{"id":182158,"date":"2003-06-30T00:00:00","date_gmt":"2019-03-11T21:19:29","guid":{"rendered":"https:\/\/www.un.org\/unispal\/?p=182158"},"modified":"2019-03-11T21:19:29","modified_gmt":"2019-03-11T21:19:29","slug":"auto-insert-182158","status":"publish","type":"document","link":"https:\/\/www.un.org\/unispal\/document\/auto-insert-182158\/","title":{"rendered":"±¬ÁÏÍøRWA – Annual report of the Commissioner-General"},"content":{"rendered":"
Report of the Commissioner-General of the United Nations Relief and Works Agency for Palestine Refugees in the Near East<\/strong><\/p><\/div>\n 1 July 2002-30 June 2003<\/strong><\/span> <\/span><\/p><\/div>\n <\/p>\n <\/p>\n \n ISSN 0082-8386<\/p><\/div>\n Note<\/i><\/p><\/div>\n Symbols of United Nations documents are composed of capital letters combined with figures. Mention of such a symbol indicates a reference to a United Nations document.<\/p><\/div>\n \n <\/p>\n Abbreviations<\/span> <\/span><\/p><\/div>\n \n ACABQ<\/p>\n<\/td>\n Advisory Committee on Administrative and Budgetary Questions<\/p>\n<\/td>\n<\/tr>\n CBO<\/p>\n<\/td>\n Community-based organization<\/p>\n<\/td>\n<\/tr>\n CRC<\/p>\n<\/td>\n Community rehabilitation centre<\/p>\n<\/td>\n<\/tr>\n DTC<\/p>\n<\/td>\n Damascus training centre<\/p>\n<\/td>\n<\/tr>\n EC <\/p>\n<\/td>\n European Community<\/p>\n<\/td>\n<\/tr>\n ESF<\/p>\n<\/td>\n Educational science faculty<\/p>\n<\/td>\n<\/tr>\n GTC<\/p>\n<\/td>\n Gaza training centre<\/p>\n<\/td>\n<\/tr>\n NGO <\/p>\n<\/td>\n non-governmental organization<\/p>\n<\/td>\n<\/tr>\n PA<\/p>\n<\/td>\n Palestinian Authority<\/p>\n<\/td>\n<\/tr>\n PIP<\/p>\n<\/td>\n Peace Implementation Programme<\/span> <\/span><\/p>\n<\/td>\n<\/tr>\n PLO<\/p>\n<\/td>\n Palestine Liberation Organization<\/p>\n<\/td>\n<\/tr>\n RMTC<\/p>\n<\/td>\n Ramallah men's training centre (West Bank)<\/p>\n<\/td>\n<\/tr>\n RWTC<\/p>\n<\/td>\n Ramallah women's training centre (West Bank)<\/p>\n<\/td>\n<\/tr>\n SGL<\/p>\n<\/td>\n Solidarity-group lending<\/p>\n<\/td>\n<\/tr>\n SHC<\/p>\n<\/td>\n Special hardship case<\/p>\n<\/td>\n<\/tr>\n STC<\/p>\n<\/td>\n Siblin training centre<\/p>\n<\/td>\n<\/tr>\n ±¬ÁÏÍøAIDS<\/p>\n<\/td>\n Joint United Nations Programme on HIV\/AIDS<\/p>\n<\/td>\n<\/tr>\n ±¬ÁÏÍøDP<\/p>\n<\/td>\n United Nations Development Programme<\/p>\n<\/td>\n<\/tr>\n ±¬ÁÏÍøESCO<\/p>\n<\/td>\n United Nations Educational, Scientific and Cultural Organization<\/p>\n<\/td>\n<\/tr>\n ±¬ÁÏÍøFPA <\/p>\n<\/td>\n United Nations Population Fund<\/p>\n<\/td>\n<\/tr>\n ±¬ÁÏÍøICEF<\/p>\n<\/td>\n United Nations Children’s Fund <\/p>\n<\/td>\n<\/tr>\n ±¬ÁÏÍøRWA<\/p>\n<\/td>\n United Nations Relief and Works Agency for Palestine Refugees in the Near East <\/p>\n<\/td>\n<\/tr>\n ±¬ÁÏÍøSCO<\/p>\n<\/td>\n Office of the United Nations Special Coordinator in the Occupied Territories <\/p>\n<\/td>\n<\/tr>\n ±¬ÁÏÍøTSO<\/p>\n<\/td>\n United Nations Truce Supervision Organization<\/p>\n<\/td>\n<\/tr>\n VTC<\/p>\n<\/td>\n Vocational training centre<\/p>\n<\/td>\n<\/tr>\n WHO <\/p>\n<\/td>\n World Health Organization<\/p>\n<\/td>\n<\/tr>\n WPC<\/p>\n<\/td>\n Women's programme centre<\/p>\n<\/td>\n<\/tr>\n WSTC<\/p>\n<\/td>\n Wadi Seer training centre<\/p>\n<\/td>\n<\/tr>\n<\/table>\n <\/p>\n \n \n President of the General Assembly<\/p><\/div>\n United Nations<\/p><\/div>\n New York<\/p><\/div>\n Letter of transmittal<\/p><\/div>\n 25 September 2003 <\/p><\/div>\n I have the honour to submit to the General Assembly my annual report on the work of the United Nations Relief and Works Agency for Palestine Refugees in the Near East (±¬ÁÏÍøRWA) for the period 1 July 2002-30 June 2003, in compliance with the request contained in paragraph 21 of General Assembly resolution 302 (IV) of 8 December 1949 and with paragraph 8 of General Assembly resolution 1315 (XIII) of 12 December 1958.<\/p><\/div>\n In chapter I, an overview of events and developments in the region is provided, with reference to ±¬ÁÏÍøRWA’s five fields of operations in Jordan, Lebanon, the Syrian Arab Republic, the West Bank, and the Gaza Strip, as well as a description of the funding situation that ±¬ÁÏÍøRWA faced during the reporting period.<\/p><\/div>\n Chapter II covers general developments in the education, health, relief and social services, and microfinance and microenterprise programmes of the Agency, and in its fund-raising activities, emergency appeals, and project activities. <\/p><\/div>\n Chapter III covers financial matters, including income and expenditure for the regular budget and the projects and emergency budgets, non-regular-budget activities, and the Agency’s current financial situation.<\/p><\/div>\n Chapter IV deals with legal matters, in particular those relating to Agency staff, services and premises, as well as constraints affecting Agency operations.<\/p><\/div>\n Chapter V provides information on ±¬ÁÏÍøRWA operations and its main programmes in the Jordan field, while chapter VI deals with the Lebanon field, chapter VII with the Syrian Arab Republic field, chapter VIII with the West Bank field, and chapter IX with the Gaza field.<\/p><\/div>\n Annex I provides statistical and financial information regarding the Palestine refugees and Agency programmes, finances and staff. Annex II refers to pertinent records of the General Assembly and other United Nations bodies. <\/p><\/div>\n Following established practice, the annual report in draft form was distributed in advance to the ten members of the Advisory Commission, whose relevant comments and observations were given careful consideration. The draft report was discussed with the Commission at a meeting held in Amman on 25 September 2003. The views of the Commission are contained in a letter addressed to me from the Chairperson of the Advisory Commission. A copy of the letter follows. <\/p><\/div>\n I have maintained the practice of showing my report in draft form to representatives of the Government of Israel, and giving due consideration to their comments. Pursuant to General Assembly decision 48\/417 of 10 December 1993 that the Advisory Commission establish a working relationship with the Palestine Liberation Organization (PLO), a representative of the PLO attended the meeting of the Commission on 25 September 2003 and a copy of the draft report was shared with him.<\/p><\/div>\n (Signed<\/i>) Peter Hansen<\/strong> \n Letter dated 25 September 2003 from the Chairperson of the Advisory Commission of the United Nations Relief and Works Agency for Palestine Refugees in the Near East addressed to the Commissioner-General of the Agency<\/strong><\/p><\/div>\n At its regular session, on 25 September 2003, the Advisory Commission of the United Nations Relief and Works Agency for Palestine Refugees in the Near East (±¬ÁÏÍøRWA) considered your draft annual report on the Agency’s activities and operations during the period 1 July 2002 to 30 June 2003, which is to be submitted to the General Assembly at its fifty-eighth session.<\/p><\/div>\n The Commission noted with concern the continuing deterioration in the political, economic and social situation, including the escalation of armed attacks during the reporting period. It expressed deep concern regarding the serious humanitarian crisis that is occurring in the occupied Palestinian territory. The crisis is evidenced primarily by increased levels of malnutrition among children, high levels of poverty and unemployment, deteriorating health conditions, the displacement of an increasing number of Palestinians following the destruction of their homes, and the disruption of educational programmes and the increasing exhaustion of the capacity of the Palestinian population to sustain itself in the face of the continuous decline in economic and social conditions since September 2000. For instance, according to recent figures from ±¬ÁÏÍøRWA, a total of 244 houses were completely demolished during the period April-June 2003, and over 10,000 Palestinians have lost their homes to demolition since September 2000. In addition, recent various reports estimate unemployment in the occupied Palestinian territory at between 37 and 65 per cent. Those conditions have had a particularly severe effect on Palestine refugees, who are often among the poorest and most vulnerable part of the population, and have required additional engagement by the Agency.<\/span> <\/span><\/p><\/div>\n The Commission noted with concern that the construction of the separation wall, internal and external closures, curfews and other restrictions imposed by the Israeli authorities in both the West Bank and the Gaza Strip has led to severe and sustained mobility restrictions on the Palestinian population and has had repercussions on their daily life and future. The restrictions have led to the loss of access by the population to employment and income as well as access to essential goods and services. The restrictions have also had a serious impact on the ability of the Agency to move staff and humanitarian assistance to those in urgent need. Obstacles to the delivery of urgently needed humanitarian assistance to refugees have remained in place as the conflict and level of violence has persisted. The Commission noted the negative impact of those practices on ±¬ÁÏÍøRWA operations and reiterated the need to take urgent measures to remove restrictions placed on the movement of Agency staff and goods, in keeping with international law and the agreements between U NRWA and the Government of Israel. The Commission also expressed concern at the sharply increased constraints on the Agency’s freedom of movement which its international staff faced at the end of the reporting period, further impairing ±¬ÁÏÍøRWA’s ability to function effectively.<\/p><\/div>\n The Commission commended the Agency’s management and staff under your leadership for the resolute and effective response to the continuing emergency in the occupied Palestinian territory. The Commission noted with appreciation the dedication with which many of the Agency’s staff members have worked for long hours in the field and, in the case of area staff, without receiving hazard pay to overcome obstacles often in dangerous and even life-threatening situations, to deliver assistance to those in urgent need of humanitarian assistance. The Commission presented its condolences to you following the violent death of six members of your staff during the reporting period. It reaffirmed the pressing need to respect the integrity of the United Nations and the immunities of its staff, particularly in the case of humanitarian staff courageously operating in areas of conflict, as stated in Security Council resolution 1502 (2003) of August 2003.<\/p><\/div>\n The Commission commended the efforts of the Agency to respond to the continuing emergency in the occupied Palestinian territory and to mobilize contributions by the international community for its emergency appeals. It noted that, up to the end of 2002, donors had contributed $208 million in response to appeals amounting to $333.2 million. It also noted that the Agency has launched appeals totalling $196.6 million for the year 2003. The Commission noted with concern that the response of the international community to the 2003 appeals has been slow, in that as of mid-September 2003 only $76.8 million has been pledged and $55.8 million actually received. In the light of the continuing humanitarian crisis in the occupied Palestinian territory, the Commission appealed to the international community to do its utmost to enhance contributions to the Agency’s emergency programmes and meet the targets as soon as possible. It also called upon ±¬ÁÏÍøRWA to review its emergency programmes and priorities in accordance with needs and anticipated funding levels.<\/p><\/div>\n The Commission also expressed its concern at the destruction of and damage to the infrastructure and facilities of ±¬ÁÏÍøRWA. It noted the sharp increase in military incursions in the Gaza Strip, and the ensuing high number of refugee shelters destroyed during the reporting period.<\/p><\/div>\n The Commission recognized that the Agency has made efforts to conduct an effective programme of delivery of emergency assistance to the affected refugees, and that the Agency’s periodic reports have been distributed to donors to inform them of its implementation. The Commission urged ±¬ÁÏÍøRWA to coordinate more closely with donors and host countries to ensure that adequate reports are received on their emergency appeal programmes. It expressed its appreciation at the improvements in coordination of emergency activities on the ground, including through the Operational Coordination Group, and the Agency’s close relationship with the International Committee of the Red Cross and with the Office for the Coordination of Humanitarian Affairs of the United Nations Secretariat. It also welcomed ±¬ÁÏÍøRWA’s cooperation with the Office of the United Nations High Commissioner for Refugees regarding its assistance to affected Palestinians in Iraq.<\/p><\/div>\n The Commission underscored the crucial importance of the Agency’s regular budget and the need for a consistent and growing level of contributions to it. It noted with concern that, for the year 2002, overall contributions to ±¬ÁÏÍøRWA’s General Fund have declined and that against an approved level of $301.8 million, contributions amounting to $275.8 million have been received. The Commission stressed the importance of a steady and predictable growth in contributions to the regular budget for the years 2003 and 2004, which is indispensable if the Agency is to respond adequately to refugees’ real needs in the five fields of operations. The Commission also called upon ±¬ÁÏÍøRWA to expand and report on its efforts to reach out to non-traditional donors to ensure that the Agency’s financial needs are fully met.