Special and Tenth Meeting of the CEHA Technical Advisory Committee

WHO-EM/CEH/144/E Report on the Special and tenth meeting of the CEHA Technical Advisory Committee

Dead Sea, Jordan 14-16 December 2005

• World Health \,\-,., ·1 (12 Organization Regional Office for the Eastern Mediterranean Centre for Environmental Health Activities @ World Health Organization 2007 All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. Publications of the World Health Organization can be obtained from Distribution and Sales, World Health Organization, Regional Office for the Eastern Mediterranean, PO Box 7608, Nasr City, Cairo 11371, Egypt {tel: +202 670 2535, fax: +202 670 2492; email: [email protected]). Requests for permission to reproduce WHO EMRO publications, in part or in whole, or to translate them - whether for sale or for noncommercial distribution - should be addressed to the Regional Adviser, Health and Biomedical Information, at the above address (fax: +202 276 5400; email [email protected]).

Document WHO-EM/CEW144/E/YY.ZZ/50 CONTENTS

1. INTRODUCTION ...... 1

2. TECHNICAL PRESENTATIONS ...... 2 2.1 CEHA's contribution to regional environmental health ...... 2 2.2 Integrated action ...... 4 2.3 Environmental health planning in the Region ...... 4 2.4 CEHA progress report ...... 5 2.5 The development of WHO guidelines on m1mmum water requirements for health...... 6 2.6 Health care waste and solid waste management in the Region ...... 7 2.7 CEHA information exchange and management initiatives, connectivity tools and services to Member States ...... 8 2.8 CEHA's cost-effectiveness analysis ...... 9 2.9 CEHA's proposed plan of action ...... 10 2.10 CERA special studies, initiatives and demonstration projects ...... 10 2.11 CEHA support to environmental health in emergencies and disasters ...... 11 2.12 Progress in preparing the guidance document on desalination for safe water ..... 12 2.13 Case study: assessment of household water security for health in Irbid, Jordan...... 13

3. COUNTRY PROFILES ...... 14 3.1 Egypt ...... 14 3.2 Jordan ...... 14 3.3 Saudi Arabia ...... 14 3.4 Sudan ...... 15 3.5 Syrian Arab Republic ...... 16 3.6 Yemen ...... 16

4. CONCLUSIONS ...... 17

5. RECOMMENDATIONS ...... 18

6. CLOSING CEREMONY ...... 19

Annexes

1. AGENDA ...... 20 2. PROGRAMME ...... 21 3. LIST OF PARTICIPANTS ...... 24 WHO-EM/CEW144/E/L

Page 1

1. INTRODUCTION

The tenth biennial meeting of the Technical Advisory Committee (TAC) for the Regional Centre for Environmental Health Activities (CEHA) was held between 14 and 16 December 2005 in Jordan. The objectives of the meeting were to:

• review CEHA's previous year's work and make recommendations for enhancement, continuation or cessation of technical activities; • provide guidance on current programme priorities; • identify priorities for environmental health in the Region; • review, amend if necessary, and endorse the proposed plan of action for the biennium 2006-2007;and • make specific recommendations to the Regional Director regarding budgetary, technical and other resources, as appropriate.

Dr M. Z. Ali Khan, Director, CEHA, welcomed Her Royal Highness, Princess Muna Al Hussein and thanked her for her patronage of the TAC meeting. He highlighted HRH's ongoing support of WHO's regional activities and welcomed all of the participants to the meeting. He briefed participants on the role of CEHA as providing technical support to countries of the Region in various areas of environmental health, such as solid and health care waste, water and sanitation, wastewater and environmental health in emergencies. Dr Khan made reference to the fact that since its inception, CEHA had trained 12 000 environmental health professionals, published 100 technical documents, manuals and guidelines (in Arabic, French and English), undertaken 500 technical missions to support countries, supported 45 special studies for approximately US$ 1.5 million and developed an electronic network: of 5000 professionals in the Region.

Dr Abdullah Assa'edi, WHO Assistant Regional Director for the Eastern Mediterranean, delivered the message of Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean. In his message Dr Gezairy expressed his continued gratitude to the Government of Jordan, particularly the Ministry of Health, for hosting CEHA in Amman. He noted the support of donors such as the Arab Gulf Programme for United Nations Development Organizations (AGFUND), the Islamic Development Bank (IDB), and the Arab Fund for Economic and Social Development (AFESD), WHO Kobe Centre, Islamic Educational, Scientific and Cultural Organization (!SESCO) and others who he said had provided excellent financial support over the years to address important environment.al health problems and issues facing countries of the Region. He said that during its 20 years as the technical arm and information exchange unit of the environmental health programme of the Regional Office, CEHA had played a major role in the initiation and implementation of a wide range of projects and activities in the Region. Important activities conducted by CEHA in support of Member States had included: the promotion of health and environment monitoring tools; the development and promotion of guidelines, technical manuals and documents; the dissemination of appropriate and reliable information; support for the establishment of a regional network of healthy cities and villages; the promotion of safe WHO-EM/CEW144/E/L Page2

management and disposal of health care waste; the promotion of food safety through hazard analysis critical control point system (HACCP) and food irradiation; the promotion of healthy environments for children; the creation of the Health and Environment Linkage Initiative (HELi); and support for research, pilot and demonstration projects and the conducting of special studies. He expressed his hope that CEHA would continue to adapt to the existing and emerging environmental health challenges in the new century, and would have all possible support from WHO and its dedicated donors. He noted the reduction of CEHA's regular budget by 50% in the current and the previous biennium to accommodate other regional programmes and overall WHO budget reductions. He said that, therefore, the biggest challenge for CEHA was to raise extra-budgetary funds, to explore other appropriate options for support of its activities and to ensure its sustainability, and that in this regard, the Regional Office had delegated extensive flexibility to CEHA in order for the Centre to carry out its activities and to raise the additional funds.

On behalf of His Excellency Saeed Darwazeh, the Minister of Health, Jordan, Dr Sa'ad Kharabsheh, Secretary-General, Ministry of Health, delivered the inaugural address. He noted that Jordan had made substantial progress in caring for the environment. A ministry for the environment had been established in early 2003 and a department of environmental health had been established in the early 1950s within the Ministry of Health. In addition, environmental health had been included in the new health care law formulated in 2002, which addressed the Ministry of Health's role in the monitoring of drinking-water quality, the management of wastewater, the safe handling of chemicals, and in the management of solid and health care wastes. He noted that environmental health impact assessment was now a prerequisite for new development projects and he thanked WHO/CEHA for technical and financial collaboration and coordination in the field of environmental health, noting that CEHA was instrumental in the formation of a national register and profile for the safe management of chemicals in Jordan.

