\n
\t<\/span>In the introduction (chap. I), I have concentrated largely upon the impact on the lives of the Palestine refugees of the situations prevailing in Lebanon and in the occupied territory of the West Bank and Gaza Strip. As a consequence of these situations, the Agency was functioning under difficult circumstances and running emergency operations in three of its five fields throughout the period covered by this report.<\/p><\/div>\n<\/p>\n
\n
\t<\/span>Chapter II provides an overview of major developments in the Agency's three main programmes of education, health and relief and social services, while summaries of activities in each of the five fields is contained in chapters III to VI. The emergency operations and reconstruction programme in Lebanon are set out in chapter IV. The Agency's programme of extraordinary measures in the occupied territory to meet humanitarian needs created by the intifadah<\/u> and countermeasures taken by the Israeli authorities is dealt with in chapter VI, as is the expanded programme of assistance which aims principally to improve the miserable conditions under which refugees live in the camps of the West Bank and Gaza. Those additional programmes have been funded by contributions from UNRWA's regular donors and other countries. However, as I point out in the introduction, in 1989 it was necessary to use some $US 3 million from the regular budget to finance these activities. At the time of writing, some $US 12 million was still required in order for the Agency to continue emergency programmes at the current level until the end of 1990, while no specific commitment had been received for 1991. As a subsidiary body of the General Assembly, UNRWA hopes that the Assembly, with your personal support, will make a special effort to ensure that the Agency's emergency humanitarian assistance will be maintained as long as the need for it remains, in adherence with the recommendations of the Advisory Commission.<\/p><\/div>\n<\/p>\n
\n
\t<\/span>Legal matters are dealt with in chapter VII, while the two annexes contain statistical tables and charts illustrating the composition of the Palestine refugee population in the area of operations and the Agency's main programmes, and references to documents of the General Assembly and other United Nations bodies related to UNRWA. In order to provide the General Assembly with the most up-to-date information in conformity with previous practice, budget estimates for 1991 and other financial data will be presented in an addendum to the present report in early October.<\/p><\/div>\n<\/p>\n
\n
\t<\/span>This report was examined in draft form by the members of UNRWA's Advisory Commission, and their comments have been given careful attention in the preparation of the final text. The Advisory Commission's views are set out in the Chairman's letter of 30 August, a copy of which appears hereafter.<\/p><\/div>\n<\/p>\n
\n
\t<\/span>Once again, I have deemed it appropriate to maintain the practice of showing my report in draft form to representatives of the Government of Israel and to give consideration to their comments in view of the fact that a major part of the Agency's operations takes place in the territory occupied by Israel since 1967.<\/p><\/div>\n<\/p>\n
\n
\t<\/span>Accept, Sir, the assurances of my highest consideration.<\/p><\/div>\n\n
(Signed<\/u>) Giorgio GIACOMELLI<\/p><\/div>\n\n
Commissioner-General<\/p><\/div>\n
\n
The President of the General Assembly<\/p><\/div>\n
\n
United Nations<\/p><\/div>\n
\n
New York<\/p><\/div>\n
\n
\n
\n<\/p><\/div>\n
\n
LETTER DATED 30 AUGUST 1990 FROM THE CHAIRMAN OF THE ADVISORY COMMISSION<\/p><\/div>\n
\n
OF THE <\/strong>UNITED NATIONS RELIEF AND WORKS AGENCY FOR PALESTINE REFUGEES<\/p><\/div>\n\n
IN THE NEAR EAST ADDRESSED TO THE COMMISSIONER-GENERAL<\/p><\/div>\n
\n
Dear Mr. Giacomelli,<\/p><\/div>\n
<\/p>\n
\n
\t<\/span>During its regular meeting on 30 August 1990, UNRWA's Advisory Commission considered your draft report on the Agency's activities during the period 1 July 1989 to 30 June 1990, which is to be submitted to the General Assembly at its forty-fifth session. The Commission examined a draft version of UNRWA's budget for 1991.<\/p><\/div>\n<\/p>\n
\n
\t<\/span>The Advisory Commission is convinced that the provision of extensive services in the area of health education and relief and social welfare, as well as the emergency assistance extended in the occupied West Bank and Gaza Strip and in Lebanon, where the population is confronted with extremely precarious living conditions, are tasks of the utmost importance, which the Agency is fulfilling in conformity with appropriate General Assembly resolutions.<\/p><\/div>\n<\/p>\n
