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;0 REC leNA FflCE FOR THE EASTERN MEDITERRANEAN
'vJORLD HEALTH ORGIl,HI Z.f,TION
REGIONAL OFFICE FOR THE EAS'lERN NEDITEl1.R..hNEA.N
ANNUAL REPORT
of the
RE GIOi~AL DIRECTOR
to the
EIEVENTH SESSION OF THE REGIONAL COHl'ITTTEE
1 July 1960 - 30 June 1961
EYJ/'RC1l/2
TABU~ OF CONT8i'i':;'S
I N T ROD D C T. I .O ~
G ENERA.- L R EV I E V!
I
II ADVISOR.Y AND TE CHiUCJiL SERVI CES
EDUCATI ON :JID TR.h.HIING
CENER.A..L • • • • •
AUXILIARY TRAINING
MEDIC:,L EDUCi,TION k'JD i.S3I.sT:.,j~CE TO EDljCATIONAL I NSTITUTI Ol!S
FELLOdSEIPS PROGRAl·1!fE
COMEUNI CA3IE DI SE;"SZS
MALARIA ERADICATIOH
TUBERCUI.OS:':S , • • •
ENDEMO-EPlDEMIC DI3EAS~S •
BILHi"l.ZH.SI S
SNALLPOX
COl';}fUlIJIClLl lE EYE DISE ASES •
LEPROSY • . • • • • . •
PUB LIC HE:flLTH fillr1I NI STRATION
GENERAL • ,
LOCAL llEALT:-l SSI-tVl CES
COl-1}IUNI TY ruv-ZLOP~NT
IEl,LTH LABORi,:;O~Y .\lID ilEL:.'IED SERVICE S
l:ATEID!AL AND CHILi) :-!:;;l.LTH
NUTRITIOH
NURSING •
J'lED! CAL RE!Wl ILl TATION i iliD PHYSIOTHERAPY
HEALTH EDUCf.TIOtJ OF THE PUBLIC • • • • •
D~!/RC1l/2 page i
13-14
15-86
15- 22
15-16
16-18
19- 20
20 -22
22 - 46
22 - 34
35-37
37-46
37- 43
44-45
45- 45
46
47- 65
Lt7
43
l.t9
49- 50
50- 56
57 - 59
59-63
63
63 -65
EH/ Rcn / 2 pa ge ii
III
IV
l,Zl;T.:iL Ht~ ;'_LTH • • • • • • • •
VITAL AND HE ALTH STidI STICS ••
EN V IROI-l1'lEN TAl, SANITld'I Oll
CANCER CON TROL
RADIATIOl~ !v'EDICINE • •
EPIDSHIOlOGICAL SECTION
ADMINI STRATIOiJ· l;l.Ji) FTIH0:TCE
p~ rt:;OiJ1~ L • • , • •
BUDGE T 1,,'J1) FIiHlll CE
. . . . . .
; ;EDICAL SUPPLIE S lJ-ID :I:qUIPi' ;EHT
PUBLIC n.JFORI!ATIOE
ANNEXES :
I PflDJECTS3Y COU"rITRIES
. •
• . . •
II AGP.EEr£!·!TS ,',;'!D PL."': 'S OF OPCRATI m: SIGilEDBET\'JSEi~ 1 JULY 1950 AND 30 JUNE 1)61
66- 70
70-72
72-7 4
75-76
76-7 8
78- 86
87 - '11
87 - 88
138-89
89 - 91
92 - 95
I N T ROD U C T IO N
~4ji~~~'"i "". ',_ . " . --,.. .. . «~I, F ~
....... ______ • .",.":.,,,....,..""',;-:r..s"". ~:"" -"-;&''7.'''--'::;:~~---''''~. ___ ';''''''J!JIOOiil"" •• O'",,, .. ___ ,.., ... _ __________ --- ..;------ --- - - ------:-------
Representatives at the IY60 Sessio n in Tun!.;; of (he WHO Reg ional Committee for the Eastern Mediterranean (Sub-Committee A) .
TENTH SESSION OF WHO REGIONAL COMMITTEE (TUNIS) Thirteen countries and territories, the United Nations and various other inter· national bodies. including the Arab League, were repre sented at the meeting of Sub·Committe A of the WHO Regional Committee for the Eastern Mediterranean, which was held trom 15 to 19 August 1960 at the Bourse du Travail . Tunis •
~.~ ... ~
, .~J>
The newl v built Bourse du Tra va il. Tun is. where t he last session of Sub-Colllmittee A was held .
A group of representatives from Eastern M editerranean cou nlri<.:s to the FOll rteen lh Wor ld Heallh Assemb ly held la sl February in New De lhi.
NURSING SEMINAR, LAHORE (PAKISTAN)
T wo nu rse ad \' i ... ~ rs from th...: Sud :m pho:ographed du ring a brc.lk in i.l plt:nary sessIOn of the \VI IO Nu r" ing SC:ll in :1L
G ro up o f pa rt icipan t ..; and oh"'l;rn.: rs a t thi s meet ing which bro ugh t (ogt.:t hc r, from 23 t<o \elllber to 3 Dece m be r 1960. under \V110 <luspkc..; , ieJ li ing lI urses a nd nursi ng ad \ lsc,'s fro m 11.:11 Ea;-.l t.: rn MeJ ite rrancan count ries.