Dr Abdullah Assa'edi, WHO Assistant Regional Director, presented shields to HRH Princess Muna Al-Hussein, and HE the Minister of Health, Saeed Darwazeh. Dr Khrabsheh was elected Chair and Professors Mohammed Ali Awadelkarim (Sudan) and Dr Falah Al Mazrou (Saudi Arabia) were elected Vice-Chairs. Dr Munjed Al-Sharif was elected as Rapporteur for the meeting. The agenda, programme and list of participants are included as Annexes 1, 2 and 3, respectively

2. TECHNICAL PRESENTATIONS

2.1 CEHA's contribution to regional environmental health By Dr M Z. Ali Khan, Director, CEHA

WHO's Regional Centre for Environmental Health Activities (CEHA) was established in 1985 in Amman, Jordan, by the WHO Regional Office for the Eastern Mediterranean to support Member States in the field of environmental health in order to strengthen national capabilities and programmes. WHO-EM/CEH/144/E/L Page3

Environmental degradation plays a vital role in the burden of disease in the Eastern Mediterranean Region (approximately 19%-25% of the total burden of disease is linked to environmental factors). It is also estimated that the annual cost of damage to health and quality of life due to environmental degradation amounts to between 1.8% and 3.4% of gross domestic product (GDP) of certain countries. The Region is threatened by various environmental challenges, such as water scarcity and quality, rapid population growth and urbanization leading to slum areas, land and coastal degradation and desertification, urban and industrial pollution, weak institutional and legal frameworks and inadequate environmental awareness and political demand for environmental protection.

Since its inception, the Regional Office has provided approximately US$ 17 million to cover the staff and operational costs of CEHA. CEHA, itself, has generated US$ 11 million for its activities in various countries of the Region, and an estimate indicates that the activities and services provided by CEHA were more cost effective than if they had been carried out by other international agencies.

Various tools have been developed in collaboration with the environmental health programme to protect health and environment in the Region and are being implemented in various countries. They include:

• environmental health strategies and action plans (14 countries); • drinking-water quality standards (13 countries); • wastewater reuse standards (11 countries); • electronic information network (13 countries); • health care waste management policies (7 countries}; • procedures for environmental health impact assessment of development projects (6 countries).

Capacity building in countries is one of the foremost aims of CEHA, and the Centre has been able to strengthen the capacity of environmental health agencies in countries of the Region by training more than 12 000 staff, supporting more than 450 technical assistance missions, sponsoring more than 45 special and research studies and providing supplies and equipment for countries in need.

Disseminating environmental health information and increasing awareness of health and environment linkages are also important aims of CEHA and the Centre has:

• provided information services to more than 4000 users; • maintained a regional environmental health information centre; • supported electronic networking at all levels; • compiled a regional database and established information centres in 14 countries; • created a base of scientific evidence to link health and the environment; • monitored environmental health problems through indicators focusing on children's environmental health; • published 100 documents in various languages and formats, in addition to producing awareness-raising materials targeting different audiences. WHO-EM/CEH/144/E/L Page4

As environmental health issues are becoming increasingly diverse and significant, the Region is facing: severe water scarcity; risks to water supplies and sanitary environments; the devastating impact of disasters; air and water pollution; the hazards of toxic chemicals; the need for the establishment of environmental health norms, standards and guidelines; emerging problems such as climate change and marine pollution; the need to create an institutional and legislative framework for environmental services and protection; and the need to protect the environment without impairing economic growth.

In conclusion, CEHA requires strong support from WHO to provide resources for its core functions and also in requesting its donors/partners to strengthen collaboration with CEHA to address the ever-increasing environmental challenges in the Region. CEHA also requests Member States to strengthen ministries of health to improve environmental health monitoring and surveillance and also to improve coordination between various sectors such as health, water, energy, agriculture and others. CEHA sincerely acknowledges the ongoing support of WHO, ministries of health, national and international partners (AGFUND, AFESD, IDB, WB) and other UN agencies.

2.2 Integrated action By Dr Ahmad Mohit, Director, Health Protection and Promotion, EMRD

Integration is the process of combining elements into one entity;, adding together diverse elements to make a logical whole (system), and creating unity out of diversity. The most effective leadership strategy to achieve integration is team work. Team work requires a common goal, a sense of belonging, paying attention to others' welfare and esteem and to the concerns of other team members. Hierarchy is based on respect, not fear, a bottom-up approach to decision-making, effective leadership and authority and attention to both everyday detail and to strategic goals. Important examples of areas of integration in the health sector are those related to the integration of services delivery, education and research, the integration of care for hypertension and/or mental health at all levels of the system, the integration of training and research in health in the daily work of an office, a clinic, a programme, etc. using all available resources. Finally, it is important that health education is integrated into daily activities and how they relate to various areas of health, such as noncommunicable diseases, child health and environmental health.

2.3 Environmental health planning in the Region By Dr H Abouzaid, Regional Adviser, Supportive Environments for Health, Coordinator Healthy Environment, EMRO

One of the recommendations of the 1988 first conference on development, the environment and health in the Eastern Mediterranean Region detailed the importance of ensuring that "health is included as an integral part of the sustainable development process". Following the 1992 Rio de Janeiro World Summit, which endorsed Agenda 21, the Regional Committee (RC) for the Eastern Mediterranean adopted the regional strategy for health and the environment in 1993. The Committee urged Member States to implement the strategy and to prepare accordingly their national strategies and plans of action for health and the environment. WHO-EM/CEWl 44/E/L Page5

The second conference on health, the environment and development was held in 1995 and adopted the Beirut Declaration on Action for a Healthy Environment that reinforced the priority health and environmental needs of the Region and underscored the importance of collaboration on environmental health risk assessment, the greater participation of individuals, education on health and environment and the development of health and environment information systems and coordination.

WHO Regional Office and CEHA provided their support to 17 countries seeking to incorporate health and environment into their planning process following intersectoral and interdisciplinary approaches. In 14 countries, the national strategy and/or plan of action developed were adopted at various levels, including by the heads of state in a few countries. In no country, however, was a clear, rational and convincing priority-setting process conducted, and only in one country was it possible to include the plan of action for health and the environment directly in the 5-year national development plan. In some countries, such as Djibouti, Pakistan and Yemen, the Ministry of Health could have been more instrumental in ensuring effective coordination among institutions which were responsible for environmental health if a department of environmental health had existed within the Ministry.

