W O R L D H E A L T H ORGANIZATION

REGIONAL OFFICE FOR THE 1 BUREAU REGIONAL DE LA

EASTERN MEDITERRANEAN MEDITERRANEE ORIENTALE

REGION~L CO~MTEE FOR THE EASTERN MEDITEXRANEXI

Seventeenth Session

EM/RC171l/bIin. 2 26 September 196,7

ORIGINAL: ENGLISH

MINUTES OF TKE SECOND MEETING

Held at the Royal Teheran Hilton Hote1,Teheran -- on Tuesday, 26 September 1967, at 9 .OO a.m. -

CXAIRMAN: Dr Nassib Berbir (Lebanon) (Vice-Chairmzn ~f the Sub-committee)

CONTENTS

1. A~mval Report of the Regicnal Director to the Seventeenth Session of t11e Regional Committee; s "atements and reports b!, Representdcives ol iflei~loer States 4

2. Co-operation with Other Organizations and i'gencies; statements a d reports by Representatives and Observers of Organjza- tions and Agencies. 19

Representatives of Member States

Government

CYPRUS

ETHIOPIA

FRANCE

IR:w

LEBANON

L r n E

PAKISTAN

SAUDI llRPSI.4

SOMALIA

SUDAN

SYRIAN A R B REPOBLIC

TUNISIA

UNJTTD ARB REPUBLIC

UNITED KINGIXlM

YEMEN

Representative, Alternate o r Adviser

Mrs S o 2 h i ~ Abraham

Mddecin-Colonel Malaspina

D r H. Morshed Engineer M. Assar D r Ch. Mofidi Dr A. Darai Engineer H. Goodwzi D r M. Rouhani Dr A. Mohtadi GT A. Azad D r M. Dadgar D r S.T. Notameni D r H. Hafezi

D r Awni Arif

D r i. Nabilsi

Dr Abdulrazzak A 1 Adwani Dr ,?bdulrahman A 1 Awadi

H.E. Dr Nassib Berbir Miss J. Abdel Me-sill

D r AbdulmaJid i.bdrlhadi

Brigadier C K H e s a n D r S. M&:fuz A l i

D r Youssef El Humeid.an

H.E. A l i Mohammed Ossoble FL- Adan Farah Abrsr

D r Osman Ibrahim Osnan

D r Nouri Rmzi

H.E. Mohzmed El ~ Q d i Khefacha D r M.T. Hachicha

D r Hashem El Kadi

Dr 'J.R. Jones

M r Mohmed El Zofri

Representatives of Associate Meriber- St~~tes

@TAR Dr M. Farid Ali

Iqorld Hea.lth Organization

Secretary to the Sub-Committee Dr A.H. Taba, Regional Director (ex-officio)

Representative of the Director- Dr A.M. Payne, Assistant Director- General General

Rep-esen-catives of United Nations Organizations

UNITED N4TIONS a d UNITED NJTIONS CHILDREN'S FUND (UNICEF) M r Gurdial S. Dillon

U K T 3 E NATIONS DGVELOPMFNI PROGRPIME (UNDP) M r Edouard Collin

UNITED NATIONS RELIEF AND WORKS Dr M. Sharif AGENCY FOR PALESTINE REFUGEES (UNRWA)

Representatives and Observers of Inrernational Non-Governmental and Inter- Governmentc.1 Organizations

INTERNATIONAL UNIOli OF ARCHITECTS

INTERNliTIONAL ASSOCIATION FOR THE PREJENTION OF BJJNDNESS

Bm/ITIONAL DENTAL FFr)E.P ?TICN

rnRNPTIONAL COMMITTEE OF MILITARY MEDICINE mD mrmIpcY

RED LION AND SUN SOCIETY (LEP.GUE OF RED CROSS SOCIETIES)

INTERNATIONAL FEDERATION OF GYNE- corny AND ~ I C S

INTERNATION.\L STATISTICAL EDUCATION WTRE (ISEC)

Mr Monaghah

Professor G. Chams

h- F. Farzin

Colonel Dr B. Milani

Mrs N..1. Roboobi

Dr Vadjed Smii

Dr. M. Mogharei

Mr Faiz El Kho1u-i

Dr F.O. Raasch

EM/RC17Afiin. 2 page 4

1. ANNUAL REPORT OF XTE XS2C;f.L DFZCTOLL TC XJ5 SE- SESSION OF THE REGIONAL CCXWETXE , , . STA-S RND REPOTS BY REPRESENTATIVES OF

STATES: Item 5 of the Agenda (document E&I/RC17/2) - Cantinuec?

Dr EL HWEIDM (Saudi Arnbi?.) t h ~ n k e d the (;overnment of I ran f o r Its

hospi tz l i ty i n receiving the Sub-committee i n Teheran ?nd d s o expressed

h i s zppreciation t o 'WHO f o r the e f for t s it was making t o improve helltin i n

the Region. I n m e f f o r t t o a t t a i n ?.pprcpriete st?n2.?rc?s of l i v ing f o r

its people, Saudi Ar:.bic had brGken down tne walls of i s c l a t i on which h2d

,>nee surrounded it and was now making gre-t s t r i d e s i n develc>mznt, desjiite

the m?ny ~ n d various problems t h z t confronted it. l'his w r s t r ue , not ~ r i l y

f o r the towns, but f o r the r u r a l ez4e,?s as well, ?nc! e f f o r t s were being m2eclsle

t o r e s e t t l e the nomadic popvl~.tion. H i s Government did not believe tha t

the necessary progress cauld be achieved by over-hasty moves, but r?.ther

t h e t ?? careful ly ccnsidered prcgrrunme h?d t o be developed t h a t was i n keeping

with the country's ave l l2b i l i t i e s 2nd resources. To th2.t end, Saudi ArcbLa

maintained close re la t ions with WHO and other internat ional organizatisns

?nc? wes grateful f o r the e s s i s t a c e it received.

With regme. t o a recent oztbre& i n S ~ u d i Arebi~. af fcod poisoning

caused by wheat f l o w cant?nin,-ted by m inscctj~cj;le, the immediate 2rablsm

had been soved by taking emergency mezsures, but he believed the prevention

of s i m i l z r cu-tbreaks i n the future t c be sf vi t?2 i,.i;,-..;-Lda-; d.d suggested

t h a t WHO shrulc! >lay e le ,ding pxt in the d r2 f t j . n~ of such i n t e r n ~ t i o n a l

reguletions as m i g h t be required.

He wished t o essociate himself with the s>e?.kers 2 t the previcus meeting

regerding the effect on heal th of the recent h o s e l l i t i e s i n the Middle East.

Dr FAHID ALI (Qater) thanked the Government s f Ires f c r i ts hosp i t c l i t :~

m d congrctulated the Regional Qi rec t - r on a most comprehensive h u a l Report.

The contaminltion of wheat f loxr mentioned by the previo7~s spezker had

also hcd t r ag i c r e s u l t s i n Q2t.v. A s 2. r e s u l t cf consumption of t h i s f lour ,

ccses of poisoning were f i r s t noticed enr ly i n the m,?rniny of 3 .P.:ne,

s t a r t i n g with vcmiting, r e sp i r - to ry d i f f i c u l t i e s a d reducer2 pulse. By

11 a.m., 250 p l t i e n t s h9.d been reportec! 2nd the number h& grown t o 500 by

the en6 of the day. The pct ients were t reated f::r orgenc>phosphate poisoning,

.and bload and vomit smples were taken for cm~lys is . On 3 July, before

the t rue c?.use cf the poisoning had been discovered, a fur ther 200 cases

occurred PAC? zppenls f o r z s s i s tmce i n tre?.ting the pet ients and investigetin&

the cause of psisoning were m?ce t c WHO, t o the Government cf UAR ?nd ti.

Scotlmd Yard i n Lon6on. In response t o these eppeals, investigp.ti3ns by

exser ts shcwed th?.t the f lou r had been c o n t ~ m i n ~ t e d with the insect ic ide

endrin while i n trmsit on .?. shia. He expressed the grat i tude of Qa.t;lr

t c a l l those whn h& SO rzpidly cnd so s k i l f u l l y contributed t o desling

with t h i s t r ag ic s i t u s t ion and s t ressed t h z t it was of grent importace thn t

WHO axd FA0 should per t ic ip?te i n the draf t ing of regulations t o prevent

the contc.min,-.tion of food s tu f f i n t r z n s i t .

I n conclllsion, he f u l l y supportea the statements made by &her Members

;f the Sub-committee reg?.rding the recent c r i s i s in the MiGdle East.

Dr OSMAN (%dm) congretulated the Chnirmsn a d other off icers i n t h e i r

e lec t icn a,' complimented the Regional Director both on h i s Annual Rep3rt

-nS: on h i s excellent swrunnry of it a t the previous meeting. H i s Gqvern-

ment w ? s most >ppreci?.tive of the work t h a t the Iietegional Office w?.s dsing

t o meet the needs of the develo2ing cauntries in the Region.

In view of the shcrtzge of c i v i l and sani tary engineers, c s?ni tary

engineering course would be s t a r t ed ?.t Khartoum University 2nd it w ? s hqoc!

Llct WHO might provide ?.n inst ructor t o z s s i s t i n t h i s . Cc-17rses were s l s c

being given i n the t ra in ing of waterworks personnel. These had prrvved

very useful nnd m i & t ~ 1 ~ 3 be valuable i f given i n other are2.s of thc Re,-icn.

