VZCZCXYZ0000
OO RUEHWEB

DE RUEHJM #1009/01 0720505
ZNR UUUUU ZZH
O 130505Z MAR 06
FM AMCONSUL JERUSALEM
TO RUEHC/SECSTATE WASHDC IMMEDIATE 0821
INFO RUEHXK/ARAB ISRAELI COLLECTIVE IMMEDIATE
RHEHNSC/NSC WASHDC IMMEDIATE
RUEHBS/USEU BRUSSELS IMMEDIATE
RUEATRS/DEPT OF TREASURY WASHDC IMMEDIATE

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