The Ministerial conference on health, the environment and development held in Damascus, the Syrian Arab Republic, in December 1997, adopted the plan of action for health and the environment in the Region which aimed at translating into action the regional strategy and the Beirut Declaration.

The forty-ninth session of the Regional Committee in 2002 discussed the health effects of environmental conditions. In the conclusions, focus was placed on the need for the health and environment sectors to establish an alliance to develop joint activities and programmes beneficial for both sectors. The resolution adopted by the RC should guide further action in the future, including in relation to the work of the Commission on Social Determinants of Health, recently established by the WHO General Director. There is a need for a renewed health and environment strategy and plan of action, and the regional advisory committee for health and the environment, established following the recommendation of the RC, should be instrumental in this endeavour.

2.4 CEHA progress report By Dr M Z. Ali Khan, Director, CEHA

The implementation rate of CEHA activities in 2004-2005 was 100%, although budgetary constraints resulted in a funding gap and vacant staff posts. Ninety-five percent (95%) of current biennium activities were supported from extra-budgetary funds. CEHA mobilized US$ 1 120 000 from donors, WHO and other UN agencies. The Centre conducted joint activities with other agencies, shared costs with national counterparts in various activities and recovered charges from its publications. Special studies were conducted in health aspects of wastewater treatment and reuse; household water security and minimum water requirements for health; the Health and Environment Linkages Initiative (HELi), children's environmental health indicators (CEHI) and Healthy Environments for Children Alliance (HECA) pilot studies; assessment of drinking-water quality; childhood lead WHO-EM/CEH/144/E/L Page6 exposure; environmental health impact assessment (EHIA) of development projects; solid and health care waste management; and food and safety issues. The response to major manmade and natural disasters in affected countries was carried out in collaboration with the regional environmental health programme and the health emergency unit. The major focus was on improving water and hygiene kits, training, information dissemination, intensifying awareness and raising funds. On CEHA's twentieth anniversary, a special advocacy campaign was launched to promote environmental health among 22 countries. A 10-minute documentary film on CEHA's achievements was developed in addition to exhibitions held in different countries. During this biennium, the Centre was linked to WHO's global private network (GPN); all its documents were electronically formatted and placed on the web and it also supported the establishment of environmental health websites, information centres and geographical information systems (health and environment linkage) in various Member States.

The Regional Committee for the Eastern Mediterranean in its Fifty-second session in Cairo, from 24 to 27 September 2005, passed a special resolution acknowledging the cost~ effectiveness of CEHA's approach to reducing the burden of environmental health risks in the Region and calling for support from Member States and donors to assist CEHA in responding to the ever-increasing challenges posed to environmental health.

2.5 The development of WHO guidelines on minimum water requirements for health Mr Hamed Bakir, Rural Health and Environment Adviser (RHE), CEHA

The Eastern Mediterranean Region includes countries which experience severe water shortages. These countries have requested information on the minimum water requirements for health to be supplied to consumers in order to establish service provision targets and water tariffs sensitive to health requirements. WHO convened a consultation on the minimum water requirement for health in December 2003 to review available evidence and to provide guidance. The consultation concluded that current evidence was insufficient and that more evidence was needed. The consultation developed a 4-year plan to generate evidence for guidance on minimum water requirements for health and recommended a methodology for generating the evidence.

The process for generating guidance is based on the following steps.

• Revision of accessible information to provide additional evidence. • Collection and analysis of water consumption data and disease surveillance data for evidence of linkages. • Developing tools for generating new data. • Collection of new data through population-based surveys to generate evidence. • Consolidation of evidence and the development and publishing of a risk assessment matrix. • Collection of additional evidence. • Generation of recommendations and guidance on water requirements for health. • Sharing of recommendations and guidance within the public domain. • Obtaining feedback and updating the recommendations for WHO guidance. WHO-EM/CEH/144/E/L Page 7

Two approaches for generating evidence for guidance on household water requirements can be followed, these include gathering existing data on water consumption by households and linking it to health information obtained from disease surveillance programmes or health surveys. and conducting population-based surveys to assess levels of domestic water consumption and corresponding health status.

The Health and Environment Linkages Initiative (HELi) provided an example of the demonstration of evidence on the correlation between water consumption and the incidence of diarrhoea. Data arising from the Initiative was refined and validated through ongoing research conducted in Irbid, the second largest city in Jordan. This project was named Guidance on household water security and minimum water requirements for health (December 2004- November 2005). Other projects in the Region include the Children's environmental health indicators surveys in Tunisia and Oman which are to be completed by the end of April 2006 and the small-scale surveys conducted in Beirut and Rabat that were completed at the end of 2004.

Future planned work in the Region on risk assessment for deriving minimum household water security requirements for health include: gathering information by conducting additional population-based studies in two locations, conducting additional analysis of existing data on water consumption and the incidence of diarrhoea in two cities and gathering data on stunting among children and examining links to water consumption and analysing collected information for evidence.

2.6 Health care waste and solid waste management in the Region By Mr Raki Zghondi, Urban Health and Environment (UHE), CEHA

This paper includes background information on the risks associated with health care waste and examines public concern over the management of health care waste and the potential risks from waste of transmitting disease and the capacity of health care establishments to meet WHO requirements for the safe management of health care waste and associated infection control procedures in low-, middle- and high-income countries in the Region. Managers of health care establishments are exerting all their efforts in planning sound and efficient health care delivery services (curative) without paying adequate attention to the management of health care waste which is an integral part of infection control. In most health care establishments in the Region, health care waste is mixed with general waste from point of generation (wards) until disposal in municipal dumping sites. Hazardous health care waste (I0o/-25%) within general waste contains many active pathogens that may cause serious health problems (e.g. AIDS, hepatitis) to medical staff, workers, patients, health care establishment visitors and scavengers. These pathogens would continuously be recirculated within communities unless action were taken to break the chain of transmission within and outside health care establishments. Establishing simple and safe practices for the management of health care waste taking into account existing human and financial resources would reduce secondary infections within health care establishments. The paper includes an overview of the situation in the Region with special emphasis on existing legislation, planning at local, regional, national and health care establishment levels, existing treatment and disposal facilities in low-, middle- and high-income countries and countries experiencing conflict and WHO-EM/CEH/144/E/L Page8 natural disasters in the Region. A summary of CERA-implemented activities concluded that drastic improvements are difficult to attain in the short term and that a phased approach is recommended for upgrading health care waste management systems in low- and middle income countries using safer and simple practices, available resources and the principles of WHO guidance for the safe management of health care waste and associated infection control procedures. It was also concluded that better and safer health care waste management does not necessarily mean that only highly sophisticated and expensive techniques should be considered. Future directions were also addressed with special emphasis on emergency preparedness programmes to respond to conflicts and natural disasters.