An e f f o r t WPS being made t o achieve smallpox eredicettion i n the Sudan P ~ C

he mentioned thc t , following the detection of one ccse of smallpcx,somc

644 232 persons had been v.-.ccinrted within a very few days. Good progress

was also being m?.de i n the f i e l d of malaria eredicztisn.

The Sab-Committee wrs meetin,? only -. f ~ w m.-nY?s &te r the recent

c r i s i s i n the Middle Enst -and he th:u&t it import?>nt thn t the members,

?s medicrl s c i e n t i s t s , should point c ieer ly t o the irreparr.ble damage t o

h m v l hellt'n ?rid l i f e t h a t was c?.used by w a l i k e z c t i v i t i e s . He, there-

fore , f u l l y supported the views of en r l i e r s ~ e n k e r s rn? expressed h i s cppre-

c int ion of what had been done by NHO ?ad UNRWA t o a l lev ip te humv suffering.

I n conclusion, he wished t? t h r ~ k the Government of Irm f o r its

generous inv i tc t inn and f o r i ts hcsp i tc l i ty .

M r OSSOBLE (Somalia) con@'-r,?ttilcted the Cho.irm,?n Fnd other o f f i ce r s on

t h e i r e lect ion 2nd expressed h i s D e l e ~ n t i o n ' s grct i tude t c Ira f o r the

wrxm welcome ?ad hospi tn l i ty being extended. He elsc congretulated the

Regicn-1 Director on h i s excellent repsr t , highlighting the n c t i v i t i e s of

WHO Fn the Regizn.

M?.leria was still ?. maacr prcblcm i n Sornclia. The f i r s t s teps tow?.rds

integrzt ing the mclzric se rv ices . in to the g e n e r r l h e a l t h services had been

taken, six new regiona.1 and sub-region?.l un i t s hr.d been s e t up, and t rc in ing

i n ma.l?.rie eradication hcJ been startec? with e c lzss f o r twenty henlth o f f i -

cers. H i s Gavernment wils grateful f o r the ~ s s i s t s n c e i n mal?xic eredication

received from WHO Pnc: hosed thn t it wculc? be ccntinued so long a s the nced

rrose . Great import?~ce wns nttrched i n Somr.lia. t o tr,c.ining of hezl th ~eirsonnel.

A t the ?.uxili?.ry leve l , more emphr.sis wc?s being given t o the t rc in ing of

persons i n the curative discipl ines; f o r instpace, twsnty-five g i r l s were

undergoing c three-yem n u r s i n ~ cGurse zt the Hzrgeisn School of Nursing m?

c?urses fo r medic:.l ,?ssistvts, 'aboratory technicians, midwives and lower

,T-de nurses were under way i n the Mogadishu Health Personnel Trcining Insti-

tu te . Since there were no medicnl schools i n Somalin, ahys ic ims hhC. t o

receive t h e l r t r z i n i n ~ zbrord. A ce r ta in number of doctcrs b d recently

completed t h e i r t rc in ing in It?.ly, Polcmd ~ n d the USSR ?nd hed returned t o

join the Ministry of Hgalth; more were expectez in 1968,

I n tuberculosis ccntrc!. th.? T ~ O / V N ~ T E ~ ?ssociated 3roject i n Mogxlishu

was c,?.rryfng cut BCG vnccination i n the school pcpul-tiqn ?nd it wcs plmned

t o exten2 t h i s beyond the ccgl ta l . In the two northern reglons of Somalia,

a mess BCG campeiy combined with smallpcx vaccinction had been s t a t e d

w i t h the essist?nce of WIO, UNICW. ?ad the America Pence Corps. A p i l o t

project f o r immuniz?.tion agzinst poliomyelitis w.3 also being aonducted in

Mogadishu.

With ?. view t o the improvement of environmental scnitaticm in urbm

a e z s , it w 2 s plmnec? t o a s s i s t the population of &-.lad in the construction

of la t r ines . Assist-nce i n the form of food was clso made within the

franework of the World Food Programme and provision was ma& for 'bu i ld ing

100 r u r a l henlth centres over three years.

There had been d i f f i c u l t i e s in s e t t i n s up the WHO css i s ted Central

Public Hellth L?.boratory, but those ha3 now been svercome anc? he hoped t o

innugurzte the l?.borztory befcre the end c l We yew.

The mzterncl and chi ld heelth services i n Somalie h?d continued t o ex-

p a d , m d since t ra ined personnel were now av-lilable, it w?.s hoped t h a t a

complete ne~uuork of MCH servlces m i a t be achieved qui te shr t ly . A debt

of & ~ e t i t u 6 e w z s owed'to WHO a d UNICEF fo r t h e i r p? r t i n t h i s project.

He w ~ s c l s c grateful f c r thc jnchzij-r. .2f the dent,?.? 'hc . l5? service project

in the 1963 progrmtne.

P, slight but ste?.dy increase i n venereel Ciseese hed been noticed in

recent ye7rs, n.ttribut?.ble t o the flow of people t o the urbm .wens, and he

hnc', tllerefcre, rsked WHO f o r tile &vice of ? short-term consultd?nt.

It h3d unfortunctely been impcssible t o implement the report of the

WHO t e m on hec l th p l ~ n n i n g , owing t o the l?.ck sf q u d i f i e d public hezlth

aGministratr:rs m d there was, conse<usntly,a need fo r '. public health te rn ,

consisting of 2 senior public heillth of f icer and 2n ewper;i;nzcd ~!i?ministr?-

t i v e c f f i ce r , t c be p ~ s t e d t o the Ministry of Heclth 2nd Labour.

EM/RC17A/hlb. 2 pege 8

D r MOFIDI (Irpn) agr:r?c5 lw,lii;:1 the Rt~?ec::;t?CLvcs of Saudi Ar.abia and

Qctar on the impcrtznce of ensuring >roper p?.ck?.~ing f o r such importsnt

s tep le foods 2s wheat f l ou r and su&estecl t hc t WHO be urged t o recommend

t c thcse internat ional oryenizztions iieeling witn focd s t~mdnrds ?ad in te r -

n.?.tional t r&e t h a t the regulations on the pnckaging ?nd t ransport of food-

s t u f f s be revised.

M r EL ZOFiiI (Yemen) sa id t h e t under the 1965-70 five-year heal th p1s.n

,gre?t e f f o r t s were bein2 mzde t o decentrclize hecl th services i n the Yemen

and t o es tzb l i sh .-.dequate medicd f a c i l i t i e s i n a l l pa r t s of the country,

b-th urb,m ?ncI rur7.l. Every attemgt was being made ?.long modern l i n e s t o

obtain e f f i c i e n t and qu?.lified personnel ?nd t o educete t he ;.ou';h of the

c ~ u n t r y t o a proper apl~reci2tion of heal th mztters. The greater p u t of

the five-year p l m h?d been cz.rried out and areas had been reached t h a t

had h i ther to been deprived of e l l heal th s ~ r v i c e s . He wished t o thank z l l

those Governments which hxi helped t o make t h i s possible.

He emphasize6 th-t the Yemen naint?.ined excellent re la t ions with WHO

and was very p z t e f u l for. the e f fo r t s msde by the Repional Office; he

essured the egion?l Director t h a t h ' s Government b~culd cont nue t o help

FIHO in its work i n every wly possible. He also t h a k e d the Government of

Irm f o r its hospi ta l i ty .

Dr JONES (United Kingdomj ccnyretv.leted the Regionzl Director f o r h i s

ccmprehensive report , which so ably stressec! the r e l a t i ve 3r ior j . t ies of

heel th work i n the Region. He expressed h i s f3~vernment's gratitucle ts I r sn

f o r i t s hospi ta l i ty anti t c , both IdHO ,-ad UNICEF f c r t h e i r essistpnce t c the

peoplz gf Aden and the Pr~rctector2te :;f South h e b i e . Health a c t i v i t i e s i n

both those are3s hed been cur te i led i n recent months owing ts the troubled

s i tua t ion , but he was confident t hz t t h e t wns merely e tempormy setback.

Dr ARTF ( I req) , commenting on cerCein d e t a i l s i n the Reg-ii.n?l Directar ' s

Annup.1 Report rec?.lled t h c t , n t the previous session of the Sub-committee,

he h,.d zsked NU0 t o consider the Fao area a problex arez so f e r as malerir

was concerned, s ince trr?iymfsz::;l I=?.$. n..t Fosn F ~ t e r r u p t e d cnd tlie reg is t -

Face of Anopheles stephensi t o IiDT h?d increased by 200 per cent. Since

then, the Region?.l Office had off'ercd t o make e v - i l a b l e the new carbanate

insect ic ide, &W-33, f o r which lie w a s mast grcteful , and he hoped t h ~ t it

m i g h t be possible t o i n i t i s t e e reserxch p-oject, sponsored by WHO, i n the

2re2.

Reg~rding smallpox, the l a s t m e s s vcccinr-tions i n Ir3.q h?.c! been con-

tvcted one month before the smellpox outbre?.k i n Kuwrrit, achieving 76 per

cent coverage, ?nci proaf cf its efficacy was t o be found i n zhe f a c t t h a t

no smcllpox c ~ s e i126 occurred ?n I r c q i t e r r i t o r y , despi te the intense bor2er

t r a f f i c bitween h i s country end Ku.wnit. Ekth dry an?. liic,ui& ?:.-cine had

been arsduced i n Iraq, but hencefcrth production would be r e s t r i c t ed t g

freeze-dried vcccine.