<\/p><\/div>\n The Commission noted that the General Assembly has approved its 2002-2003 biennial budget at the level of $791.7 million. It also noted that, against a regular budget planned expenditure of $315.1 million during the current year, pledges of only $293.3 million has been received as of the end of August 2003. The Commission stressed the importance of adequate contributions to the regular budget to ensure and enhance the maintenance and effectiveness of the Agency’s infrastructure and its main programmes of assistance to the refugees. It emphasized the importance of a working capital reserve to ensure the timely implementation of intended programmes. It advised the Agency to improve management of special projects, including proposal preparation, budget estimation and feasibility assessment.<\/p><\/div>\n The Commission welcomed the progress made in solving the issue of reimbursement of value-added tax (VAT) payments by the Palestinian Authority. It noted with appreciation that the Palestinian Authority has introduced a zero rating system for VAT in the Gaza Strip and has agreed to extend that system to the West Bank. It urged the Agency to continue to pursue the matter with the Palestinian Authority. It also requested the Agency to continue discussions with the Israeli authorities with a view to recovering all outstanding port charges, in accordance with the 1967 Comay-Michelmore agreement between Israel and ±¬ÁÏÍøRWA. <\/p><\/div>\n The Commission recognized the structural under-staffing of the Agency at its headquarters and field offices, and urged ±¬ÁÏÍøRWA to request support for the four new international positions from the United Nations “assessed contributions” budget. It noted the Agency’s intention progressively to bridge the gap between the area staff rules of 1999 and the pre-1999 compensation structure for its area staff and supported its efforts in that regard. It noted that a sum of $5.1 million was still outstanding with respect to the expenses incurred by the Agency on account of the shifting of its headquarters from Vienna to Gaza, in accordance with the instructions of United Nations Headquarters. The Commission requested you to pursue the matter with the United Nations Headquarters for the reimbursement of the amount as soon as possible.<\/p><\/div>\n The Commission noted with appreciation that the Agency has submitted two reports describing the various reforms it has undertaken to improve its management and programme practices and processes. It encouraged the Agency to continue with its reform process. It expressed its wishes that those reforms reflect positively on services provided for refugees in all aspects of the Agency’s activities. It also noted with satisfaction the introduction of more informal and substantive interaction processes and workshops at the Agency’s biannual informal major donors and host countries meetings, and noted that the Agency is currently providing a thorough record of the proceedings of those and other stakeholders’ meetings.<\/p><\/div>\n The Commission recognized the vital role the Agency plays in providing the refugees with essential services and in contributing to regional stability. It expressed its support for the expansion of the ±¬ÁÏÍøRWA microfinance and microenterprise programme, as well as for the various major rehousing and infrastructure projects undertaken in, inter alia, the Jenin, Neirab, Tel el Sultan, Khan Danoun, Khan Eshie and Khan Younis camps, as well as the ongoing Palestine refugee records project. It also underlined the need for donor countries to continue to enhance their contributions to the ±¬ÁÏÍøRWA budget at the current critical stage so that ±¬ÁÏÍøRWA can continue to fulfil its mandate until a just settlement to the refugee issue has been implemented, in accordance with relevant United Nations resolutions.<\/p><\/div>\n The Commission expressed great appreciation to the host Governments for the continuing support and services they provide to Palestine refugees and also recognized the important contribution made by the Palestine Liberation Organization and the services it provides to the Palestine refugees.<\/span> <\/span><\/p><\/div>\n The Commission expressed its warm appreciation for your personal commitment to the service of the refugees and the effective leadership you are providing to the Agency at a particularly difficult period in its history. <\/p><\/div>\n (Signed<\/i>) Koichi Obata<\/strong> \n Overview<\/strong><\/p><\/div>\n 1. ±¬ÁÏÍø Relief and Works Agency for Palestine Refugees in the Near East (±¬ÁÏÍøRWA) was established pursuant to General Assembly resolution 302 (IV) of 8 December 1949. The Agency became operational on 1 May 1950, and began responding to the immediate humanitarian needs of about 880,000 Palestine refugees in the region. Over the past five decades, the Agency has grown into one of the largest United Nations programmes, employing over 24,000 staff members, including teachers, health workers, social workers and other service providers. The Agency operates some 900 facilities providing education, health, relief and social services, and runs a microfinance and microenterprise programme, for a growing population of refugees who now number over four million. ±¬ÁÏÍøRWA provides its services in Jordan, Lebanon, the Syrian Arab Republic, the West Bank and the Gaza Strip. About one third of the refugees live in camps that are administered by the respective governmental authorities. A number of the Agency’s installations are also located in the camps and its services are, for the most part, rendered directly to the beneficiaries. While the Agency’s services are funded directly from its budget, where appropriate and possible, refugees contribute to the cost of the services through co-payments, self-help schemes, participation fees and voluntary financial contributions.<\/p><\/div>\n 2. The Agency’s services for the refugees include the following broad categories: elementary and preparatory education; vocational and technical training; comprehensive primary health care, including disease control and family health; assistance towards hospitalization; environmental health services in refugee camps; relief assistance to vulnerable households; and developmental social services for women, youth and persons with disabilities. The Agency has developed a successful microfinance and microenterprise programme which assists in developing the entrepreneurial skills, the income-generating capacity and self-reliance of the refugees. In addition to its regular programme, the Agency undertakes a range of infrastructure projects to improve the living conditions of the refugees. As a result of the ongoing crisis in the occupied Palestinian territory, ±¬ÁÏÍøRWA has implemented a comprehensive programme of emergency activities for the Palestine refugees which includes the provision of food aid, cash assistance, emergency employment generation, shelter repair and reconstruction, remedial education, and the provision of emergency health services, including trauma counselling and psychological support. <\/p><\/div>\n 3. An important development during the reporting period was the crisis in Iraq. ±¬ÁÏÍøRWA was actively involved in the United Nations contingency planning efforts before the conflict erupted, and has followed developments closely as they affect tens of thousands of Palestinians living in Iraq, many of them Palestine refugees. ±¬ÁÏÍøRWA has remained in close touch with the Office of the United Nations High Commissioner for Refugees (±¬ÁÏÍøHCR) throughout the crisis to address the needs of the persons affected. The Agency also participated in delivering emergency assistance to Palestinian families fleeing the conflict and temporarily accommodated in tented camps on the Jordanian-Iraqi border. As a result of the looming conflict, the United Nations Security Coordinator declared security phase III in the occupied Palestinian territory, Jordan and Israel, forcing the Agency to relocate “non-essential” staff and all dependants between March and April 2003.<\/p><\/div>\n 4. During the reporting period, the conditions of strife in the occupied Palestinian territory persisted. Suicide bombings inside Israel continued, causing heavy loss of life. The reoccupation by Israeli forces of almost all of the West Bank and Gaza Strip and ensuing large-scale military operations caused heavy loss of life and widespread damage to and destruction of Palestinian property and infrastructure, including governmental institutions, residential buildings, water and electricity supply systems, and sewerage disposal systems.<\/p><\/div>\n 5. There was a significant increase in the incidence of large-scale military incursions into refugee camps, in particular in the Gaza Strip, during the reporting period. As a result, the number of fatalities rose markedly and demolition of refugee shelters by the Israel Defense Forces (IDF) increased significantly. No less than 506 refugee shelters were destroyed and 1,518 were damaged in the Gaza Strip. <\/p><\/div>\n 6. The severe economic downturn that the Palestinian economy had been experiencing since September 2000 intensified during the reporting period. Labour flows have virtually ground to a halt as closures and other measures continued to keep large numbers of Palestinians unemployed. According to a World Bank report published in May 2003, 92,000 Palestinians had lost their jobs in Israel and the Israeli settlements while another 105,000 jobs had been lost in the occupied Palestinian territory. Unemployment remained at a very high level, reaching 30 per cent at the end of the third quarter of 2002. Real gross national income shrank by 38 per cent from its 1999 level at the end of 2002. Real per capita income fell by 46 per cent, and total investment declined by approximately 90 per cent during that same period. As a result, approximately 60 per cent of the Palestinian population was living below the poverty line. <\/p><\/div>\n 7. Once again, ±¬ÁÏÍøRWA too was a direct casualty of the continuing hostilities in the occupied Palestinian territory. Six ±¬ÁÏÍøRWA staff members were killed during the period: Maher Saqallah, Iain Hook, Ahlam Riziq Kandil, Usama Hassan Tahrawi, Majed Hussein Al-Sleibi, and Ibrahim Al-Othmani. A particularly tragic event was the death by Israeli sniper fire of Mr. Iain Hook, ±¬ÁÏÍøRWA’s project manager in Jenin, who was killed inside a clearly-marked ±¬ÁÏÍøRWA compound, while arranging for the evacuation of his staff as a result of an Israeli military operation. During the reporting period, 64 staff members were detained by the Israeli authorities, and the Agency was systematically refused access to members of its staff in detention, only one of whom was charged with any offence.<\/p><\/div>\n 8. The Agency is indebted to its staff and acknowledges their dedication and loyalty in such difficult and often dangerous circumstances. It notes with regret that ±¬ÁÏÍøRWA’s 12,000 local staff in the occupied Palestinian territory are ironically the only United Nations staff members working in the area who do not receive hazard pay, whereas they are arguably the most exposed to immediate danger. Efforts at solving this anomaly with United Nations Headquarters were ongoing, but have unfortunately not yet succeeded. <\/p><\/div>\n 9. The environment in which the Agency had to carry out its operations in the occupied Palestinian territory continued to affect negatively its ability to deliver services. The World Bank estimated that the physical damage from the conflict had reached a figure of about $728 million by 30 August 2002. Among the buildings damaged and equipment destroyed were ±¬ÁÏÍøRWA installations, such as schools, training centres, and health-care facilities. Closures and checkpoint delays prevented schools from operating normally as large numbers of teachers and students could not reach their schools or return to their homes. Office workers, doctors and nurses could not reach their health centres and clinics, trucks carrying humanitarian supplies could not reach their destinations in time, ambulances were delayed or prevented from moving patients needing urgent treatment, and ±¬ÁÏÍøRWA school buildings were taken over by Israeli forces and used as bases and detention centres, Agency vehicles were fired on, and staff members were killed, injured, beaten or humiliated by Israeli soldiers. In all such incidents, the Agency protested to or informed the Israeli Ministry of Foreign Affairs and the Israel Defense Forces. They were reminded of their obligations under the 1946 Convention on the Privileges and Immunities of the United Nations and the 1967 bilateral Comay-Michelmore Agreement between the Agency and the Government of Israel as well as international norms on the issue of humanitarian access (see chap. IV). There were also a few instances where Palestinian militants entered ±¬ÁÏÍøRWA premises. The Agency took immediate steps to effect their removal from the installations and protested to the Palestinian Authority, which responded promptly and effectively. <\/p><\/div>\n 10. In the West Bank, military operations carried out by Israeli