The paper introduced the concept of community-based healthy solid waste management and its role in promoting hygiene at community level, particularly in low-income areas, and it also examined the role of community associations in sustaining community-based projects and initiatives. CEHA activities in this area were presented using models applied in two pilot communities in Yemen and Lebanon. The paper includes photos showing the situation before and after the establishment of community-based schemes in pilot communities. The paper concluded that community-based solid waste management models should be replicated in the Region, particularly within the framework of ongoing projects in healthy cities and villages. As a future direction, the paper stressed the need to assist countries in assessing the burden of disease associated with solid waste management schemes, projects and facilities.

2. 7 CEHA information exchange and management initiatives, connectivity tools and services to Member States By Mr Mazen Malkawi, Technical Officer, CEHA

This paper reviewed the progress of activities and services of CEHA's regional environmental health information network (CEHANET) during the biennium 2004-2005 and presented its plans for the biennium 2006-2007. The environmental health infonnation exchange capacity at the regional level was discussed. Unfortunately, such capacity is still lacking and is hindering the implementation of environmental health activities in the Region. In 2004-2005, CEHANET followed various approaches to address these shortcomings including strengthening its own information exchange capacity for providing environmental health information services to Member States. CEHA 's communication capacity was strengthened by aligning its voice and computer networks to the WHO global private network. Consequently, CEHA is now in a better position to communicate with WHO offices in countries of the Region. CEHA's regional environmental health information centre was strengthened by adding more documents to its library and by having online access to reliable information resources. Electronic information services were provided to more than 1500 users through the Internet while more than 12 000 documents were disseminated using traditional methods.

The second approach was to strengthen the national environmental health information exchange capacity. Yemen and the Islamic Republic of Iran were supported in establishing their own websites. More than 25 national experts were trained on modem information management and processing tools. WHO-EM/CEH/144/E/L Page9

The third approach was the compilation of relevant and reliable environmental health information. Twenty-five (25) documents and five training videos were published and disseminated to users in the Region. Twelve (12) other documents are in the final stages of production. All new CEHA documents are available in electronic format, in addition to the printed format and are available in PDF format on CD-ROM. A list of publications is available on CEHA's home page http://emro.who.int/ceha/publications.

CEHA made use of the special occasion of CEHA's twentieth anniversary to advocate for CEHA and to promote environmental health among the 22 Ministries of Health in the Region. A 10-minute film was prepared documenting CEHA's achievements over the past 20 years and which focuses on future problems and needs. A package of awareness-raising materials was produced and disseminated. An exhibition was also organized displaying all CEHA documents and other materials during the four days of the exhibition. Several exhibits were also organized in Egypt, Jordan, the Syrian Arab Republic and Tunisia. These exhibits were followed by massive dissemination of information.

CEHNs efforts to bridge the gap in access to environmental health information will continue during the biennium 2006-2007 following the same approaches, and efforts will continue to provide state-of-the-art information to users in the Region. Environmental health information management capacity at national level will be strengthened through the development of human resources, systems and tools, the establishment of model information centres and the promotion of networking at regional and national levels. Websites for six environmental health units will be created in collaboration with AGFUND. Appropriate and reliable training and educational materials will be compiled, developed and translated, and production and dissemination of materials in multimedia and electronic formats will receive special attention during the current biennium.

2.8 CEHA's cost-effectiveness analysis By Mr Mazen Malkawi

It is difficult to quantify the value of CEHA's interventions in reducing the burden of environmental diseases and in improving the quality of life. However, a cost-benefit analysis has proven the effectiveness of CEHA's approach. The objective of this study is to estimate the cost of CEHA's activities and services provided to countries of the Region during the last 20 years ( 1985-2005), and to show the cost-effectiveness of CEHA's services and activities by comparing its estimated costs with the cost of similar services offered by other competent international agencies in the Region.

CEHA's budgetary resources were analysed to show that 60% (US$ 17 million) of the cost of CEHA's activities and services came from WHO's regular budget and the remaining 40% (US$ 11 million) was covered through collaboration with national, regional and international partners. Simple analysis was used to estimate the cost of CEHA's activities and services provided to Member States from 1985-2005 and the first unit cost of CEHA's activities was estimated by adding the cost of staff, operational costs and the direct costs of activities and the number of services provided to Member States. WHO-EM/CEH/144/E/L Page 10

One way of showing the cost-effectiveness of CEHA's approach is to compare the cost of its activities and services with the cost of other competent organizations, such as the WB, USAID, etc. Simple calculations show that if CEHA's activities and services had been implemented by other organizations, they could have cost as much as US$ 102 million, five times as much as the cost as implemented by CEHA at US$ 17 million. Therefore, in addition to the commitment towards improving health through protection of the environment, CEHA's services have also proven to be very cost effective.

2.9 CEHA's proposed plan of action By Dr M Z. Ali Khan

All CEHA's activities are conducted within three areas: environmental health policy and risk assessment including CEHA's core functions (59%), water supply and sanitation (35%) and food safety (6%). Special effort will be exerted in raising funds for chemical safety and healthy villages and communities. CEHA plans to develop partnerships and collaborations with other health programmes to enhance resources in terms of funds and staff. Of the total budget, 44% will go towards staff costs and 56% toward the cost of activities. Extra budgetary funds will cover 95% of activities. Activities will include: 16 intercountry/regional meetings (22%); 24 technical cooperation and assistance missions (14%); compilation and production of technical documents, audio-visual materials (13%); 65 national training activities (13%); core functions of CEHA (11 %); 13 demonstration and problem-solving projects plus supplies and equipment (10%); information resources, processing, compilation, preparation and dissemination (9%); applied research, situation assessment, surveys and country profiles (8%).

It is worth mentioning here that the regular budget for this biennium is less than the previous, and therefore, additional regular budgetary allocation would be needed to carry out core functions. It is imperative that CEHA increases efforts to raise extra-budgetary funds from all available sources and recruits staff to fill vacant posts. Special focus will be placed on emergency response services and improving environmental health conditions in refugee camps among displaced populations and in emergency affected areas.

2.10 CEHA special studies, initiatives and demonstration projects By Mr Hamed Bakir

The following is a description of several completed and ongoing CEHA demonstration projects and special studies.

