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