forces, which included the imposition of curfews and closures and the creation of closed military zones, had an adverse impact on the Agency’s ability to carry out its humanitarian functions in support of the Palestine refugees. Movement of humanitarian goods, particularly in places where supplies of food, medicines and other items were urgently needed, was often blocked, delayed or made very difficult. In a number of instances, ±¬ÁÏÍøRWA vehicles and staff had to face life-threatening situations as they came under fire from Israeli forces. <\/p><\/div>\n 11. In the Gaza Strip, the external closures imposed on the area and the internal closures that effectively bisected or trisected the Strip for significant periods of time led to severe disruption in the delivery of ±¬ÁÏÍøRWA humanitarian supplies to distribution centres and other installations. At the same time, the Agency’s staff working at the headquarters and the field office in Gaza City could not reach their work places from cities and refugee camps in the centre and the south of the Strip. Following a suicide bombing in Tel Aviv in May 2003, the Israeli authorities imposed severe restrictions on the movement of ±¬ÁÏÍøRWA’s international staff into and out of the Gaza Strip, stranding senior officials on either side of the Erez crossing. These unprecedented restrictions considerably impaired the ability of ±¬ÁÏÍøRWA to function effectively. Intensive efforts on all sides did not yield significant results in addressing these new obstructions during the reporting period. Access to and from the Agency’s headquarters continued to be highly unpredictable. <\/p><\/div>\n 12. During the visit of the Personal Humanitarian Envoy of the Secretary-General, Ms. Catherine Bertini, extensive discussions were held with the Israeli authorities to establish and put into practice measures to facilitate the work of international humanitarian organizations. Numerous efforts have been made to strengthen liaison functions between ±¬ÁÏÍøRWA and other United Nations agencies on the one hand, and the Israeli authorities on the other, with a view to securing improved humanitarian access. While the commitments entered into between Ms. Bertini and the Israeli authorities were but a modest gesture and fell far short of international obligations incumbent upon Israel, implementation of these commitments was sporadic and largely symbolic. The constraints imposed upon the Agency hampered its ability to implement its humanitarian and human development mandate to a considerable degree during the reporting period.<\/p><\/div>\n 13. ±¬ÁÏÍøRWA sought to alleviate the suffering of the Palestine refugee community in the occupied Palestinian territory during the reporting period. As described in previous reports of the Commissioner-General to the General Assembly, ±¬ÁÏÍøRWA has put into place an extensive emergency assistance programme for refugees affected by the strife. ±¬ÁÏÍøRWA’s largest activity has been the provision of food aid to over 1.3 million refugees. Its emergency employment programme has generated 1,724,329 workdays in 2002. ±¬ÁÏÍøRWA also provided remedial education to its pupils and psychological counselling to children and adults during the reporting period.<\/p><\/div>\n 14. The Agency also provided temporary accommodation and emergency assistance to the refugees when their shelters were destroyed. It launched several re-housing projects to afford the refugees new dwellings which conform to standards of minimum human decency. In the West Bank, after a year of heavy destruction, as a result of the intensive Israeli military operations inter alia in March and April of 2002, ±¬ÁÏÍøRWA expanded its shelter rehabilitation and re-housing programmes. Reconstruction of the destroyed area of Jenin camp, large-scale shelter repair and rehabilitation of water and sewerage networks was undertaken during the reporting period. Meanwhile the rhythm of shelter destruction in the Gaza Strip increased significantly, necessitating the expansion of major reconstruction and re-housing programmes there. The Agency managed to provide 201 new housing units and repaired 5,887 refugee shelters, but it was not able to keep up with the pace of shelter destruction. <\/p><\/div>\n 15. To facilitate the Agency’s activities under its emergency programme, the Operational Support Officers programme was expanded in the West Bank and re-introduced in the Gaza Strip. The programme played a crucial role in facilitating the delivery of humanitarian goods, safe passage of Agency staff through checkpoints and more generally enhancing the proper implementation of Agency programmes in accordance with United Nations norms. <\/p><\/div>\n 16. Appeals for assistance from the international community to fund the Agency’s emergency programme in the occupied Palestinian territory were first launched in October and November 2000. During the reporting period, appeals were launched for 2002 ($172.8 million) and for the first half of 2003 ($93.7 million). <\/p><\/div>\n 17. The international community’s response to these appeals in 2000 and 2001 was prompt and generous. The response to the appeals for 2002 were slower and at the end of that year, only $96.8 million had been pledged. There was a further erosion of donor support to the emergency in 2003, as only 40 per cent of the appeal for the first half of the year ($37.3 million) was pledged. It was clear that other crises had to some extent diverted the attention of traditional donors from the Palestinian issue. It must be stressed that continued support for ±¬ÁÏÍøRWA’s Emergency Appeal is crucial to the survival of the Palestine refugees in the occupied Palestinian territory. The Agency’s emergency assistance programme has been instrumental in relieving economic hardship and alleviating the effects of the cycle of violence on the refugees.<\/p><\/div>\n 18. The end of the reporting period saw the emergence of a glimmer of hope. The adoption of the road map proposed by the “Quartet” (the United Nations, the European Union, the United States and the Russian Federation), and the first efforts regarding its implementation, did not yield concrete results in the reporting period itself, but it was fervently hoped that this would be the case in the near future. It must indeed be noted that even if the road map would be implemented in the coming months, the damage done would still require years of rehabilitation and reconstruction efforts to restore economic and social stability and gradual improvement in the lives of the refugees to the status quo ante. Meanwhile emergency assistance will continue to be indispensable for a large proportion of the Palestine refugee population in the occupied Palestinian territory. During the current reporting period, the Government of Israel proceeded with the construction of a “separation wall” inside the West Bank. The Agency fears that the wall, when completed, will impoverish and isolate thousands of refugee families and will constitute a new and formidable obstacle to the delivery of essential ±¬ÁÏÍøRWA services to refugees living in the vicinity of the wall, along the entire length of its route.<\/p><\/div>\n 19. During the reporting period, ±¬ÁÏÍøRWA continued to implement its regular programme, providing education, health, social services and microcredit assistance to Palestine refugees in its five fields of operation. It also vigorously pursued its processes of internal management reform, with a view to enhancing the Agency’s overall efficiency and effectiveness.<\/p><\/div>\n 20. ±¬ÁÏÍøRWA’s education programme is its largest activity: it currently runs 651 schools providing basic and preparatory education to approximately 490,000 pupils (of which 50.1 per cent are female), as well as five secondary schools in Lebanon, eight vocational training centres and three teacher training colleges. It has benefited since its inception from its close cooperation with ±¬ÁÏÍøESCO, which funds crucial senior managerial and technical posts within the Agency and provides it with ongoing technical assistance and general guidance. The Agency’s schools follow the national curricula of the host countries in each of its five fields of operations. As a result, the Agency is required to implement all improvements and enhancements to the curriculum introduced by the host country authorities. Because of its precarious financial situation, ±¬ÁÏÍøRWA has been struggling to keep pace with such developments, which include the introduction of a tenth year in basic education in the occupied Palestinian territory, English language in elementary schools in Jordan and computer science in Jordanian and Syrian preparatory schools. The Agency’s university scholarship programme was being discontinued due to financial constraints, a decision which in time will inevitably affect the Agency’s capacity to attract trained medical staff for its health centres. Financial constraints have also hampered the modernization of the curriculum and infrastructure of the Agency’s vocational training centres, endangering the effectiveness of these centres of excellence. Despite the financial challenges, ±¬ÁÏÍøRWA’s Education Department continues to implement reform and improvement of internal processes within the framework of its five-year development plan, as well as specific projects such as the Computer Information Technology Initiative. Enrichment material advocating tolerance and peaceful conflict resolution has been successfully introduced Agency-wide. In the reporting period, ±¬ÁÏÍøRWA continued its introduction of limited secondary schooling in Lebanon, as a result of continued restrictions in access for Palestine refugees to the Lebanese public education system. In the West Bank and Gaza Strip, operations were severely hampered by the ongoing crisis. Israeli military action tragically left 40 pupils dead and 85 injured in the reporting period. The loss of schooldays rose to approximately 52,000, and the reporting period showed declining examination pass rates in the Agency’s schools as a result of the strife. ±¬ÁÏÍøRWA’s emergency programme hence included remedial and compensatory education for approximately 40,000 pupils. <\/p><\/div>\n 21. Technical supervision of ±¬ÁÏÍøRWA’s health programme is provided by WHO, which also supplies the services of senior management staff and short-term consultants, technical literature and publications. The Agency’s current focus is on sustaining adequate levels of investment in primary health care (with special emphasis on maternal and child health and disease prevention and control), enhancing the process of institutional capacity-building and developing its human resources. Management reforms implemented during the reporting period led to the introduction of new systems relating to health information, hospital management and drug supply management. The situation in the occupied Palestinian territory has caused a significant deterioration of the refugees’ health: various studies document the increasing prevalence of acute and chronic malnutrition as well as iron deficiency anaemia and low birth weight. ±¬ÁÏÍøRWA’s health centres continue to face abnormally high workloads, with an average of nearly 100 medical consultations per doctor per day. Studies also warn of breakdowns in preventive services to women and children, resulting in a drop in infants completing immunization on schedule. Additional expenditure was incurred by the Agency following the breakdown of cost-sharing arrangements in the West Bank regarding secondary care, caused by the generalized impoverishment of the refugee population. In Lebanon, ±¬ÁÏÍøRWA strengthened its cooperation with the Palestinian Red Crescent Society facilities in the country, providing cost-effective secondary health care to refugees unable to afford the high cost of private hospitalization. The Agency also continued its environmental health services in refugee camps throughout its areas of operations, introducing and\/or improving sewerage disposal, storm water drainage, provision of safe drinking water and refuse collection. During the reporting period, major projects were under way in the Syrian Arab Republic and Lebanon, relating to construction of water and sewerage systems in various refugee camps. <\/p><\/div>\n 22. ±¬ÁÏÍøRWA’s relief and social services programme addresses the needs of the most vulnerable among the refugee population, and applies a community development (self-help) approach in fostering community-based organizations with a special focus on women, children and youth, as well as physically\/mentally challenged refugees. The Agency’s special hardship programme is in increasing demand due to the difficult socio-economic situation in Jordan, continuing restrictions on employment of Palestine refugees in Lebanon, and the crisis in the occupied Palestinian territory. The current trends in the programme clearly point to a feminization of poverty among the refugees, as the incidence of female-headed vulnerable households increases. Shelter rehabilitation has continued insofar as extrabudgetary funding was forthcoming, as the current state of the General Fund does not allow such activities to be funded from the Agency’s regular budget. During the reporting period, provision of land by the host authority enabled the Agency to launch re-housing projects in Gaza, following large scale destruction of refugee shelters. <\/p><\/div>\n 23. Significant progress was made during the reporting period in the implementation of the Palestine Refugee Records Project, made possible through extrabudgetary funding. This project will ensure a major improvement in the quality of refugee registration data, as well as the safe preservation through electronic means of the Agency’s archive of 16 million family file documents. <\/p><\/div>\n 24. In addition to its traditional services, the Agency continued to promote income generation activities on two levels. One was in the overall context of its relief and social services programme, and the other was as a commercial, self-sustaining and market-oriented microfinance and microenterprise programme. In the reporting period, the latter programme expanded its operations into Jordan and the Syrian Arab Republic. In the reporting period, it provided 8,910 loans worth $6.01 million in the region. Women entrepreneurs received 43 per cent of the loans. This award-winning programme of the Agency came under great strain owing to the severe decline in economic conditions in the occupied Palestinian territory since October 2000. The continuation of that economic decline resulted in the programme’s inability to maintain its normal state of financial self-sufficiency for a second year. By June 2003, the lending outreach in Gaza increased to 1,141 loans (923 in the previous period) valued at $806,175 (vs. $655,276) but still showed a sharp decline when compared with 1,304 loans amounting to $1.46 million in September 2000.