Since the sup;?ressisn of the 1966 cholera outbreak, no fur ther cese of

cholere hac'. been recordec! i n i r zq and vigorom mei?sures had be& taken t c

prevent my new outbreak, These included 2n extensive s too l survey in the

t w s months following the end of the outbreak, invclvine the cul ture of

250 000 st3i1- smples . Stool. sampl ?s continued t o be c c l l , 2ted st the r e t e

.sf ?bout 1 000 a day throughout the country with z view,.n&so much t o pre-

venting the introcluction of chclera, as t o providing infornlction whlch

would meke it possible t o t?ke immediate s teps shoul6. the diseese occur.

Qci te a ser ious 2roblen; in I r a q w ~ s t h z t o f cerebrospinal meningitis,

of which some 5 0 t o 150 ceses occurre? ~snnv.??.lly, with ;:snks every t r~e lve t c

t h i r t een years, as shown by ,? retrospective study. A study 9f .c l se -h is tor ies

hed revealed t h a t the use of s u l f c 2 r u ~ s rrlcne was not Pdequnte, since they

ellowed a case f a t a l i t y r z t e of 14.2 per cent ns against no deeths when

c,,mbinec! treatment wzs given with both suIfa.Jrugs a d penici l l in . A l l

hospi tc ls h d , therefore, been recommended t o use the combined tre?.tment

exclusively.

hlitn respect t o the .:u.tbrealc of f.-a? pzisoning frcm cont~.mineted f lou r

mentioned e a r l i e r , he said thnt f l ou r frem one contaminr.ted shipment h?d

been received i n I raq, but t ha t , i n view of the timely wpxning receivec!

f r m WHO it hzd been possible t o t e s t it before it wr.s dis t r ibuted an6 t o

find t h a t the sacks unloaded ir, 1r-q h2.d not,, i n f z c t , been contminated.

He f u l l y supported D r Mofidi's suggestions reg?srl:ng internaticna.1 contrcl

measures.

D r M O F D I ( I r rn ) sa id th?.t OMS-33 had been 'mder i n ~ r e s t i g ~ t i o n i n I r?n

f o r three years end h.-d, so f , ? r , been found entcmologicnlly ane toxicolci.ic?lly

2deqv.a.te i n a vil lage-scsle t r i a l . The stu6y, hcwever, was not yet com-

pleted 2nd he wculd elc come fur ther ev=l;ztion of the insect ic ide i n Iraq.

He egreed w i t h Dr Arif t h ~ t A. s t e ~ h e n s i required p m t i c u l a r e t tent ion,

especis l ly i n view of the cyclic epidemics of rnelaria t h 2 . t occurred i n I rzn

cad Iraq.

Dr MALGSPINA ( & a c e ) congrztulated the Chcirman on h i s e lect ion and

th~ulked the Government of Ira f z r its hospi ta l i ty . He gre2.tly 2.ppreci3ted

the Regional Director ' s Annual Report and the Region?.l Off ice 's contribution

t 3 tuberculosis contr-1 i n the area vnder French &minis t ra t . ' 3n.

Mrs I1BRAHAM (Ethiopic) r.ssociated horself with previous speakers' ccn-

gr?tulations t o the keirman on h i s ultct i '2n and t o the Xez?cn,zl Directrir

on h i s Reixrt ,?nd t h a k e d WHO f 3r i ts c o n s t ~ n t encourr.zement ass is t -ace

in improving the public k a l t h s i t ue t i cn In Ethiopiz. Th?aks were a lso due

t o the Government of I r r n f o r i ts hospi ta l i ty .

Dr R!WZI (Syrian E.re.b Republic) s a id t ha t the SyrL-A Government whcle-

heertedly il.i;reed with the emphzsis placed i n the RcgionCq.l D i r t c t ~ r ' s repcr t

on the impcrtrnce of the t ra in ing of personnel. Adequztely traine* person-

nel c ~ n s t i t u t e d the mnin bzse on which heal th services cc.ulC be extended.

New Suildings h<ad ri?il.de it possible t o admit more students t o lnc?.l hecl th

t ra in ing centres i n Syrir. a d 1 new school f o r t ra in ing l a b o r ~ t o r y techni-

c i m s was uncier construction a t which the f i r s t p r a c t i c ~ l courses would

begin in 1968. S l x nursing schools hcci bcsn s t a r t ed rnd were alrerdy

t ra in ing the mrximum nmber of stucents. A new r u r e l hec l th centre hod

recent ly been established in m e pve rno r~ . t e and a seccnd one would be

spened i n 19613 i n .-nother goverrisrc3.te.

M r ABRAR (Sbmelin) sa id t h a t he wcs pleased t c note i n the Regioncl

Director ' s re9ort th-t mcre medical schools were being opened in the Regicn;

these would he12 t o improve the physicim/Pctient r a t i o . In Som&lia, how-

ever, t h z t r e t i u was nbout 1/200 000 'uld the estzblishment of ,? medical

school w?.s very remote. He wondered, therefore, whether WHO would consider

the estr.blishment of an inter-country medical school i n the Region 2s it

h-d done f o r the t ra in ing .of paramedical personnel.

The REGIONAL DIRECTOR thnnkeC the spe?.kers f o r t h e i r expressions of

nppreciation of the work d ~ n e by WHO ?a6 the Regicnr.1 Office.

With. reference t o the problem of malorip. i n the occupied por t s of Jzrdan

thc t had been r c i s e s by D r Nabilsi, he s z id thct the m?.lzria eradication

programme in Jordan hzd. been progressing well up t o the time of t he recent

h o s t i l i t i e s . He hoped soon t c be cble t o obtain inform.ztion a s t c whe-ther

the cane work w a s be i iq ccntinued.

I n res2onse t o the suggestion made by the Representrtive of Kuwait, he

tho-t it should be possible t o inclucle the arcblem of a l l e r ~ i e s z r i s ing

C r i m ,ar pol lut ion i n the seminm on rir pollution planned f o r 1968.

Answering an e m l i e r question frcm the Representative of I ran, he s?.il

t ha t n-: recent cases of cholera h?.d been reported cutside the <are?.s of en-

demic cholern i n the Region, 2nd t h z t lJHO w's cmrying out :. ncmber zf

s tudies with n view t o improving the eff icecy of choler? v?.ccines.

With reference t o the question of e n inter-country medic?-l school rcis?.'

by the Rcrresentrt ive zf somaiia, he thought thet such e school would be

f2.r more d i f f i c u l t t o es tab l i sh than a school f o r pr.r;imeciical personnel, :;us

s t ressed t h z t many medical schools i n the Region 'admitted students frm

neighbcwing countries, e i t he r un6er b i l a t e r a l u rxgemen t s o r on hX0 f e l l w -

shiyns.

F@hc17A/Elln. 2 page 12

D r PAYNE ( A s s i s t ~ n t Df.rsc+:-?-Gcncrrl), ?:>?'erring t o the outbreak of

food poisoning i n Q,?t?x ?.nd S-udi Arabic, srs iC tin-t WHO had received i ts

first intimation c6 the 3 June outbre& on Sunday, 4 June, ~ n d hacl immedi-

a te ly nrrsnged f c r ? st?.ff member to f i y t Q~.tnr GZI 5 >me. Other events

had, hawever, unfcr t ;~n te ly caused -11 f l i g h t s t c be c?r.celled cn t h t t

very day 2nd the person concerned f inc .11~ s r i v e d i n Thursd;ly, 8 J m e ,

which w?s >. considerable r.chievement i n the circumstances. A f u l l .cci:unt

of the incident would be svailz.ble i n due course. He wwsld, however,

-.ttemy,t t o si:nun:irize the s i t ~ c t i s n s r . f'nr as it wcs known a t present.

On four occcsions, i n t w d i f fe ren t l z c z l i t i e s in %he Eastern Ivledi-

t e r r ~ n e m Regi,.in, f l c u r intended f o r bred-m,zlring, im?orteG sr. t;,rd different

ships, w-ts he?vily cant-minated with ,? l iqu id - .griculturel insect ic ide of

very high t ax i c i ty , which hcd been pl?cld i n the same hold ,?s the sacks cf

f l ou r md. i n d i r ec t contact with them. The insect ic ide ccnteiners were

?.pparently not properly iden t i f ied , and no .'ndic?.tion w7.e given i n the m m i -

f e s t regerding the nature a d tox ic i ty of the product. The pecking was

in?dequr.te, f o r severe.1 of the receptacles leaked o r were even completely

drained of t h e i r dangerous ccntents.

The r e s u l t wes four cutbreaks of m a s p c i s c n i n ~ involvin;; hunilredc of

persons 2nd cnusing more th<ul n score of deetiis. Epidcmiol~~gic21 invest i -

gations pr-ved d i f f i c u l t swine to the l:ck of ide:i t if ication cf the product

'and, i?.t l e a s t when the f i r s t incidents cccurred, the highly com2etent medi-

c?J. personnel t h ? ~ t t reated the vict-ims XI^ the public herdth zu thar i t i es

which were seeking t o prevent z recurrence cf these intoxications faund it

very d i f f i c u l t t c disccver t h e i r cxdse.

The shigs csncerned csl led a t other pc r t s ?nd vnlr:?.ded f lour which

might h -ve Seen cont,?minated. WHO hcd t o give technics1 ?.ssistznce ts the

cauntries concerned f a r the epidemiol;gic?.l invest ipat isn of these dis-

t ress ing incidents and considereble effor t6 were made t o inform the zuthcri-

t i e s of the ports a t which dulgerous f lourrmi&t h ~ v e been unlmded.

