AID AGENCIES CONSIDER ASSISTANCE TO ADDRESS

UNCLAS JERUSALEM 001009 SIPDIS SENSITIVE SIPDIS NEA FOR FRONT OFFICE; NEA/IPA FOR WILLIAMS/GREENE/LOGERFO/WAECHTER; NSC FOR ABRAMS, DORAN, MUSTAFA; TREASURY FOR ADKINS; PRM FOR FRONT OFFICE AND PRM/ANE; STATE PASS TO USAID/BORODIN; STATE PASS TO OFDA E.O. 12958: N/A TAGS: PHUM PREF ECON EAID PGOV KWBG SUBJECT: AID AGENCIES CONSIDER ASSISTANCE TO ADDRESS HUMANITARIAN CRISIS REF: JERUSALEM 906 ¶1. (SBU) Summary: USAID partners, UN agencies, and NGOs agreed in a March 3 consultation that they would not be positioned to cover serious gaps in healthcare service delivery and increasing food insecurity in an environment of deteriorating security and political restrictions. USAID highlighted an increased risk of disease due to worsening water quality. UNRWA and WFP expressed willingness to expand operations but will require more funding. NGOs expressed concern they would no longer be eligible for USG support due to policy constraints. All agreed that staff security was their immediate concern. End Summary. Breakdown in healthcare delivery expected -------------- ¶2. (SBU) USAID predicted that the current institutional and financial vulnerabilities in the PA MOH would likely lead to a rapid deterioration of healthcare service delivery. The MOH operates 55 to 60 percent of the primary health care facilities, 30 percent of hospitals, and 41 percent of family planning clinics. MoH funding is highly dependent on external funding with donors paying 87 percent of the non-salary operating budget. (Note: USD 58 million was spent for patient care referrals abroad. End Note.) 60 percent of the MoH budget is dedicated to paying 11,000 personnel. A cut in salaries would not lead to walk-outs but encourage medical practitioners to start informally offering services for fees. ¶3. (SBU) USAID anticipated stock-outs of key medicines would occur within one to two months. (Note: CARE reported to EconOff March 7 that the MOH in Gaza was out of 40 drugs and had only a month to a month and a half supply of other drugs. End Note.) These drug and service shortages will impact patients requiring specialized care. UNICEF representatives confirmed that all EPI vaccines for 2006 are in place, but noted EPI vaccines for 2007 need to be ordered by July 2006 to avoid any break in coverage. The PA administers 85 percent of the vaccines in the West Bank, while United Nations Relief and Works Agency (UNRWA) administers the remaining 15 percent. In Gaza, where refugees comprise 70 percent of the population, UNRWA administers 75 percent of all EPI vaccines and the PA 25 percent. ¶4. (SBU) Participants noted that restrictions on movement in the West Bank would also exacerbate the access problem. The Office for the Coordination of Humanitarian Affairs (OCHA) noted that it will continue to be difficult for Palestinians to access healthcare facilities located in the seam zone -- the area between the separation barrier and the Green Line -- where 71 MOH facilities are located. ¶5. (SBU) Turning to alternate service providers, NGO representatives noted that NGOS provide healthcare to half the population at present but noted that their coverage is limited in the West Bank and Gaza: NGO clinics are located in only 190 of the 600 localities in the West Bank and Gaza. In addition, these clinics are unable to offer a wide range of health services. The NGO sector does not have the capacity to assume the functions of the MOH, which has 413 clinics in the West Bank and Gaza. ¶6. (SBU) Asked if Islamic charities would be positioned to bridge the gap in relief or other services more generally, UNRWA argued that recent studies suggested that their capacity would be limited; the latest University of Geneva public perception report on the role of international aid showed that Palestinians currently receive only 8 to 10 percent of assistance from these charities in Gaza. Food security declines -------------- ¶7. (SBU) Asked to comment on current levels of aid dependence, OCHA head David Shearer emphasized the critical role played by direct donor assistance in the current environment. He reported that Palestinians had already turned largely to the informal sector or subsistence agriculture. The poorest areas in the West Bank and Gaza were also those most likely to be affected by rising unemployment in the public sector, as those areas have the highest proportion of people employed by the PA. (Note: Thirty-seven percent of Gazans and 14 percent of West Bankers are employed by the PA but public sector salaries are estimated to support more than 25 percent of the Palestinian population. In the West Bank, one salary supports 4.5 individuals; in Gaza one salary supports 7.5 individuals. End Note.) ¶8. (SBU) Shearer added that traditional coping strategies, including reducing expenditures, borrowing money, or purchasing foodstuff on credit were also now under pressure. Credit in the West Bank and Gaza is largely dependent on the largest employers in the West Bank and Gaza, the PA or UNRWA. UNRWA also noted that the international community would have to create 100,000 jobs in the next year alone to maintain the current rate of unemployment of 29 percent in the West Bank and Gaza. ¶9. (SBU) World Food Program (WFP) representative Arnold Vercken added that the recent Karni closures have caused serious shortages of food stocks and raised prices, creating a difficult food security situation for vulnerable Palestinian families. (Note: Karni re-opened for a limited time to allow humanitarian assistance for the first time into Gaza March 9. End Note.) An inevitable decline in law and order -------------- ¶10. (SBU) Security was