<\/p><\/div>\n 25. While the Agency’s financial constraints have tended to necessitate attention to short-term priorities, the Agency has nevertheless persisted with its long-term internal reform process. Since its inception, ±¬ÁÏÍøRWA has continuously adapted to the rapidly changing political environment in the region while catering to the needs of Palestine refugees. The reform process focuses on improvement in the efficiency and effectiveness of the management of the Agency’s resources, the cultivation of an open management culture, the strengthening of strategic planning capabilities, expansion and improvement in the Agency’s relations with donor countries, host countries and the agencies and programmes of the United Nations system, and increased responsiveness, effectiveness and efficiency of the Agency’s operations in providing services for the refugees against the background of changing socio-political conditions. The Agency also continues to seek ways to enhance and improve its relationship with all its stakeholders. The introduction of more informal thematic sessions at ±¬ÁÏÍøRWA’s informal meetings of major donors and host countries is an example of such enhanced interaction. The need to be in ever closer touch with donor and host Governments throughout the areas of the Agency’s operations led to the redeployment of some of the Agency’s external relations staff. The Department of External Relations is also increasing its efforts to broaden the Agency’s donor base by approaching non-traditional donors as well as stimulating individual and private sector contributions. <\/p><\/div>\n 26. Administration and human resources reforms within the Agency included progress in shortening the comprehensive procedures for recruitment, and in the current critical situation in the area, greater use of short-term contracts to speed recruitment and save administrative and personnel costs. In the reporting period, the Agency faced increased challenges in many of its recruitment processes as a result of Israeli restrictions to staff freedom of movement, inordinately long delays in the granting of visas for international staff and restrictions on visits to ±¬ÁÏÍøRWA headquarters by prospective staff members for interviews. The Streamlining of Area Staff allowances was undertaken and was expected to reduce the processing time and costs. Despite the continuing underfunding of its regular budget, the Agency attempted to narrow the compensation gap created by the implementation of the 1999 Area Staff Rules, which were introduced as an inevitable austerity measure and have eroded the Agency’s competitive position as regards recruitment and retention of qualified staff. <\/p><\/div>\n 27. ±¬ÁÏÍøRWA’s Finance Department focused its reform efforts on improvements in the efficiency and effectiveness of its resource management. An important project was the completion of a new finance, payroll and human resources system. This has been made possible by donor-funded extrabudgetary assistance. The new financial system is expected to improve financial control and help attain a higher level of accountability and transparency in all field operations. The new payroll system replaced manual payroll processing (reducing paperwork, time spent and personnel costs), increased online accessibility of information through an electronic database, and removed payroll anomalies by simplifying the system. The new system will also integrate human resource-focused reforms, such as training and career development planning with an employee database. The Agency plans to move on to the introduction of a new procurement system which will complete the last phase in this reform process. Staff training programmes for the new systems are also being strengthened. <\/p><\/div>\n 28. Budgetary reform within ±¬ÁÏÍøRWA was initiated when the 2000-2001 budget was presented to the General Assembly. The new format is programme-based and results-oriented and specifies the objectives, targets and accomplishments of each substantive Agency programme. ±¬ÁÏÍøRWA has sought to continue improving the formulation of its budget for the 2004-2005 biennium, increasingly applying a results-based budgeting approach to link closely the programme’s objectives and expected outcomes with the programmed activities and their ensuing budgetary allocations. The introduction of key performance indicators is now enabling all departments to monitor their programmes more closely and to undertake periodic substantial reviews of budget goals and their reflection in programme activities. <\/p><\/div>\n 29. The Agency has enhanced its internal audit and inspection capacity by upgrading the former audit office to full department level. After being upgraded to a full department, the function of investigation was added to its responsibilities. The Department has recruited additional staff and is currently implementing a new policy on treatment of allegations and complaints. It is also actively engaged in increasing the awareness of and responsiveness to audit recommendations by programme and field directors. The audit and inspection committee has been revitalized and is now chaired by the Deputy Commissioner-General.<\/p><\/div>\n 30. The Agency has sought to improve planning and analysis capacity at headquarters by strengthening its Policy Analysis Unit. The focus is on responsive analyses of the developing situation as it affects the refugees and the operations of the Agency, particularly in the current difficult circumstances. This involves data collection and generation, long-term strategic planning, analytical reporting and periodic assessments of the situation. These analyses have been of great assistance in policy formulation. The Unit is currently deepening its analytical grasp of the issues involved in the complex environment in which the Agency operates, to assist management in responding quickly and effectively to changing needs and demands as the situation evolves.<\/p><\/div>\n 31. The Agency continued to strengthen its communications and information capacity thanks to an extrabudgetary contribution. A new communications strategy was being introduced progressively, aimed at improving outreach to Agency stakeholders, who include the refugees, the host countries and the international community, particularly the major donor countries. A significant increase in the media coverage of Agency activities has been realized, with the adoption of a more proactive approach to the news media, and audio-visual capacity was strengthened with the recruitment of a staff member with a background in film production. Efforts to improve coordination among the information units located in the headquarters in Gaza and the units in the five fields were set forth, with improvements in exchange and sharing of information and in speed of response to media comment in the region. The ±¬ÁÏÍøRWA web site was redesigned and continued to improve both in its English and Arabic versions. In the same context, coordination with the Department of Public Information of the United Nations in New York was strengthened. The Agency also provided opportunities for its information staff to receive specialized media training in workshops organized by a private sector organization. <\/p><\/div>\n 32. The Agency is heavily reliant on voluntary contributions to fund its regular programme operations. During the reporting period, there was renewed strain on the Agency’s regular cash budget. As compared with 2001, the Agency’s donor contribution income saw a drop from $282.39 million to $275.79 million in 2002. The General Assembly at its fifty-sixth session reviewed and approved the Agency’s budget submission for the 2002-2003 biennium at the level of $674.82 million. Donor pledges for the budget for 2003 amounted to $293.55 million by the end of the reporting period, leaving a funding gap of $24 million which it is hoped will be covered in the remaining months of the year. Otherwise, the Agency will once again find itself in a very difficult financial situation at a time when its services are ever more vital. <\/p><\/div>\n 33. Even if contributions were to match the Agency’s approved budget, they would still only cover levels of expenditure that are minimal in relation to refugee needs. For example, in education, the Agency’s largest programme, 77.1 per cent of schools operate on a double-shift basis owing to a shortage of school buildings. In the Jordan field, where the largest number of refugees reside, 92 per cent of schools operate in double shifts. In local government schools, the situation is the reverse, with approximately 90 per cent being in single-shift operation. Classroom occupancy rates continue to average 44.3 pupils per class, and in some fields this figure rises to 47.1 per class. For the immediate future, the Agency is compelled to plan on the basis of double shifts in its schools, which has adverse effects on the quality of education by reducing teaching time, eliminating extracurricular activities and, at the same time, raising maintenance costs. Teacher salaries are at levels where the Agency is experiencing difficulties in recruiting and retaining qualified staff. Similarly in the field of health, increasing pressures were felt as health staff had to cope with inordinately high numbers of patients. An increasing refugee population has also meant higher numbers of special hardship cases requiring relief. The Agency’s relief and social services staff has had to deal with 233,044 special hardship cases in the reporting period, compared with 229,404 in the preceding year. These pressures have increased substantially as a result of the conditions of strife in the West Bank and the Gaza Strip.<\/p><\/div>\n 34. Chronic underfunding of the Agency’s regular programmes has had an adverse impact on the Agency’s human resources and infrastructure, thus affecting the programme services it provides for the refugees. The financial situation requires concerted steps by donor countries to increase their contributions to ±¬ÁÏÍøRWA to keep pace with the increase in the refugee population, to eliminate the structural deficits in the Agency’s budget and to re-establish a sound basis for its future financial viability. Those steps would also bring an end to the end-of-financial-year crises that the Agency has had to cope with in recent years. The preservation and further strengthening of the Agency’s recognized capacity to deliver human development and to deal with humanitarian emergencies is essential if the refugees are to be provided with adequate services. This capacity will ultimately be undermined in the absence of the required financial resources over the longer term. <\/p><\/div>\n 35. The Agency’s operations have been sustained over the past five decades with the generous assistance not only of its major donor countries, but of its host countries as well. Over the reporting period, the Agency has continued to receive the strong support of the Governments of Jordan, Lebanon, the Syrian Arab Republic as well as the Palestinian Authority in conducting its operations. Chapters V to IX of the present report provide detailed information on how the Agency has been carrying out its mandate in its five fields of operation.<\/p><\/div>\n 36. In the occupied Palestinian territory, the living conditions of the refugees have been severely affected by the violence and the Israeli closures, destruction of institutional property and other measures against the Palestinian Authority and the population. The impact of these measures and the Agency’s response have been described in the earlier paragraphs and in chapter IV. During the reporting period, significant progress was made in solving the outstanding issue related to reimbursement of VAT paid by the Agency to the Palestinian Authority. The Agency’s regular budget allocation for the occupied Palestinian territory was $154 million in 2003 compared with $149.1 million in 2002.