\n
\t<\/span>The Advisory Commission believes that the activities of the Agency are an indispensable contribution in preventing the situation from deteriorating to an extent where efforts in favor of a just and lasting solution of the Palestinian question would be jeopardized. Aware of the increasingly difficult situation in which UNRWA is operating, the Advisory Commission is of the opinion that the Agency's emergency services must continue to be provided as long as they are needed. It urges member Governments and others to contribute generously to the financing of UNRWA activities both under the regular budget and for emergency programmes.<\/p><\/div>\n<\/p>\n
\n
\t<\/span>The Advisory Commission notes with appreciation the efforts of the Governments of host countries to facilitate the operations of UNRWA, as well as the activities, contributions and assistance of these Governments on behalf of the Palestine refugees.<\/p><\/div>\n<\/p>\n
\n
\t<\/span>The Advisory Commission commends UNRWA for the measure of protection its general assistance is providing the Palestine refugees in the West Bank and the Gaza Strip and requests the Agency to continue on a flexible and emergency basis general assistance to the population in need.<\/p><\/div>\n<\/p>\n
\n
\t<\/span>The Advisory Commission remains concerned that despite calls for an end to interferences with UNRWA operations by the government authorities described in your report, these difficulties have increased during the period. This can only add to the suffering of the population concerned and lessen the ability of Agency operations to alleviate them. The Commission therefore urges the authorities mentioned above, to respect fully the Agency's status, including the inviolability of its premises and the security and the freedom of movement of its personnel, and to extend to it all necessary assistance, both regarding its regular and emergency activities.<\/p><\/div>\n<\/p>\n
\n
\t<\/span>The Advisory Commission notes that, at the request of the Government of Jordan and upon the Advisory Commission's recommendations the Agency intends, while taking into account the financial implications, to incorporate a tenth year into its education programme to fit in with the ten-year compulsory education cycle now in force in that country. It also notes that the same measure will be extended to the West Bank by the occupying Power, thus adding to the financial burden carried by UNRWA. The Commission therefore appeals to Governments to assist UNRWA in meeting these requirements.<\/p><\/div>\n<\/p>\n
\n
\t<\/span>The Advisory Commission commends the role played by UNRWA, in co-ordination with the Government of Jordan and other governmental and non-governmental organizations, in providing humanitarian assistance to Palestine refugees and other displaced persons from the Gulf region.<\/p><\/div>\n<\/p>\n
\n
\t<\/span>The Advisory Commission notes with interest UNRWA's intention to work out a biennial planning and budgeting cycle, and its provision of budget estimates for 1991.<\/p><\/div>\n<\/p>\n
\n
\t<\/span>The members of the Advisory Commission thank the Secretary-General for his continued personal support of the Agency and the interest he consistently shows in UNRWA's activities. They also wish to express once again their appreciation, Mr. Commissioner- General, for the unwavering commitment shown by you and your staff, and for UNRWA's vigorous response to the many challenges it faces in carrying out its mandate.<\/p><\/div>\n\n
Yours sincerely,<\/p><\/div>\n
\n
(Signed<\/u>) Georges VILAIN XIIII<\/p><\/div>\n\n
Chairman of the Advisory Commission<\/p><\/div>\n
<\/p>\n
\n
Mr. Giorgio Giacomelli<\/p><\/div>\n
\n
Commissioner-General of the<\/p><\/div>\n
\n
\t<\/span>United Nations Relief and<\/p><\/div>\n\n
\t<\/span>Works Agency for Palestine<\/p><\/div>\n\n
\t<\/span>Refugees in the Near East<\/p><\/div>\n\n
\n
\n<\/p><\/div>\n
<\/p>\n
\n
I. INTRODUCTION<\/p><\/div>\n
\n
1.\t<\/span>In the introduction to last year’s report, I noted how events in the area of operations had created additional needs among Palestine refugees and, at the same time, raised new expectations of the Agency on the part of the international community. The spectrum of requirements had never been so wide: traditional programmes, emergency assistance, protection in the form of general assistance, social and developmental functions all had come to be seen as different but equally necessary elements in the performance of the mandate.<\/p><\/div>\n<\/p>\n
\n