G en. W.A . Burki , M in IS te r fo r lI ealth , Lahuur a nJ Soc ia l Welfa re (Pa ki sta n). nnl- n l'd Ih ,· NII ... ;;; in o ' .. n 'l n :1 1- r n n vpnp'; La ..: ! f :.l1 in I h ,· A (."f" 'nh l ... · 1-I !\ 1I I !lhnl"l'
INTRODUCTIO N
Since my last Annual Report, the Republics of Cyprus and
Somalia have attained their independence, and this is indeed a
matter of importance to our Region. I wish to extend a hearty
welcome to the two new Republics whose participation as full
members in the work of the Regional Committee will, I am sure,
be of benefit to all.
*** An objective review of the last twelve months shows that
satisfactory progress has been achieved in most health fields.
Governments are increasingly taking account of the fact that
health is an essential element in any programme for economic
and social development, and national budgets for health show a
proportionately ascending trend. By and large, due priority is
being glven to the development of basic health services with
coordination and integration as far as possible of those aimed
at cure with prevention. A growing number of countries are
ini tiating or adjusting long-term pro grarranes along these line s.
Increasing attention is being given to the need for inter
country collaboration, and coordination of health measures in
the Region and between Regions. It is gratifying to note that
the Regional Office, in its capacity as adviser to Member Govern
ments, has been able to contribute to some extent towards these
achievements.
*** The highlights of our activities during the period under
review continued to be: assistance to countries in the education
and training of profeSSional and awd..liary personnel, combatting
communicable diseases; strengthening of national health services,
EVJ/RCIl/2 page 2
and evaluation of health measures and programmes . With the
Regional Office no., establishe d for more than twelve years, the
last-mentioned aspect of our l'lork is becoming increasin gly impor
tant, not only for assessing the value of the Hor k hitherto
achieved but particularly for the adj ustment of future plans.
The marked inadequacy of health personnel has been empha
sized in previous reports. 34.6% of our budgetary allocat ions
for 1960 was spent on training prograrr~es. It is interesting
to note that more than a third of t he professors provided in
196() by lrJHO to assist educational i nstitutions were assi gned to
the Eastern Nediterranean Region. Training of auxiliary per-
sonnel of all categorie s constitutes an important element of
this programme. The policy is still to train and recruit auxi-
liaries with a vie,_ to their ultimate absorption into a general
public health service and to avoid their over-specialization.
The whole question, however, will be discussed and an overall
policy formulated at the Inter-Re gional Seminar I-lhich is being
organized jointly with the Reg:ional Office for Africa and is
expected to be held in Khartoum in December this year. Eedical
education, which is gaining in imp ortance in the Region, will
be the subj ec t f or discussion at a , conf erence early i n 1962. A
medical education mission c onsisting of three professors visited
Tunisia in order to advise t he Government on the possible esta-
blishment of a medical school. imothe r medical mi ssion ,vill
visit Iraq this summer to advi se on strengthening the present
curricula and trainin g facilitieiJ. Thi s mission will also corn-
prise three professors, r ep resenting the clinical field, basic
sciences and public health.
ElVRCIJ./2 page 3
In 1960 it was possible to award 221 f ellovlShips ./hich is
the highest number ever aHarded in the Region. However, most
significant is the fact that out of t hese fellowships, 107 intra
regional visits Here undertaken by fellows within the Region,
.mich is also the hi~~est number so fa~ l~ached.
A consultant for medical libraries this year visited five
countries of the Region in order to advise on the future use,
organization and administration of their library services which
are of great importance in the teaching of students as ;'Iell as
for highly qualified medical workers.
The Nursing Seminar held in Lahore, Pakistan, was very
effecti ve in bringing together a large numoer of nurses from
the Region. The Hork of the Conference ,.,as commendable, and
the Regional nursing problems, including the educational policy,
were discussed. In this connexion, I am glad to report that
marked progress is being achieved in the promotion of professional
nursing throughout the Region.
Our programme for the control and eradication of communicable
diseases still constitutes a major part of our activity. 50.6%
of the Regional budget was allocated to such projects in 1960.
The shift of emphasis towards research and evaluation continues
progressively.
In the field of malaria eradicat ion, the Regional Office
has concentrated on helping the countries already undertaking
eradication or planning to do so to develop comprehensive plans
of operation, including all the guarantees that will ultimately
bring these programmes to success. More than three-quarters
of the total population of the Region is still under risk. In
order to raise the technical proficiency of the malaria eradication
El'i/RCll/ 2 page 4
personnel, training facilities have been expanded and fellol.;ship
grants increased, Two national malaria training centres in
Pakistan have been established in addition to the Regional malaria
eradication training centre in Cairo and the training centre in
Ethiopia. Negotiations are under way to open a ne,l training
centre in Sudan vii th help from lVHO and US-ICi~. DurinE the period
under revie,T, fifty-three fellovTshipswere granted to candidates
to attend regional or international training centres. r:Ioreover,
the Regional Office has met all the needs of country programmes in
illiO advisory services by assiQ1ing to them the experts required.