1. The objective of the national survey, Rapid assessment of drinking-water quality-Jordan ( completed in October 2005) was to pilot the WHO/UNICEF joint monitoring programme for water supply and sanitation protocol for monitoring drinking-water quality.

2. The Health and Environment Linkages Initiative (HELI) assessed the health, environment and economic impacts of water efficiency policies in Jordan for evidence- WHO-EM/CEH/144/E/L Page 11

based decision-making. It ended in June 2005. The Initiative provided a demonstration tool for evidence-based decision-making on health and the environment.

3. The objective of the Children's environmental health indicators surveys conducted in Tunisia and Oman was to implement the global initiative on children's environmental health indicators in the Region. They resulted in national surveys of environmental risk factors affecting children's health and provided tools for monitoring and assessing environmental risk factors affecting children's health.

4. The objective of the Healthy Environments for Children's Alliance (HECA) project Creating healthy settings for children in Yemen and Pakistan is to promote healthy school environments for children. Its achievements have included the fact that several schools were certified as schools with safe physical environments in both countries. The project is due to finish at the end of 2006.

5. The AGFUND project on healthy environments for children in Yemen and Pakistan assesses environmental risk factors affecting children and promotes healthy environments for children. It will lead to a national assessment of risk factors affecting children and several schools will become certified as schools with safe physical environments in both countries. Its expected time of completion is the end of 2007.

6. The objective of the WHO guidance on water requirements for health is to generate evidence for the development of WHO guidance on water requirements for health. It will provide an assessment of water requirements for health in Amman (completed), Irbid (ongoing), Beirut (completed) and Rabat ( completed). The final document on water requirements for health is expected in 2008.

2.11 CEHA support to environmental health in emergencies and disasters By Dr M Z. Ali Khan

The Eastern Mediterranean Region is one of the most badly-affected regions from both manmade and natural disasters. According to United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and the Office of the United Nations High Commissioner for Refugees (UNHCR), of the 23 million refugees around the world, 9 million are in the Eastern Mediterranean Region (39%). These disasters and emergencies range from drought, tsunamis, earthquakes and wars.

CEHA's support for environmental health aspects in emergencies and disasters for the biennium 2004-2005 included infonnation support to back-up both local and WHO emergency teams, technical assessments and advisory missions, human resource development, the production of training and educational materials and the preparation of water and hygiene kits. CEHA's approach has included:

• establishing an information database for environmental health aspects in emergencies in addition to establishing hotlines for affected areas; WHO-EM/CEH/144/E/L Page 12

• building its own technical capacity in addition to that of country capacity in environmental health preparedness for emergencies; • developing human resources for environmental health preparedness.

2.12 Progress in preparing the guidance document on desalination for safe water By Dr H Abouzaid

The recommendation to develop a WHO desalination guidance monograph was endorsed by the WHO committee on drinking-water quality guidelines in June 2000. The joint WHO, United Nations Environment Programme (UNEP), Regional Organization for the Protection of the Marine Environment (ROPME) consultation, May 2001 in Manama, Bahrain, emphasized the need to involve the broad participation of the numerous interested organizations and individuals from around the world in the guidance development process managed by the WHO Regional Office. The organization of the guidance development process consisted of an oversight committee (WHO, UNEP Regional Office West Asia and ROPME), a steering committee and a technical committee.

The steering committee is responsible for overseeing the operations and progress of the project. The technical committee resolve problems that develop and review and revise the draft and final reports. The steering committee consist of representatives from WHO and key stakeholders from international agencies and organizations, governments and academics from Australia, the Cayman Islands, Japan, Saudi Arabia, Spain and the United States of America (USA). The technical committee consists of a group of international experts, scientists and engineers with particular expertise in the different technical areas that are required for each of the five technical working groups who deal with different aspects of the issue. These working groups and their members conduct scientific analyses and produce technical documents that form the basis for the recommended guidelines.

A single workshop on the topic was conducted in November 2003. The report of this meeting is a contribution to the desalination guidance programme and has been published in draft form on the WHO website for public external review. The final report is currently at press. A symposium and expert meeting will take place from April 24-28 in Baltimore, USA, to examine the scientific basis for the "hard-water benefits" hypothesis and to provide recommendations for future WHO guidelines. Financial support was provided by AGFUND to initiate this process. The most important step in the development of the initiative was the decision of the WHO Regional Director for the Eastern Mediterranean to use Development Funds to effectively start implementing the 3-year workplan to prepare the guideline document. The following institutions have also contributed financially to advancing the work: Kuwait Foundation for Advancement of Sciences (KFAS), WHO headquarters, the United States Bureau of Reclamation, the United States Environmental Protection Agency (USEPA) and the American Water Works Research Foundation. Support was also provided by the Saline Water Conversion Corporation in preparing a background document on water quality aspects of desalinated water in member countries of the Gulf Cooperation Council (GCC). The planned schedule for completion aims at producing an internally and externally reviewed guidance document by October 2006. WHO-EM/CEH/144/E/L Page 13

2.13 Case study: assessment of household water security for health In lrbid, Jordan By Dr Munjed Al Sharif, National Temporary Adviser

WHO's Regional Office for the Eastern Mediterranean has launched a 4-year plan to develop guidance on the minimum water requirements for health. Such guidance is sought for establishing water supply service goals. It is also an opportunity to encourage domestic water pricing policies which are sensitive to the health benefits of a water supply. Guidance on minimum water requirements for health may be provided in two stages. The first stage presents a risk assessment matrix linking water, its availability in households and the incidence of waterborne diseases, utilizing existing evidence and gathering additional evidence from within the Region. The second stage presents a recommendation on minimum water requirements for health protection after sufficient and conclusive evidence has become available.

This proposed study (as part of the 4-year plan) will be implemented in Irbid, Jordan, from December 2004 to December 2005, and is expected to establish the level of water security afforded to households in Jordan and to determine the health risk associated with various levels of household water security.

The specific objectives of this study are the:

• design and pilot testing of an assessment tool for household water security; • conducting of an assessment of household water security through household surveys in Irbid, Jordan; • the preparation of an assessment report and follow up recommendations; • the development of a risk assessment matrix linking available household water quantity, water quality and the incidence of disease.