2.\t<\/span>Those trends were confirmed and reinforced over the past year. The Agency responded by strengthening its traditional programmes, elaborating new approaches and activities that would better satisfy the requirements of the beneficiaries, while striving to overcome a variety of difficulties, financial and otherwise. In so doing, it became essential to ensure a steady flow of information to Member States as well as to the beneficiaries to secure their understanding and support. I see my annual report as an important means to that end. Detailed information about the activities of UNRWA is provided later in the report; in keeping with past practice, this introduction highlights some general concerns.<\/p><\/div>\n\n
\t<\/span><\/strong><\/p><\/div>\n\n
3.\t<\/span>In Lebanon, the reporting period began with the sea blockade of east Beirut and heavy shelling and fighting, particularly in the central area of the country. Subsequent developments involving a variety of political and, military forces were often accompanied by violence and led to a roller-coaster of hopes and delusions. Palestinians, along with the least privileged sectors of Lebanese society, bore the heavy consequences of the violence, lack of security and continuing economic difficulties. Some 23,000 Palestinians were displaced by the turmoil and it is estimated that 43 registered refugees were killed as a direct consequence of it.<\/p><\/div>\n<\/p>\n
\n
4.\t<\/span>For many months, however, refugee camps were not physically affected and, in spite of occasional disruptions, the repair and rehabilitation of shelters continued, particularly in Shatila and Burj el-Barajneh camps. A major exception occurred in February 1990 when more than 20 per cent of shelters were damaged or destroyed by heavy shelling in the refugee camp of Dbayeh near Jounieh. In the latter part of the reporting period, active involvement of Palestinians in the fighting led to an increase in the casualties and caused some damage in camps such as Rashidieh and Ein el-Hilweh. Israeli air raids over southern Lebanon also caused causalities and destruction.<\/p><\/div>\n<\/p>\n
\n
5.\t<\/span>The Agency managed to carry on its regular programmes and to provide a degree of emergency assistance. Schools in the central Lebanon area made up for the time lost in the previous school year and four emergency food distributions to about 230,000 beneficiaries were successfully completed. Following the decision taken last year to relocate part of the operations from Beirut to Siblin, in March 1990 major operational difficulties and an increasingly complex-security situation led to a further readjustment with the transfer of administrative units and supply and transport facilities from Siblin to Bar Elias in the Beqa'a valley, which is closer to the alternative supply route now reaching Lebanon via Latakia and Damascus. The Agency was, however, following developments closely and looked forward to returning its entire Lebanon headquarters operations to Beirut as soon as circumstances permitted.<\/p><\/div>\n<\/p>\n
\n
6.\t<\/span><\/strong>Meanwhile, I must draw attention again to the Agency's constant preoccupation, caused by the need to manage and control a large programme of activities while trying to ensure staff safety. Threats, physical violence and the danger of kidnapping were most worrying. Palestinians were affected by the high state of tension and uncertainty throughout most of the country, and this was occasionally reflected in the aggressive behavior of some individuals or groups in their dealings with the Agency and its staff.<\/p><\/div>\n<\/p>\n
\n
7.\t<\/span>Given the prevailing circumstances in Lebanon, UNRWA continued to extend emergency assistance as well as most of its regular programmes, including education, to the entire Palestinian community and not merely to registered refugees. It also actively participated with other United Nations agencies and international relief <\/i>organizations in activities to provide assistance to the Lebanese population in general. Thus, for instance, from January 1990 onwards UNRWA made available water tankers to help the Government in its efforts to supply water to west Beirut, and it provided relief in the form of food and other basic necessities to Lebanese families in Dbayeh.<\/p><\/div>\n<\/p>\n
\n
8.\t<\/span>In the occupied territory of the West Bank and Gaza Strip, the intifadah<\/u> continued throughout the reporting period. Its intensity varied in a highly charged atmosphere where diverse developments, including those on the political scene, could unleash extremely violent confrontations and high casualties. The Israeli authorities continued to apply harsh repressive measures, and violations of human rights were widespread. Between 1 July 1989 and 30 June 1990, 85 Palestinians were killed in Gaza and 164 in the West Bank. More than 20,000 sought emergency medical attention in local hospitals and the Agency's clinics, suffering from beatings, tear-gas inhalation and rubber bullet or live ammunition wounds; 24 children under 15 years of age were killed and some 1,640 were treated for beatings.<\/p><\/div>\n<\/p>\n