Such incidents, the -rr=~i';y ;f wh'ch ncsded n? emphasis, could hcve

been prevented by n sim?le 5i)21ication of the spec i f ic regulations of

Cl12.3ter VII of the I n t e r n ~ . t i o n i l Convention f o r the Scafety of Life a t See

1960 ?nd the de ta i led p r o v i s i ~ n s of the Intern2t ionr l M?zltime Denzerous

Goods Code. I n p r t i c u l n r , the above Canvention required, i n t e r a l i e ,

t h z t eelh receptr:cle ccntsining dangerous ir;oods shcluld be well made 'md i n

g o ~ d condition, capable of witkstwding the crc'ine.ry r i s k s of hrnsling and

cerrizgc by se?" md , i n ~ d d i t i n , should be mcrked with the correct tech-

n i cc l nvne ( t rx i e nmes shculcl not be used), ~ n d should be 1c.belled dis t inc-

t ive ly so o.s t o m?.ke c l e m the dmgerous c:luacter of the goods. The

correct i-cchniccl nme m ~ . s t ~ l s c be shi,wn i n the m ? ~ i f e s t shcrtrin,? the dm-

gercus pods being ccsried ? ~ l d t h e i r l !~cnt ion i n the ship. A fu r ther re@-

l s t i o n prrvided f o r the segregation of inconpctible goods (which would

c lear ly include the c--sc ~f toxic l iqu id insect ic ide cmd foodstuffs sukh

2s f l cu r ) . The Dan~er9.a Goods Code, Volume 6 , which re la ted in pcrrticulzr

t o Toxic Subs t~nces , wzs besec! cn the Recommendetions of the Uniked Nctions

Committee of Experts an the Tr-nsport of Dancereus Goods in a l l matters

r e l c t i ~ t o the names 2nd clcss5ficntion of s u b s t a c e s 2nd the 1r.bels t o be

.?ff!xed ts pnck,?.ges. Additicn?.lly, the Code s ~ e c i f i e d various su i tab le

packagings 2nd s e t out appro2rizte segregcticn ?ad stowcage provisions f c r

each subs tnce .

The country of or igin of the toxic sroduct wzs, of course, immedi?.tely

informed and ected i n the most f u l l y co-oper:'.tive s p i r i t . The 2utinoritie.s

of the countries of destin?.tion zlso displayed the highest eff ic iency, but

the l?.ck of inform?.tion md the time th?.t inevit:.bly elapsed before the

cluse of the intoxiczt icns could be determined nevertheless ,zllcwec' out-

brelks of mzss poisoning t o occrir.

Steps a lso had t o be tnken t o discover tine m u t e end destinat!.on si'

one of the ships , which w?.s going i n b d l a s t t o take on e ci-wgc i h z: dis-

t en t ccuntry, so t h z t ?n extremely .thrirov.& cleening oS t h e .ccnt?min?.-.tee

holds c<,uld be c?xried cu t . T15s wrs ill eons'der-.tion, not only gf t he

pos s ib i l i t y of c thcr foodseaffs 'oecsming ccnti^m;Lncted, but d s ? of the

pos s ib i l i t y of crews o r dockers themseives being auisonea, f o r t he product

i n qu-estion wcs h i d i l y t:.xic iin mere ccnt-ct with the skin.

WHO immediztely discussed the imglic?tions with the Inter-G~vernment-1

&,.ritime Consultative Orgmization (IMCO). It wcs .-.greed t h a t these twc

Ore-nizntions should simultnnesusly r.dvise t h e i r Member St?.tes of the

cccwrences described. I n view of tne megnitude of p s s i b l e d i s l s t e r s

- r is ing frcm such cccurrences, i t hzd been recommended t h z t the f;>reGing

d e t r i l s be given se r icus consider;.tt?n by a11 n ~ t i o n r l mnritime 2nd he:.lth

zu thor i t i es , w i t h ?. view to preventin;: tnem by ttlic ,3; ;~lic?. t i :1l of ex i s t in&

in t e rn , - . t i~ in l regulnti_?ns ?n?nd reccnmeni2-.tims. It i l d ?Is3 been desired

t c exrmine the incidents i n d e t r i l nt the IMCO meeting t .7 he held i n

November 1967.

Dr MOFIDI (Ir,-.n) proposed the f c l l o w i n ~ drz.ft resclution:

The Sub-committee,

Notinc the recent unhzppy e p i s ~ d e s of m - s s p c i s~n jn i . i n severcl criuntri+s cf the region t- ccntmin%ti:>n ef whe?t i l c u r with endrine ;

Secl iz ing t hn t the n ~ l e s ?nrl rewl?.ti?ns f z r p x k - ~ i n z 'end t r -asportc t ion of f-i->6stuff, iic.rticulr?ly wheat ?ad whe?.t f l o u r , ?.re e i t he r non-exist-at sr in~.dequ,?te, thus mzking then! vulnerable t c vnricxs con t~minmts ;

Considering t h a t the i x i s t i n g ru l e s ?nC regulations f a r ;;~.-ks"ging ?nd mnritime t r ~ n s 2 c r t - t i o n of the insect ic ides were ne t f u l l y observed,

1. APPRECIATES Lke effect ive interventi.>n cf WHO 'and other agencies fir the r rp id d i ~ . i ~ l c s i s -nd c c n s e c ~ t i v e control ~ c t i ? n ;

2 . REQUESTS WHO t o take necessary action with the respective in tc rnu t ionr l orpniz?tions f o r necessary review m3 ;!rep?;~:tion of ~Aequ2.t~ 2nd s t r i c t st2ad;trds f o r pnck,?ging ?ad trsnsport?. t icn of fcodstuff , ps.rticul,?.rly st:.>le foods such 2s whe.?t f l ou r , r i c e , etc. ; 2nd

3. rWQUESTS WHO ta in t i rvenc befsre --s;;-;ctive in te rna t icnz l ?.-.cencies ,and ~overnments fo r n s t r i c t abserv?.ticn s f r u l e s r n d reguli..ticns f a r pzckaging .=nd tr?nspcrt?.ticn cf dmgerous goods.

The CHAIRIQX ~rcposec! t h z t , i n the opening sentence of the prerrble,

the wcrds "severr l countries" shoulc? be re71zced by "tws countries".

~r !& AWADI (Kuwcit) s a id th-t, ncccrdin: t a h i s informction, more

thm t w b countries were zffected.

The REGIONAL DIRECTOR then suggested the wording "scme countries".

Deoislon: tine r e s d u t i o n wzs -doi;teP as ,mended.

The CMIFiMAN reP.d out the fr l lcwing d r ~ . f t resolution:

The Sub-committee,

Hcving reviewed the Pnnt,:il Report of t he Re;:i>n-l Oirectcr f o r the period 1 July 1966 t c 30 June 1967,

1. NOTES with ?.p$reci.tion the e f fec t ive WHO co-operztion in the pro$yess which hcs Seen reccrcled dm* the past t en ye?.rs i n the

fu r the r development cf hec l th work throu@v>ut the Region;

2. ENWRSES the emp;;s~z being Siven t o t h s development of scwnd h e r l t h p l m i n g bcsed on the ev,?lu~.tion of the nctucl needs of the country concerned m2 as an i n t e p a l pa r t of the over211 nstl3n-1 sncic-economic development;

3. REQUESTS the Region21 Directsr t; ccntinue t:, give p r i o r i t y ccnsideration t o t h e i m p o r t x t question of education end tr-inin; of basic heal th m?npower; ~ n d

4. CONMENIS the Regionc.1 Director fo r h i s docwnented report which 2rovides ;. goad review of the work accomplished in etch csuntry 'jf the Region.

Phr KHEFACHA ('Punisia) suggested t h z t e phrcse be inser ted i n the t h i r d

i2."-ra?@,?>h reqwstini; the Regionr.1 Dj.rectcr to give p r i c r i t y t o the ccntrol

of communic?~ble and ccnt,?gious disenses in zddit ion t o education t ra in ing

cf basic he?.lth manpower.

The REGIONAL DIRECTOR c-.id 21?t k;: !:XI i:bjccti;n t o such ?n addition,

but it went without se.ying tha t the c ~ n t r o l cf communicable 2~16 c~n tag ious

disezses, which h ~ d been an i n t z p ? l p a r t of the prqg-mile f o r many years,

would ccrltinue t c receive pr ior i ty .

Decisi'an: the d r z f t resolution w2.s Mopted without amendments.

