children and women will be an important challenge, presenting new opportunities to improve the conditions of Palestinian families. Supporting the peace process will require a rapid improvement in social services and creation of employment to raise the average level of family income. The expected creation of a central authority with, inter alia , a mandate to coordinate and strengthen basic services will help to overcome the fragmentation, duplication and inefficiency of current services.
86. During the period 1994-1995, UNICEF will continue to give priority to three major strategies:
(a) Improving the quality of social services and developing local capacity to achieve goals for the survival, protection and development of children and women. This will include setting up and maintaining an information base for monitoring indicators relevant to children and women; establishing policies and professional standards through appropriate decision-making bodies; promoting universal adoption of those standards through advocacy; and providing relevant training and technical support at the community level to facilitate their application. Longer-term issues of sustainability can be addressed only once a central authority has been established and policy formulation progresses;
(b) Empowering communities through public participation, advocacy on children's rights, broad partnerships with local organizations and encouraging private and community initiatives. UNICEF will extend its partnerships to include a broader range of local organizations, and a new authority will continue these activities on a larger scale;
(c) Strengthening programme complementarity with other United Nations bodies. While UNDP and UNRWA provide support for building infrastructure and overhauling the service sectors, UNICEF will focus on service delivery rather than the development of infrastructure.
87. UNICEF cooperation is designed to be integrated within the framework of the Palestinian Development Programme and the Palestinian National Health Plan. UNICEF cooperation will also be integrated into the overall framework of donor coordination initiatives.
88. United Nations organizations will support a new authority in standardizing and upgrading health policies, strategies and approaches. UNICEF will continue to support preventive, promotive and curative MCH interventions. Working in close cooperation with the Palestinian Health Council and other health institutions, UNICEF will continue to support EPI, CDD, ARI, exclusive breast-feeding of infants during the first four months and the rational use of essential drugs for CDD and ARI.
89. UNICEF will support (a) immunization, to maintain high coverage levels; sustain vaccine supply; assess the cold chain and improve the quality of storage, transportation and monitoring of vaccine stocks; and upgrade the skills of managers and service workers; (b) CDD, to promote universal ORT use and assist in the design and implementation of surveys of knowledge, attitudes and practices among health workers, mothers and child minders; (c) ARI, to standardize case management and promote positive behavioural changes among health workers and families; and (d) nutrition, to mobilize hospital and health unit staff and families on the promotion of breast-feeding and the prevention and elimination of micronutrient deficiencies.
90. Other cross-cutting activities will include (a) fuller appraisal of PHC problems and institutional capacity in those services, which will facilitate the planning of sectoral policies and the setting of standards; (b) the development of policy and service protocols and their harmonization, through consultations with PHC providers, pilot testing of models and evaluation; and (c) appropriate training and related material assistance, for example, the provision of training equipment and learning materials to encourage the adoption of service protocols at all levels in management, clinical practice and community education.
91. UNICEF has established solid working relationships with all the major PHC providers. In line with the emerging framework of Palestinian authority and decision-making, this network of established partnerships can help to promote policy development, harmonization and cost-effectiveness through well synchronized UNICEF technical and material assistance for PHC.
92. UNICEF will continue to help improve the quality of primary education through the development and promotion of classroom enrichment materials for effective learning and the expansion of training and networking activities for teachers and supervisors. UNICEF will also support the development of new training systems for teachers and new teaching methodologies and will assist in the development of diagnostic, testing and remedial education services. In addition, UNICEF will provide each school with packages of materials for both educational and recreational activities, which will support the promotion of effective learning.
93. This programme, through the provision of materials, the enhancement of teacher training and the promotion of effective learning techniques, will complement the work of UNDP, UNRWA and local organizations in the revision of curricula.
Youth and community activities
94. There is an urgent need to give children and young people an opportunity to expand their activities for intellectual, physical and emotional development. These were major priorities identified by communities at the onset of the transition phase, and are based on the need to create among young people an important role for them in improving their environment.
95. Therefore, UNICEF will promote the establishment and development of non-formal educational activities for youth, which will help to foster an active commitment towards improving their environment. UNICEF will support a wider organization of summer camps, youth centres, sports clubs and children's centres and playgrounds which will cover more localities and target groups. Activities highly suitable for children and youth will be introduced. UNICEF will support local initiatives that focus on sound psycho-social health and cognitive development of children and young people. The programme will concentrate on locations most in need: Gaza and the northern and southern areas of the West Bank. Artistic expression will be encouraged through theatre, music and art workshops, especially programmes for females. Literacy will be addressed through the development of a children's magazine and an adult education programme in Gaza.
96. UNICEF will assist in the coordination of needs assessments, networking and training of youth leaders and youth club managers, programme development and advocacy. UNICEF will provide some supply assistance through the UNICEF Supply Division at Copenhagen; UNDP and UNRWA will be responsible for renovation activities and will assist with the bulk of supply assistance.
Early childhood development
97. This programme focuses on enrichment of the child's environment and development of social and psychological well-being. Those needs have been addressed by a variety of local NGOs and women's committees which operate nurseries, kindergartens and child-care centres. Owing to a lack of technical and financial support, those services have declined, and they need to be revived.
98. The strategy is to reach caregivers in service groups, whether they be child-care institutions or households, with information and training in ECD. An integrated approach to child rearing will be promoted through:
(a) Community education, with a wide range of professionals and paraprofessionals trained to provide support and information to parents;
(b) Training and support to nurseries and kindergartens. These services should continue until the incoming authority has the opportunity to review and establish goals, policies and standards;
(c) Development and support of community play areas. In 1993 a range of designs and approaches to community play areas was tested. In 1994 the programme will expand geographic coverage through construction of play areas;
(d) Policy harmonization and improving the sustainability of the ECD sector, again using training and appropriate assistance as strategies. This sector is already a recipient of significant contributions from Palestinian women's committees, and it can serve as an important channel for greater influence of women on the social development process.
99. Exposure to military force during the intifadah has left physical and emotional scars on a large number of Palestinian children. In addition to those children suffering from physical disability, there is a large number of children suffering from symptoms of aggressiveness, anxiety, hyperactivity and depression. In cooperation with UNRWA and several local organizations, UNICEF has been supporting new activities to address child mental health needs through existing service organizations - the clinics and schools - with which children have frequent interaction.
100. This programme will be continued and expanded. Schoolteachers in UNRWA and in new public schools will be equipped with crisis counselling and guidance skills to help children with psychological trauma. UNICEF will help local NGOs to incorporate counselling services in PHC centres in rural areas and refugee camps through the hiring of recent college graduates. UNICEF will support increased training and provision of relevant material assistance, including the preparation of training and communication modules to help parents understand and cope with child trauma.