(^Ш/ World Health Organization ^^^^ Organisation Mondiale De La Santé
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(^Ш/ World Health Organization ^^^^ Organisation mondiale de la Santé FORTY-SEVENTH WORLD HEALTH ASSEMBLY Provisional agenda item 32 A47/INF.DOC./3 2 May 1994 Health conditions of the Arab population in the occupied Arab territories, including Palestine The Director-General has the honour to bring to the attention of the Health Assembly the attached annual report of the Director of Health of the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) for the year 1993. HEALTH CONDITIONS OF THE ARAB POPULATION IN THE OCCUPIED ARAB TERRITORIES, INCLUDING PALESTINE Report of the UNRWA Department of Health, 1993 CONTENTS Page I. INTRODUCTION 2 II. UNRWA'S HEALTH PROGRAMME 2 III. HEALTH STATUS OF PALESTINE REFUGEES 3 IV. PROGRAMME ACTIVITIES DURING 1993 5 Medical Care Services 5 Maternal and Child Health Care 5 Mental Health 6 Environmental Health 6 V. SITUATION IN THE OCCUPIED TERRITORY 8 VI. UNRWA'S CONTRIBUTION TO HEALTH SECTOR DEVELOPMENT 8 VII. UNRWA'S ROLE DURING THE TRANSITION PERIOD 10 STATISTICAL ANNEX 13 I. INTRODUCTION 1. The Annual Report of the Department of Health of UNRWA for 1993 covers a year in which historic events have taken place that will create a radically different situation in the Agency's area of operations. 2. The Palestine Liberation Organization and the Government of Israel have recognized each other and signed a Declaration of Principles, which is guiding their negotiations for an interim self-government period in the Gaza Strip and West Bank. 3. There is no doubt that these momentous developments have already had a great impact on the perceptions of all parties concerned as well as on UNRWA's role under the new conditions. 4. UNRWA, which is one of the major health care providers in the occupied territories, will make every possible effort to contribute to the process of sustaining and developing the existing health care system and harmonization of the services of the various health care providers. In addition to its Peace Implementation Programme which aims at, inter alia, upgrading the basic infrastructure of primary health care facilities and improving environmental health conditions, the UNRWA Department of Health and the Palestine Red Crescent Society/the Palestine Council of Health have already started a process of ongoing consultations in an effort to further co-operation between the two parties in the health sector including reinforcing and expanding existing programmes, co-ordination of new programmes, exchange of information, harmonization of the standards of service, development of a universal health insurance scheme, development of human resources for health, and material support in fund-raising and health development projects. 5. UNRWA can continue its activities within any framework that would be considered appropriate by the emerging Palestinian health authority and supported by the international community. UNRWA's major contribution towards building a coherent, unified and affordable health care system in the Gaza Strip and West Bank will be focused on the transfer of appropriate technology with special emphasis on primary health care. In the meantime it is needless to emphasize that the Agency will also continue to seek funding and implement projects for meeting essential health needs of the Palestine refugees in Jordan, the Syrian Arab Republic and Lebanon. II. UNRWA'S HEALTH PROGRAMME 6. As at 31 December 1993 UNRWA cared for a total of approximately 2.9 million registered refugees, of whom one-third live in camps and the rest in cities, towns or villages. The registered refugee population is distributed in the five fields as follows: Gaza Strip 625 000, Jordan 1 140 000, Lebanon 335 000, Syrian Arab Republic 321 000, and the West Bank 492 000. 7. UNRWA provides primary health care services to the registered refugee population, including medical care (both preventive and curative), environmental health services in camps, and nutrition and supplementary feeding to vulnerable population groups. Medical care at the primary level is complemented by secondary services, including hospitalization and other referral services. 8. UNRWA's policy is to provide essential health services to registered Palestine refugees consistent with the humanitarian policies of the United Nations and the basic principles and concepts of WHO. The prime objective of the Agency's health programme is to protect and promote the health of the refugee population by meeting their basic health needs. 9. Since 1950, under the terms of an agreement with UNRWA, WHO has provided technical supervision of the Agency's health care programme by assigning personnel to UNRWA headquarters, currently six WHO staff members, including the Agency's Director of Health. 