<\/p><\/div>\n 37. The largest number of Palestine refugees reside in Jordan. The majority of them enjoy full Jordanian citizenship and are able to work in government offices and throughout the local economy, and have access to governmental institutions and developmental and other assistance. The Government of Jordan has reported expenditures amounting to $423,121,161 on behalf of Palestine refugees and displaced persons during the reporting period. This covers services such as education, rent and utilities, subsidies and rations, camp services, health care, public security and social services. The Agency’s regular budget allocation for the Jordan field was $72.7 million in 2003 compared with $71.1 million in 2002.<\/p><\/div>\n 38. Palestine refugees in Lebanon are among the most disadvantaged. They have only limited access to government services and have to depend almost entirely on the Agency for basic education, health and relief and social services. Lebanese authorities continued to restrict construction in certain refugee camps, and entry of construction materials continued to be subject to military approval, which was not always granted. Palestine refugees in Lebanon suffer from poor living and housing conditions and high rates of unemployment. New legislation aims at preventing refugees from buying immovable property and depriving them of their inheritance rights. There are similar attempts to retroactively annul the Lebanese nationality obtained by certain refugees in 1994. The ±¬ÁÏÍøRWA regular budget allocation for Lebanon field was $50.1 million in 2003 compared with $48.2 million in 2002. <\/p><\/div>\n 39. Palestine refugees in the Syrian Arab Republic continued to have full access to government services. The Government of the Syrian Arab Republic reported expenditures of $93,722,541 on behalf of the refugees during the reporting period. These covered education, health, housing, utilities, security, supply costs and social services. In addition, the Palestine refugee population and the Syrian Arab Popular Committees have also provided significant amounts of financial support to ±¬ÁÏÍøRWA’s emergency activities in the occupied Palestinian territory. The Agency’s budget allocation for the Syria field was $26.8 million in 2003 compared with $26.2 million in 2002.<\/p><\/div>\n 40. ±¬ÁÏÍøRWA maintained close cooperation with a number of United Nations agencies, including the United Nations Development Programme (±¬ÁÏÍøDP), the United Nations Educational, Scientific and Cultural Organization (±¬ÁÏÍøESCO), the Office of the United Nations High Commissioner for Refugees (±¬ÁÏÍøHCR), the United Nations Population Fund (±¬ÁÏÍøFPA), the United Nations Children’s Fund (±¬ÁÏÍøICEF), the Office for the Coordination of Humanitarian Affairs (OCHA), the United Nations Special Coordinator in the Occupied Territories (±¬ÁÏÍøSCO), the World Health Organization (WHO), the World Food Programme (WFP), and the Joint United Nations Programme on HIV\/AIDS (±¬ÁÏÍøAIDS). The Agency also cooperated with local and international non-governmental organizations in its five fields of operation. In particular, it enjoys an excellent working relationship with the International Committee of the Red Cross (ICRC) and the Palestinian Red Crescent Society (PRCS). In order to fulfil the responsibilities of the Commissioner-General as the United Nations Designated Official for the overall security and protection of United Nations staff and family members in Israel, the West Bank and the Gaza Strip, ±¬ÁÏÍøRWA maintained contacts with the United Nations Truce Supervision Organization (±¬ÁÏÍøTSO). ±¬ÁÏÍøRWA also continued to participate in the multilateral aid coordination structures for the occupied Palestinian territory, facilitated by the Office of the United Nations Special Coordinator for the Middle East Peace Process and Personal Representative of the Secretary-General to the Palestine Liberation Organization and the Palestinian Authority (±¬ÁÏÍøSCO). In the reporting period, ±¬ÁÏÍøRWA actively contributed to the strengthening and improving of mechanisms coordinating the United Nations system’s response to the humanitarian emergency in the occupied Palestinian territory, chairing the Operational Coordination Group (OCG) to which the Office for the Coordination of Humanitarian Affairs (OCHA) of the United Nations Secretariat provides solid secretariat support. The Agency also participated in the drafting of the 2003 Humanitarian Action Plan (HAP) for the occupied Palestinian territory compiled by OCHA and is a member of the numerous aid coordination forums in place.<\/p><\/div>\n 41. ±¬ÁÏÍøRWA entered the fifty-third year of its operations in 2003. By its resolution 56\/52 of 10 December 2001, the General Assembly renewed the Agency’s mandate until June 2005. The Agency has, over the decades, become the symbol of the international community’s commitment to the well-being of the Palestine refugees until a just and durable settlement of the refugee problem is achieved. Maintaining the quality and extent of the Agency’s services is essential to the international community’s interest in terms of its humanitarian commitment, its engagement in favour of human development and its desire to promote regional stability.<\/p><\/div>\n \n Chapter II<\/strong><\/p><\/div>\n General developments in Agency programmes<\/strong><\/p><\/div>\n A. Education<\/strong> <\/p><\/div>\n 42. Objectives<\/i>. The Agency’s education programme seeks to impart Palestine refugees with the requisite knowledge base and skill-set that will develop their human potential and enable them to become self-reliant, productive members of their communities. The programme is consistent with the identity and cultural heritage of the refugees. It seeks to inculcate a spirit of interdependence and tolerance among refugee pupils towards differences among individuals and groups. It also aims to foster awareness and promotion of fundamental human rights. These objectives are geared to preparing refugee pupils for the multifaceted challenges and uncertainties of a rapidly changing world and to competing successfully at higher levels of education and in the job market. The Agency’s Department of Education aims to fulfil this mission through its four main programmes: general education; teacher education; vocational and technical education; and education planning and management.<\/p><\/div>\n 43. Elementary and preparatory schooling<\/i>. The basic education programme of ±¬ÁÏÍøRWA consists of a six-year elementary cycle and a three-year or four-year preparatory cycle, depending on the educational system of the host authorities, which ±¬ÁÏÍøRWA follows. There were a total of 488,657 pupils enrolled in the 2002\/2003 academic year in 651 ±¬ÁÏÍøRWA schools in the five fields of operation. Total enrolment increased by 1.04 per cent, or 5,006 pupils, over the 2001\/2002 academic year, though it was not evenly distributed. While the enrolment in the West Bank and the Gaza fields grew by 2.53 per cent and 2.36 per cent respectively, the Lebanon, Syrian Arab Republic and Jordan fields registered negative growth of 0.39, 0.23 and 0.41 per cent respectively. These trends are explained by, inter alia, natural growth in the refugee population, transfer of refugee pupils from Agency schools to government schools and transfer of refugee pupils from tuition-based private schools to Agency schools. The Jordan and Gaza fields each accounted for approximately one third of total Agency pupil enrolment. The ±¬ÁÏÍøRWA school system continued to maintain full gender parity, with 50.1 per cent of pupils being female. Under existing exchange agreements between ±¬ÁÏÍøRWA and the host authorities to provide schooling for pupils in remote areas, 216,676 refugee pupils were reported to have enrolled at government and private schools at the elementary and preparatory levels. Some 39,084 non-refugee pupils attended ±¬ÁÏÍøRWA schools at the elementary and preparatory levels.<\/p><\/div>\n 44. Secondary schooling<\/i>. ±¬ÁÏÍøRWA offered secondary-level education on a limited scale in the Lebanon field in order to address the issues of low access of Palestine refugees to government schools and the prohibitively high cost of private schools. There were a total of 2,292 pupils enrolled in five secondary schools in Burj El-Barajneh, Ein El-Hilweh, Rashidieh, Baddawi and Wavel camps during the 2002\/2003 academic year. According to Agency estimates, approximately 70,413 refugee students in all fields were studying at government and private secondary schools.<\/p><\/div>\n 45. Education infrastructure<\/i>. Increasing enrolment, the consequent need to accommodate new pupils and the drive towards improving the learning environment has necessitated the continued maintenance and upgrading of education infrastructure of ±¬ÁÏÍøRWA. Enrolment growth exceeds the infrastructure capacity of Agency schools. Between the 1993\/1994 and 2002\/2003 academic years, the number of school buildings increased by 0.97 per cent and the number of schools increased by 2.5 per cent, whereas the total enrolment increased by 23.1 per cent. Overcrowding within the Agency’s education system continued, with the average classroom occupancy rate at 42.2 pupils in the 2002\/2003 academic year. Occupancy was highest in the Gaza Strip at 47.1 pupils per classroom and lowest in Lebanon at 36.4. Many ±¬ÁÏÍøRWA schools, particularly those constructed in the 1960s, have become dilapidated, a problem exacerbated by the lack of sufficient funds for maintenance. The Agency continued to seek project funding for the improvement and expansion of its education infrastructure. The number of ±¬ÁÏÍøRWA schools increased from 644 in the 2001\/2002 academic year to 656 in the 2002\/2003 academic year. Newly constructed schools were larger and had adequate classroom sizes, science laboratories, libraries, computer laboratories and playgrounds. The newly constructed schools helped to reduce running costs and to provide a better educational environment. During the reporting period, the Agency completed the construction of eight school buildings, 89 additional classrooms (to avoid triple shifting and to replace unsafe\/dilapidated classrooms), 18 rooms equipped for specialized activities, nine water tanks and three canteens. A total of 11 school buildings, 96 classrooms and 21 specialized rooms are under construction. <\/p><\/div>\n 46. Double shifting<\/i>. As enrolment exceeded the capacity of the existing school infrastructure and construction could not keep pace owing to the Agency’s financial constraints, ±¬ÁÏÍøRWA had to resort to operating schools on a double-shift basis, i.e., housing two separately administered schools in a single building. ±¬ÁÏÍøRWA aims to reduce the number of schools operating on a double-shift basis. However, despite the expanded programme of school construction since 1993 under the Peace Implementation Programme, there has been a slightly significant improvement in the rate of double shifting between the 1992\/1993 academic year (75 per cent) and the 2002\/2003 academic year (77.1 per cent). The education department has had to maintain its policy of considering double shifting as a major planning assumption for budgetary purposes to avoid triple shifting. The latter would further reduce teaching time, exclude extra-curricular activities and increase maintenance costs. <\/p><\/div>\n 47. Rented schools<\/i>. In the past, the Agency rented premises for some of its schools, mostly outside refugee camps. Such rented buildings generally lacked adequate classroom space, proper lighting and ventilation and space for extra-curricular facilities. The situation resulted in cramped conditions for pupils and staff and also increased costs by limiting the number of pupils that could be accommodated in each classroom. In the 2002\/2003 academic year, the classroom occupancy at rented schools averaged 29.91 students per class as compared to 44.3 students per class at Agency-built schools due to smaller sizes of available classrooms. ±¬ÁÏÍøRWA had aimed to replace all rented school premises with Agency-built schools, subject to the availability of project funding and appropriate plots of land. Through project funding, the Agency managed to reduce the number of rented premises by 18.1 per cent from 94 in the 1993\/1994 academic year to 77 in 2002\/2003. The 77 rented premises housed 113 schools, with the Lebanon and Jordan fields having the largest numbers of such schools. <\/p><\/div>\n 48. Education reform by host authorities<\/i>. The Agency’s education programme continued to adhere to the education curricula of the host authorities, necessitating the introduction of changes in ±¬ÁÏÍøRWA school curricula when such changes were made in host authority curricula. The extension of the basic education cycle in the occupied Palestinian territory from 9 to 10 years was the most significant change. The Agency was unable to introduce the 10th grade owing to financial constraints. The Palestinian Authority, therefore, accommodated the 10th grade students in its schools. A new Palestinian curriculum was introduced for the 1st and 6th grades in 2000\/2001, for the 2nd and 7th grades in 2001\/2002, and for the 3rd and 8th grades in 2002\/2003 to replace the Jordanian curriculum in the West Bank and the Egyptian curriculum in the Gaza Strip. In the Syrian Arab Republic, a new study plan, new curricula and textbooks for the elementary and preparatory cycles were gradually introduced. The new format for the 6th elementary grade was fully implemented in ±¬ÁÏÍøRWA schools in 2002\/2003 while the new format for the 7th grade was implemented in selected ±¬ÁÏÍøRWA and government schools. ±¬ÁÏÍøRWA also introduced Computer Science for 8th grade in its schools, following the introduction of the subject in government schools. In Jordan, computer science was introduced during the reporting period in the preparatory cycle in the 7th grade in government schools. ±¬ÁÏÍøRWA introduced computer science for the 7th and 8th grades.