\n
9.\t<\/span>Other severe measures were applied in the occupied territory. They ranged from deliberate damage to property, demolition and sealing of individual shelters and houses to incarcerations on a large scale. In some cases, representations by UNRWA staff were sufficient to prevent the arrest of young children or to bring about their early release. The temporary detention of young people was used at times as a form of economic pressure since parents had to pay in order to secure their release. Innocent parties were made to suffer for suspected individuals, such as when relatives or neighbours were detained until the person sought after would turn himself or herself in.<\/p><\/div>\n<\/p>\n
\n
10.\t<\/span>The frequency of strikes and curfews varied. The latter increased in the West Bank, while in Gaza they dropped from 1,178 camp\/area days between July 1988 and June 1989 to 399 camp\/area days during the reporting period. In the West Bank, schools reopened in late July 1989. The Agency's vocational training centres were also allowed to open in stages between March and May 1990. Owing to selective closure orders by the authorities as well as strikes, however, school life was severely disrupted. In Tulkarm in the West Bank, for instance, Agency schools were open for only 41 out of 141 school days scheduled for the 1989\/90 school year. Universities remained closed throughout the reporting period. Therefore, while the reopening of certain facilities was welcome, the situation remained unsatisfactory and the problems faced in trying to provide adequate education to 135,000 young Palestinians in the occupied territory continued to be among the major concerns of the Agency.<\/p><\/div>\n<\/p>\n
\n
11. \t<\/span>Beyond the tragic toll of lives and the physical repression, the prolongation of the conflict in the occupied territory was, in itself, causing progressive damage. The income of Palestinian families was increasingly affected by the slow-down and occasional paralysis of economic life and the detention or unemployment of breadwinners. The young people's traditional perception of education as a redeeming value in refugee life was seriously threatened. The very fabric of society showed increasing strains in an uncertain and at times contradictory political and social context. The killing of alleged collaborators and of community members who deviated from the prevailing ethical standards was a phenomenon that assumed major proportions from early 1989. During the reporting period, it is estimated that 132 such individuals were killed in the occupied territory; four of them were staff members of the Agency.<\/p><\/div>\n<\/p>\n
\n
12.\t<\/span>The situation in the West Bank and Gaza Strip led to repeated calls for the protection of Palestinians. 1<\/u>\/ What the Agency did in extending a measure of protection through the provision of general assistance is detailed elsewhere in this report. It should be recalled here, however, that the emergency activities of the Agency reached out to the Palestinian community in general. Indeed, the Advisory Commission of the Agency, after a special session held in March 1988, urged me to provide, as far as practicable, humanitarian assistance on an emergency basis and as a temporary measure to non-refugees in the occupied territory who were in serious need because of the present situation. 2<\/u>\/ This is not a new feature of Agency operations, as UNRWA has on various occasions provided emergency assistance to Palestinians in some of its fields, regardless of their status. This happened, for instance, in Jordan after the 1967 hostilities; as mentioned earlier, it is the case at the moment in Lebanon. Resources permitting, the Agency will continue to pursue its emergency programme in the occupied territory, an undertaking which is intended to respond to obvious needs of the beneficiaries as well as to repeated requests from the international community.<\/p><\/div>\n<\/p>\n
\n