10. More than 3200 professional and other support staff, most of whom are locally recruited Palestinians, provided essential primary health care services to the refugee population throu^i UNRWA's expanded íacilities of health centres/points and mother and child care clinics. (For details on UNRWA's health personnel, see Annex, Table 1.) 11. During the reporting period UNRWA received contributions and incurred expenditure in the Health Programme under the following main headings: regular programme, Extraordinary Measures in Lebanon and the Occupied Territory (EMLOT), Expanded Programme of Assistance (EPA), Gaza General Hospital project and the Peace Implementation Programme (PIP). TABLE 1. REGULAR HEALTH PROGRAMME BUDGET (thousands of United States dollars) Syrian Gaza Jordan Lebanon Arab West Bank HQ Total Republic 1990-91 19 849 14 972 14 498 12 948 20 897 3 072 86 236 Expenditure 1992-93 Approved 24 809 18 697 14 925 12 895 23 668 7 804 102 798 budget 1994-95 Proposed 29 586 22 578 16 188 10 615 29 016 10 024 118 007 budget III. HEALTH STATUS OF PALESTINE REFUGEES 12. The health status of the Palestine refugees today resembles that of many populations whose countries are evolving from a developing to a developed state. As such, it has much in common with both. 13. Communicable diseases preventable by immunization and malnutrition are problems of the past. Morbidity from non-communicable diseases, often associated with life-style, such as diabetes mellitus, cardiovascular diseases, and cancer are on the increase. However, birth rates among the refugee population are still high and birth intervals are short. Communicable diseases transmitted through the environment, such as diarrhoea and intestinal parasites, are highly prevalent, and more than 50 per cent of pre-school children and women of reproductive age are anaemic. Services for fertility regulation and mental health are very limited and as such are largely ineffective. The provision of hospital beds, especially in the Gaza Strip, is totally inadequate and the environmental health conditions in refugee camps, especially in the Gaza Strip, Lebanon and the West Bank, are very poor. 14. In the absence of a reliable source of information for obtaining demographic data on the refugee population, and because of the incomplete registration of births and deaths, there are no means of calculating crude birth rates and infant and child mortality rates with accuracy. However, according to the best available estimates, the crude birth rate is estimated at 35 per thousand population and could be as high as 50 per thousand in the Gaza Strip. Infant mortality rates are well below the WHO target of 50 deaths per thousand live births for developing countries by the year 2000. 15. In a recent study conducted by UNICEF in the Gaza Strip and the West Bank, infant mortality rates and child mortality rates were estimated at 41 per thousand and 51 per thousand live births respectively, with significant differences in mortality patterns between camp and non-camp populations. Whereas infant and child mortality rates in refugee camps were 32 per thousand and 39 per thousand respectively, they were 40 per thousand and 50 per thousand in towns, and as high as 48 per thousand and 62 per thousand respectively in villages. ORGANIZATION OF THE DEPARTMENT FIELD OFFICES О POSTS LOCATED AT HQ-VIENNA П POSTS LOCATED AT UHB-AMMAN П POST LOCATED IN GAZA 16. These significant differences in rates can be mainly attributed to the easy access of camp population to the Agency's highly effective primary health care services, and its impact on reduction of infant/child morbidity and mortality. IV. PROGRAMME ACTIVITIES DURING 1993 Medical care services 17. The Agency's efforts to improve the quality of care continued unabated in spite of the limited financial and human resources available to the programme. Several measures were taken to reduce overcrowding ât general clinics, including extension of appointment systems, redeployment of staff to improve patient-flow, expansion of the afternoon-shift clinics in the Gaza Strip, and expansion and upgrading of the Agency's infrastructure of primary health care facilities and basic support services such as clinical laboratories, specialist and special care clinics and dental clinics. 18. In recognition of the changing morbidity pattern of the refugee population, the Agency continued to reinforce its strategy of integrating special programmes for control of non-communicable diseases within its primary health care activities. 19. Analysis of statistical data on diabetes care revealed satisfactory progress. Over 3500 patients were added during the year, i.e., more than 15 per cent. The highest rate of increase was in the Jordan Field, namely 26 per cent. During 1993 more emphasis