<\/p><\/div>\n 49. Remedial and special education<\/i>. The Agency’s remedial and special education services are geared towards maintaining achievement levels and enabling slow-learning students and pupils with learning difficulties to benefit fully from the Agency’s basic education services. Such measures for pupils included remedial classes, voluntary extra class periods, audio-visual programmes, curriculum enrichment materials and self-learning kits. In the 2002\/2003 academic year, those activities benefited 850 slow learners, 1,138 pupils classified as remedial cases, 11 blind children, 81 deaf children and 115 handicapped. In the absence of sustained project funding for special education, the Agency explored ways to provide assistance for all children with learning difficulties at no additional cost by utilizing the Agency’s available resources and expertise.<\/p><\/div>\n 50. <\/span>School councils<\/i><\/span>. School councils were present in all Agency schools, with each council consisting of 10 members: the head teacher (chairperson), three teachers, three members selected from the local community and three students. The councils helped maintain cooperation between the school and the local community.<\/span> <\/span><\/p><\/div>\n 51. Vocational and technical training<\/i>. The total number of training places in the eight ±¬ÁÏÍøRWA vocational and technical training centres in the five fields of operation was 5,101 in the 2002\/2003 academic year, an increase of 210 compared with the previous year. At the post-preparatory level, 22 two-year vocational training courses were offered and, at the post-secondary level, 32 two-year technical\/semi-professional courses were offered to trainees in a variety of technical, paramedical and commercial subjects. Women accounted for 64.17 per cent of all trainees enrolled in technical\/semi-professional courses in 2002\/2003. Courses varied from centre to centre, according to the needs of local labour markets and the availability of training opportunities at other institutions. Owing to financial constraints, the Agency was unable to introduce new courses or expand the capacity of the existing ones except by discontinuing old courses. In addition to the two-year training courses, Agency training centres in Jordan, the West Bank, the Syrian Arab Republic, Lebanon and the Gaza Strip offered short-term training courses of up to 33 weeks’ duration, organized on an ad hoc basis in cooperation with governmental and non-governmental organizations or the Palestinian Authority. During the 2002\/2003 academic year, 654 trainees were enrolled in 15 such courses offering training in a wide variety of disciplines. Furthermore, one Cisco regional academy was established at Kalandia training centre. This raised the number of local academies at training centres to six.<\/p><\/div>\n 52. Training courses<\/i>. In the year 2002\/2003, ±¬ÁÏÍøRWA training centres offered 22 trade courses in the fields of mechanical, electrical, building and vocational courses for girls and 32 technical\/semi-professional courses in the field of technical, paramedical, commercial and home management. During the year under review, ±¬ÁÏÍøRWA introduced new training courses with a higher employability, including electronic control, computer applications, banking, marketing and financial management, telecommunications, and fashion design. Training courses are open for both male and female trainees, with the exception of Ramallah Women Training Centre (RWTC), which is for females only.<\/p><\/div>\n 53. Education science faculties<\/i>. The three branches of the educational science faculties in Jordan and the West Bank continued to provide pre-service training leading to a first-level university degree, as part of a process of upgrading the qualifications of Agency teaching staff to meet the revised standards set by Jordan and the Palestinian Authority. The four-year pre-service programme that grants university-level degrees was offered to 1,035 secondary school graduates, including 684 women. During the reporting period, 230 students graduated from the pre-service programme. Of the 199 pre-service graduates in 2000\/01 from the three education science faculties, 167 were recruited by the Agency in 2001\/02. In addition, 71 trainees graduated in 2001\/2002 from the Siblin Training Centre and all of them were recruited by the Agency in 2002\/2003. <\/p><\/div>\n 54. Institute of education<\/i>. ±¬ÁÏÍøRWA provided in-service training through the ±¬ÁÏÍøRWA\/±¬ÁÏÍøESCO Institute of Education to promote and improve the professional competencies of Agency teachers, head teachers and school supervisors. The training was implemented in cooperation with the five education development centres. In 2002\/2003, the total number of teachers, head teachers and school supervisors enrolled in the in-service training in the five fields was 921, of whom 521 were taking courses lasting from one to two years, while the remaining 400 trainees were new teachers appointed according to the ±¬ÁÏÍøRWA area staff rules or converted from contract teachers. Activities related to in-service training included planning, organizing and preparing training programmes and instructional materials. <\/p><\/div>\n 55. University scholarships<\/i>. Budgetary constraints have forced the Agency to discontinue its contribution from the general budget to the Agency’s scholarship subprogramme since 1997\/1998. However, the Agency continued, with project funding, to support some scholars until they graduated. In 2001\/2002, 140 scholars graduated and one failed; the number of continuing scholars was 56, of whom 27 were women. At the close of the reporting period, scholars were studying in 10 universities in six countries in the Middle East. All scholarship recipients were studying medicine (100 per cent). The scholarship awards ranged in value from $200 to $1,000 per year, depending on university tuition rates.<\/p><\/div>\n 56. Placement and career guidance<\/i>. The Agency offered placement and career guidance services to Palestine refugee graduates of Agency training centres and other educational institutions to facilitate their employment. Such counselling services were offered to pupils in the Agency’s preparatory schools and government secondary schools to familiarize them with the training courses available at the Agency’s training centres. The Agency continued to follow the employment histories of its graduates and their career performance after the initial period of employment. Of the 2,132 graduates from ±¬ÁÏÍøRWA vocational training centres in 2000\/2001, 1,556 or 73 per cent, were employed in 2002. The Agency’s placement and career guidance office facilitated the work of employers’ recruiting teams, helped match candidates with vacancies and made candidates aware of available job opportunities. ±¬ÁÏÍøRWA also carried out periodic surveys of market demand in order to achieve a better match between training courses and job requirements. Based on the survey findings, new training was introduced at the vocational training centres in communication skills, creative job skills, interpersonal skills, computer skills and the ado ption of the English language empowerment project. Accordingly, new courses were introduced, such as banking and financial management in Damascus Training Centre.<\/p><\/div>\n 57. Programme budget and administration<\/i>. The education programme remained the largest single area of activity in the Agency, with 17,047 education staff (including teaching and administrative staff), representing 72 per cent of all Agency staff, while the programme budget of $179 million for 2003 amounted to 52 per cent of the total Agency budget. Actual cash expenditure for 2002 was $175.45 million, representing 60 per cent of total Agency expenditure. In all fields except Gaza, nominal contributions at prescribed rates were collected from pupils and trainees on a voluntary basis to improve facilities and equipment in schools and training centres. Overall contributions collected in 2002\/2003 amounted to $515,808. Other forms of community support for the education programme included donations of equipment, furniture, photocopiers, tape recorders, videos, overhead projectors, personal computers, printers and other equipment and supplies. <\/p><\/div>\n 58. Special projects<\/i>. The Computer Information Technology Initiative (CITI) for vocational training centres launched in 1998 continued and resulted in upgrading of the technical training and management practices at the eight ±¬ÁÏÍøRWA vocational training centres. During the reporting period, Phase IV of the Computer Information Technology Initiative project supported the efforts to meet expanding host country curricular requirements and changing market needs that necessitate computerization across a range of training specializations. Phase IV also included efforts to establish an Information Technology Unit (ITU) in the education department in order to streamline information technology (IT) activities, and to upgrade computer laboratories at each vocational training centre. During Phase IV, the education department also enforced compliance with Intellectual Property Rights, as stipulated under WTO regulations. Training and certification for computer instructors, ICDL training and certification for VTE instructors and senior education staff also were carried out during Phase IV. The Kalandia Training Centre was designated a Cisco Local Academy. In full coordination and cooperation with a major donor and the senior education staff at both headquarters and the five fields, a five-year development plan (2000-2004) was prepared. The suggested plan for the year 2002\/2003 was completed covering the areas of educational planning, staff and management development, vocational and technical education, education management information system, personnel and finance. Within the framework of the plan, a project was proposed to further develop management at all levels within ±¬ÁÏÍøRWA’s education programme and to enable schools to become focal points for development. Extensive training of the concerned education staff at both the managerial and school levels was initiated to improve the management and delivery of appropriate education systems, pro cesses and planning by staff in ±¬ÁÏÍøRWA at the school, region, field and HQ levels. Over the past year, the ±¬ÁÏÍøRWA education department worked on a pilot project, the Development of English Language Ability (English for empowerment) project, for instructors and trainees at ±¬ÁÏÍøRWA Vocational Training Centres in the Jordan field to deliver competitive training in English language communication skills necessary to function in an English-speaking workplace. To that end, local and regional market surveys were carried out, English language instructors were trained on syllabus design and writing of special English for vocational courses, and a draft core textbook was produced in September 2002 with 1,000 copies for mechanical courses. <\/p><\/div>\n 59. Teaching tolerance and conflict resolution<\/i>. In December 1999, the Agency began a project with donor funding aimed at further strengthening and supporting ±¬ÁÏÍøRWA efforts to supplement existing curricular materials and to promote concepts and principles of basic human rights, to raise awareness of the importance of tolerance and to train Palestine refugee children and youth in non-violent means of conflict resolution, including the promotion of peer mediation techniques in the West Bank and Gaza fields. Enrichment materials for social studies, Arabic language and Islamic education curricula were prepared. In addition, the related teachers’ manual and the students’ worksheets were finalized. In 2001, six children’s stories addressing human rights issues were distributed to schools in the West Bank and Gaza fields. In 2002, these stories were later produced and distributed to schools in the Syrian Arab Republic, Lebanon and Jordan fields. Training of trainers’ workshops were conducted to train teachers on the utilization of these stories in actual classroom situations. Training programmes for staff in Jordan, the Syrian Arab Republic and Lebanon were prepared. In August 2002, ±¬ÁÏÍøRWA started the implementation of a similar project under the title “Promoting tolerance, Conflict Resolution and basic concepts of Human Rights” in the Jordan, the Syrian Arab Republic and Lebanon fields. This project is funded by the German Government for students from the 5th grade to 8th grade in 49 pilot schools and more than 300 school supervisors. Head teachers were trained on strategies of teaching tolerance, conflict resolution and basic concepts of human rights. Enrichment materials for students were prepared together with manuals to assist teachers in utilizing the enrichment materials in actual teaching situations. <\/p><\/div>\n 60. Impact of funding shortfalls<\/i>. Funding shortfalls directly impacted on the programme’s ability to expand at a rate commensurate with growth in the beneficiary population, resulting in reduced teacher\/pupil interaction, higher workloads for teaching and supervisory staff, and difficulties in hiring qualified teachers at the new salary scales. Financial constraints also limited the Agency’s attempt to keep up with educational reforms introduced by host authorities, which would widen the gap between the education systems of ±¬ÁÏÍøRWA and the host authorities and undermine ongoing harmonization efforts. Other funding shortfalls seriously affect the education programme by reducing maintenance allocations and by cutting allocations for vocational training equipment and supplies, resulting in deteriorating school infrastructure, and the use of obsolete equipment and supplies by vocational trainees. The double shifting in ±¬ÁÏÍøRWA schools continued to constitute a burden on the education process with 77.1 per cent double shifting. In addition to that, ±¬ÁÏÍøRWA was not able to redress the problem of unsuitable rented premises for its schools. The average occupancy rate per class continued to be high at 42.9 during the reporting period. In addition, lack of funding prevented the introduction of new courses in vocational training centres. The funding shortfalls also affected the quality of teaching and the capacity of children to learn, due to the lack of teaching aids and equipment, among other things. The quality of the in-service teacher training operation was also expected to be negatively affected due to the cut on the travel budget for Headquarters professional staff.