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~.JIt...:QtREGIONAL OFFICE FOR THE EASTERN MEDITERRANEAN
REGIONAL COMMITTEE FOR THE EASTERN MEDITERRANEAN Eleventh Session Agenda item 7 (b)
, ,
BUREAU R~GIONAL DE LA MEDITERRANEE ORIENTALE
EM/Rcn/l2
1 August 1961 ORIGINAL: ENGLISH
REPORT OF THE HEALTH DIVISION OF THE UNITED NATIONS RELIEF AND WORKS AGENCY FOR PALESTINE REFUGEES
The Regional Director has the honour to present to the Eleventh Session of the Regional Committee for the Eastern Mediterranean the Quarterly Report of Dr. S.S. McKenzie Pollock, Chief, Health Division
and WHO Representative of the United Nations Relief and Works Agency for Palestine Refugees, for the period 1 January - 31 Harch 1961.
No.
I II III IV
V VI VII VIII
IX
X XI XII
FOR PALESTINE REFUGEES
REPORT OF THE HEALTH DIVISION 1 January to 31 March 1961
Table of Contents
Section General
Medical 6are
Maternal and Child Health Nutrition
Communicable Diseases Environmental Sanitation Public Health Nursing Health Education
Tranining Programmes Medical Supplies
Records, Reports
&
Statistics Personnel~
1 3 5 8 10 11 14 14 15 16
17 17
UNRWA Headquarters Beirut, Lebanon.
May, 1961.
Dr. J. S. McKenzie Pollock Chief, Health Division &
WHO Representative UNRWA
To From Subject
: Direotor
: Chief, Health Div.is-ion & WHO Representative UNRWA :. Quarterly Repor.tfor the Period
1 January to 31 March 1961
I. GENERAL
Throughout the quarter the weather was seasonal.
Temperatures were averagef'or the time of year and the much-
welcomed heavy rainf'alls in all f'our countries gave an assurance of improved water supplies throughout the coming months. Some winter gales occurred but resulting damage to housing was slight
and was soon repaired.
The fasting month of Ramadan began this year on 16
February and ended with the feast of Eid El Fitr on the 17 March •.
The Chief, Health Division proceeded on 6 February directly from his home leave in Sco.tland to attend the World Health Assembly at New Delhi,rettirning to duty at Beirut on 23 February. ". The Deputy Chief Health Division was appointed temporarily as UNRWA Assistant Director for Liaison, Europe, and was absent from Beirut during the period 1-15 February
visiting Geneva and Bonn. He subsequently departed from Beirut on 9 March for Geneva which remained as his duty station until the . end of the period under review.
The Nursing.Services Officer was seconded by WHO to the Government of Cambodia for a period of 8 months with effect from 2 March, the date on which she left Beirut for Phnom-penh.
After preliminary meetings and planning which took place in February, a full-scaie nutr~tion survey by a special team (headed by Dr. Darby, Division of Nutrition, Vanderbuilt University Nashville, Tenne~see) ·01' the United. States Inter- departmentalCommittee on Nutrition for. National Defence was
begun e84'lY,in March coverin~llot .only the Lebanese civilian population and army, pu!-.also the refugee population in' that country. Various staff members of the UNRWA Health Division participated including the H.ead Preventive Medicine Branch, the Nutritionist. from HQ,and the Assistant Fif;lld Health,
Pffj;cer, Preventive Medicine Branch, UNRWA Field Office·Lebanon.
The s'QI'vey was still, proceeding at the close of period of report.
At a meeting .~eld at ~Q on 1·5 February. the Director's Executive Cabinet, incll.lding tTh'RWA Representatives, approved all Health Division items'appearing under the priority I heading of a list of 1961 supplem.entarybudget items prepared at the end of January by a special Review Committee set up' for that purpose.
Funds thus became available for the replacement of two clinic buildings in the Syrian Region, for the replacement of ambulances in the Gaza District as well as for improvements to water
supplies and latrine facilities in the four countries.
2/ •••
On 9th February a meeting took place in the Director's office with representatives of the Lutheran World Federation at which were discussed various administrative matters' connected with the Augusta Victoria Hospital, Jerusalem. R€presenting the Lutheran World Federation were Dr. Hoffman DIrector, LWF Geneva, Rev. Allan Rosengren, Senior ttapresentativeLWF (DWS) in Jordan and Syria, Dr. Farah, Medical Director, Augusta Victoria Hospital, Mr. HaaIles, Director, Augusta Victoria Hospital.
At the request of the Acting Director, the Acting Chief Health Division, accompanied by the Nutritionist and a
representative of Supply & Transport Division HQ visited on 30 January Mr. Harry L. Harting, USOM Comptroller at the US Embassy, Beirut, to discuss the procurement and usage by UNRWA of
an
item of agricultural produce (skim milk) coming under the heading of Title 3 of US public Law 480.IhLeb1Ulon steps are being taken by the Field Health Officer to establish closer ties between his office, the Agency's medical staff, and the corresponding offices and medical staff .in the government health services in order to ensure that there isa full exchange of public health informa- tion as well as mutual co-operation in all matters of common interest in the health field.
In Jordan, His Excellency the Minister of Development and Reconstruction visited the Jericho Area and· inspectt;ld the camp clinics and supplementary feeding centers at Karameh and
AkabatJaber.
Visitors to HQ Beirut during the quarter included ; Mr. Martin Sand berg, Chief programme Officer UNICEF EMRO
Beirut accompanying Professor,Gyorgy, Professor of PaediatriCS, University or Pensylvania who was proceeding on a world tour under the auspices of WHO UNICEF' and FAO; Dr. L.Emett Holt, Jr., of the paediatric Department, School of Medicine,Univer- sity of New York. (These two experts also paid brief visits to the Lebanon and Jordan fields); Drs. Darby, Kampmeier, and Johnston of the US Interdepartmental Committee on Nutrition for National Defence;. Mr. N. Yanowsky of the Medical Informa- tion, Agency, US'ArmyMedical Services; Dr. Dajani, Scbool or public Health,Americ1ID University Beirut; Dr. Van Veen,- Chief, Food Processfng Division, FAO HQ Rome; Dr. Pr.lthpal Singh,Regional Malaria Advisor EMRO, Alexandria; .Mr.F .•
Bishara, ,Supply Orficer WHO/EMRO Alexandria •
. The Chief Health Division visited Jordan and Gaza once.