13.\t<\/span>Contacts with the Israeli authorities were frequent at the working and policy-making levels. In spite of the ongoing efforts to explain the circumstances and concerns of the beneficiaries and the programme requirements of the Agency, relations on the ground remained difficult. Privileges and immunities of UNRWA were increasingly disregarded. Violations of premises, such as the assault on the Rimal Health Centre in Gaza Town on 12 June 1990 in which many innocent infants and young children were injured, were strongly protested to the authorities and were condemned by the international community. Beyond those specific incidents, there were attempts by the occupying authorities to attempt gradually to assert control over Agency operations. This took the form of increasing administrative red tape, limiting the freedom of movement of staff members and interrogating them about work-related matters, enforcing new and time-consuming clearance procedures for activities that used to be carried out within the Agency's own authority and dictating the terms and duration of the school year. For the sake of its fundamental obligations to the beneficiaries, UNRWA tried pragmatically to carry on with its work while protesting specific incidents. There are, however, limits to the extent of interference that the Agency can withstand if it is to preserve its independence and international character.<\/p><\/div>\n<\/p>\n
\n
14.\t<\/span>In a constantly tense and confrontational environment, difficulties arose in ensuring that Agency premises, which given their functions are generally open to the public, were not at times also placed in jeopardy by individuals or groups from the local community. This was particularly so of Agency schools which, like government schools, were at the centre of student unrest. Measures were taken by the Agency with a view to reducing the impact and frequency of such situations.<\/p><\/div>\n<\/p>\n
\n
15.\t<\/span>Elsewhere in the area of operations, the difficulties confronted by the largest number of refugees related to the economic situation prevailing in the host countries as well as in most other countries in the region. Skilled and semi-skilled Palestinians who had found employment outside Jordan and the Syrian Arab Republic, particularly in the Gulf States, returned in increasing numbers to their families with resulting loss of income and likelihood of continued unemployment. It is probable that the growing demands on the Agency's health and welfare services in both fields were related to this economic hardship. Against this background the Agency hoped that ongoing discussions with the authorities in the Syrian Arab Republic over the implementation of its social welfare programmes there would soon lead to a mutually acceptable solution.<\/p><\/div>\n<\/p>\n
\n
16.\t<\/span>In early December 1989, demonstrations in support of the intifadah<\/u> took place in some refugee camps in Jordan. Following the killing of seven Palestinian laborers in Israel on 20 May 1990 and the subsequent incidents in Israel and in the occupied territory, solidarity strikes and protests were called in Jordan, particularly in Baqa'a and Marka camps. In the ensuing clashes with security forces, four refugees were shot dead and about 400 were wounded or treated for tear-gas inhalation.<\/p><\/div>\n<\/p>\n
\n
17.\t<\/span>During the reporting period the Agency continued to operate simultaneously regular programmes and emergency activities in three of its five fields. This required complex managerial and administrative arrangements to balance the need for proper control with that of ensuring rapid and effective delivery of services. A major decrease in the contribution of the largest donor announced in November 1989 led to a last-minute review of the programmes and priorities of the 1990 budget. While most of the cuts could be re-absorbed owing to a subsequent additional contribution by the same donor, which compensated for much of the earlier reduction this was but one further reminder of the fragility of the financial basis of UNRWA and its dependence on a limited number of donors, particularly for its regular budget. A degree of donor fatigue was also manifest in the ad hoc<\/u> funding of the emergency programmes in Lebanon and the occupied territory. In 1989, it was necessary to use some $3 million from the regular budget to finance these activities. At the time of writing, some $12 million was still required in order to continue emergency programmes at the current level until the end of 1990. Furthermore, no specific expression of support or commitment had been received for the funding of any emergency activity for 1991. While this may be due in part to the very nature of an emergency programme, I was profoundly concerned by a situation which, in a matter of weeks, could result in the curtailment or discontinuance of indispensable assistance in Lebanon and in the occupied territory.<\/p><\/div>\n<\/p>\n
\n