<\/p><\/div>\n 61. Cooperation with the host authorities<\/i>. ±¬ÁÏÍøRWA’s basic education programme continued to follow the curricula of the host authorities’ education systems. Senior Agency education staff in all fields continued to participate in major educational development activities of host authorities. <\/p><\/div>\n 62. Cooperation with ±¬ÁÏÍøESCO, ±¬ÁÏÍøICEF and the League of Arab States<\/i>. The ±¬ÁÏÍøRWA education programme was run in cooperation with ±¬ÁÏÍøESCO, which continued to fund six senior managerial and technical posts at ±¬ÁÏÍøRWA, including the Director of Education. Of the six posts, two were international posts funded by ±¬ÁÏÍøESCO on a non-reimbursable loan basis, and four were area posts whose costs were covered by ±¬ÁÏÍøESCO. The 12th annual joint meeting of ±¬ÁÏÍøRWA and the League of Arab States’ Council on Education for the Children of Palestine was held in Cairo in December 2002. The Council welcomed the Agency’s efforts to provide Palestine refugee children and youth with educational services, despite financial constraints. ±¬ÁÏÍøRWA participated in the thirty-second session of the General Conference of ±¬ÁÏÍøESCO from 18 to 22 September 2002 in Paris. The Gaza field, in cooperation with ±¬ÁÏÍøICEF, conducted training of teacher counsellors for psychological intervention. In addition, in the Syrian Arab Republic, the education programme in cooperation with ±¬ÁÏÍøICEF conducted several courses for teachers on health education, global education and child rights. <\/p><\/div>\n 63. Emergency compensatory education<\/i>. During the reporting period, restrictions on the movement of Palestinians in the West Bank imposed by the Israeli authorities resulted in the loss of 1,372 school days, an average of 14.4 days per school, and in the loss of 31,874 teachers’ school days, an average of 134 absentee teachers daily, constituting 7 per cent of the teaching staff. A total of 3,956 instructor’s days were lost at the three training centres. Some 283 additional teachers were employed by the Agency under the Emergency Appeal in March 2003, 126 to replace teachers who were unable to make it to their workplace and 157 to extend remedial teaching to low achievers. Several other measures were taken to ensure access of teachers to schools such as deployment of teachers hired through the job creation programme, use of a graduate training programme through emergency appeal funding, and temporary exchanges of teachers between ±¬ÁÏÍøRWA schools and PA schools. In the Gaza field, remedial measures, which were taken to minimize the negative impact of the prevailing situation, included remedial\/compensatory education programmes implemented under emergency appeals to compensate approximately 40,000 pupils affected for the time lost in schooling and to counteract the adverse effects of the current crisis on the academic performance of children. Evidence of declining performance resulting from the crisis includes deteriorating examination pass rates, a trend which the emergency compensatory education activities are helping to address. For example, the success rate for students between grades 3 and 9 who attended remedial education during the period between March 2003 and May 2003 in the Gaza field improved, in Arabic language, from 39 per cent to 80.9 per cent. <\/p><\/div>\n <\/strong><\/span>B. Health<\/strong><\/span><\/p><\/div>\n 64. Objectives<\/i>. The ±¬ÁÏÍøRWA health programme aims to protect, preserve and promote the health status of Palestine refugees and meet their basic health needs, consistent with basic WHO principles and concepts and with the standards of the public sector health services in the region. The Agency’s strategy is focused on sustaining adequate levels of investment in primary health care, enhancing the process of institutional capacity-building and development of human resources, improving the quality of essential services provided to Palestine refugees and aligning health policies and service standards with those of host authorities. Programme priorities during the biennium 2002-2003 continued to focus on improving primary health-care services, with special emphasis on expanded maternal health and family planning services and child health and integrated disease control; bringing about cost-efficiency through the use of appropriate technology, such as mechanization of refuse collection and disposal with a view to reducing recurrent staff costs; optimal resource utilization for enhanced programme performance; and improving the environmental health infrastructure in camps by funding water, sewerage, drainage networks, solid waste management and other projects.<\/p><\/div>\n 65. Impact of the emergency situation in the occupied Palestinian territory on the health programme<\/i>. The continuing strife in the occupied Palestinian territory and the repeated Israeli military incursions into camps, towns and villages have led to an increased demand for the Agency’s outpatient medical care services during the reporting period. Movement restrictions imposed by the Israeli forces caused denial\/delay of humanitarian access for emergency medical assistance to Palestine refugees, especially camp residents. Moreover, Israeli restrictions caused shortages of water, electricity and medical supplies and obstructed access to medical care services. ±¬ÁÏÍøRWA medical personnel worked under dangerous circumstances in providing emergency health services. During the reporting period, medical consultations increased by 45.1 per cent in the Gaza field and 40.3 per cent in the West Bank field. As a result of the Israeli military operations and movement restrictions, 7,881 health staff-hours were lost in the West Bank field during the reporting period. The Agency’s emergency health intervention measures sought to address the additional health demands. However, the health and nutritional status indicators of the Palestine refugee population recorded disturbing trends. A multi-organizational survey conducted in the occupied Palestinian territory of urban, rural and camp communities, revealed that 13.2 per cent of children under five years of age in the Gaza Strip and 4.3 per cent in the West Bank were suffering from acute malnutrition, and that 17.5 per cent of children in the Gaza Strip and 7.9 per cent in the West Bank were suffering from chronic malnutrition. Moreover, it was found that more than 40 per cent of women in the reproductive age group were suffering from iron deficiency anaemia. Rapid assessments carried out by ±¬ÁÏÍøRWA and a donor-funded study to monitor trends in service delivery at the primary health-care facilities of the Ministry of Health of the Palestinian Authority, ±¬ÁÏÍøRWA and NGOs revealed the consequences of delayed\/denied preventive health service access. They indicated a 25 per cent increase in the incidence of low birth weight, over 5 per cent drop in regular attendance of children for growth monitoring and approximately 36 per cent decline in the number of infants vaccinated on schedule in the West Bank. Destruction of camp infrastructure and cross-contamination led to an outbreak of diarrhoeal disease in Balata camp during the reporting period. Such breakdown in the coverage and quality of maternal and child health-care services, immunization and treatment of non-communicable diseases threatened to erode the Agency’s sustained achievements in primary health care and could lead to a further outbreak of diseases or cross-border transmission of infections in the region. Movement restrictions also adversely affected programmes for capacity-building and staff development.<\/p><\/div>\n 66. Health status<\/i>. The current demographic and epidemiological profile of Palestine refugees resembles the profile of many populations in transition from a developing to a developed stage and has much in common with both. While vaccine-preventable diseases were well under control, the prevalence of vehicle-borne and vector-borne infections was still high. Morbidity and mortality from chronic non-communicable diseases, such as diabetes mellitus and hypertension, were on the increase. Fatal diseases, such as malaria, syphilis and neonatal tetanus, were eliminated long ago and no cases of poliomyelitis have been reported among refugees since 1993. It may be noted that ±¬ÁÏÍøRWA operates in an area of very low prevalence of HIV\/AIDS. Nevertheless, regional data on incidence of sexually transmitted diseases give reasons for concern. Women of reproductive age and children below 15 years of age constitute approximately 58 per cent of the population. Crude birth rates were as high as 40.7 per 1,000 population in the Gaza Strip, 37 in the West Bank, 30 in the Syrian Arab Republic, 29 in Jordan and 23 in Lebanon. The total fertility rate was estimated at 3.5, with the highest rate of 4.4 in the Gaza Strip. The mean marital age of women was 19.7 years Agency-wide with more than 36 per cent of refugee girls in the Gaza Strip married at or before 18 years of age. Birth intervals were generally short, with 22 per cent of women in the West Bank having birth intervals of less than 18 months. <\/p><\/div>\n 67. Primary care<\/i>. The ±¬ÁÏÍøRWA health-care programme remained focused on comprehensive primary health care, including: the full range of maternal, child health and family planning services; school health services, health education and promotion activities; outpatient medical care services; prevention and control of communicable and non-communicable diseases, and specialist care with emphasis on gynaecology and obstetrics and cardiology. These services were complemented by dental and basic support services, such as radiology and laboratory facilities (see annex I, table 6). During the reporting period, Agency outpatient facilities handled 8,290,460 medical and 583,528 dental consultations, as well as 1,181,347 visits for nursing services, such as dressings and injections. The Agency’s primary health programme included rehabilitation of the physically disabled and the provision of essential medical supplies. The workload at ±¬ÁÏÍøRWA’s general clinics continued to be high, with an average of 99 medical consultations per doctor per day Agency-wide, reaching a peak of 124 in the Gaza Strip at the end of December 2002. <\/p><\/div>\n 68. Health protection and promotion<\/i>. During the reporting period, ±¬ÁÏÍøRWA primary health-care facilities provided preventive care to 195,588 children below the age of three, representing approximately 85.1 per cent of the registered refugee population below that age, and some 79,937 pregnant women, who accounted for approximately 60 per cent of expected pregnancies among refugee women of reproductive age on the basis of current crude birth rates. The prevalence of modern contraceptive usage among women of reproductive age utilizing ±¬ÁÏÍøRWA maternal services was approximately 50 per cent, Agency-wide, with the highest rates of approximately 65 per cent in the Syrian Arab Republic and Lebanon. Over 21,122 family planning acceptors were registered during the reporting period, bringing the total number of women using the Agency’s family health services to more than 94,137. The Gaza field, which had over the past years recorded a steady increase in the usage of family planning services by the refugees, had maintained this trend while it ha d simultaneously reported an increase in the number of pregnant women registered for antenatal care. The Agency continued to implement its surveillance of maternal deaths to reduce maternal mortality from preventable causes. Performance indicators were developed and applied to measure progress in the coverage and quality of antenatal, post-natal and family planning services. In addition, the Agency provided intra-partum care through six maternity units integrated within its largest health centres in the