Deputy Chief .HealthDivision visited Jordan once. Head
Preventive Medicine Branch visited Lebanon, Jordan and Gaza once.
Nursing Services Officer visited Jordan once. The Public Health Engineer visited Lebanon once and Jordan, Syria and Gaza twice.
The Nutritionist visited Syria once. The Supply Officer (Medical) visited syrIa qnauaza once and hiS Assistant visited Gaza
twice and Syria and Jordan once. The Health Educator visited Syria and Gaza twice. The Insect Control Technician visited Gaza twice.
II. MEDICAL CARE 1. Clinics
In general clini(!s:ervices were maintained satisfactorily in the four countries.
Sufficient :fist .. .aid· sets, each set including among other items two Keller-Bla.k€ leg.spllnts, nave been issued to all four countries to equip all ambu1.anceso~:rated by the Agency. Field Health O:fficers have been re'quested 'to organize courses of in-
struction in first-aid for para...medical personnel and for ambulance drivers.
Lebanon. In January official notification was received from the Council of Ministers of the decision by the Government Authorities to donate to UNRWA a site for-the construction of the proposed new Agency health center for Ein al Hilwah camp within 1;11e compound of the Government Hospital, Saida. Since then the land has been measured and marked. New drawings and estimates have been prepared by the Technical DiviSion to
provide a two-storey building as being more suited to the srte than the earlier plan for a single-storey building. Part of the funds required to defray the costs of construction have been provided by the Agency, the remainder being derived from a
generous donation fromtheN€w Zealand voluntary 'SGCiety CORSO, the secretary treasurer of which, Mr. C.E. Morrison, visited Lebanon and the site in January.
An arrangement has been made with the Jesuit Fathers in respect of their OUt-Patient.Medical Center at Ta'nayel near Zahle.where SpeCialists from the Beirut Hospitals Visit according to a fixed schedule and where X-ray :facilities are available. Under this arrangement refugee patients residing in the' Beka'.a may be referred for specialist consultation by the conCerned UNRWA Medical Offi'c-er. The service will reduce very much the necessity for patients from this area to travel to Beirut:for specialist ~onsuJ:tation at the American University Hospital or at the Hotel Dieu. In addition, refugees living in the various surrounding villages may attend at this center for their day-to-day medical care.
Syrian Region. On 27 February the Agency's new health center to serve the some 20,000 refugees living in Yarmouk village, on tne outskirts of Damascus, was opened in temporary premises generously provided by PARI ,pending the completion,of a perm<ment building already uilderconstruction. By the end of MarCh the center was working at full capacity and eliminates thenecesSlty for patientsll'esidillltin Yarmouk to utilize either Souk SarouJa or Alliance clinic services as hitherto.
As already referred to in Section I General above, the Director '.s ExecutiV.e Cabln€tappr"oved.on 15 Febl'Uary of the
issue of funds to provide :for the replacement of the existing unsatis:factorycllnlc building.· in Khan Esh Shieh and Homs Cite c'aI\lpsrespectiv.ely. Already consultations and exchange o:f vi-€ws have 'taken place between the Syrian Field, the
Technical Division .and this office in respect of the type 01' clinic building required and agr'eement has been r€/l'ched.
The way is now clear for the production by the Technical.
DivisiQn of detailed, drawings and cost estimates.
4/ •••
December has now been in operation for three months
and is proving to be very satisfactory.
Arrangements are being made under which, on payment by the Agency of a suitable monthly subsidy,the Government's outpatient consultant ophthalmic ser'lti'C:es in EastJ,ordan
become avai~able to the refugee population, referrals being made by the Agency's medical off'icers. In West Jordan as heretofore similar services continue to be provided by St. John's Ophthalmic Hospital, Jerusalem.
Gaza. Services have continued normally. Fund,s have been made-iVailablefor the installation of electricity in the Khan Youn1s clinic.
Statistics of clinic. attendances during the quarter are shown in Annex I, Table 1.
2. Hospitals
Service:shave proceeded normally in all four countries.
Lebanon. The daily fee at been increased for mental patients though the fee for those requiring unchaged.
Hopital de la Croix has undergoing active treatment, custodial careorily remains Greater use has been made of the 29 beds at Nahr El Bared camp hospital where the daily average occupancy during the quarter was 24 i.e. 83% of' capacity. The occupancy rate in Bhannti5 Sanatorium still continues to be low (average dailY' occupa.n:cy 103 out of· a total of 150 beds) i.e. 68%, which, however,is a modest increaSe over the corresponding figure for the previous quarter (62-%). Negetiations are proceeding
wi tli the admirtlstration of thiJ: hospital for the purpos.e of revising the existing agreement with. the' Agency. It is hoped to reach a mutually satisfactory agreement in the fairly near future.
The t'omograph donation by the Swiss Government for Bhannes Sanatorium has been received and is being installed.
Syrian Region. The arrangements made during the previous quarter rEilspecting hospital facilities for refugees
living in the Homs and Hama Areas are: proving to be satisfactory.
BeCause of the outbreak of measles in the camp, greater use has been made during the quarter of the children's ward in Nairab Detention Post.
Jordan. Bed occupancy rates continued to be lO'win the following hospitalst-
Name of Hospital
%
Evangelical, Nablus AWL Children,Nablus AWL Maternity, Nablus Tuberculosis, Nablus King Hussein, Bethlehem Government, Hebron
No. of Agency
Beds Average daily
occupancy Occup.
30
15
100 10 30 50
19.33 8 4-.4 64-.6 1903 21
e:
64- 64.6 4-2 64-The meeting on9 February between representatives of the Agency and the Lutheran World Federation to discuss various
administrative aspects of the Augusta Victoria Hospital has already been referred to under Section I General above.
~. Services continue to operate normally. A reply from the Government Authorities is still awaited concerning the proposed agreement in respect of services to be provided to refugees in Government hospitals. Average daily occupancy of the 80 beds in Agency camp maternity centers was 62% compared with 51% for the previous quarter.
construction naacommenced or the new ward ror female patients at Bureij Tuberculosis Hospital. Legal difficulties respecting the site of the proposed new ward .for male patients have been solved and it is expected that building will begin shortly.