In general, the methodology adopted to achieve the anticipated objectives can be summarized as follows:

• reviewing the knowledge base related to household water security and minimum water requirements for health; • identifying significant parameters related to household water security and their relation to the incidences of diarrhoeal diseases among children, particularly children under 5; • developing assessment protocols and tools; • carrying out a pilot testing scheme of assessment protocols and survey tools on approximately 100 households in the study area, analysing the pilot testing scheme and carrying out necessary modifications to the protocols and tools; • launching a comprehensive survey in the study area; • analysing results of the comprehensive survey; • performing statistical analysis and developing a risk assessment matrix for the variables related to household water security and minimum water requirements for health; • generating evidence to provide guidance on water requirements for health; • developing a risk assessment matrix linking the available quantity of household water, water quality and the incidence of disease; WHO-EM/CEH/144/E/L Page 14

• presenting the recommendations on minimum water requirements to ensure health protection.

It is expected that the results of this study in Irbid, Jordan, will contribute to the evidence base for WHO guidance on water requirements for health.

3. COUNTRY PROFILES

3.1 Egypt

Egypt is faced with a number of environmental problems, some of which demand immediate attention. Egypt supports sustainable development programmes taking environmental factors into consideration. Environmental policy is embodied in several main axes, all of which form an integrated structure that seeks to achieve proper management of the environment, in addition to using and enhancing renewable and non-renewable resources with a focus on the environment in development projects.

3.2 Jordan

The Ministry of Health, in general, and the Environmental Health Directorate, specifically, provides a wide array of services in the context of environmental health-related issues. These services include:

• duties and activities implemented by various divisions in the Directorate and relevant divisions in health directorates in the districts; • monitoring programmes for the management of drinking-water and municipal wastewater; • monitoring programmes for solid waste and liquid waste disposal sites; • conducting various programmes for ambient air sampling and measuring noise; • physical, chemical and microbiological tests performed on various types of environmental samples; • creating a mechanism for the licensing of various development projects; • monitoring progress achieved in medical waste management; • assessing the progress of work in the context of controlling chemical hazards and chemical information services; • different institutions and relevant legislation in the field of environmental health; • implementing basic strategies for major environmental issues and recommendations.

3.3 Saudi Arabia

Saudi Arabia faces rapid environmental change as well as country profile variations due to rapid population growth, industrial expansion, migration from rural to urban areas and rapid urban development. Maintaining a healthy environment is the cornerstone of sustainable development in the country. The General Government Law by Royal Decree No. A/90, Article 31 states that the Government is responsible for public health and works to provide health WHO-EM/CEH/144/E/L Page 15 care for all citizens. Moreover, Article 32 states that "The Government shall endeavour to conserve, protect and develop the environment as well as to prevent pollution". The Ministerial Committee for the Environment was formed by Royal Decree No. SB/5635. The Committee is chaired by HRH the Crown Prince and Minister of Defence and Aviation and Inspector General. The Committee is the highest environmental authority in the country and has been formed to address policy-related issues, to establish national environmental strategy and to coordinate between different environment-related activities at national level. The relevant sectoral ministries represented in the Ministerial Committee are Health. Agriculture, Water and Electricity, Municipality and Rural Affairs, Trade and Industry, Petroleum and Mineral Resources, Foreign Affairs, Interior, Finance, Planning and National Economy, Culture and Information. In addition to representatives of these ministries, HRH the President of the Presidency of Meteorology and Environment (PME), the President of the King AbdulAziz City for Science and Technology (KACST) and the Secretary-General of the National Commission for Wildlife Conservation and Development (NCWCD) are also members of the Ministerial Committee.

The country has witnessed a noticeable rapid growth in the domain of urbanization. This growth has been accompanied by some negative effects on the natural environment. Preserving the environment and natural resources and ensuring sustainable development is considered a national priority for ensuring a better quality of life for the citizens of Saudi Arabia.

3.4 Sudan

Sudan is a vast country with an area of 2.5 million km2 which had an estimated population of33.6 million in 2003, 70% of whom lived in rural areas, 25% in urban areas and 5% of whom were nomadic. The annual population growth rate is 2.6%. The status of environmental health in Sudan is similar to that of the majority of developing countries. In urban areas, 70% of the population have access to a safe water supply, while only 50% of the rural population have access to safe water. The majority of residents (80%) in the urban areas have access to excreta-disposal facilities as compared to half of the population (50%) residing in rural areas.

The national priority areas in terms of environmental health are improvements in the provision of a safe potable water supply, increasing the percentage of the population using excreta-disposal facilities within the next 5 years, the control of vectors transmitting disease, the control of foodbome diseases, the study of environmental factors that enhance the prevalence of emerging diseases, such as cancer in certain northern states, air pollution and industrial waste management and capacity building and strengthening the environmental health administration at federal, state and local levels. Under federal law the environmental health administration in the Federal Ministry of Health is responsible for setting policies, handling emergency situations, setting guidelines and laws, carrying out monitoring and evaluation of environmental issues, organizing training and public education and conducting surveys and research in different areas of environmental health. The objective of the national plan is to improve the quality of life through the reduction of morbidity, mortality and the burden of diseases associated with poor environmental sanitation management. The national WHO-EM/CEH/144/E/L Page 16 plan covers food safety, water supply and sanitation, chemical safety, waste management and public awareness. Khartoum's state plan of action was also presented. CEHA's activities in Sudan are divided into two parts-training and technical assistance. In conclusion, the major causes of the spread of infectious and communicable diseases in Sudan are the lack of access to safe water and basic sanitation. Chemical safety is not yet a priority and there are weaknesses as regards to tools of inspection, laboratory equipment and supplies. Environmental health legislation needs to be revised. It is recommended that the number of people who would have access to safe water and basic sanitation are increased, and in terms of water surveillance, food safety, chemical safety and industrial waste management, it is necessary to build capacity and to review legislation related to environmental health.

3.5 Syrian Arab Republic

A number of priority environmental problems were evaluated and analysed from available data by the national committee of environmental health and were reported to the Highest Council for Environmental Protection. The environmental health sector in the Syrian Arab Republic is administered by a number of ministries and establishments. These ministries are all represented in the Highest Council for Environmental Protection. The mission of this Council is to prepare and submit all environmental laws, standards and legislation in the country.

3.(j Yemen

CARE International is one of the world's largest independent relief and development organizations, working in more than 70 countries and benefiting over 45 million poor and marginalized people. CARE International has developed a comprehensive programme to empower Yemeni communities and institutions by reducing poverty and improving social justice. This programme will be launched primarily in the governorates of Ha.ti, Al Mahweet and Abyan. The resources will be allocated by CARE International and various bilateral donors.