18.\t<\/span>During the reporting period, the Secretary-General provided his unwavering support to the Agency at a time when it was particularly needed. I personally appreciated his understanding of the concerns and priorities of UNRWA and his willingness to help it in the pursuit of its mandate. The initiative undertaken by UNRWA in March 1989 to ensure greater co-operation for an effective response to the economic and social needs of Palestinians in the occupied territory continued with a second inter-agency meeting and other initiatives such as the publication of a periodic bulletin outlining the ongoing and projected activities of the organizations in the United Nations common system. I am convinced that more can be achieved in this undertaking provided all organizations strengthen their commitment to it. Co-operation with other international organizations, particularly the International Committee of the Red Cross, was also intensified during the reporting period.<\/p><\/div>\n<\/p>\n
\n
19. \t<\/span>Until a just and lasting solution to the Palestine question is reached, UNRWA is likely to remain an important presence in the Middle East. With its 18,000 staff, it is one of the largest single employers in the region. Its well established quasi-governmental education, health and social welfare programmes benefit over 2 million people, two thirds of whom no longer live in refugee camps. Emergency activities in Lebanon and in the occupied territory confirm the capacity, within obvious financial and political constraints, to provide swift, practical responses in emergencies. At a time of continuing political stalemate, the knowledge and skills acquired in over forty years of operations are, I believe, a most useful instrument available to the international community in expressing its commitment to the Palestinian people. Support to the Agency will help it exploit to the maximum extent possible its remarkable potential.<\/p><\/div>\n\n
II. GENERAL DEVELOPMENTS IN AGENCY PROGRAMMES<\/p><\/div>\n
<\/p>\n
\n
A. Education<\/u><\/p><\/div>\n
<\/p>\n
\n
20.\t<\/span>The education programme of UNRWA, which is run with the technical assistance of the United Nations Educational, Scientific and Cultural Organization (UNESCO), provides general education, vocational and technical training, pre-service and in-service teacher training and university scholarships for higher education (see annex I, tables 5 to 7). The programme, even in relatively normal times, is beset with many difficulties, notably a lack of adequate financial resources leading to problems such as dilapidated buildings and crowded classrooms. Such difficulties were compounded during the reporting period by even more serious problems in three fields of operation.<\/p><\/div>\n<\/p>\n
\n
21. \t<\/span>After a lengthy closure ordered by the occupation authorities, schools in the West Bank were permitted to reopen in July 1989, but teaching was seriously affected by curfews, strikes and individual closure orders and the school year itself was shortened by 69 days. In addition, pupils witnessed scenes of violence, a pervasive presence of security forces, intrusion of soldiers into school compounds and classrooms involving at times the firing of ammunition, rubber bullets and tear-gas, the detention of students and teachers, the imposition of curfews keeping large families confined to miserable dwellings for indefinite periods, the wounding and killing of school friends, relatives or neighbours and the demolition of houses and other property. While the Agency strived to provide an element of stability and normality in the lives of students, it is easy to appreciate that this could have only a limited effect in ensuring that they not only develop their intellectual and social skills, but also that there is no psychological damage over the longer term.<\/p><\/div>\n<\/p>\n
\n
22.\t<\/span>The situation of the education programme in Lebanon was also difficult. Schools continued to operate in the context of chronic instability, which caused frequent forced movements of population and prolonged local school closures. Damaged schools, transfers of pupils and outbreaks of fighting provided a poor background for learning, and again parents were left with uncertainty as to what the long-term effects would be on their children. <\/p><\/div>\n<\/p>\n
\n