Statistics in respect of hospitals are shown in Annex I, Table 2.
3.
Laboratory Services.These serVices continued to be provided by Agency'"
operated, governmental, university, or subsidized private insti tut-ions according to circumstances and the type of examination requiroo.
Lebanon. Servic'Es have proceeded normally.
Syrian Region. The Field Health Officer continues to review the situation in the Damascus area in. order to ,eliminate or reduce the number of unnecessary pathological examinations.
Jordan. There is nothing speCial to report.
~. During the quarter a total of 2912 VDRL tests were performed, mostly rElated to pre-natal care. This number
amol.1Ilts to almost 39% of the total number of specimens examined in the Agency's Public Health Laboratory. Over 650 specimens were. als·o examined. ill connection with the ancylostomiasis
survey conducted among the school children of Beit Hannoun village.
Relevant statistics are shown in Annex I, Table
3.
III. MATERNAL AND CHILD HEALTH
The MeH medical personnel in all the four host countries have made a special effort to obtain a more accurate registrati~n
of births and infant death data - meanwhile the home visiting programme has been intEnsified to prevent pulmonary complications of measles wherever severe outbreaks occur.
An appraisal of the work performed by the Agency in the field of MCH has been prepared by the Head Preventive Medicine Branch and has been distributed to the Field Health Officers
6/ •••
under the title of "Technical Guidance on UNRWA. MCH programme".
After study by the medical personnel concerned, this document is expected to provoke very useful discussions and comments from the field office staff.
Besides an analytic study·of the services rendered to the refugees, the report contains some vital statistical data. The most informative figures are given below :-
I. Coverage Jordan Gaza Lebanon Syrian Agency Region Wide
%
of women attending5lf:
prenatal clinics 96 75 35 65
%
of babies attendingInfant Health Clinics 51 95 68 37 63
%
of deliveries medically1t2 61t
controlled 55 99 31
II. Re£Ularitl of Attendance
%
of regular atteIJdance atprenatal clinics. 82 92 BIt 81t 86.2
%
of regular attendance at IHCduring 1st year 90 87 81 82
87
- do - 2nd. year 55 39 30 22 44
I I I . Average Weight at Births (in kg) Average Pre-maturity Weight rat~
a!
Gaza 1952 survey out of 2lt9 births 3.lt4B 6.1t Lebanon 1952 survey out of 338 births 3.325 7.1 Syrian Region 1953 survey out of l61t births 3.327 7.9 Jordan 1959 survey out of 705 births 3,310 6.3
IV. Infant Mortal1tl·Surve:£s Births
a) Jordan (Ka1andia 1955-1958) survey amongst ,all
births in camp 1t91
1,381 b) Lebanon (5 camps 1959) - do
c) Gaza statistical analysis ,of all births in Gaza during 1960
Country
a) Jordan b) Lebanon c) Gaza
Birth rate per
1000 inhabit.
Neonatal lIlort. rate deaths 0-28 days per 1009 live births
68.5 1t2.7 V. Children (I-It) Mortalit:£ Rate
9,500 Infant mort.
death 0-2 year per 100Q live births
Ilt7 100.6 1lt9
(Deaths per year among 1000 children of' the relevant age group). According to Gaza survey 1960: mortality rate I-It around 20.0.
1. Pre,..natal Care
The work in all pre-natal clinics continued to be carried out satisfactorily throughout the quart.er~
Syrian Region. The staff of the Yarmouk camp clinic has been increased by the appointment of two CBAs who will assist the qualified nurse in charge and will carry out a limited home
visiting programme.
Jordan. The survey on the increase in weight during pregnancy is still conducted in 10 selected centers. The
practical value of the information collected is, however, limited
and the survey may soon be discontinued.
Statistical information in respect of the STS carried out on pregnant women during the quarter is as given in Annex I,
Table IV.
2. Maternity Services
Lebanon. The camp mat~rn"ity in Nahr El Bared is working satisfactorily.
SUian Region. A new delivery rOObl was constructed at
Neirab camp maternity·center. Onl January the Palestinian midwife who has been in charge of the center during the last 10 years
left the services of the Agency on grounds of age.
Jordan. Local midwives continue to attend home deliveries with limited super:vision from the Agency staff.
Gaza. Four more cases of tetanus neonatorum have been reportedinMaghazi. In order to prevent the occurrence of further such cases an intensive in-service training has been started 'under the initiative and with the active participation of the Field Nursing Officer. while the qualified camp midwives are making great effort·s to ensure' close supervision of the
local midwives.
3. Infant and pre-schoolChild Health
Attendance in our infant health centers is still on the increase in all the fields, while outbreaks of measles, mumps
and whooping cough render the task of the medical staff even more difficult.
Lebanon. ]!;!"!"orts were maae oy tne nurses to react1.vate the infant feeding centers of Jisr El Pacha, Dikwaneh and Mia Mia camps and higher attendance has been recorded. In this field also at three camp clinics, name'ly, JiBr El pacha, Gouraud and
Dbayeh, preventive services for pre-school age children have recently opened on a trial basis. This constitutes a very
laudable effort on the paTt of the medical staff' already burdened by their normal activities.
Syrian Region. Home visiting services have been greatly increased at Aleppo,Hama and Dera'a during the measles outbreak in order to prevent, a.s far as possible, the occurrence of
secondary pUlmonary infecti·ons or at least to ensure, when they do occur, their prompt and efficient treatment.
Jordan. In this field the pressure of work is at its highest and the neavy work-load of routinea.ctivities seriously endangers the quality of services. It also may exhaust
eventually the devotion which the staff has always shown, despite their adverse working conditions. It is absolutely essential either to obtain enough nurses to carry out the programme, or else to curtail present activities.
8/ ..•
Gaza. Attendance is high at infant clinics and infant feeding centers. Apart from that described for Lebanon above, it is the only field wnere preventive services for pre-school children exist,but the quality of work done at the toddlers' clinics leaves much to be desired. The interest of the camp medical officers in this aspect of the child health programme
is generally insuff;1cient and needs to be further aroused
and guided.
4. School Health
Lebanon. The school team has been occupied mainly in examining school entrants.