The Regional Office has maintained excellent coordination
and cooperation in the field of malaria eradication with both
US-ICA and UNICEF. vii th a view to strengthening the coordinated
activities of neighbouring countries approaching the maintenance
phase, a lmO inter-country evaluat ion team ,vas established in
Beirut during this period. It is gratifying to note the progress
of the Regional malaria eradication projects involving almost all
the countries of this Region, 2~d the great interest the Govern
ments hav., in giving them priority in their national hGalth pro-
gramming. The Horld Health Assembly decision on financing malaria
eradication programmes from ~egular fWlds does not obviate the
necessity for voluntary contributions. It is therefore gratifying
that the Government of Libya is next year issuing malaria eradica
tion postage stamps and donating 20% of the proceeds to the Nalaria
Eradication Special Account. The Governments of Iran, Jordan,
Kmmit, Pakistan, Tunisia and the United Arab Republic are making
similar plans and it is hoped that other countries subscribing to
the principle will also consider issuing malaria eradication
stamps, as recormnended by the Fourteenth Horld Health Assembly
(Resolution lVF..Al4. 27).
EYJj'RCll/ 2 page 5
I am glad to report that measures to eradicate smallpox
from the Region are being intensified in the countries concerned.
Hot,ever, much yet remains to be done, especially concerning'the
enforcement of legislation, and border control. The Regional
survey team completed its work in Augus t 1960 and its recommenda
tions were communica ted to the interested countries. Assistance
is being provided to several countries for the production of a
potent and heat stable vaccine . The three million doses of
dried vaccine which the Government of Jordan has offered to
donate yearly has already been put to good use in the campaigns
in the Sudan, Lebanon a..'1d Yemen.
acknowledged.
Thi s generOSity is gratefully
Bilharziasis is generally accepted as the cause of much
morbidi ty and mortality in the heavily affec ted areas of the
great river valleys of the Nile, the Euphrates and the Tigris,
in this Region. Prima facie it may, however, remain unimpres
sive as a major public health problem in the less heavily affected
areas due to the insidious and chronic nature of the disease un-
associated with the drama of other acute infections. But bil-
harzi asis wherever it occurs in the R8fion should not escape the
attention it deserves because , ironically,irrigation schemes
in such area s, aiming primarily at improving living standards,
may quickly spread and i ntensify the infection and seriously
undermine the health of the people, unless adequate preventive
measures are taken in the planning stage .
Difficulties encountered in t he successful elimination of
this infection are inher ent in the intricate epidemiological
problems involved, and the l ack of potent, safe and easily
aclmini.stered drugs and of safe molluscicides with residual
effects. The very long span of life of the parasi te in the
El4/RCll/2 page 6
human host (about 25 years) and the extremely p r olific nature
of the intermediate snail hosts create major hurdles to be over-
come. Operative rese arch r el ating to ~ransmission of infec t ion,
field evaluation of drugs ::nd the cycle of e fi'e cti ve application
of molluscicides a r e among t.1-J.e objectives of t.he pilot proj ects
"in Ira.:.. and Iraq , 'out a uide . iield of :'r.:::ic re;:;earch i::;
envisaged in the l a rge r proj ect started during the year in the
United Arab Re,;)Uolic , Province ofEg:y~t, with the participat.ion
of UlnCEF.
The p~st year has seen a crystallizat ion of certain concepts
of tuberculosis control to eno.~)le the future deve lopment of more
effecti ve pro gre.mrn.e s . As a ca se in p oint the Tube rculosis
Chemotherapy Research Pro ject in Tunisia has te rmin~ted, and
preliminary observa tions on drug therc.py ho.ve been made . The
problem of microbial r esi st2J1ce has loomed l e.rge r than ever, so
that a re-e valuati on of' singl e versus combined drug therapy has
become ne cessary. The Regional Prevalence Survey TCaJl1. has al so
finished its work. It has fulfilled its main ksk of training
national personne l in mobile co.se-finding t.:;chnique s .1hilst at
the SanE time i rj. tia ting a p r eval ence sc.mplin g su rvey .vi thin an
area of each count~r . Expericnc(c) has shmm t hat the bes t
utilization of n p revnl ence &ll.rve:y i s its c omoi nation ,·rith an
existing hco.lth service capable of foll m,i ng up with tuberculosis
control measures, Al ong simil nr li~es , t he unique project being
ca rried out in the ·~.ilotzone of Sous se , TuniSia, which ,rill ter
minate at the end of t hi s year, ~las demonstr ated thl: value of
the mass mO'oile approach c ombined Hi t h the st::tic clinic app r oach.
The c oncept of c ombined <lIld i n t egrnted progrornmes has been
felt also with regard t o BCG vaccination, so that the f easibility
of employing simple tube rculosis c o::.t r ol methods, such as
..