Dr mDW.DI (Libya) introduced the &af t resolution submitted by the

Represent?.tives of I raq, Jordm pad Liby?.. He explzined t h a t , i n cccord-

arce with the Sub-Committee's i n s t r ~ c t i o n s , the worklng pzr ty had studled

the proposils made by v,"ri3us rcpresentr t ives csncerniw the s i t ua t ion

a r i s ing :ut of recent events i n the H?stern M e d i t e r r ~ n e ~ n Region and had

draftee! the resc lu t icn i n consultetion with the Leg;il Adviser, be=-l3.n

mind the need t c keep it i n conformity with WHO'S Constitution. He then

reF.6 out the d r a f t resclution:

The Sub-committee,

Reclizing tha t the recent events i n the Emtern Mediterrae?a Re,:ion have affected and w i l l continue t o c f fec t the heal th s i t u - .-.tion in countries of the Region, with consequent adverse e f fec t cn other Regions;

Believing t h a t a prsmpt solution by the Unite6 Nations f o r t he elimination of t he consequences of these h o s t i l i t i e s w i l l put :m end t o the d e t z r i o r a t i i a ii Lhe hor.lth situ:.ti;r i- the Region as well ,?z s=fegu,?rding humm vxlues,

1. REQUESTS the !;fsrl.d Health Gi-gr.niz,-.tion t o submit a report t o the S:cret?sy-Generzl of the United N-tions indicat ing the e f f ec t cf the recent events i n the Emtern Medilerrmem Region i.n WHO'S progrzmmes i n the Regicn;

2. FUFiTHER REQUESTS the Wcrl2 Heclth Orgmiz?.tion t o continue t o exer t a l l possible e f for t s i n prcviding effect ive hezl tn ,-.ssistance t o refugees, i n crder t o ensure t h e i r cver.11 heal th protection; a 6

3. EXPRESSES i ts s incere t h a k s t o the Region21 Director f o r h i s endeevours and the essistznce extended t~ the refuged> i r b . , ~ Rrcb States which suffered frcm the h z s t i l i t i e s .

Dr EL HUMEIDAN (S?.'?di !lr:-bi?.> th;-&t %i:.t Fx t l l e r c1erific:;tisn was

needed of the phrwe "recent events i n the Eastern Mediterrpnern Region"

It should be made cleLr what kind of events were referred t o md he suggested

th7.t sime such t e rn as "?.Egression'i shculd be used.

Dr ABDIJTJLWI (Libya) repl ied t h a t the resolution h?.d been draf ted in

such e way es t o express the views zf the Sub-Committee on the consequences

cf tine events on the heel th s i tun t ion i n the Region nad on the wxk of the

Region21 Office. WHO wcs not 2 l o i i t i c a l o r g ~ n i z a t i o n snd the use of 2

wore such 7.6 "ag&ression" wc>uld conf l ic t with WHO'S Constitution.

Dr PLL AWADI (Kuwait) suggested the inser t ion of the phrase "mnd re-

pc t r i a t i on of thc d i s ~ l ~ c e d persons'' c f t e r "consequences ~f these h o s t i l i t i e s "

D r NABILSI (Jcrden) 2nd D r SHAMMA (Iraq) supacrted the proposed Pdditicn.

Dr R P m I (Syrian Ar2.b Re?u.blic) thaught t h z t the t i t l e should rePd

"Drsft Resolution Submittec! by the Representatives 3f the Arab Ccuntries"

t o m?.ke it c l e m t h a t it expressed the views of -11 of the 2cr.b countries.

He 2 . 1 ~ 0 sucgested the inser t ion of the words "2nd he?.lth care" a f t e r "over-

el l hea.lth protection" i n the seccnd ;;?.r2.e;rt~.ph.

The REGIONAL DIRECTOR e x ~ i a i n e d t h c t t he d r a f t resolution wcs only C-.

working dacurnent a d t h a t no n2mes would zppesx on the f i n a l resclut ion

once it hcd been ?doptea.

Dr PBDULHADI (Libya) edded t n z t syml3cthy with the resolution was not

limited ti the Pz.ab countries ?ad thr.t the resoluti?n, i f adopted, would be

in the rime of the en t i r e Sub-committee.

AERm (Sam,-.lia), i n supyr t in i : the dri.ft resolution, swgusted

the inser t ion of Lie ward "quick" before "re>atri<-.tion" i n the amendment

proaosed by Dr E;L A w d i .

Dr OSMAN (Sudm) suggested replccing the word "events" In tne premble

by the wcrd "wm".

D r P B D W I ( ~ i b y r ) r q l i c ? . t ? n ? % it v-z nct the ?bject cf the ress-

lu t ion t n pr>be in to ?sq of the p o l i t i c c l a s ~ e c t s 2f the situ?.tion ~rnd

tha t , ?.ccordin& t~ the leg?l ~ d v i c e they h ~ d been ~ i v e n , the word "events"

was more i n keepin(; with the s p i r i t of the WHO Csnsti tution.

After some fur ther discussion, the mended resolution we+ adopted

with the following wording:

The Sub-committee,

Realizing t h e t the recent events in the Eastern Mediterr?ne?ir~ Region hsve nffecte? ?nd w i l l continue t~ af fec t the hezl th s i t u - a t ion in countries of tho Regkn, with consequent -dverse e f f e c t on other Regions;

Believing t h a t c grompt solution by the United Nations f o r the elimin~.t ion of the consequences of these h o s t i l i t i e s 2nd the quick repekrintion of the displaced lersons w i l l put en end t o the deter iorct ion of the h e d t h s i t ua t ion i n the Region, 2s well as

safegumding human vC3.lues,

1. REQUESTS the World Hezlth Organization t o submit r. report t o the S3cretary-Gener3.l cf the Unite6 Nztions indicc.ting the e f f e c t of t he recent events i n the Erstern Mediterranem Region on WHO'S proGr?mmes in the Region;

2. F'URWR REQUESTS the \World Health Organizetion t o continue t o exer t 7.11 23ssible e f for t s i n p r sv id iw ef fcc t ive he,alth .,?ssistmce t o refugee;, i;; ;r&r t ~ . ensure t h e i r zvcr-.ll heal th protection ?ad ccre; ?nd

3 . EXPRESSES i ts sincere thanks t o the Regional Director f o r h i s endeavcurs ?nd the i s s i s t ~ n c e extended t o the refugees f r ~ m Arab Stetes which suffered from the h o s t i l i t i e s .

Dr EL KADI (United Ar,"o Republic) thanked the Sxb-Camittee fsr

adopting the resolution and drew c t ten t ion t c the f a c t t h z t the 2.ggressors

ha3 n s t snly v i d a t e d intern?.tion,-.l 1-w, but h'7.d z lso d i s r e ~ a r d e d human

velues bec?.use c i v i l i ~ n areas had clso been ~ t t n c k e d . He went cn t o give

exzmples of damage t o medical establishments, h o s p i t ~ l s , tbc. of cesu-.

e l t i e s PmonE: c i v i l i ~ n s , He ?.lso referred ta the use >f n z p A ~ ~ bombs and

s?.id t hz t 300 victims of such bombs were s t i l l i n hosp i t s l .

Dr ABDULHADI (Liby-!, re fe r r ing t z the regliest m-de i n the resolution

th2.t WHO should subni t 9. report t o the Secretmy-Gener,:.l of the United

N.?tions, u r p d thr.t t h i s should be done a s soon a s possibie, zs the United

N-.tions Gener2.l Assembly w;.s n-w i n session.

The REGIONAL DIRECTOR explained t h a t once the report of the Sub-

Ccmmittee had been :Ldcpted a t the end of the session, it wculd be presznted

t o the Director-General of 2JHO who would submit it t 3 the ExecutTve Board.

It was f o r the Executive Board t o decide what ncticn should be taken. In

any c6.se he would t r y t o submit the Re>ort t o tha ~ i rec tor -Genera l ?s soor.

cs possible.

h.. AE!DUTXADI (Libye) e p e e 6 with what the Rzgionnl Director h?d 55224,

but believed t h e t I n urgent c?ses the Chnirmpn cf the Executive %,-A

cculd ~ c t on behalf of the Board and, I f the Director-General obtaine? h i s

egreement, he could submit the Report t a the Secret?=-Generr.1 of the United

Nations without waiting f o r the %?rd t o meet.

2. CO-OPERLTION W I T H OTHER ORGANIZATIONS AND AGENCIES; STATEMENTS AND REWRTS BY RFPFBSEKPATIVES AND OBSERVERS OF ORGANIZATIONS AND PGENClES: Item 6 of the Agenda (doclment EM/RC17/9)

Dr SH.GRIF, Director of Health, United Nntions Relief and Wo,r!rs .Agency

f c r Pelestine Rsfugees, on bshc.lf of M r L,-.urence Mic;lelmore, Commissisner-

Ganer-1 of UNRWA, thpnked WHO f o r inv i t ing the Agency t c send 2. represent--

t i v e t o thc meeting.

He b e g n with c. br ie f zccomt of the he?.lth services provided by UNi?h1'k

t o about 1.3 mil l iun P?.lestine Arab refugees. The Agency wcs cintinuiiig

t o observe t he p r i n c i ~ l e of meintnining approximately t he sax? leve ls cf

hec.lth services ns those provided by the host governments f r e e of ch,?sge t o

t h e i r own c i t i z ens in comparable economic circumstances.

The mzin emphasis was on h e d t h promotion a d disease ?revention.

Chr?tive services included medical consultct ions i n UNRI4F. c l i n i c s , i n j e c t i m s ,

dressings, eye tre,?.tmenis, l l m l i u i : lent:?.l .ZC.T md the disaensing of medi-

cines. I f ilecesszry, :x.tients m i & t be referred ti. syec i c l i s t s o r h 1 s p i t r . 1 ~

2nd they were even r-ble ts benef i t frXom such recent zdvances as open cardiec

surgery. Rc~utine immmiz-tions qp. inst ce r tz in diseeses were given a t in-

fan t health centres and BCG vficcin,?ticn projects hC?d been i n i t i z t e d l a s t

year f o r infcnts md elementcry school entrants i n three countries. Mass

iwnunie?.tion programmes ?..i;cinst me,?sles were r i s o being develcped.