Syrian Region. Camp medical officers pay regUlar visits to the school in their district while the school team limits its activity to Damascus town. Heights and weights of three thousand pupils attending the schools at Yarmouk camp
(near Damascus) have been collected and statistically tabulated, thus providing valuable information on the local growth patterns of the various age groups.
Jordan. The team in West Jordan has completed the physical examination of school entrants in the Jericho and
Nablus Areas, while the team in East Jordan did the same in the Irbed Area.
~. An ankylostoma survey has been conducted .. amoIlg the school children of Beit Hannoun (North of Gaza town). Some of the camp clinic staff are sent regularly to the school to ensure follow-up of pupils affected with chronic skln or eye infections. The so called "school tamarjies" who visit the school premises on a strict sched.ule do not belong to the school health team, but work under the direct supervision and
Under close control of the camp medical staff (camp medical officers and camp nurses).
IV. NUTRITION
1. Supplementary Feeding and Milk
During the quarter a document on the supplementary feeding and milk programme waS submitted by the Acting Chief Health Division to the UNRWA Director reviewing the present status of the supplementary feeding and milk programme, emphasizing its intrinsic value and merits but at the same time drawing attention to its defects, where such exist, and making specific recommendations for the·reduction or elimina- tion of these weaknesses and for fUrther improvement of the programme. The memorandum, which is intended to be used as a basic document in the development of the Agency's future
policy and action in respect of the supplementary feeding and
milk operation, has also been forwarded to all UNRWA Represen- tatives for their studY,comments, criticism and suggestions.
When all replies have been received and digested, it is intended to present the whole subject for formal Cabinet review and policy deciSion, which is now felt to be required as a guide to those con~erned with the future operation of the programme.
As the fasting month of Ramadan occurred during the period of review, permission was granted to supplementary feeding beneficiaries observing the hours-of fast to take their supplementary meal home for consumption after sundown.
The school milk programme was also to a great extent affected as the older children did not take their portion of milk.
The average daily number of hot meals served during the quarter was 42,692 as compared with 46,028 for the previous quarter, the decrease being almost entirely in Gaza. The
corresponding figures for the average daily number of liquid milk issues were' 237; 9,1 and 24,,618 the decreases occuring mainly in the sehoolmilk beneficiaries in Lebanon and Gaza.
Issues of supplementary dry·rations·topregnant and nursing women amounted to 31,283 as compared with 31,026 during the previous period. A total of 1,387 tuberculous outpatients were in receipt of a dOUble issue of the standard monthly ration.
Lebanon. The number of pregnant and nursing mothers in receipt of ~upplementary rations has reached ,,000, which is in excess of theperlnitted budget ration ceiling of 4,800.
As it is anticipated that this increase will be maintained, appropriate actioh tor a review of the ration ceiling will have to be taken during the coming 4uarter.
The refugees living at TripOli and at Mina who, during the previous quarter, had refused to collect their entitled milk issues because of their objections to the stricter control
measures introduced- 'by the ~gency, recommenced in January to collect their milk~ These control measures are helping to decrease the sale of milk b~ refugees to local merchants.
Arrangements are in hand to improve facilities in the following centers : at Ein el Hilweh milk center by the installa-
tion of electriCity, at Mia Mia feeding center by the provision of wash basins.
Syrian. Region. Services are proceeding satisfactorily.
The mobile canteen from Quneitra served 1,0 beneficiaries at Abbasieh village in the South Area during the quarter. Infant feeding attendances in the North Area showed some decrease due to the prevalence of measles.
Jordan. Selection of supplementary feeding beneficiaries was in accordance with the new instructions that at least 70% of
those selected should be in the age-group 0-, years. It was
possible to do this in camps, but in towns it proved difficult to find therequ.islte numbers in the lower age-groups.
Gaza. Similar experiences are also reported from this field, even in camps, where it was found to be difficult to reach the full permitted ceiling of beneficiaries. The actual average daily number of beneficiaries (10,728) shows a decrease of just over 1000 beneficiaries as compared with the corres- ponding number from the previous quarter (11,7,7) and is leSS than the permitted ceiling by approximately 1800 beneficiaries.
The Agency continued to make an average daily issue of 6,759 skim milk portions on behalf of CARE to Gaza residents.
Statistics in respect of supplementary feeding and milk programmes are shown in Annex I, Tables ,(a) and ,(b).
10/ •••
1. I~f!idemiology
The list of infectious diseases and the number of cases notified among the refugee population during the quarter are shown in AnneX I. Table 6.
None of the six "convention" diseas.€s occurred. FOllow- ing the seasonal pattern, there was an increase of upper res- piratorYinfections and common infectious diseases of childhood:
measles, mumps, whooping cough and chickenpox. Some sporadic cases of enteric fever were reported particularly from Nablus Area, Jordan. One old case of leprosy from Lebanon had to be re-admitted to the Quarantine Hospital.
2. Immuni~ations
The number of vaccinations and prophylactic injections given during the quarter were as follows :-
Lebanon
Triple Vaccine
Doses TAB Doses
gm.
BoosterSyrian Region 1206 1206 1206 40 37"9l~ 37,91~ 2511 Jordan
Gaza
IX B
~
3.
35 39 • ;93 1,32
- - -
- - -- -
Total 1241 1245 1246 39,.851 39,237 2511
• In addition 95 TAB 1st dose were done by local GovernmentD.
Statistics of trnrn1)nizations done to infants 0-1 year are SLw-..m in Annex I, Table IV and are not included in the above statistics.
Tuberculos~ontr61
Smallpox
798 798
-
Relevant statistics in respect of the activities of the Agency and of the concerned government tuberculosis clinics are shown in Annex I, Table 7.
In three fields services were carried out normally by the differeIit specialists employed by the Agency and in the case of Jordan by the subsidized government department. During the quarter 101 nm,l cases were detected. Usually such cases require hospitalization less often or fora shorter period and
the~e is a general tendency to reduce the nuwber of subsidized beds in sanatoria.
Lebanon. A ne",l form of contract has been proposed to the authorities of Bhannes Sanatorium and seems to have met
with their acceptance. According to the ne", agreement the Agency
wil~ paya.fixed subsidy per year without regard to the number of patients hospitalized. It is expected that the new contract, if accevted by the sanatorium authorities, will save the ,~gency around LL 50 per day.