NEW PLAN OF OPERATIO N (SAUDI ARABIA)
A plan of operation for a malaria era· dication survc} co\ cring an arca of some 5.000.000 pupula lion sl ill ~iI ri sk. IVas signed in R,yad, on 9 Ja nual y I '!ti l , hy H.E. Dr. Has~an Na!'s if. Mini ,tc r of l-ie:1 lth (Saudi A rahla ) and the R egiona l Director.
INAUGURATION OF THE TB CENTRE (SOMALIA)
This WHO -assiste d Ce ntre set up to de m o nst rat e TB co ntrol te ch ni qu e s and tra in hea lth staff, w as inau gu rated o n 22 Ma r ch 1161
H.E. Seck Ali G iumalc. Mini"ter of Healt h ( So mal ia) del ivers his opening speech .
In the Cen tre's X- ray room. the President of the Republic of Somalia sets a good exampie.
NURSING GRADUATION (SUDAN)
A gradua te of the K ha rt oum N ursing Co llege receives her diploma from Dr. M.G . Ca nda ll . WHO D irector-General. in the pre~ence of D r. A . A . Zaki. D irector o f Hea lt h Services (Sudan) and the \VHO senior nu rse educa to r.
AGREEMENT ON ADVISORY ASSISTANCE (YEMEN)
His Highcness Scif EI Islam EI Badr, erO\\ n r ri nc~ uf the K ingdOIl1 of tht..' Yemen and Dr. A . H . Tab". W I I 0 Regiona l Direc tor. signed in November 1960. in Sana '11. an agreement for the P IO\ j:, jon of \VHO t~..: h nkal ad\ iSO fV a:..:-. i ... lancc to th l.: YI.:fl1\!Il . .
COMMUNITY WATER SUPPLY SEMINAR, .ADDIS ABABA (ETHIOPIA)
H is Imperial \· t ajt:'t~ I lail!: Sr.:I a:-.:-. il.: n':l: l."i\(~d participants 31 the Imer- Kegional Seminar on rOflll11 unil : Wal~r Supp): . \\ hich brollght IOge- ther In A dd i..; Ahd ba. frum 28 NO\~l1lber to 3 D e:."c-mbcr. pollC) - l11aklng rcp rl.: ... cntati\\,,;., from 17 A fl ican <In ti Lastern Mediterranc~ln cuunt ri!.:..:.
EI1/RClJ.j2 page 7
tuberculin testing and BCG vaccination (which are already a
feature of tuberculosis centres), will also be tried out in
health centres, maternal and child health centres, and other
clinics. It is felt that the modified methodology which has
evolved from these experiences makes it desirable to include
these in the training of public health workers in tuberculosis.
For this reason, a tuberculosis training centre to serve the
whole Region, as well as health personnel from other parts of
the world, is being established in Tunisia.
Now a brief reference to S0100 of the fields .rrlich, in the
light of new needs in the Region, are receiving progressively
increasing attention. The Proposed Programme and Budget Esti-
mates, document EM/RCIl/3, reflect this trend.
There is no need to stress the growing importance of the
mental health aspects in our Region, where very rapid evolutions
in the social fields, with consequent repercussions on health,
are taking place. iii th the addition to our staff of a Mental
Health Adviser, activities in this field have been considerably
increased and widened in scope, and it has been possible so far
to carry out 3.lrveys of the situation in eight countries and to
put on foot plans for future assistance to these and to other
countries in the Re gion. To provide guidance in this task, a
meeting of seventeen mental health experts from the Region was
convened in December 1960 in Alexandria.
Detailed plans for continuing activities already undertaken
or those envisaged in the mental health field may be found on
pages 66-70 of this Report. In brief, emphasis has been placed
on long-term plans for the training of personnel at all levels,
the integration of certain aspects of mental health into public
health activities, which will be the subject of discussion at a
EM/RCll/2 page 8
Regiona:'. Study Group meeting in 1962, the problein of chronic
cases in mental hospitals, and the important question of
organizing mental health care for children within the frame
work of paediatric services. Another interesting field . for
study is the question of the possible role of viruses in the
aetiology of certain neuro-psychiatric conditions in the Region.
As an example, it has been found that the spread of the African
horse sickness in 1960 in one country, coincided with the inci
dence of neuro-psychiatric cases of doubtful aetioloGY; in
another country there is strong support for the belief t hat
there is a relationship between mental health and entomological
and virological factors.
It is planned to hold a meeting in 1963 to consider the
introduction of epidemiological methods and coordination of
techniques for purposes of comparison. It is hoped that a
preliminary study yielding valuable epidemiological data can be
carried out in Kuwait l-Thich is largely a city state with a high
degree of homogeneity in population, and which at present is
being rapidly urbanized.
There is a growing interest in many countries in developing
provincial mental health servi ce s , and details of plans to en
courage this trend are given on p2.ge 68. During the period
under review, it has been possible to provide assistance to
countries within the Regio~ either t hrough advi sers attached
on a long-term basis to their mental health services or through
the provision of short-term consultants or teams. Of parti
cular interest in this connexion "ms the sending of a WHO team
of an experienced psychiatrist and a nurse from the Region to
study the long-established Ethioyian mental hospital which had
been unable to adapt itself to the needs of the rapidly evolving
community around it. The te= uorked in the hospital for one
EM/RCll/2 page 9
month and suggested measures for rapid refonn which are now under
active consideration. It is hoped that this experiment will
point the way to an effective and speedy method of improving and
enabling mental hospitals to cope adequately with changing con
ditions.