The strategic directions of this programme include: improving governance at local level, empowering women, strengthening livelihoods and organizational strengthening. The major sectors focused on are: water and sanitation, education (including adult literacy and girls' education) and rural livelihoods and income generation. Various activities are planned to be accomplished within these areas and these include the:

• formation of close partnerships with the local authorities, communities, national and international organizations and institutions;

• participation of various stakeholders and different partners at all levels of planning and implementation;

• capacity building of local communities and nongovernmental organizations through intensive training programmes; WHO-EM/CEH/144/E/L Page 17

• networking and sharing of information with other organizations working in these sectors and advocating successes of the programme to policy/decision-makers, donors and other interested parties;

• highlighting and maintenance of the role of gender equity by culturally acceptable approaches and activities;

• the adoption of household livelihood security measures to ensure sustainable and continuous support to the marginalized populations;

• issue of social justice, resolving the underlying causes of poverty and generating well being in the community.

4. CONCLUSIONS

The Technical Advisory Committee wishes to express its satisfaction with the information presented in the CEHA progress report for the biennium 2004--2005 and in the proposed plan of action for the biennium 2006-2007, despite the difficult financial constraints faced by CEHA during the current biennium. The Committee notes with appreciation the successful record achieved by CEHA in implementing its planned activities and endorses the proposed plan of action for 2006-2007. It also authorizes flexibility to CEHA in amending its plan, in view of budgetary and resource allocation for the biennium 2006-2007.

The Committee also wishes to express its continued appreciation and thanks to the Government of Jordan and to the Ministry of Health for their continued support, cooperation and encouragement to CEHA. They also wish to express their special thanks to the Arab Gulf Programme for United Nations Development Organizations (AGFUND) for providing continuous financial support and encouragement to CEHA and look forward to continued collaboration in the future. The Committee acknowledges with thanks the efforts, assistance, participation and support provided by the Arab Fund for Social and Economic Development (AFESD), the Islamic Development Bank {IDB), the World Bank (WB), WHO Kobe Centre, Islamic Educational, Scientific and Cultural Organiution (ISESCO) and others that have contributed to the work of CEHA.

Recognizing the unique support that CEHA provides to countries of the Region, the Technical Advisory Committee expresses its appreciation of the WHO Regional Director for the Eastern Mediterranean, for his continued support to CEHA, and they request him to take steps to safeguard the regular budget allocations to CEHA to maintain the current level of staffing and to ensure the sustainability of its core functions.

The Committee notes with satisfaction that the Regional Committee for the Eastern Mediterranean Region in its Fifty-second session emphasized the need to support CEHA in maintaining its core functionality from both WHO and Member States. WHO-EM/CEW144/E/L Page 18

S. RECOMMENDATIONS

Intensifying resource mobilization l. CEHA should continue its efforts to raise extra-budgetary resources with the objective of increasing its resource base for the purpose of developing and strengthening effective national and regional activities in the area of environmental health.

2. CEHA should develop and implement effective and proactive fund-raising and marketing approaches to increase recognition of its achievements and capabilities by external partners, collaborators and donor community. In addition, CEHA should reach out to individual donors (philanthropies) and the private sector. CEHA should also continue to prepare project proposals encompassing the needs of recipient countries, as well as the policies and priorities of the donors. This requires systematic and intensive regular contacts with the donor community on an institutional and personal basis.

Priority issues and areas

2. CEHA should continue to respond to the urgent needs of the Region for improving institutional capacity, in addition to generating practical information for decision making and improving networking with and among countries.

3. CEHA in coordination with the Regional Office should continue advocating to Member States the importance of strengthening the existing environmental health units/divisions and establishing new ones, where they do not exist, in order to raise the profile of environmental health within national health institutions. This should include developing model terms of reference for, and organization of, environmental health departments or units within Ministries of Health. CEHA action, in that regard, should address similar needs of other agencies dealing with environmental health. CEHA should support national capacity-building efforts through stimulating the promulgation and enforcement of appropriate environmental health legislation.

4. CEHA should further advance and strengthen its role in the implementation of environmental health aspects of emergency preparedness and response.

5. CEHA should strengthen and expand its work on health and environmental linkages and tools for policy development and decision-making, including environmental health impact assessment of development policies and continue promoting EHIA of development projects in the Region. Tools include health risk assessment studies, environmental burden of disease and information systems such as geographic information systems (GIS).

6. CEHA should intensify its action in training environmental health professionals/technicians. This should include promoting the introduction of basic environmental health aspects in academic graduate and undergraduate curricula. WHO-EM/CEH/144/E/L Page 19

7. CEHA should continue human resources development in environmental health information and data management through training users of the system in Member States and providing assistance in developing their means and communication channels for the electronic exchange of information on environmental health issues.

8. CEHA should continue to foster information exchange and communication channels between Member States on the issue of environmental health. To this end, it should strengthen and expand electronic information exchange services, offering access to information through electronic channels, and initiate the use of innovative tools for linking health and environment information on a geographically referenced basis.

9. CEHA should enhance the complementarity and mainstreaming of its work on good practice guidance adapted to regional needs within the regional healthy environment programme. Other than the above-mentioned technical areas, priority issues include:

• water quality, water supply, sanitation and hygiene, including wastewater reuse; • water security for health and development; • healthy environments for children; • indoor and outdoor air pollution; • health care waste management; • food safety.

In addition, emerging environmental health issues such as climate change and transportation and health should be considered. CEHA should also continue promoting intercountry projects and research activities.

Approaches

11. In implementing its activities, CEHA should take advantage, whenever possible, of the robustness and effectiveness of the community-based initiative approach and give due consideration to gender mainstreaming.