No crses of quai--ntincble diseases had been repcrted from eny of UNRI+!A's

f i e l d s of operztions, but following :-n outbreak of cholera i n e neighbo.ming

country i n Av.&-rlst 1966, s t r i c t prec-.utionrxy measures, including mass i m -

munizntim, had been in s t i t u t ed thrcughout these ?re,?.s. The grez tes t

challenge was still t h a t from g ~ s t r o - e n t e r i c infections, but seventeen

rehydrs.tion/nutrition uni ts with 202 cots were now i n operation t o help

reduce mortality. Other communic?.ble diseeses czusins grave problems were

the acute resp i rc tc ry infect ions , i n f e c t i m s hepa t i t i s and the en te r ic

group fevers. On the other h a d , there had been a decrease i n the com-

mmicable eye dise?.ses, lcrgely as a r e s u l t of moeern methods of treetment.

He?ltk. services f c r school children were continuing 2.: Jng est.=kllished

l i n e s , but medicnl exminati3n procedures and the system of reporting hzd

been revised. P s2ecinl study on scholnstic?lly r e t x d e d children had

been conducted i n col l rborzt icn with the ?csncyrs Deixrtment .of lBuc,-.tion.

A survey 3n h e - l t h s t r t u s , msrbidity -nd mcrtnli ty i n the pre-schcsl chi ld

(2-5 ye-rs) had been carr icd out i n dl has t ccuntrics.

A he?.lth educ?.ticn ~rogmmme h?d been inst ibdted w i t i l the aim cf en-

couraging the refugees t c recopnize t h e i r h e ~ i t h ~roblems ?ad f ind ss lut lons

t o them with the help of the he?.lth st?Yf. Heclth educati?n now formed

p a r t of the curriculum i n the Agency's tezcher t r - i n i w centres.

Tno a c t i v i t i e s of the n-wsing s t a f f were very wides~-re:.~ ?ad C-.pil.rt

frc'm t h e i r work i n v,?ricu.s hcsp i tab ?nd c l in i c s , they undertook home vj.sitin:;

rnd p-xtici;ated i n m?.ss cmpaigns of imuniz?.ticn, schocl he-lth services ,

s u p e r v i s i ~ n of inf?nt feeding -ad he.zlth educ<:.tic;n 2-ctivit ies.

To p r s t ec t cert?.in m l r z I ali;~:.'s;e j r c - q ~ s ii' the refugee popul~.ticn,

including children. premriit woman ; nwsing mothers mnd tuberculous out-

pa t ien t s , a p r c & r m e cifsupplementmy feeding hsd been in s t i t u t ed , the

sLqp1ement.s kin;- issued in the form ;f milk, spec i r l l y prepnred meals o r

~ d d i t i m e l ra t ions . Tha school milk progrmme hsd h?.d t o be suspended

9win~: tr, e reduction i n the ~ .vn i lzb le milk suspl ies . About 45 000 bene-

f i c i a r i e s , mainly i n f w t s >nd children uncler s i x years 3f ?&e, received

nu t r i t i one l ly belmced h3t mid-dzy me,~ls , and vitamin A+D c .psules were

issue?, on 26days in e?.ch month t o children attending the supplement?.ry

feeding centres. Additionnl dry r a t i ons were being issued on medical ce r t i -

f i c c t i o n t o expect?nt mothers from the f i f t h month of ,?re=<-.nc!r mnd fo r one

year c f t e r delivery, snd s lmi la r rc t ions were given t o tuberculvus out-

p ~ t i e n t s . A cornflour/soy-milk mixt7~1-e was being used cs sn d t e rn r . t i ve

s w r c e of prc;tein i n the hot-me".l >rogr,?mme.

In the environmentcl senit ,?t ion progrmme;progress was being m?Ae i n

the provision of s a f e wr.ter svp j l i e s m d there hnd been ~n i n c r e ~ s e i n the

number 2f public we.ter points and t?.ps ns well a s i n p r iva te d ~ m e s t i c con-

nexions. F, sewernge scheme hzfi heen completed in one can?- end s i m i l w

schemes were being ccxried cu t by l o c c l e u t h o r i t ~ e s w i t ? ? UNRlJA e s s i s tmce .

About th i r ty-nine per cent of refugee f m i l i e s l i v ing i n c ? q s now h~.d pr i -

vate l z t r i ne s . Waste writer dis;losal continued t o aresent se r icus problems

i n some canps s i tua ted within or n e m munici2al bzmd,?ries. V?ricus

methods of i n sec t ?ad rodent control were be in^ ~ c t i v e l y 2ursue2 *ad the

Agency wes co-oper?.ting c losely with n-ltioncl mal?xi.:. er?.dic?.ticn ?roiyilmmes.

A number of s c h o l ~ r s h i p s h<=.d been provided t o enable stu6ents t o m1er-

tzke bcsic medico1 and p l r~med ica l t ra in ing , a d p~xame6ic;-1 tr?inin~ courses

h?.d been provided f o r ~h?xmccis t s , ;,ublic heal th inspectors, 2nd l:.bor?.i.ofy

technic ims . The p r o p m e cf in-service trainLng f o r doctors, nurses pad

n k i l i a r y s ta f f w.as beb.? continued.

Dr Sh,vif then turned t-. th? effezt 01- the UNfiIJA hea l th services of

the recent h o s t i l i t i e s i n the E-stern Mediterranern Regian. After the

c e s s ~ t i o n of h o s t i l i t i e s it had been estimated t h z t there were 2-bout 116 000

displaced persons i n S p i n m d 200 000 i n J ~ r d r m . Some of these had been

zaccomodated with r e l a t i ve s o r f r iends , but the vas t mr-jority hxi crowded

in to public buildings.

El Syri?. and Jordm, rfledicel t.ems had been established ts v i s i t the

sick. In Jordnn tlie Gcvernment hc.d 2.pproved the establishment s f tented

canps and it had been ?greed t h ? ~ t UNRWA would Lack r f t e r the registcroci

refugees while tihe government would be r e s ~ o n s i b l e f o r otiier displnced

persons. Six tented cmps h?.d been es t~.bl ished by the Pgen.:y .?r.d t he

i n h a b i t a t s of these cmps now benefited f r m the normal r'mge of UNRWA

heal th services. I n Syria ,-nd East Jordrn, mess irmnuniz2.tion c;lmpnll-.;ls

ageinst tyjhoid .md smallpox had been c?.rried out tow?zds the end s f June

<md i n AuEust/~eptember rei;istered refugees hr6 a l so received 2 cholerc

booster dose. No mnjor outbreeks of comunic,?ble d i s e a e s hnil been reported.

D r Sharif described how the milk distr ibv.t ion ?ad su~plementnry feceing

?rogr?.mes l.6 been extended t o various c~. te&ories of clis3l-.ced perscns and,

i n some c?.ses, even t c children who h?.d nnot been displ?.ced. Arrangements

h2d ?.lsc been m-de t o provide "fani ly k i t s " , co r~s i s t i nz cf 2 prlmus s t w e ,

2 cooking pot, cut lery , e tc . Voiunt,?ry $r,-?niz?.tions hce been cc-c-;?erating

in supglying merls f c r displaced persons.

The san i ta t ion problems c r i s h g from the overcrowding jcf displaced

persons h2.d been ccnsiderable, hv.t i n the m?.in they hcd been successfully

rjvercome ,and in the Ga.22 s t r i p <?nd on the West Bank of t he Jordpn, the

s;init?.tion services had been running more o r l e s s normclly from the middle

3f June.

In cL,.nclusion, D r Sh?rif expressed UNRWA's d e c ~ 2.2preciation of the

va.luable ?a s i s tmce -and supsnort provided by WHO i n the form of t e c h i c n l

guid~.nce a d Rctvice <and a l so the Agency's grr-titude f o r the co-opsr?tii:n sf

the minis t r ies :>f h e ~ l t h of the host ,rovernments.

M r DILLON, Resiaent Circzts;- fir the E-stern Mediterrmecn Region,

United N - . t i a s Children's Fund, s?i& t h a t it was a g r ~ - ? t pr ivi lege f s r him

to represent, not cnly UNICEF, but -1 se the United N-tions, ?ad he conveyec'.

to rll ;,resent tine ccrc'.i?l greetings ;?nd good wishes of the Secretmy-

Genernl of the United Nations ,uld s f the Executive Director of UNICEF.. He

?.lso 2ssociated himself with previc-us speakers i n thanking the Gcvernment

of Ira f o r its hos:)itality ?md i n ccn@; . tu l a t i~ the Regionzl Director on

h i s comprehensive report .

The United Nztions and i ts 2gencies were deeply interested i n the views

of the R e g i c n ~ l Director, which 'rose from h i s long and intim--te associction

with the he;?-lth problems of the Region. UNICEF wns p?.rt;~ul?zly interested,

since children formed approximately fifty-two per cent of the t o t a l pcpu-

1-tion of the Region. The Re,nion-1 Di rec ts r ' s report referred t o the in te r -

re la t ionship between hezl th ?a< eccnomic md soc ia l 6eveloprnent. Health

was de-eendent cn the .av.?.ilability md u t i l i za t ion , not only of hospit-ls

Z n ? c l i n i c s , but ~.lsc; of socifil ?ni. welf-re services , ?ad covered such prob-

lems 2.s d i s z b i l i t y , mental i l l n e s s , ~ n d f ~ m i l y p l~nn ing . The in;~ort,?nce

an6 influence of soc iz l ?nd. environment?.l fec tors on clise;sc were well known,

?nd t'ne re?.ppear;?nce of suck, cunln'mic:.bie i i~s t : - ses as the venerecl disecses,

plague ?ad yellow fever, chcler?", l?i lhzrzicsis, ~ n d .lnfecticus hepa t i t i s

reflectec! :?rcblems of sccic".l diilgncsis ?nd c o n t r d .