Syrian Region. Following the discovery that a teacher in a certain school was suffering from open tuberculosis the pupils of this establishment were subjected to an X-ray (micro- film) examination by the Government Tuberculosis Team. Results are not yet known.
Jordan. During the quarter
53
new cases were admitted to hospital while 61 patients were discharged. The number of beds at Barakeh Sanatorium. Arroub, has been reduced from 40 to 30 as from 1 March.Gaza. A total of 43 new cases have been detected 26 of Whom had bacteriologically positive sputum_ The public health nurse of the tuberculosis control team has intesified her home visiting programme, concentrating her efforts on visiting household contacts of known open tuberculous cases newly discovered_
4. Malaria Control
statistical figures are shown in Annex I, Table 8.
In general the Agency closely cooperates with the WHO national malaria team l.n theacti'Ve surveil-lance phase of the eradica- tion programme,. which consists mainly in applying anti-
larvicidal measures to potentia,! breeding places and in taking blood films in every suspected case of malaria, and in instances of pyrexia of unknown origin.
puring tl1e quarte:r under review I;: cases in Jordan and
5
cases in Gaza were discovered. A detailed epidemiological survey is carried out on each case and the patient receives suppressive treatment and is subject to a close follow-up.Anti-malaria measures are being particularly intensi- fied in Gaza to avoid a possible summer outbreak, as happened last year to a limited extent (159 cases in 1960). OUr team works in .close cooperationwitl1 the local authorities who are responsible for the surveillance of the towns and villages, while UNRWA staff is responsible for the camp areas and their immediate surroundings. The campaign is technically supervised by WHO experts of the Regional Office (D'Chang, Entomologist,
and Dr. Farman Farmaian, Malariologist).
VI. ENVIRONMENTAL SANITATION 1. Wate.r Supplies
After thre.e consecutive years of drought, it is indeed fortunate that there has been widespread rainfall.during the quarter (especially in January and February) resulting in a considerable increase in the annual rainfall for 1961 over the aVi2rage annual ralnfall for the past several years. Conse- quently, . water .sources were replenished and there has. been a marked improvement noticeable in water supplies in all camps.
The emergency water SUpply programme ceased to function in Jordan and Lebanon.
Lebanop_ Water supplieswere.normal in all camps by late Jahuary_ In Dikwaneh and Jisr el Pacha camps of Beirut, a water tanker was used tosupple_ment the short supplies
obtained through the Beirut city pipe network. Similarly, in Nabatieh camp, the water Company was unable to supply any
water due to their inadequate distribution system and water was provided to the camp by means of an Agency tanker.
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Syrian Region. With the general rise in ground water levels, water supplies were plentiful in all camps'to the
extent of adequacy and capacity of equipment and pipe networks.
In Homs camp, during a brief breakdown of the PARI pumpset, water was supplied to the camp by the Homs Municipality using a tanker.
Jordan. Jordan camps, especially in Hebron area,
reverted to their normal sources of water supplies i.e. shallow spring sources which were replenished by the heavy rainfall in January and February. The nUmber of tankers in all areas was reduced to
5,
the bare minilllUItl required, mainly to serve Agency installations outside camps. In Karameh camp, the engine of the pumping set had a major breakdown and a temporary engine was installed in its place. Meanwhile, procurement of areplacement engine and measures to repair the damaged engine are being undertaken. In Jalazone camp, the development of an old Roman spring for camp use is in progress.
Gaza. Water supplies in Gaza camps were normal as the drought· COndi tions did not affect the deep wells. Constructi,on of overhead R.C. reservoirs in Bureij and Nuseirat camps was completed during this quarter as was also that of a deep gravel-packed tube well in Jabal1a camp.
During the quarter an assistant engineer was engaged to make engineering surveys and to collect field data to help the F'ublfc Health Engineer prepare plans and estimates of works proposed for construction during 1961. Large scale improve- ments in water supplies in Jordan, Gaza and Lebanon are provided for.
2. Sewage and Refuse Disposal
Lebanon. Construction of 10 seats of septic tank
latrine units in the new extension to Beddawi camp was completed during this period.
Syrian Region. Hama camp sewerage system was completed during this quarter. Consequently, construction of private hand-flushed water-seal latrines with the Agency cash grants is in active progress. It is proposed to rGduce gradually the public latrine seats in the camp to a bare minimum.
Jordan. Construction of 16 seats of septic tank latrines was completed in the extension to Fara'a camp.
Additional subsidies were issued for private latrines making a total of 1825 out of the 2000 programmed for 1960. For voiding, a new chassis and a new vacuum pump were provided to replace the old ones which will serve as stand-by and to
supplement during periods of excessive demand~ Refuse
collection in Amari camp was entrusted to the Bireh Municipality since March at a cost of JD 12.5 per month, thus solving the long.;.standing problem of incineration in an ihhabited area.
A revised proposal to improve refuse collection in the Amman area camps is under active consideration
~. Construction 01'345 units of water-seal latrines as well as that of the new shelters in Jabalia and Khan Younis camps was, completed with materials manufactured by the
Environmental Sanitation Branch.
In general, voiding and maintenance of public latrines and refuse disposal proceeded normally. In the 1961 construction programme is included construction of additional public latrines in Lebanon, subsidies for private latrines in Jordan, Gaza and Syria, minor lewerage works and construction of inciherators •.
3. Insect and Rodent Control
Statistical information in rEspect of insect control activities is shown in Annex I, Tables 9(a), 9(b) and 9(c).
Cold weather with rains reduced the fly population in all areas although the breeding places viz. manure dumps, stables etc.
still continued to exist as before. Delousing on a selective basis was carried in all fields as required.
Trapping and rodenticides were used in all areas as required for destroying mice and rats.
~. Anti-malaria activities during this year are in the process of intesification in terms of larViciding
i
entomological and epidemiological follow-up and a specia budget has been proposed. Bedbug infestation in Gaza
shelters is still under surveillance and is at a low residual level.
4.
Ancillary FacilitiesThe use of bathhouses in all areas is gradually returning to normal with the advent of good rainfall and the availability of water supplies. Utilization was as follows :-
Country Lebanon
Syrian Region Jordan
Gaza
No. of baths taken 24,532
20,720 15,157 189,102
Increasing use is being made of Agency slaughterhouses in Lebanon and· Jordar" while in Gaza and Syria use of the
slaughterhouse of the local communities under the control of local health authorities is the rule.