6. CLOSING CEREMONY

Dr M. Z. Ali Khan, Director, CEHA, expressed his gratitude and appreciation for the Chair, the Vice-Chairs, the Rapporteur and to all of the participants for their active management and participation. He pointed out that their involvement in the discussions and their comments on the progress report and achievements of the biennium 2004-2005, the special studies, initiatives and demonstration projects, and the action plan for the biennium 2006-2007 have contributed to the integrity and strength of these items. Special mention was made of the excellent support provided by the Minister of Health and his staff. Dr Khan also noted that the conclusions and recommendations of the tenth Technical Advisory Committee meeting would be conveyed to the WHO Regional Office. Dr Khan also expressed the wish of CEHA to exert all possible efforts to fulfil the recommendations of the meeting for the benefit of countries in the Region. WHO-EM/CEW144/E/L Page 20

Annex 1

AGENDA l. Introduction of participants and nomination of officers

2. Purpose, scope and expectations of the meeting

3. CEHA's contribution to regional environmental health

4. Global strategy for health and environment

5. Review of progress report and the achievements of the 2004-2005 biennium

6. Development of WHO guidance on minimum water requirements for health

7. Health care waste and solid waste management in the Region

8. CEHA information exchange and management initiatives, connectivity tools and services to Member States

9. CEHA's cost-effectiveness analysis

10. Proposed plan of action for the biennium 2006-2007

11. Special studies, initiatives and demonstration projects

12. CEHA support to environmental health in emergencies and disasters

13. Progress in preparing the guidance document on desalination for safe water

14. Case study: Assessment of household water security for health in Irbid, Jordan

15. Environmental health priorities of participating countries

16. Conclusion and recommendations and closing ceremony WHO-EM/CEH/144/E/L Page 21

Annex2

PROGRAMME

Wednesday, 14 December 2005

09:30-10:00 Registration

10:00-10:30 Opening ceremony

• Introductory remarks by Dr M. Z. Ali Khan, Director, CEHA • Message of Dr Hussein A. Gezairy, Regional Director, EMRO, delivered by Dr Abdullah Assa'edi, ARD/EMRO • Address by Dr Sa'ad Kharabsheh, Secretary-General, on behalf of HE The Minister of Health, Jordan • Presentation of shields by ARD/EMRO to HRH Princess Muna Al- Hussein, and HE the Minister of Health, Saeed Darwazeh

11 :00-11 :15 Introduction of participants

11:15-11:30 Nomination of chairperson, Vice-chairperson and Rapporteur, adoption of agenda

11 :30-11 :40 Purpose, scope and expectations of the meeting: Dr M. Z. Ali Khan, Director, CEHA

11:40-12:00 CEHA's contribution to regional environmental health: Dr M. Z. Ali Khan

13:00-13:15 Integrated action: Dr Ahmad Mohit, Director, Health Protection and Promotion, EMRO

13:15-13:30 Discussion

13:30-13:45 Environmental health planning in the Region: Dr H. Abouzaid, RA/SEH, Coordinator Healthy Environment

13:45-14:00 Discussion

14:00-15:00 CEHA progress report for the biennium 2004-2005: Dr Khan

15:00-15:45 Review and discussion ofCEHAprogress report 2004--2005

15:45-16:00 Development of WHO guidelines on minimum water requirements for health: Mr Hamed Bakir, RHE/CEHA

16:00-16:15 Discussion WHO-EM/CEH/144/E/L Page 22

16:30-17:00 Health care waste and solid waste management in the Region: Mr Raki Zghondi, UHE/CEHA

17:00-17:15 Discussion

Thursday, 15 December 2005

09:30-10:00 CEHA information exchange and management initiatives, connectivity tools and services to Member States: Mr M. Malkawi, Technical Officer/CERA

10:00-10: 15 Discussion

10:15-11:15 Presentations by TAC members:

• Dr Mohamed Hafez, Egypt • Dr Sa'ad Kharabsheh, Jordan • Dr Falah Al-Mazrou, Saudi Arabia • Professor Mohammed Awadelkarim, Sudan • Ms Intisar Mardini, Syrian Arab Republic • Eng. Abdul-Hameed Al Basheri, Yemen

11 :30-12:30 "Brain-storming" discussion on environmental health priorities and issues

12:30-13:00 CEHA's cost-effective analysis: Mr Mazen Malkawi

13:00-13:45 Proposed plan of action for the biennium 2006-2007: Dr MZ Ali Khan

13:45-14:30 Discussion

14:40-15:15 CEHA special studies, initiatives and demonstration projects: CEHA technical staff

15:15-15:30 Discussion

15:30-15:40 CEHA support to environmental health in emergencies and disasters: Dr M. Z. Ali Khan and Mr Mazen Malkawi

15:40-15:50 Discussion

15:50-16:15 Suggestions for conclusions and recommendations

16:15-18:15 Drafting recommendations and draft report (temporary advisers and WHO staff committee) WHO-EM/CEW144/E/L Page23

Friday, 16 December 2005

09:30 09:45 Progress in preparing the guidance document on desalination for safe water: Dr H Abouzaid

09:45-10:00 Discussion

10:00-10:15 Case study: Assessment of household water security for health in lrbid, Jordan: Dr Munjed Al Sharif, National Temporary Adviser

10:15-10:30 Discussion

11:00-12:00 Review, discussion and finalization of conclusions and recommendations

12:00--12:30 Closing session

12:30-16:30 Individual meetings of national experts with the CEHA team WHO-EM/CEW144/E/L Page 24

Annex3

LIST OF PARTICIPANTS

Members of the Technical Advisory Committee

Dr Mohamed Hafez Director General Occupational and Industrial Health Department Ministry of Health and Population Cairo EGYPT

Dr Sa' ad Kharabsheh Secretary General Ministry of Health Amman JORDAN

Dr Falah Al-Mazrou Director General Preventive Health Unit Ministry of Health Riyadh SAUDI ARABIA

Co-opted members of the Technical Advisory Committee

Professor Mohammed Ali Awadelkarim Department of Community Medicine Faculty of Medicine University of Khartoum Khartoum SUDAN

Ms Intisar Mardini Ministry of Housing and Construction Damascus SYRIAN ARAB REPUBLIC WHO-EM/CEH/144/E/L Page 25

Eng. Abdul-Hameed Hamood Al Basheri Vice Chairman Rural Water Authority Sana'a YEMEN

Other organizations

AGFUND Mr Nasser Al Dueb Project Coordinator Projects Department Riyadh Saudi Arabia

AFESD Dr Muwaffaq Saqqar Senior Environmental Engineer Arab Fund for Economic and Social Development (AFESD) Safat Kuwait

WHO Secretariat

Dr Abdullah Assa 'edi, ARD/EMRO Dr Ahmed Mohit, Director, Health Protection and Promotion (DHP), WHO/EMRO Dr H. Abouzaid, Regional Adviser, Supportive Environment for Health (RA/SEH), WHO/EMRO Dr M.Z. Ali Khan, Director, CEHA, Amman Mr Hamed Bakir, Rural Health and Environment Adviser, CEHA, Amman Mr Ralci Zghondi, Urban Health and Environment, CEHA, Amman Mr Mazen Malkawi, Technical Officer, CEHA, Amman Dr Amir Johri, STP/CEHA, Amman Dr Munjed Al-Sharif, National Temporary Adviser, Amman Mr Salah Al-Hyari, National Temporary Adviser, Amman