UNICEF wrs interested i n many, i f n, : t a l l , of the needs nentioned by

the Regisn?.l Director i n h i s r e p r t aid wcs ass i s t ing csuntr ies i n the

Seeion t o de'l with m?ny of thein. The UNICEF Executive E!@?.rd, which had

met in New York i n June 1967, h?.d z;??rdved 2llocations ?me-~nting t o

US$ 3 192 000 f ~ r heal th pr::.jects ?nd $ 3 582 000 f o r other p r i J ec t s i n the

Region. The majsr share of its . m u d zl locat ions wns therefcre still Ge-

voted t o heel th projects.

The Execl~tive Bocrc! h?.d 2.1~0 reviewed its previous pol ic ies on ,?id ts

m.?l,-si~-. er?.dication projects 2nd h2d est?.blished its policy cin ?.is t o f.?.mily

:,l?nnin&. With regpxzi t s the fcrmcr, the 3-.:.r? hnd cccepted the recom-

mend-.tisns of the WHO/UNICEF Jo in t Committee on Health P;licy t o the e f fec t $.

t hc t it shsuld continue t5:&.~j~part malaria era3ication a c t ~ v i t i e s In accord-

mce with its previously established policy. With re&.-rd t o the l a t t e r ,

the k a r d had cpproved the report qf the Jo in t Committee on the heclth

?.spects cf f m i l y planning. In accordance with the.t policy, UNICEF eid t o

family p1:-nning could be given only i n resgonse t o goverment requests ?nd

25 p?rt of the country's he-.lth services, n o t n s :?. sepmate category of

csslstcnce. It would be l imited t o the usu,?.l fcrms of UNICEF ?.id t o hecl th

services, such as the t rc in ing of personnel and the r rovis ion of vehicles,

supplies ?ad equipment f o r metern,d end child hezl th services. UNICEF

would not tr.ke any respons ib i l i ty f o r the orgmizc t icn md ~.dminisfrrt ion.

of f m i l y ~1~minff services ,-lld would be siclee by the technic21 advice 3f

WHO ?ad the United Nctions Social Develspment Division. In ' sho r t , UNICEF

wcu.ld not wsist f m i l y plr-?ning progremes unless they were fu l ly integr,r.ted

i n t ~ the country's regular mrternal mc: child heal th services. UNICEF

would thus give tzp p r i c r i t y t c the t ra in ing s f personnel.

Dr B U M A D 1 (Libye) exp-essed h i s zppreciation of the work t h c t UNFiWA

was carrying out f o r t f i i re?;t;czs. U'""" A , .x;;:-ding t o t he stztement of

its r epesen ta t ive , wr.s workin6 in occupied ?reas such as the G-ze stri?

-nd the west bmk s f the Jordm, where it had orieln,rUy s e t ilp i ts he?.lth

services. Scnie of the refugees, however, hzd f led from thcs? zrer-s, ~ n d

he wished t o kn-w whether the services remzlned ?.s they h2.d been befcre, or

Iw.d been h~nded cver t o the occuyjring forces.

D r S H A R P , Director of Her.lth, United N?.tions iielief and Works Agency

f o r Palestine Refugees, s?.id t h? t i.11 the h e d t h services were in txt 9nc1

were being operzted by UNRWA. The &vernment :f I s r a e l h?d invi ted UNFMI?

to r e s t e r t the services a f t e r the cess?.tisn cf h o s t i l i t i e s and they were

wcrking t o t h e i r f u l l extent.

EM/RC17A/kin. 2 page 25

In reply tc. D r AL AW,WDI (Kuw-it), he s-.Lr2 th-t vitp.1 s t z t i s t i c s such

as the b i r th r s t e , the de?th r c t e , en<. the mrternnl der.th r&e, were t c be

fcund i n the m u a l g e n e r d re;-::rt published by UNitWA. The detai led

morbidity 2nd mcrtcli ty i n the pre-school zge group were under study ?nd

the findings wc,uld shor t ly be repcrted. About fourteen =er cent of the

budget of UNRWA wr.s devoted t a hezlth, i.e. $6.5 inillion out of $38 million.

M 2 s t s f the inject ions eiven were ~ n t i b i o t i c s , but v i t ~ m i n s and insu l in

were 2lso given if prescri5ed. Most 2ttendmces wcre a t the generzl c l in i c s

,and f o r the trectment of Eiserse. Simple lcbwatory techniques were em-

ployed i n the c l in ics , bu-t the f igure of 40 000 laborstory t e s t s ment5:ned

i n h i s report referred tc , the more elaborate l ~ b c r e t o r y investip?.t ims.

UNRiA hosed t o est2.blish moreel~.borcte l&or?.tories i n a short time in the

big centres.

Er NABIISI (Jordan) sc id t h a t UNRWA co-operated most effect ively t o

sc-.fegu?xd the hec l th of the refugees and t o provide deque te medicel md

soc iz l services. There w2.s one question, however, th9.t he wished t o ask

the UNRWA Representctive. In Jericho there had been 65 000 refugees since

1948 i n two camps. A s a r e s u l t of the h o s t i l i t i e s , only 2 500 remcine6 i n

the cmps, the r e s t f lee ing t o .the eas t bank sf the r i v e r along with other

refugees. Would UNRWA extend i t s services t o a l l the refugees, o r cnly t o

those whc hs.d been refugees since 1948?

Dr SHARD, Director of Hedth , United Nr.tions Relief ?nd Wcrks Agency

f a r P?.lestine Refugees, s - id th - t UNRWA operated only in 2cc~rdence with

the United N?.tions mm$?te. In cr.ses of severe hardship it could zive

emergency c s s i s tmce , but only temporarily. To extend its services on ?.

permanent b?.sis, it would require f resh instruct ions from the United Nntions.

Mr COLIJN,. k s i e e n t Representative, United Nations D..velopment Frc@'*me,

ccnveyec! t o the Sub-committee the best wishes of the Administretor of the

United Nctions Development Progranme.

The Development J-roe;rx~ie wcs mnxious t c bi: - . ssxinted with the work

of WHO within the frmework of i t s techniczl c--o2erctii.n prop;r,zrnmes, s ince

hezl th w r s sne af the b i s i c ;;~rrls ~ f ' 211 si,ci;l a d eccnomic devclc~ment.

Beceuse cf the relationshi;) b~ tween he".lth mr! economic r a c l soc i z l devclop-

ment, co-crdin?.ti,:n ?.nd ct.-oper?ticn were required between the in te rna t iona l

ngencies. I n t h c t respect , the r c l e r:f tile Inter-Agency Consultative

Bo"rd was af gret-.t import-nce . Excellent wcrking rel?.tions ex is tee throughout the Region between the

v,?rious ~rz;niz; . t ians i n the United N? . t i~ns f m i l y . The Regional Director

had mentione? grccrmrnes i n the f i e l d of nutr i t i i in 2s ru? i l l u s t m t i a n .

Similprly, r q i d c'evelopments i n the ~ec -ce fu l ut i l iz? . t ion of the ?.torn d s 3

imgnsee c l s se co-cser-tion between Fr'HO, IAEA, m d FAO. Another f i d d in

which co-cpcr.ticn occGrrc3. w?.s t h s development of wctcr resources.

P t i ts l n s t Ses s im , theSub-Committee he.d nated with concern 2 general

trend towcrds 2. decrezse i n funds fo r hecl th unZ.er the United Nations

Development &;grcunme. The Jdminis tmtcr of the P r o g r ~ m e f u l l y supported

WHO'S e f f s r t s t> ensure th?.t governgents were zwnre of the 2 y s s i b i l i t i e s

cffered by the Pr~gr-mne i n the f i e l i of heclth. The new : -0cedures

recent ly 2.dcpted by the Governing Council, t c tcke e f f ec t from the beginning

of 1969, would give mwe f l e x i b i l i t y t o ; ;>vements i n the prepmzt i sn cf

t h e i r requests f ? r technic?l i ss is tance. The ?resent system sf b i enn i l l

;ro&r?mming cycles wculd give wly t o 2 system i ~ f continuous prcgr?mminl;.

In bro,?d out l ine , therefore, wvernments would henceforth be .2ble t o submit

new requests ?t ?ny time, within the ce i l i ng (,f ? ~ i v e n ?nn.dsl t m g e t fipuri. ,

f o r prcgr?mmes spmning m e , t w , ?r three '3r mare ye?.rs, 2s the c:se might

be. In th2t w2.y pro,g-?mies would b e t t e r r e f l e c t tile r.ims :,nd the require-

ments of the rec ip ien t countries t h ~ n the previous system, which h9.6 tendeir

ts impose . ~ r t i f i c i c l l imitz t ions on :,rejects es well es t o c?ncentr?te

?l~nnir:: ind prC,-rme formul<-.tii.n intc> 2 very sh3rt peri,;d cf time before

etch biennium. Health mithor i t ies i n each ccuntry would thus be ?.Me t c

tcke f c d l ,-.dvrinte.ge of the new p o s s i b i l i t i e s offerei',.