identified as a serious short-term issue. As the national security institutions weaken, especially in Gaza, people will turn to their families for protection. Rising incidents of criminality such as kidnapping have been noted, and looting and extortion are expected to increase. Security tensions could also result in attacks on settlements and more frequent IDF incursions. Many NGO representatives expressed concern about a possible backlash against western institutions and governments in the event of a large-scale humanitarian crisis in the West Bank and Gaza and the implications of donor "branding" for NGO staff. USAID noted that it can grant time-limited waivers of its branding requirements for partners on a case-by-case basis. Heightened risk of water-borne diseases -------------- ¶11. (SBU) USAID reported on water scarcity and deterioration of water quality in both West Bank and Gaza. The Palestinian Water Authority (PWA) chlorinates public drinking water supplies, but may soon be unable to continue financing this operation, raising the risk of the water supply becoming contaminated by discharged untreated sewage. A recent United Nations Children's Fund (UNICEF) survey has shown an increase of intra-hospital infections among newborns, a finding attributed to higher bacteria counts in tap water. OCHA representatives predicted that public sanitation workers would not remain on the job if their salaries were cut or delayed, which would result in a pile-up of solid waste and refuse in the streets of Gaza and the West Bank, creating an immediate and obvious impact on quality of life and public health. UNRWA and WFP need funds -------------- ¶12. (SBU) Representatives from UNRWA's Gaza Field Office briefed the group on UNRWA's capacity to expand the basic services it provides to Palestinians who are registered refugees (about 70 percent of the population of Gaza and 29 percent of the West Bank),noting an increasing demand for UNRWA services as evidenced by UNRWA's 54 primary healthcare clinics. Although UNRWA assisted two-thirds of the refugee population in Gaza, they estimated that they were only meeting 30 percent of Palestinians' needs. Each UNRWA doctor currently serves 120 patients/day. UNRWA also noted that the agency, which relies on voluntary contributions, is currently in a precarious cash-flow situation. While UNRWA has two months' stock of essential medicines and food stuffs to cover their emergency supplementary feeding programs, UNRWA will need an immediate cash infusion to prevent breaks in its emergency interventions, including its temporary job creation programs and emergency food aid. Emergency food distribution normally takes three months to procure. ¶13. (SBU) UNRWA said it could immediately ramp up emergency food distribution and cash aid but were constrained by access and security in Gaza. UNRWA said their core capabilities center on primary health and education and could technically expand those services to non-refugees, but noted that the agency has no mandate to do so. (Note: UNRWA has no hospitals, except in Qalqilya, and operates no secondary schools, with the exception of one camp in East Jerusalem. UNRWA's core mandate, renewed every 3 years, stipulates that UNRWA can assist refugees from the 1948 war. An additional resolution that is annually renewed expands the mandate to cover Palestinians displaced by the 1967 war and more recent conflicts. End Note.) ¶14. (SBU) WFP explained that it sought to provide assistance to 480,000 beneficiaries who are among the most food insecure non-refugee population subsisting on less than USD 1.60 per day in the West Bank and Gaza under its current appeal. However, WFP expects its caseload to double in the coming months. Local WFP representative Arnold Vercken said 60 percent of Palestinian beneficiaries are served through the PA Ministry of Social Affairs, while 40 percent are assisted through the Catholic Relief Services (CRS) and CHF with USG funding. Vercken said WFP estimates that CHF could expand its coverage by 20 percent and CRS by 10 percent. "Food For Work" and "Food For Training" programs were under a six-month cycle and could be extended to ten out of 12 months with an immediate infusion of USD 4.5 million. He said the next fund-raising campaign would start in September and would ask for USD 15 million. NGOs may lose USAID support -------------- ¶15. (SBU) NGOs said they faced technical, geographic, and financial constraints. Five major Palestinian NGOs account for 40 percent of the NGO clinics in the West Bank and Gaza. Four of these decline to sign the Anti-Terrorism Certification (ATC) and are thus ineligible for direct funding or sub-grants through USAID. Other NGO clinics may be ineligible to be USAID partners because of a failure to pass the security vetting review. One NGO representative estimated that only 38 percent of NGO clinics may remain eligible for USAID support and these would cover only 190 of the 600 localities in the West Bank and Gaza. Safety of staff is number one concern -------------- ¶16. (SBU) OCHA representatives said the deterioration in security will influence the operations of the UN. The UN had hired private security guards for travel in Gaza. They also said that there would be an increase in fighting between families if the militants lose their jobs. One could also see an increase in kidnapping, looting, and criminality, particularly if Hamas cannot impose law and order. As a result, OCHA said the security of UN staff would be their main concern in providing humanitarian assistance. The group echoed its assent that security would determine to what extent they could provide assistance. STEVENS