5.
Housing and Surface Water DrainageExtension to camps viz. Beddawi, in Lebanon, Jabalia and Khan Younis in Gaza, Irbid, Dheisheh and Aida/AZzeh in Jordan and cash grants for roofing in Syria were the main housing operations. During the quarter, because of storm- water collections in camp sites without natural drainage and
some of which are the result of indiscriminate increase in built-up areas considerable time and effort had to be devoted by the sanitation staff to provide surface water drainage.
Emergency measures were adopted to relieve flooding of premises.
14/ •••
A document containing proposals for a standard nursing staffing pattern for Agency clinics has been compiled at HQ and sent to all fields for study and comments. It is intended, when the study is completed, to submit this plan to the
Director's Cabinet for consideration.
In all fields the nursing personnel have continued their efforts to improve the home visiting service, but shortage of staff ser~usly limits these activities.
A new MCB reporting system was introduced on a trial basis in the field in January and appears to be working satis- factorily. This new system aims at standardizing field reports and eliminating the recording of unnecessary information.
The periodicity of weighing of infants in Infant Health Centers was changed during January since when all children
(with the exception of the sick and underweight) are now weighed monthly only.
Lebanon. Services are proceeding normally and there is nothing special to report.
Syrian Region. With the appointment of an Assistant Field Nursing Officer with effect from I January more help
and supervision has been given to the nursin,g services in the field, especially in the Quneitra Area where hitherto nursing
supervision has been very limited.
Jordan. In the smaller camps the IHC work previously carried out by auxiliary nurses has been taken over by the qualified staff nurses. Over the years this programme has developed into one of such major importance that it was felt
only a qualified nurse was capable of running it. Unfortunately, in the larger camps, the one ~ualified camp nurse cannot be
released for this full-timepTogramme.
The Deputy Field Nursing Officer left the Agency on 6 February to take> up a WHO aSSignment. Her post.has since been filled by a senior well-qualified nurse·midwife.
~. Reference has been made elsewhere in this report to the increased home visiting to tuberculous patients, the follOW-Up of family contacts, the measures taken to prevent
tetanus neonatorum, the main responsibility for which has fallen largely on the nursing staff.
The number of nurses employed in the MCH programme is shown in Annex I, Table 10.
VIII. HEALTK EDUCATION
Jordan. In all areas a health education campaign on nutrition similar to that of last year and with the same
objectives, namely, to explain the nutritional value of food, was planned and conducted through health committees in camps, in schools and in youth centers. In most of the areas the
contributed to the success of the programme. Lectures, meetings, talks and discussions with the various age groups were held by the Health Education Worker and by members of the camp health committee. In Hebron ar,ea, in conjunction with the government health services, a food handlers course was initiated. In Jericho area a film on "Blood Donation" was ~;nown to 150 UNRWA employees and another on "Ante-natal Care" to some 250 mothers.
Lebanon. As part of the nutrition campaign which was launched in all areas with the cooperation of school health committees, special efforts were made by the HEWs to popularize
and improve the consumption of milk in UNRWA schools. The HEW at Tyre concentrated on stimulating infant feeding attendance.
Films on dental hygiene, immunization, infant care were shown in several centers. An exhibi.tion at Jisr el Pasha clinic
showing the various dishes that could be made using milk proved to be very popular especially with mothers.
Syrian Region. The health education in-service
training course, which was begun in Damascus late last year, came to an end on
5
March. One HEW was assigned to Aleppo and the second to Dera'a. Activities during the period were centered on schools and in the camps, the major subjects being "Personal Hygiene", and "Environmental Sanitation" respectively.In Aleppo the new HEW concentrated on "The Transmission of Measles". The HEW in Hama was transferred to Homs as from 1 February.
Gaza. The HEWs have cooperated in the campaign for the prevention of tetanus. Talks were also given to the general public and the school age group in Bei t Hanoun c.oncerning ankylpstomiasis and its prevention. Personal hygiene was discussed extensively in schoolS.
IX. TRAINING PROGRAMMES
Two of the Agency medical officers from the Gaza District and one of international nursing staff have been
granted study leave for the present academic year and are taking post gra.c1uatepublic health courses at Alexandria and
Harvard univers1ties respectively and at the Statens Sjukskot Erskeskola in Stockholm.
Lebanon. Basic Nursing Trainin~. The
5
students financed by the volunta.rysociety APARAid to Palestine Refugees) are continuing their studies,4
at the Makassed Hospital (3 in their second year and 1 in her third year) and 1 at the American University Hospital (second year).Under the UK Training Scheme one student from
Lebanon, who completed her basic training, is now undergoing a one year post basic course in operating theatre techniques.
One other student from Lebapon is also training in the UK the cost of which is borne by a voluntary society.
This student is due to graduate in O·ctober 1961.
Syrian Region. Preparations for a series of one
month in-service training courses for qualified and practical nurses have now been completed. The first course will start as soon as the new clinic premises in Yarm~village are completed. The aim of the course will be to improve nursing
16/ •••
techniques, to widen the knowledge of the nurses especially in the field of maternal and child health and to standardize records and administrative procedures. Six trained nurses and 18
auxiliary nurses have been selected to attend these courses.
Jordan. Post Basic Midwifery Training UK. Miss N.
Mikhail, Area Nurse Nablus left Jordan on 29 January on one year-:s leave (without pay) for post .basic midwifery training, but returned on her own volition on 18 February.
Basic Nursing Training AUB.
recruit) a first year student at the making satisfactory progress.
Miss. F. Rayan (Jordan AUB is reported to be Augusta Victoria Hospital School 01" Nursing. Several di.scussions took place on the subject of the re-opening of the above school by the LWF with Agency assistance. The LWF are now proceeding with plans to re-open the school during October 1961.
Gaza. Four candidates for basic nursing tr~ining at the Baptist Hospital Nursing Training School Gaza have been pre- selected at an interview held at Beirut by the Fiel.:. Hursing Lebanon. It .is hoped that thes.e candidates will be able to travel to Gaza when their d'ocumentation has been completed.