The extreme importance of adequate and safe water for life
and 'ftell-being does not need emphasis. The Tweli'th World Health
Assembly charged the Organization with responsibility for assis
tance to the Governments in their long-tenn plans for provision
of adequate public and domestic water supply and also for its
safety and potability. A Seminar .was organized in November last
year in Addis Ababa, where experts from the Eastern Mediterranean
and African Regions discussed the problem and their countries'
needs. The Regional Office is also assembling a team of experts
to be available for advice to Governments on request. The team
will be visiting Pakistan later this year.
Ionizing radiation is being used more and more in medicine
and also in other fields such as agriculture and industry. In
medicine, the main sources of ionizing radiation are X-rays and
radioisotopes - the former now universally used in the Region,
and the latter increasingly so in some countries. There is
therefore clear need for Governments to develop sound programmes
for reducing health hazards from such medical or other sources.
The RegionalOffice 1s now prepared to furnish advice and help
Governments on this question, especially with the training of
personnel in the use of radioiso~opes, radiation protection
and safe waste disposal. A number of fellowships are being
awarded and a training course is planned.
EM/RCll/2 page 10
Other fields such as nutrition especially as related to
maternal and child health, cancer epidemiology in the Re€,ion,
virology, especially with reference to trachoma and poliomyelitis
and its reported increase in our Region, housing and its rela
tion to health, these are subjects where surveys and studies are
under way. Detailed reference to these problems is made in the
"General Review" of this Report and also in technical documents
presented to the Committee .
I am pleased to report that the Arabic version of the
International Statistical Classification of Diseases, Injuries
and Causes of Death is about to be completed and is expected
to be available to the Regional Committee at the Eleventh
Session.
As far as the organizational and administrative pattern of
the Regional Office is concerned, I have no major changes to
report. It is hoped to strengthen the environmental sanitation
advisory services by the addition of a sanitary engineer to
assist with the community water supply programmes. In this
connexion, the financial assistance available from the Inter
national Development Association for such projects is worth
mentioning. One major step in the extension of the activities
of the Office to countries of the Region is the establishment
of · additional Area Representative/Country Adviser posts, a
number of l.mich, it is hoped, will be filled shortly. It is
gratifying to note the inte rest and the support of the Govern
ments in the filling of these posts.
The work on the top floor of the Regional Office building,
which includes a conference hall, is now completed. In this
EM/RClJ/2 page 11
connexi on, contributions in kind from the Governments to the
decorations and furnishing will be welcome so that the artistic
and cultural traditions of the Region may be well represented.
1t- * * Close liaison continues to be maintained with other agencies
and organizations. Under the nerT decentralization arrangements
of the United Nations Children's Fund, good collaboration at the
country level as well as through their Regional Offices should
prove to be fruitful in the future as in the past, The Regional
Office has worked closely with the Technical Assistance Resident
Representatives, whose cooperation and assistance at the country
level in our programme planning has been most helpful. Contacts
with the United Nations Economic Commission for Africa have been
established through the WHO representative in Addis Ababa and
also by the advisers from this Office attending conferences
organized by this Commission, The Regional Office has also
been in close contact at the regional and country level with
the staff of the United Nations Department of Social Affairs in
connexion with their new community development projects. Co-
operation with the Food and Ag~culture Organization and UNESCO
has continued to be maintained by regular exchange of infonnation
and by visits of officials, and contacts with the International
Atomic Energy Agency are increasing. l'lliO is also closely asso
ciated with the activities of the International Bank for Re
construction and Development in this Region and very recently
with their mission in Kuwait.
Collaboration with the Health Department of the League of
Arab States is being further strengthened by an agreement with
this inter-governmental organizat ion. Close contact has con
tinued to be maintained va th the United States International
Cooperation Administration and other bilateral agencies.
EN/ RC1J./ 2 page 12
Thlri ng the peri od under revieH t he Govsrnmc nt of Saudi ilro.bia,
in collo.bor2.tion with l\lHO, start0d c. progro.mme of studies on the
effects of exce ssi V b heat o...1'J.d solar r c.dio.ti on on humc.n hec.l tho
This is 0. Drobl cm of' spocid importsncE: to this Re &i o:: , On the
invi tation of the Saudi i,raoio.D Government, the Re gioY!o.l Office
sent a teo.m of experts tc particip o.te in the liecoa Pilgri=ge :md
assist thu So.udi i,ro.bian :L;o.lth ;,uthori ti0s with their studies on
heat diseases and sun stroke , Useful do.to. wer e obto.i nc d 2nd t he
studies 2.re b eing continue d in collabor o.tion wi th the Government,
On the bo.sis of the findings, 0. docum<..mt \,ri.ll be prepo.red for sub
mission to the Rc 6iono.l Committee next yeo.r when the subject for
Technical Discussions will b e "Sol o.r RC'.dio.tion o.nd its Re l ated He C'.t
Effect on the Human Org2.l1ism".