23.\t<\/span>As to the education programme itself, the Agency's tight budgetary situation continued to leave little room for major new initiatives. This resulted in the programme being essentially of an ongoing nature, catering to an increasing school population, with new undertakings being in the nature of necessary reactions to external factors or ad hoc improvements facilitated by extra-budgetary donations. One such external factor was the high level of disruption of school operations in the West Bank and Gaza Strip. To reduce the impact of this situation, UNRWA developed – and hopes to develop further if funding is obtained – alternative approaches to education, including written self-learning materials and video programmes. Such self-learning materials covered the basic subject areas of the school curriculum.<\/p><\/div>\n<\/p>\n
\n
24.\t<\/span>Another external factor affecting the education programme was the introduction of significant reforms in Jordan, namely, the extension of the general education cycle from 9 to 10 years and the requirement that all teachers in elementary and preparatory cycles possess a first university degree in order to obtain the education profession license. As mentioned in last year's report, UNRWA welcomes these but remains most concerned at the substantial increase in expenditure that would be required to adapt to the new system. The potential financial implications, ranging from the employment <\/strong>of <\/strong>new staff and construction of additional classrooms to the upgrading of the qualifications of existing teachers, became more serious during the reporting period with the decision of the Israeli education authorities to introduce the tenth year to the West Bank.<\/p><\/div>\n<\/p>\n
\n
25.\t<\/span>Funds for the construction required to prevent triple shifting in some schools, the replacement of unsuitable rented premises and dilapidated schools and sanitary facilities were not included in the Agency's regular budget. During the reporting period, virtually all such construction was therefore dependent on ad hoc<\/u> contributions from Governments, regional agencies, non-governmental organizations and private individuals. While UNRWA was grateful for the assistance received, it did not suffice to meet the most urgent requirements within a reasonable period of time.<\/p><\/div>\n<\/p>\n
\n
26.\t<\/span>The Agency's eight vocational, technical and teacher-training centres train 5,000 refugee students in 45 courses. The programmes have produced more than 52,000 graduates over the years and have an annual output-capacity of 2,500 graduates. Many of these graduates, in addition to becoming self-sufficient and helping their families, have contributed their skills to various countries in the region. In the case of vocational and technical training, a survey is carried out every two to three years to assess the demand for skills in the host and neighbouring countries and to adjust courses accordingly. At the end of the reporting period, UNRWA was in the process of introducing new courses, particularly for skills at the semi-professional level, and upgrading and re-equipping existing courses. The university scholarship programme received a boost during the year when two Governments provided contributions to be spread over five years for the provision of about 100 additional scholarships.<\/p><\/div>\n<\/p>\n
\n
27. \t<\/span>The Agency follows the curricula of host countries. Specialist staff, however, are continually engaged in devising enrichment material to supplement them. During the year, the Department of Education carried out a programme of in-service training for more than 840 teachers and education staff of various categories, including 111 vocational training instructors whose qualifications were upgraded. The syllabuses for more than 40 courses operating at the training centres were updated while new teachers' guides were produced.<\/p><\/div>\n\n
B. Health<\/u><\/p><\/div>\n
<\/p>\n
\n
28.\t<\/span>The Agency's health programme, which is essentially community-based, provides primary health care in the form of medical care services, health protection and promotion services, environmental health services in camps, and nutrition and supplementary feeding to vulnerable population groups. Its prime objective is to meet the basic health needs of the refugee population in accordance with the humanitarian policies of the United Nations and the basic principles of the World Health Organization (WHO).<\/p><\/div>\n<\/p>\n
\n