A statistical summary of students undergoing training at the Agency's expense at the various universities is shown in Annex I, Table 11.
x.
MEDICAL SUPPLIESThe medical supply situation, in spite of some shortages of individual items, has been on the whole satisfactory.
The value of medical supplies and eqUipment received in the Base Warehouse Pharmacy during the period under review was:
$ 113,968
The val:ue of medical supplies and equipment issued from the Base· warehouse Pharmacy to the Field Central
Pharmacies was :-
Jordan Gaza Lebanon Syria
Total
$ 42,679
$ 21,572
$ 9,067
$B,506
$ 86,824
The value of medical supplies and equipment issued from the Field Central Pharmacies to Field Medical Installa- tions was :-
Jordan Gaza Lebanon Syria
Subsidized units Supplies .& equipment
11,696 $ 1,891 28 2,363 15,978
UNRWA units
Supplies & equipment 6,251 $
12,426 6,626 5,639 30,942
Total
$ 17 '4947 12, 54 8,517 8,002 46;920 Decentralization of medical supplies came into effect
Indents for the 23rd Cyclic Review were prepared in the Fields. Many difficulties were experienced in the
preparation. The Assistant SUpply Officer (Medica1) visited all'fields to discuss and correct these indents, arid also visited clinics in Gaza and Syria.
,During the period underrev1ewa. generator, X-ray unit and table basculante with motor were received and handed over to the Bhannes Sanatorium, Lebanon.
Keller-Blake leg splint transportation sets were received and distributed to the fields for use in the ambulances .'
XI. RECORDS, REPORTS AND STATISTICS
In order to obtain more accurate statistical informa- tion of the maternal and child health programme, Table
4
of the Statistical Annex of this report has been revised.XII. PERSONNEL
The Chief Health Division proceeded on 6 February directly from his home leave in Scotland to attend the World Health Assembly at New Delhi, returning to duty at UNRWA HQ Beirut on 23 February.
The Deputy Chief Health Division was appointed temporarily as UNRWA Assistant Director for Liaison Europe and was absent from Beirut during the period 1-15 February visiting Geneva and Bonn. He subsequently departed from Beirut on 9 March for Geneva which remained as his duty station until the end of period of review.
The Head Medical Care Branch returned from home leave and resumed duty at HQ Beirut on 11 January. The Field Health Officer Gaza who fell ilIon 26 December 1960 while on home leave has been on sick leave status during
the whole of the period of review. The Nursing Services Officer was seconded by WHO to the Government of Cambodia for a period of 8 months with effect from 2 March, on which date she left Beirut for phnom Pe~ From that date until
the end of the period of report the Field NurSing Officer Lebanon has been acting Nursing Services Officer in addition to performing her duties in the Lebanon Field.
The Supply Officer Medical has been on sick leave from the periods 14-26 February and from 15 March till end of period of report.
The post of Assistant Field Nursing Officer Syrian Region was established with effect from 1 January 1961.
18/ •••
A s1lIlllllary of the budget allocations and expendi tures as at 31 March 1961 in respect of personnel is shown hereunder :-
Code 13 Code 14- Code 16
Budjet Expend. Budjet Expend. Budjet Expend.
$ $ $
International
Staff Costs 3,361 3,011 2,630 2,777 36,364 32 ,617 Area Staff
Costs 18.572 18,325 15,0lt3 14-,643 38,868 38,4-83 21,933 21,336 17,673 17,4-20 75,232 71,100
====== ------
====== ======
------ ------. /' v:J
/~
.J
/~ 0 / . _:_~/-/ --Z-o j _ _ _ _UNRWA, HQ
Maison UNESCO, Beirut.
May, 1961.
Dr. J. S. McKenzie Pollock Chief, Health Division
&
WHO Representative UNRWA
STATISTICAL REPORT
1. Clinics
31st March,1961.
Visits including rspeated attendances to the 100 static and 8 mobile clinics (covering together 128 points of service) throughout the countries during the quarter are as followa.-
Table 1
Lebanon Syrian Jordan Region
Population served
by Medical Services ( 1) 123,513 107,477 585,080 General Medical Cases 105,232 75,803 152,731 Dressings & Skin 48,286 29,966 153,026
Eye Cases 28,430 11,725 132,249
Dental 10,616 4,144 21,555
192,564 121,638 459,561
(1) Figures are based on the Registration Statistical Bulletin for the fourth quarter, 1961.
Gaza Total
244,549 1,060,619 112,064 445,830 111,984 343,262
97,960 270,364 4,118 40,433 326,126 1,099,889
quarter are as follows,-
Table 2
No. of beds available Lebanon Syrian Jordan Gaza Total Region
General Tuberculosis Maternity + Paediatric Mental
(1) 142 78 628 287 1,135
150 20 130 150 450
18 11 66 80 175
27 18 140 17 202
50 50 100
387 127 1,014 534 2,062
Bed per 1000 population 3.01 1.23 1. 75 2.18
(1)
+
Rate is based on refugee population of 123,513 in Lebanon 372 beds, 107,477 in Syrian Region 132 beds, 585,080 in Jordan 1,024 beds and 244,549 in Gaza 5311 beds, allowing for availability to refugees f'rom Jordan and Syrian Region of 10 and 5 beds respectively of the 150 tuberculosis beds located in Lebanon.
lncludes maternity beds in UNRWA camps.
No. of' H osRi tals
Goyornmo~t & Looal Authorities
Voluntary & Private Societies Hospitals Agency"'s
And in addition there are 3 maternity centrers in Jordan and 8 in Gaza.
21 46 7 74
======
The number of patient days utilized during this and the previous period of report were as f'ollows:-
Present Period Previous Period 1.94
No. of' ;:, of' total No. of'
%
of' total patient bed days patient bed daysdays available days available
used used
Lebanon 29,820 86 30,400 84
Syrian Region 8,489 74 9,087 80
Jordan 74,663 82 77,581 82
Gaza 41,233 86 41,962 85
154,205 83 l:i2so~ 83
The most significant of these were as follows:-
Services Blood
Films for Malaria and re- lapsing Fever
W:i.da:1
Malaria
Relapsing Fever Weil Felix
S.T.S.
Stools
Ova and Parasites Asoaris Ta.enia Ankylostoma.