I s.~ ould like he re t o t h:mk the Govurnment of Saudi i,rabie. f or
hc.vin g invite d l'iHO to po.rticip2. t e in their pr ogr~.rnme of studies on
he[,t effects, 2.nd o.lso to rei"r t o t he considerabl e l·;rork and effort
of their Heo.lth i,uthori t i e s in beho.lf of the pilgrims. It ",re.s r:.
remarkable f e at t ha t the Dilgrim2.ge S02.S0n , involving 1,185, 940
persons from all ove r the world, proved free from quo.ro.ntinable
diseases and m2.jor hGc.lth h 2.zo.rds.
Before passi n g t.o th0 Gen(;; r a l Rr~ vi ()w of our work during tha
year, I sh::mld like to express my l1c.m thanks b ot.h t.o i ndi vidu<ll
Gove r:1lllents c.nd to the RcgL"1,~.l Con'C.i tte0 0. 3 <l "hol e, f or t.heir
c onstont coopcr:'.tion whi ch me on s s o much to us ~.ll in our ,-lork,
and h.J.s m'J.de possibl" tha conc0rted effort. t ho.t is csscntic.l to
st.e c.dy progre sS .
Pilgri ms in front of the main hospi tal in Menu. F irs t-aid l:<lrs are read) to pick up eme r£ency ca~cs .
11.L. D r. Ha ssa n Nass if. M inis ter of Hea lth of Saudi A rabia. h is senior tech nica l staff a nd \~/ HO ad\'ise rs rev ic\\'cu the health sitllJ tion duri ng the 1380 (1961) P il gri mage scason and signed the declaration on rhe freedpnl or th is 'eor', Pi lgr image rrom qua- MECCA PILGRIMAGE (SAUDI ARABIA) ra ntinable disease. .....,
\
G ENE R A L RE V l E W
EM/RCll/2 page 13
I THE REGIONAL COI'1MITTEE FOR THE EASTE1'tN I'1EDITERRANEAN 'lENTH SESSION
1. Sub-Committee A of the Regional Committee met in Tunis from IS to 19
August 1960 and Sub-Committee B met in Geneva from 24 to 26 August 1960.
The resolutions adopted by the two Sub-Committees on subjects common to
both agendas were identical.
2. During the discussions which led up to the approval of the Annual
Report of the Regional Director, it became evident that the majority of
countries had made advances in the field of health during the year under
review. The education and training of ;:>rofessional and aUJd..liary per-
sonnel was again mentioned as an all-important task but the latter should
be recruited and trained with a vielv to their absorption into the general
public health service s rather than in specialized fields. The -necessi ty
to continue assistance to medical faculties was particularly stressed.
It was considered t hat the evaluation of the fellmvships programme would
be of great help in formulating future plans and the evaluation of other
regional and country programmes was urged.
3. Approval was given to the general trend towards inter-country and
inter-regional activities. In the field of cammunicable diseases
advances in the eradication of malaria and smallpox were commended, but
it was considered that inter-country cooperation and legislation should
be improved, and that particular attention should be given to research
in trachoma, bilharziasis, tuberculosis, leprosy and onchocerciasis~
The paediatric aspect of maternal and child health should be- strengthened
and in the field of nursing it was urged that the curricula should in-
clude social medicine, public health and mental health courses. Concern
was expressed in the problem of nomadism and it was recommended that
studies should be undertaken on its influence on health problems.
Interest was shown in the nevI developments in environmental sanitation,
particularly community water suppl y, in housi ng as related to health
EM/RClJj2 page 14
and in radiation medicine. It was recognize d that social and economic
advances in the Region were making it essential to give closer considera
tion to mental health problems and to promote hea~th education of the
public. In again emphasizing the necessity to coordinate activities
between countries and regions the increasingly close cooperation between
Governments, i·mO and uther agencies and organizations vms commended.
4. The proposed programJ11.e and budget estimates for 1962 1·iere endorsed
and general appreciation was expressed for the continued emphasis being
placed on corrmunicable diseases, environmental sanitation , mental health,
nutri tion and education and training. The supplemental technical assis
tance programme for Cyprus and Somalia was also approved, and in the
latter connexion the ti'W new Repu'olics were congratulated on gaining their
independence and Kuwait was i·,elcomed as a new membe r of the Regional
Committee.
5. Malaria Zradication, Mental Health, Kala-azar (Visceral Leishmaniasis)
and the Public He alth Role in the Disposal of Radioactive i-Jc.ste were the
technical matters di scussed.
6. During Technical Di scus sions on "Tuberculosis Control ,lith Particular
Reference to Domiciliary TreattJ.enttl it vTas recognized t hat tuberculosis.
remains one of the principal medical and social community problems in the
Eastern Hedi terraman Region. It was reco~mended that control p rogrammes
should be made simpler, more econo~~cal a~d effective, utilizing BCG vac
cine and anti-microbial drugs i n the prophylaY~s and therapy of tuber
culosis. Emphasis should be placed on progr =es based on domiciliarj'
chemothe rapY. It was pointed out t h&t s olu~ioLs to the complex problems
involved in setting up an effective national programme must be considered
within the context of national resources, priorities, and culture .
