“Global Health Challenges of Tomorrow: Impact and Response”

06 April 2010

Keynote Speech by Filippo Grandi, UNRWA Commissioner-General 

DIHAD Conference, Dubai, 4 April 2010

Excellencies,
Distinguished colleagues and guests:

I am grateful to the organizers for the opportunity to address this important forum and to Her Royal Highness for her inspiring words at the start of the conference. On behalf of UNRWA, let me also – at the outset – offer condolences over the sad loss of His Highness Sheikh Ahmed Bin Zayed El Nayan, who was so well known for his generosity and humanitarian work.

This is the first time an UNRWA Commissioner-General is addressing DIHAD. My presence – I hope – reflects the growing importance of partnerships between UNRWA and governments and institutions in the region. It also signals my personal determination to give such partnerships enhanced attention as we redouble our search for new ways to serve Palestine refugees more effectively.

I would like to take this opportunity to express UNRWA’s appreciation to our host, the United Arab Emirates – a generous supporter of Palestinian refugees and UNRWA. Through the UAE’s humanitarian institutions, notably the UAE Red Crescent under the direction of His Highness Shaikh Hamdan Bin Zayed, the Khalifa Bin Zayed Foundation, the Zayed Foundation and Dubai Cares, UNRWA has received many important contributions for relief and construction projects. Most recently, the Khalifa Bin Zayed Foundation joined UNRWA’s “Adopt a School” initiative in Gaza. The Foundation will thus become the principal source of support for specific schools, ensuring that UNRWA will continue to create and enhance learning opportunities for the children of Gaza.

Distinguished guests,

UNRWA’s programmes offer means by which Palestine refugees can be equipped to lead more fulfilling lives until such time that a just and lasting solution resolves the six-decades old refugee question, and their plight as the largest exiled population in the world. As many of you know, we pursue our mission in a manner which is unique in the UN system – by working directly with refugees in primary and vocational education, primary health care, relief and social services, infrastructure and camp improvement, and microfinance. We are an agency known for its humanitarian response to crises, such as in Gaza last year or during the Nahr el Bared emergency in Lebanon in 2007, but our core mandate – for the past sixty years – has been to create, nurture and expand opportunities for Palestine refugees.

UNRWA thus manages one of the largest non-governmental health programmes in the world, delivering services primarily through a network of 137 clinics located across the region, both inside and outside refugee camps. Our targets are guided by the Millennium Development Goals and our operations by the policies and standards of the World Health Organization. The majority of our staff in this sector - including some 2,500 health workers and 450 doctors - are refugees themselves. We have defined ensuring long and healthy lives for those whom we serve as one of our four human development goals.

The successes of UNRWA’s health programme over the decades – among other examples of how we help refugees improve their lives – are well known. In spite of hardship and conflict endured by refugees, in fact, our health work is widely acknowledged to have contributed to the control of vaccine-preventable and other communicable diseases, while maintaining minimal levels of infant, child and maternal mortality. And we also continuously strive to improve what we are doing, making considerable efforts to adapt to new health challenges – for example in responding to the rising incidence of non-communicable diseases. Surely, there are obstacles and difficulties. One of the most severe is the lack of adequate resources. We suffer from chronic budget shortfalls concerning approximately 20% of our overall requirements every year and this increasingly affects the quality and availability of our activities, which for many Palestinians, especially in Gaza and Lebanon, are the only access to health services. Shortage of resources also hampers innovation efforts, such as the transition from existing traditions of curative medicine to a system centred on a prevention approach – one which takes as its point of departure the avoidance of health risks at every stage of the life-cycle. Such an approach would include initiatives to promote healthy lifestyles, thus making refugee communities – rather than health centres - the principal arena for UNRWA’s health care interventions.

But besides UNRWA’s financial problems, distinguished guests, it is to the bigger picture that I would like to draw your attention – to the context in which UNRWA operates and which has a profoundly negative impact on the human development of the refugees we serve, including their health. In Gaza and the West Bank, including East Jerusalem, Palestinian lives are dominated by a cycle of poverty, armed conflict and serious risks to welfare, liberty and life. This cycle is sustained by an occupation which is now in its forty-third year, and by policies of border closures and movement restrictions which isolate, segregate and repress Palestinians, including Palestine refugees.