M r FAIZ EL KHOU;II, L?ter:l.sticn?l St?t is t lc? . l E3.ucation C ~ n t r c , nssoci-

zted himself with h i s c?llengues iq expressing h i s zppreci?.tinn f o r the

hoscit?.lity prcvided i n Teher~n. The Regi~n~q.1 Director 's report w2.s r.

document of greet velue, ?nd he propased t o spe,".k G% v i t a l a d heal th

s t r . t i s t i c s snc? cn educstion ?ad. t ra ining, which were both menticned i n it.

With considerzble help frcm WHO, much progress hmi been male i n stc-. t ist ics

i n the Regicn; i n most countries some s t a t i s t i c l l services h?.6. been e s t ~ b -

l ished. Nevertheless, the s t n t i s t i c s i n the Region on the whole were poor.

~ . e of the mzin causes w ? s the s h 3 r t ~ g e of trained s t ~ i f f ; s t n t i s t i c i c n s ,

s t a t i s t i c a l a s s i s t ~ n t s cnd s t a t i s t i c 2 1 clerks were still l ~ c k i n g . The

Intern- t i . inal Stc. t ist ica1 Wuc?.tion Centre hzd s-ttempted t o remedy the

shart2ges, with some success, since it h?d t rc ined 531 students, both male

?nC female, representing twenty-twi. countries. Training was e t the i n t e r -

medicte leve l , ?nd the Centre had s s s i s t ed v a i o u s countries i n the Region

t c s e t up t h e i r own ns.tione.1 centres. Ncne of the centres in the Region

w7.s r e d l y engr-gec! i n v i t a l w d henlth s t a t i s t i c s , hnwever, except the one

i n Sav.cl.i !ir?.bin, where the l c s t yecr of e three-yerr ccurse WP.S concerned

with th?t subject . He hoped t h r t other countries w ~ u l d follow the ex?m,?l.e

of S m 2 i Ar~bi;?.

The Centre 's p?xent body hz3 decided a t i ts recent meeting t r . 1er.v~.

the basic t ra in ing course i n s t a t i s t i c s t o gr?vernments themselves cad t o put

tne Centre on t c more specialized courses. 4 condition, however, w2.s tn-i;

the United N?.tions specialized ngencies should give some ?ssist?nce, otker-

wise the Centre ruoulr? be clcsed. That woulci be a misfsrtune, since the

Centre h<?.cl f i rs&-clzss equipment f o r such specialized csurses.

I n z ~ n c l u s i m , he expressec! h i s deep 8 ~ ~ 2 t i t u d e t o the Regicncl Dircst-rr

f,?r t!le i n t e r e s t he hcd clwcys tzken in the Centre.

Di2 EL EIUTEIDPN (S-.udi Ar?.bir.) s l i d t h a t the statist ic?.l centre t h - t

Lizc? been s e t up in h i s country awed much t o the co-operation -nd cssist,l-.cc

of thd Internet ional S t n t i s t i c ~ . l Ebuc-tion Centre i n Ekirut .

Dr PAilZIN (Intern-ticnr.1 Dentp.1 Fe$.er- tbn) thpnkec: the Ch?.irmcn f o r

the pr ivi lege ;f speaking before s-zch a distinguished i.;z.therint;. The

mr.in c?.ust.s f o r the 1-aor condition of the t ee th cf the ~ t o p l e of the Region

were c-.ries md sericdont?.l disepse, Pnc! t c ) cornbet them there wns n e i a e r

encur& s t r z f , n?r encup? equipment. I n mmy ccuntries there w . ~ s ,inly one

den t i s t t i , 20 000, 30 000 o r even 100 000 :~opul,?tion, wherers i n the USA

there w r s one t c ) 1 700.

To improve the dent .1 heal th of the papulxtion, the Intern=tisn,?l

Dcnt,-.l Federation mace the fsllowini; ;!r:,pos':.ls: (i) the number of stoma-

t z l o g i s t s should be incre-sed by i n c r e ~ ~ s i n g the number ~f dentz.1 f acu l t i e s ;

( i i ) den ta l ,-.ssist?nts shculd be increzsed i n number by the crect icn of

schozls f o r -.wtilinries rnd t e c h n i c i ~ n s ; (iii) ccurses af l e n t c l hygiene

should be ore-nized, e i t h e r i n medicP.l schools, o r i n schoi l s of public

her.lth, t c ccqu?.int dcct'x-s with the extent #of the g r~b lem; ( i v ) exser ts

should be sent t 3 cr:untries t o teach the pr inc ip les of den ta l hygiene and

prcphylrxis; (v) d e n t ~ l ;-:ssrcir.tions of ecch c c m t r y should sprecd the

pr inciples of den ta l hygiene by orgrnizing "Dentcl D?.ystl; ?ad (v i ) methoris

of fluorid?.tion should be st?.nd~.rdized t;. enrble countries t o f l u ~ r i d i z e

w-ter i f they so wished.

A s regards the s i t u a t i c n i n I ran, there wer. three dent21 schcols cn6

two more would shor t ly be estT.blished. The Ministry of Hezlth h2.d s e t up

209 dispenswies fo r dental work ?nu they were dsing vr . lu~ble work. The

Heclth Corps hn6 shown i t s e l f t o be effect ive . A s regards f lu3r ida t ion ,

while it w?.s su i t ab l e in some ?.recs it m i ~ h t not be i n others. In th2.t

cannexi-n, ex?ertassistr .nce frcm WHO would be useful.

D r OSMAN (Su6.w) expressed h i s gr:itihde t o the s2ecinlized .-.gencies

sf the United N.-tions f o r t h e i r help t c the developing countries, i n :??.rti-

c s l c r h i s own. Nevertheless, he f e l t th2.t WICEF w?.s not providing

sv f f i c i en t help t o Stdrn; cxnpar2.tively the aid given r?nked pocrly, nc t

snly with th?.t given t o other countries, bu.t illso with whzt was required

f ~ r the children of h i s c?mtry. H ~ c Gzvcrnqi3nt r e l i ed on the ,-.ssistrace

cf UNICEF f o r cer ta in s ro j ec t s , r ~ d if it did. nzt receive t h r t assistcnce

scme prc jec t s mirat h w e ts be ab.-ndoned. He, therefore, hoped t h - t

UNICEF would recansider its zllotment ;f funds, especially i n the l i g h t of

the preview tha t hed been m?de f o r the next f i ve y e u s .

Dr .KL AWPDI (Kuw?.it), re fe r r ing t o the st:.tement of the Representntive

cf the Internation,?l Dental Federntion, s c id th2.t most dentr.1 csssciet ions

took l i t t l e i n t e r e s t i n c?entll hygiene. Gre.?ter i n t e r e s t on t h e i r 2,zi-t

would help governments ccmbnt dente l disease.

The CHAIRMAN, s ince there were nc more comments on thr.t item of the

-gendz, suggested t h - t the followinp d r ~ f t resolution shculd be adopted by

the Sub-committee:

The Sub-committee,

Having he-rd with i n t e r e s t the statements a d reports of Repre- , ;entntives of Or.;rmizrticns ?n< :-. ,,encies ;

Hrving studied the Repcrt s f tne D~pwtment s f Health of the United Nctions Relief -nS Wvrks Agency f ? r Pelestine Refugees,

1. THAM(S UNFlbJE, fni. continuirig t o ccrry cut its valu?.ble work i n cnring f o r the he r l t h ?nd welfare of the Palestine Refugees; ,-nd

2. EXPRESSES i ts sa t i s f sc t ion with We csntinuing close co- cper?.tion between intern<:tion.-.l org~niz?. t isns i n f i e l d s re lz ted t c he?.lth.

Dr AEIDUIHADI (Libyn.) swgested tha t m ~dd. i t Ionz1 sentence shcuid Se

ndded t c pr;mgr~.ph 1, t o s3.y t h l t the Szb-C3mmittee h:>ped t h z t UNRWA wsulc!

continue ts carry out its wcrk inside m d outside the occupied ?rec?.s.

Dr N, AWPEI (Kuweit) thou@-t t h a t it m i g h t be be t t e r t o include i n

;lil.r?.p=ph 1 ,-. sentence t 3 the e f fec t t h c t the Sub-Committee ur~ec? U1J:ildA C,3

ccntinuc tc exert i ts utmost e f fgr t s f o r t he refugees i n s y i t e cf the c r i t l c n i

situ?.ticn i n the =e?..

D r !BDUUUDI (Libyc) cr:nsj&erecl b,-jth ?nenr\ments t o hcve much the s m e

ef fec t , but the vi t -1 point wzs thc t the s-me s t ac l~ . rds should be observed

both i n s i l e 2nd outside the occujied ?zens.

De.?.ling with the suggestion by D r PL AWADI (Kuwait), he ,-ddeZ t h a t

cccsrding t c the mnndzte of UNRWA refugees were defined as refugees from

Pzlestine in nre.^.s nei~&bcurinz cn I s r c e l , i . e . the Grza s t r i 2 md the west

b?nk of the J c r 6 n . Pa les t in ims elsewhere were nzt regarded as refupees

but as s e t t l ed .

The REGIONAL DIRECTOR f e l t thn t the views i;f the Re:>resentntlves of

Kuw.".it mncl Liby? would be met by the inser t ion i n p?x?.grn.ph 1, e f t e r the

~ 3 r d ~ "P?.lestine refugees", -f the phrcse "including those i n presently

occupied rrces" . It w?.s s o agreed.

Dzcision: the drr.f=ft resolution a s mended wcs c.do::ted un?nimously.

The meeting rose e t 1.25 D.m.