7. l1S01ar Radiation and its rk lated Heat Effect on t he Hu.:J.an Organisml1
was chos'en as the subject for the Technical Di scu ssions in 1962.
l1Poliomyelitis"will be t he subject for t he Technical Discussions at
t he Eleventh Session of the Re gi onal Comllli ttee . -
II ADVI SORY AND TECIE ICAL SERVICES
EDUCATION AND TRAINING
GENERAL
EH/RCIJ/2 page 15
8. The principles underlying t he ,IDole education and training programme
were explained in detail in last year's Report and it .. TOuld thus seem
sufficient this year to summarize the salient points and to dwell only.
on some of the main problems which are being encountered. Their assess
ment should further collaboration between HHO and the Goverrunents in the
proper analysis and channelling of reque sts and ensure that the resources
of the Organization are used to the best advantage.
9. The basic concept developed by the Organization to overcome the
shortage of trained professional and auxiliary staff by assisting Govern
ments to increase their training facilities, has been strengthened.
Projects undertaken in t he field of me dical education range from the
establishment of medical f~:ulties in Regional countries to the vocational
training of girls and boys for health vlOrk in situations where practically
no vocational training existed before. Careful study preliminary to
gi ving "JHO assistance, direct contact 1-1i. th Governments and educational
authorities, the follow-up and occasional evaluation of active projects -
these are phases of the work l.mich , if given emphasis, will lead to still
better results. Conside ration must be given to the varied local condi-
tions and to the availability of national resources. Priorities for
projects which need inte rnational assistance, type of assistance to be
given as well a s extent and timing, are factors which ne ed constant
revision.
10. It has previously been emphasized that, although educational work
is of a long-term nature, 1·mO assist ance to individual programmes must
o~ necessity be within the limits of available resources and a yearly
budget. The criteria for the selection of a p roject should be fully
EM/RCll/2 page 16
understood: it should be urgently needed; it should be of such a nature
that local resources alone would not permit it to be ~~dertaken and there
fore international assistance is essential; it should be expected to
result in strengthening the national health services. Staff educated
or trained t hrough 1"n-:O assistance should be required to )Jut their services
at the disposal of their Government, and the Goverr~ent in turn should
immediately prov-lde for them Hork for which they have been trained.
11. Inter-country training projects, even if limited to a few countries
and not involving a whole Region or Regions, obviously differ widely from
those designed to assist only one Government. The former type of project
provides for the training of personnel in various categories for specific
purposes (e.g. for malaria eradication) who, upon repatriation, train
their own countrymen, it enables experienced educators and administrators
to exchange ideas; it affords opportunities for groups of highly qualified
professional workers to visit one or more countries mld learn through ob
servation and discussion (USSR travelling seminars). These activities,
apart from providing the envisaged educational eJq:lerience abroad, have the
advantage of bringing people of the Region together, allowing them to be
come fa."11iliar .vi th one another I s problems and thus bring more personal and
professional un.dersta.~ding.
AUXILIARY TR.4.TImm
12. Experience during the period under revieH has shOHn that equally
important to the selection of trainees, preparation of ~ualified counter
part teachers, effective utilization of the graduates, is the strengthen
ing and development of a comprehenSive health plan as part of the country I s
overall socio-economic policy. If such a plan is conceived, worked out
and agreed upon then it is not too difficult to define the types and num
bers of personnel needed and to ensure their err.ployment. This will also
help to solve another problem, that of adjusting the work of personnel
previously employed who may have had only practical in-service training.
It should be realized th".t the training of au..uliar ie s is progressive
EY,jRCll/2 page 17
and involves not only the educator but also the administrator who plans
the work as Hell as those i'Tho need the services of the trainee in the
co~~ty they have to serve,
13. In one country an interesting study Has undertaken to evc.luate the
utilization of the trainees after graduation. The results showed that
the maj ori ty of the graduates (94%) 1,ho answered the questionnaire were
actually employed in the field for which they had been trained, and that
58% of the trainees were working under supe:cvisors .. Tith higher qualifi:-
cations than theirs. It is interesting to note that 11% of the trainees
were i'TOrking in national schools in order to acquire higher general edu
cation; 19% of the trainees had been granted scholarships by the Govern
ment in order to take higher courses in their field of study and be pre-
pared for further work in the health services. ~,o-thirds of the gra-
duates \fere of the opinion that their training was not long enough and
that it should be extended and ~ore particular err.phasis should be placed
on practical training and health education. Some of them had encountered
certain difficulties particularly when working with untrained health assis-
tants who had been doing the job before. This \'las one of the points
mentioned by graduates ,-Tho had had one to three years of experience. These
facts clearly indicate that although certain adjustl'lDnts may be necessary
in the future the immediate results of this traini~ rr can be classified is
successful.