Even from the health perspective alone, the implications are dramatically telling. Poverty, malnutrition, food insecurity, and unsanitary living conditions directly raise health risks for many. Infants, children and young adults constitute a significant percentage of the population in the occupied Palestinian territory. They have the highest stake in the future, yet it is they who are most susceptible to the destructive, long-term effects of the violence engulfing their lives and affecting their health. These effects cannot be overstated. Psycho-social and trauma-related disorders are on the rise. The cumulative consequences of poor nutrition include stunted physical growth and impeded intellectual growth. It is the people – the most precious asset of the future Palestinian State – who are therefore being denied the long and healthy lives which should be theirs by right, thus undermining not only their individual and community development, but also – and well in advance – the promise of a viable, prosperous independent Palestine.

Recurrent armed conflict directly threatens well-being and the right to life itself, with a high cost in lives lost, injuries, disabilities and forced displacement. In the West Bank, sporadic conflict and political tensions compromise safety and human security. Physical movement obstacles blend with administrative controls to limit Palestinian access to health services and often impede the ability of UNRWA and United Nations staff and other humanitarian workers to reach those in need. This is particularly true of the health centers in East Jerusalem which are all but barred to the Palestinian population not residing in the city, in a context of demolition, evictions and refusals of building permits for Palestinians, which serve to deepen the climate of oppression.

In Gaza, the blockade imposed since June 2007 has contributed to the poor sanitary and living conditions and the demise of public health infrastructure. Tertiary health care services are either of very poor quality or are not available. Yet reports from the World Health Organization suggest that a high percentage of requests to leave Gaza for specialized health care continue to remain unanswered or be refused, placing at particular risk patients, including children and the elderly, who suffer from life-threatening conditions or are in urgent need of care unavailable in Gaza.

Distinguished guests:

In the face of the context I have outlined, the question we must confront is how threats to Palestinian health can be minimized, managed or eliminated. I direct this question not only to ourselves, to UNRWA and the United Nations, but also to you because health issues – including Palestinian health issues – are global and multi-dimensional, and by their very nature engage the shared responsibilities of the regional and international community.

But let us make no mistake: “health security” is not just a technical, specialised matter, and cannot be pursued in isolation – and nowhere more so than in situations of displacement and exile, and particularly in the highly complex political context of the Arab-Israeli conflict. Therefore, our efforts to secure longer and healthier lives for Palestine refugees can eventually succeed only if there are radical improvements in the human rights situation of Palestinians, particularly in the occupied Palestinian territory, including East Jerusalem. The current circumstances generate levels of suffering and distress which can neither be reconciled with minimum standards of health nor with Palestinian entitlements under international law. Health in its most comprehensive and holistic sense can only be an illusion in a situation of occupation that is steeped in violations of human rights and humanitarian law. This situation must be reversed if “a long and healthy life” is to have real meaning for Palestine refugees.

Ultimately, the establishment of a viable, secure State of Palestine and the realization of a just and durable solution to the plight of refugees are the means by which the Palestinian situation will be resolved. In spite of the setbacks of recent months, UNRWA calls on the parties and the international community to stay the course and to continue pressing forward towards these vital goals.

Background Information

UNRWA is a United Nations agency established by the General Assembly in 1949 and is mandated to provide assistance and protection to a population of some 5 million registered Palestine refugees. Its mission is to help Palestine refugees in Jordan, Lebanon, Syria, West Bank and the Gaza Strip to achieve their full potential in human development, pending a just solution to their plight. UNRWA’s services encompass education, health care, relief and social services, camp infrastructure and improvement, and microfinance.

Financial support to UNRWA has not kept pace with an increased demand for services caused by growing numbers of registered refugees, expanding need, and deepening poverty. As a result, the Agency's General Fund (GF), supporting UNRWA’s core activities and 97 per cent reliant on voluntary contributions, has begun each year with a large projected deficit. Currently the deficit stands at US$ 69 million.

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