29.\t<\/span>During the reporting period, morbidity from infectious diseases continued to decrease despite the unsatisfactory environmental conditions prevailing in most refugee camps (see annex I, table 10). With the exception of limited outbreaks of measles among susceptible children, which are not unexpected among highly immunized populations, no epidemics of communicable diseases preventable by immunization occurred in the area of operations. Studies on infant mortality in camps revealed rates ranging between 25 and 35 per 1,000 live births. The main causes of infant deaths continued to be respiratory infections, low birth weight and prematurity, congenital malformations and gastro-enteritis. The prevalence of malnutrition among refugee children remained low despite deteriorating economic and social circumstances in most fields. Children showing growth failure were assisted individually with a view to identifying underlying causes and providing appropriate case management.<\/p><\/div>\n<\/p>\n
\n
30.\t<\/span>Events in the occupied territory created a high demand for emergency and casualty care. In April and May 1989, a team of WHO consultants carried out an assessment of needs in respect of emergency medical care in the UNRWA clinics and non-governmental hospitals in the West Bank and Gaza. Based on their recommendations, UNRWA took steps, described in paragraphs 87 and 100 of this report, to upgrade the emergency capacity of its health care system at the primary level. The implementation of these measures was assessed by another consultant who visited all health centres, emergency and night duty clinics in Gaza and West Bank in April 1990. The findings testified to improvements in the quality and magnitude of the management of casualties in health centres and stabilization of conditions requiring referral to hospital for urgent surgical intervention and resuscitation, thus providing life saving services to a large number of injured persons.<\/p><\/div>\n<\/p>\n
\n
31.\t<\/span>During 1989, there was a 9 per cent increase over 1988 in the number of medical consultations Agency-wide (annex I, table 9). This was due to the deterioration of economic conditions and the ever-increasing cost of medical care, especially that provided at government and private hospitals, and required additional resources beyond the capability of the Agency. This increase could have been greater had not access to UNRWA clinics been limited by restrictions on the movement of people in the occupied territory.<\/p><\/div>\n<\/p>\n
\n
32.\t<\/span>During the reporting period, several key problems and issues were addressed at workshops organized by the Agency. The psychological health problems among groups at risk received greater recognition and attention at a workshop on mental health, organized by UNRWA and WHO, held at the Amman Training Centre in July 1989. Subsequently, a plan for a multidisciplinary programme for the prevention and management of mental health problems among children was developed as a basis for further consultations. The problems of overcrowded health centres and quality of patient care were discussed at two workshops on patient flow analysis which were attended by senior health staff. The objective was to reduce patients' waiting time and provide more efficient service in the health centres. Transfer of the technology and methodology of this operational research activity to all fields was due to be completed in 1990, and the appropriate adjustments and reforms to the clinic service will be introduced in 1991.<\/p><\/div>\n<\/p>\n
\n
33. \t<\/span>The coverage and quality of maternal health services, particularly to women at high risk, continued to be a priority and in September 1989 a project formulation workshop was arranged in Jerusalem, co-sponsored by the United Nations Population Fund (UNFPA) and UNRWA, in order to develop an expanded maternal health programme for Gaza and the West Bank. Finally, the changing pattern of morbidity among refugees and the need to introduce programmes for the control of non-communicable diseases were the focus of new planning efforts. A workshop held in Jordan in February 1990, in collaboration with experts from the University of Zagreb in Yugoslavia, developed an appropriate strategy for the control of diabetes mellitus. At the time of writing this report, recommendations for action were being implemented to upgrade the level of service in the, 53 diabetic clinics run by UNRWA, as well as to expand such special care clinics where needed. <\/p><\/div>\n<\/p>\n
\n
34.\t<\/span>During the reporting period there was no material evidence that human immunodeficiency (HIV) virus and acquired immunodeficiency syndrome (AIDS) infections represented a major problem among the refugee population. Nevertheless, UNRWA had to keep pace with the global strategy for prevention of this pandemic. A short-term plan of action for HIV\/AIDS prevention and control in all fields was prepared in collaboration with WHO. Over $200,000 was contributed by WHO to implement this plan, giving priority to epidemiological surveillance, staff training and blood safety measures.<\/p><\/div>\n<\/p>\n