Gaza Strip as well as by supporting hospital deliveries of high-risk pregnancies in all fields. Overall, 97.3 per cent of reported deliveries were attended by trained personnel and 98.7 per cent of pregnant women served by ±¬ÁÏÍøRWA were immunized against tetanus. Consistent with WHO recommended strategy, two rounds of de-worming campaigns of school children were implemented in all Fields, using the one-dose highly effective anti-helmenthic agent. A study on infant and child mortality and an in-depth analysis of reported cases of maternal mortality during the last eight years was carried out in March 2003. Special attention continued to be paid to the early detection and management of micro-nutrient disorders, especially iron deficiency anaemia that was still highly prevalent among pre-school children and women of reproductive age. The Agency undertook measures to improve the specifications of iron and folic acid preparations issued to pregnant women and children as part of the strategy for prevention and treatment of anaemia. ±¬ÁÏÍøRWA also took steps to fortify wheat flour, distributed in the context of the Agency’s food aid programme, with iron and folates. A modest mental health programme providing psychological counselling and support was started in the context of the Agency’s programme of emergency humanitarian assistance in the oPt and efforts are being exerted to establish linkages with other national and international organizations who are pursuing similar initiatives such as ±¬ÁÏÍøICEF and WHO. <\/p><\/div>\n 69. Disease prevention and control<\/i>. The Agency’s efforts in this regard included the control of vaccine-preventable diseases, other communicable diseases of public health importance, the prevention of newly emerging infectious diseases such as HIV\/AIDS, the control of re-emerging infectious diseases such as tuberculosis, and the prevention and control of non-communicable lifestyle diseases such as diabetes mellitus and hypertension (see annex I, table 7). The Agency maintained optimal immunization coverage against vaccine-preventable diseases. It participated in national immunization campaigns for the eradication of poliomyelitis in May and June in the Syrian Arab Republic and Lebanon in the context of the regional strategy of WHO and in close coordination with local health authorities. As a result of these campaigns, 48,000 children were immunized. It is worth mentioning that the poliomyelitis campaign in the Syrian Arab Republic was carried out simultaneously with an MMR (measles, mumps and rubella) vaccination campaign whereby ±¬ÁÏÍøRWA immunized more than 20,000 children. In addition, ±¬ÁÏÍøRWA participated in a mop-up poliomyelitis vaccination campaign in Rafah launched by the Palestinian Authority’s Ministry of Health during October\/November 2002. The Agency reinforced its system of surveillance of communicable diseases, including vaccine-preventable diseases and other diseases of public health importance such as brucellosis and salmonellosis. ±¬ÁÏÍøRWA emphasized strengthening of tuberculosis surveillance and control measures, coordinating them with those of public health authorities in all fields, based on the directly observed short-course treatment strategy. The Agency provided non-communicable disease care through 115 health centres, with special focus on the management of diabetes mellitus and hypertension. Around 105,000 patients benefited from such care during 2002, of whom 23.1 per cent suffered from diabetes, 48.2 per cent from hypertension and 28.7 per cent from both. A record-based survey was conducted early in 2003 in all fields to assess the prevalence of risk factors among a sample of 8,157 patients receiving non-communicable disease care at 30 Agency health-care facilities as well as to assess programme performance and outcomes of care in terms of compliance, control status and complications. The Agency-wide control rates were 36.4 per cent for diabetes, 45.5 per cent for hypertension, 29.4 per cent for patients with both diseases and 37.2 per cent for all patients. The control status was 44.6 per cent among patients who had one or more of these diseases for less than five years and 31.9 per cent for those who had the disease for more than five years. Likewise, end-stage complications were found among 4.6 per cent of patients who had the disease for less than five years and 10.4 per cent among patients who had the disease for more than five years. Later complications were present among 31.1 per cent of patients whose conditions were under control and 37.7 per cent among those whose conditions were not controlled. Thus, the study revealed strong associations between risk factors and complications and emphasized the need for further improvement of the quality of care in terms of case-finding, proper management and prevention of adverse outcomes through staff training and patient education. <\/p><\/div>\n 70. Health education<\/i>. Health education activities aimed at promoting healthy practices, reducing exposure to disease-causing factors, nutrition education and promoting the use of modern contraceptive methods, constituted an integral part of the Agency’s primary health-care activities and continued to be provided by medical and nursing staff through focus group sessions and individual counselling. Special emphasis continued to be placed on enhancing the skills and capabilities of health professionals on appropriate counselling techniques. Health promotional activities targeting schoolchildren and adolescents continued to be provided as self-learning material focusing on prevention of tobacco use and prevention of HIV\/AIDS. All international occasions, such as the World Health Day, World No Tobacco Day, World AIDS Day and World Diabetes Day, were observed through planned activities held in Agency installations inside and outside the camps. The two health educational programmes on prevention of tobacco use and of HIV\/AIDS were implemented as multidisciplinary activities targeting adolescents and schoolchildren.<\/p><\/div>\n 71. Secondary care<\/i>. ±¬ÁÏÍøRWA provided assistance towards secondary care for Palestine refugees through the partial reimbursement of costs incurred for treatment at government or NGO hospitals and\/or through contractual agreements with NGO or private hospitals. Secondary care was also provided directly by the Agency at one ±¬ÁÏÍøRWA facility in the West Bank, the 43-bed Qalqilia hospital. Works were completed for the construction of a 20-bed paediatric ward, radiology and physiotherapy units and nursing dormitories. Catering services and the casualty and emergency department were upgraded and additional equipment was procured for the hospital. These improvements increased the capacity of the hospital to 63 beds. The hospital played an important role in treating strife-related injuries in the West Bank. However, the heavy casualty toll, on one hand, and Israeli movement restrictions on the population and ambulances, affected hospital services. Refugee patients in the West Bank could not reach ±¬ÁÏÍøRWA contracted hospitals and had to be treated at other hospitals and be reimbursed for the cost of treatment. High unemployment rates and widespread poverty caused by the conditions of strife and the movement restrictions led to a breakdown in the cost-sharing system. In addition, hospitals experienced significant shortages of medical supplies and needed assistance from the Agency. Such additional expenditures were covered through special contributions under the Agency’s emergency appeals. During the reporting period, 59,907 patients benefited from ±¬ÁÏÍøRWA assistance over 154,698 hospital days. ±¬ÁÏÍøRWA hospitalization arrangements continued to face funding constraints. This necessitated the continuation of stricter referral criteria, maintaining a system of co-payment and development of a hospital management information system to monitor morbidity trends of hospitalized patients and assess referral practices and utilization trends. The Agency implemented a decentralized system for settlement of reimbursement claims in the Jordan field. Additional budget provisions were allocated to Jordan and Syrian Arab Republic fields under the 2002-2003 biennium budget in order to meet the requirements for sustaining essential hospital services at government and\/or private hospitals at the current level. <\/p><\/div>\n 72. Capacity-building<\/i>. The Agency continued to focus on human resource development through basic in-service training The Agency experienced great difficulties in sustaining post-graduate training in public health and other related disciplines to facilitate career progression and meet future replacement needs, because external support to the programme was discontinued. The Agency pursued a donor-funded capacity-building programme for enhancing the skills and capabilities of health personnel at all levels, which was developed in collaboration with the WHO Collaborating Centre at the Centers for Disease Control and Prevention in the United States. The objectives of the programme were to assemble a core team that could further train health-care professionals to enhance system performance and improve the quality of care by transferring the acquired knowledge and skills to other staff members; assess the appropriateness and relevance of the various programme components and enhance surveillance, monitoring and response at the service delivery level. The revised management information modules were shared with field staff during a planning and evaluation workshop organized in September 2002 and arrangements were made to expand the system to additional primary health-care facilities effective March 2003, whereby a new trial run of the revised modules was started in 38 health centres. It is contemplated to replace manual data collection and analysis methods by computerized techniques as soon as the equipment becomes readily available and staff are trained on use of information technology. It may be noted that capacity-building programmes were adversely affected as a result of the emergency situation and movement restrictions of Agency staff in the occupied Palestinian territory.<\/p><\/div>\n 73. Health infrastructure<\/i>. ±¬ÁÏÍøRWA primary health-care services were provided through a network of 122 facilities located in and outside the refugee camps. ±¬ÁÏÍøRWA continued to repair or replace health facilities through special funding, primarily from project funds. Construction, upgrading and equipping primary health-care facilities helped to improve service standards and patient flow, with a marked impact on the quality of care. During the reporting period, construction of two new health centres to replace rented premises in the Jordan field, and replacement of two health facilities each in Lebanon and West Bank fields were completed. <\/p><\/div>\n 74. Environmental health<\/i>. Approximately 1.3 million Palestine refugees in 59 official camps in the five fields of operation, representing 31.9 per cent of the total registered population, benefited from environmental health services provided by ±¬ÁÏÍøRWA in cooperation with local municipalities. Services included sewerage disposal, storm water drainage, the provision of safe drinking water, the collection and disposal of refuse and the control of insect and rodent infestation. The Agency continued to play an active role, particularly in the Gaza Strip, in the planning and implementation of large-scale projects for the construction of sewerage, drainage and water networks in camps and the upgrading of solid waste collection and disposal capacity through mechanization. After the establishment of its special environmental health programme in the Gaza field in 1993, the Agency implemented projects in sewerage, storm water drainage and solid waste management in and outside the camps at a cost of $25.65 million, while projects planned for implementation, subject to availability of funds, are estimated at $14.36 million. In Lebanon, feasibility studies and detailed designs were completed for the rehabilitation and construction of the water and wastewater infrastructure in five refugee camps. The funding agreement with the donor, in this regard, was extended until June 2004 and contracts were awarded in April 2003. In the Syrian Arab Republic, a partnership and financing agreement between the Government of the Syrian Arab Republic, the donor and ±¬ÁÏÍøRWA, seeks to focus on improvement of water supply systems in two refugee camps and construction of a sewerage network in one camp. The agreement covers projects for the development of rural areas and refugee camps. In this regard, a memorandum of understanding was signed in December 2002 between the Government of the Syrian Arab Republic and ±¬ÁÏÍøRWA, which will be the implementing agency. Capital projects were complemented in all fields by self-help camp improvement activities, to which the Agency contributed material inputs and the community voluntarily provided labour inputs. <\/p><\/div>\n
\n<\/span>United Nations <\/span>·<\/span> <\/span>New York, 2003<\/span><\/p><\/div>\n
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Abbreviations<\/span> <\/span><\/p><\/div>\n
\n<\/p><\/div>\n
\nCommissioner-General
\nUnited Nations Relief and Works Agency
\nfor Palestine Refugees in the Near East<\/p><\/div>\n
\n<\/p><\/div>\n
\nChairperson of the Advisory Commission<\/p><\/div>\n
Chapter I<\/strong><\/span><\/p><\/div>\n
\n<\/p><\/div>\n