Triohiuris Trichiura
Table 3
Amoebae Rist. (CYSts. or Troph.)
Smears and CuI tures
Coryn. Diphtheria Neisser. Ganorhea MYoobact. Tuberculosis
No. examined
321
102 33 4,315
10,148
59 21 1,500
No. positive
6 2 161
o
11
2,310 258 616 733 904
o
3 213
Lebanon Syrian Jordan Region
Gaza
A. Ante-natal Services No.of pre-natal clinics No. of pregnant women regtd.
Average monthly attendance No. of STS performed
No. of cases with positive serology
No. of home visits (ante- natal care)
B. Natal Care
Total No. of deliveries regtd.
No. of home deliveries No. of deliveries in camp
maternities
No. of deliveries in hospitals No. of live births
No. of still births Reported maternal deaths
No. of home'visits (post-natal) C. Infant Health Services
s.2
1,673 1,554 286
5 418 1,457 1,214 114 129 1,447 10
1
1,726 No. of infant health centres 20 No. of 0 - 1 year infants regtd. 3,973
" 0 - 1 " " attend. 3,494
II 1 - 2 01 01 regtd. 3,462
01 1 - 2 01 " attend. 964 Reported infants deaths (0 - 1) 112 No. of smallpox vaccination 1,271 No. of TAB immun._completed 485 No. of triple vaccine immun.
completed 707
No. of home visits (infant care) 1,86Q D. Pre-school Age Preventive Servioes
No. of chil.dren (2 - 6) clinics No. of children registered Monthly average attendance
Home visits (children 2 - 6 care) E. Sohool Health SerVices
~
605 579 348
o
232 644 546
~ 90 643 -1
268
o
~
2,037 1,275 1,163 413 39 324 39 1,974 375
No. of school health teams No. of UNR ~ schools
1 1
Primary Secondary
No. of UNR'TA school children Primary
Secondary
No. of children examined No. of schools inspected
61 11.
40 63
n.x
I I18,752 17,443 16,565
2.187 1,829 68
13,840 3.603 4,106 No. of TAB boosters given 40
No. of diphtheria boosters given 3,863
£2
3,554 2,875 1,482 6 1,148
.2.
4,061 3,741 2,472 36 90 3,571 2.711 2,756 1,339 174 1,312
~ 60
3,555 16
2
1,903
Jl
8,003 6,561 4,547 3,532 294 1,190 58 1,850 8,800
2,684 27
o
805 L 9,213 8,663 6,808 2.771
217
579 1,460 9 - 14,290 3,044 58
2 1
m
8297 53
12.
£248,542 48,331 40,189
8,353 13,359 60
37,790 10,541 796
50 3,824
Total
~ 9,893 8,749 4,588 47 1,888 8,383 5,855 1,690 838 8,329 54 3 4,702
M
2),226 19,993 15,960 7,680 722 1,653 2,293 2,932 14,094 14,290 9 3,044 58 5 J2£
139 253 133,068 108,384 24.684 20,090 218 9,269
Table 5 (a) Daily Cooked Meal Beneficiaries
(Average for Quarter)
Monthly Dry Ration Beneficiaries (Average for quarter)
Country No. of 0-2 2 - 15 Total Pregnant Nursing TB Total Total
Feeding years years & A women mothers Out- B A&B
Centres special patient
Lebanon 22 564 4,058 4,622 1,344 3,534 268 5,146 9,768
Syrian Region 18 397 3,633 4,030 615 1,246 185 2,046 6,076
Jordan 41 1,729 18,801 )
~
23,312 3,042 10,849 588 14,479 37,791x24 189 2,593
Gaza 16 1,258 9,470 10,728 2,750 7,903 346 10,999 21,727
Total 121 4,137 38,555 42,692 7,751 23,532 1,367 32,670 75,362
x Centres operated b,y v oluntary Societies.
Country
Lebanon
Syrian Region Jordan
Gaza Total
Number of Milk Centres Preparation
& Dist..
23 22 81
x 35 16 177
Distribution only
11
4
15
x Centres operated by Voluntary Societies,
Table 5 (b)
Daily Number of Beneficiaries (Average for qaurter)
Milk Distri- Schools, Orphanages, Total bution Centres Medical prescriptions
etc.
37.822 2,606 40,428
34.580 5,594 40,174
74,919 16,420 94,539
3,200
43,976 18,834 62,810
19_4,497 43,454 237,951
amongst refugees during the quarter were as fo11ows.- Table 6
Lebanon Syrian :Jordan Uaza Region
Total Population at riskx
123,513 107,477 585,080 244,549 1,060,619
Plague 0 0 0 0 0
Cholera 0 0 0 0 0
Yellow Fever 0 0 0 0 0
Smallpox 0 0 0 0 0
Typhus (Louse Borne) 0 0 0 0 0
Typhus (Endemic) 0 0 0 0 0
Relapsing Fever (Louse Borne) 0 0 0 0 0
RelapsirrgFever (Endemic) 0 0 I 0 1
Diphtheria 0 0 1 0 1
Measles 172 400 2,178 767 3,517
Whooping Cough 68 284 425 71 848
Chickenpox 235 136 367 271 1,009
Mumps 291 105 421 16 833
Meningitis (Cerebro Spinal) 1 5 3 9
Polioll\Yelitis 2 11 13
Enteric group Fevers 3 105 133 5 246
Malaria 0 0 4 4 8
Bilharziasis 0 0 0 24 24
Ankylostomiasis 8 4 249 261
Tuberculosis 38 22 59 43 162
SyphiliS 11 4 4 25 44
Gonorrhoea 0 1 3 1 5
Scar.let Fever 0 0 0 0 0
Rabies 0 0 0 0 0
Tetanus 1 0 1 4 6
Brucellosis 0 0 0 0 0
Infectious Hepatitis 19 30 42 38 129
Leishman~asis 2 0 0 0 2
x Figures are based on the Registration Statistical Bulletin for the four1h
quarter 1960.
The following statistics show the number of clinic attendances in respect of the diseases inlicated,-
-LEib.arulll Syrian :Jordan Gaza Totsl Region
Dysentery 2,207 1,565 2,255 3,162 9,189
Trachoma 199 188 3,350 3,071 6,814
Conjunctivi tis 944 719 3,921 1,881 1,531