14. The use and training of au.."d.liary personnel in medicine, nursing,
midwifery and sanit a t ion was the subject considered by the viHO Expert
Commi ttee which met in Geneva f rom 19 to 23 September 1960 and ,·lhos e
report was published early in 1961. (1) It is 1-iorthi·lhile to note the
approach to the probler:. nO'll being adopte d since it has become more
(1) Technical R(?port Series No.212. The Use an d t he Training of Auxiliary Persor-ncl in Medicine, Nursing, YJidwifery and Sanitation. Ninth Report of ~he Expert Committee on Professional and Technical ~ ducatior. of Medical and Auxilia rJ Personllel
EM/RCll/2 page 18
important through the independence of a numbe r of iurican countries.
Health services which had previously been krgely run by IIE:::pe.triates l1
become their O1oJl1 responsibility. The f, rowing realization tha t such
services should consist of far more thc:rc simp ly providing medical care
to a few urban centres, ho.s ir:creo.sc d demands for the training of per
sonnel, particulo.rly for those local and !"Qral areas where health C'J1d
social services are inadequ:'.te.
15. The report of the Expert Co~ittee will be of great help to all
those countries still needing auxilio.ry workers and few countries can
entirely dispense with them. It might be thou ght th.:'..t in highly deve
loped countries auxiliaries 1-mre superfluous, but on the contrary, . with
the growing specialization i n the professi onal fields their training now
is necessc.ry to staff the r:ev, s ervices thJ.t are developing.
16. The Regional Seminar on Training of Auxiliary Health Personnel
mentioned in last yec.r! s Report is now being planned 2.S o. joint inter
Regi onal project, l·lith the Reg'ioml Office for Africa and \J;-':O Headquarters,
and is scheduled to be held a t the end of this year in Khartoum.
17. Loce.l persmnel should be trc.ined a s ttfront line "Torkerstt in the
various brenches of health, s ocio.l service, eciuc~.tion, agriculture, to
work to gether in teams nnd towo.rds their common goal - the development
of thei r community. They should be taught that to Hork effectively for
the people is to ,lork with the people, CL'1d an underst=ding of thi s fact
on the po:crt of -!be communities themselves will further the proper traih
ing o.nd use of auxiliary workers. Hork to\·I~.rds triG end at t he UNESCO
sponsored Aro.b St.:ttes Training Centre for Education in C orrc~'uni ty Develop
!rent has continued and cooperQtion 1-Titb the Re gi onal Office h.:ts been
further strengthened. Sever.:tl Governments have r equested HHO group
fellowships for training o.uxili :'.rie s there, and t h e se rvices of a IlliO
Public Health Adviser have 'oeen continuous .
A \VH O ad\ i:-.a ,n the Iligh In st itute of Public HI.:a llh . Akxa ndria. conducts a ' \ :hamba" experiment. Samples of polluta nt s from mine!) Ilf fact ories are imruuuccd Into the chilmhcr. together with a gUlllc<!·pig. for
EDUCATION AND TRAINING (UAR, IRAQ) tox icilY Il1c,",urcmcnl pu rposes.
Students fro m the School of Sanit3rians (Baghdad) wa tc.'h o ne o f the milk pasteuri.lation processe"duri ng a field vis it 10 the Milk Con,er\'3tion Pl an t in Baghdad - a jo int UNICEF /FAOl(raqi Government p roject.
( ~)
HEALTH CENTRE AN D TRAINING SCHOOL
(YEMEN)
Nurse trainees of the Ccntrc'~ MCH dinic, Sana'a. follow one year o f general .:cillca tion oefore taking up nu r~ lf1 g (,,:u ur!<. I.! ::,.
I
The: 10l:al Child Welfare Society ha s donated a sewing machine to make In; ,!'Ic~ fn r poor children .
Smiling Yemenite child nnds routine examm:ltio n faIrly pleasant. The 'V.' H 0 mi l's," educawr a n"\\'ers a qucr~ On ::, kdew l anatomy .
EM/RClJ/2 page 19
MEDICAL EDUCATION AND ASSISTANCE TO EDUCATIONAL INSTITUTIONS
18. The establishment of new medical schools in this Region is going
forward with increased impetus. Administrators and educators realize
the need to the full as well as the numerous problems inherent in such
an important undertaldng. Previously, medical schools were largely
established by cultural agreements with more developed countries or by
colonial powers. However, it will now be the countries themselves who
must take responsibility for such an important step in their educational
and medical growth. Medical education cannot be undertaken on a year
to year basis; it is a process of long pla.'Uling, of surveys, of deli
berations, often necessitating execution by phases or steps.
19. As financial resources are limited the Office has given careful con
sideration as to how best to fill Government requests for assistance in
the field of medical education. Large capital investments are needed,
particularly in the beginning. Teaching hospitals, basic science depart-
ments and research facilities .need continuous support. The role of the
Regional Office is by necessity largely confined to advisory services.
W~ thout overestimating this n':'ldest f U:1c tio; . it fa.".:;" well l ead to
important results if advice is given at t he right time and in the proper
form. During the period unde r review, an Advisory Medical Group of
three professors visited Tunisi a.
visit Iraq later in 1961.
It is planned for another group to
20. Another project of an advisory nature has b een realized during the
period under revie\v. From p re·vi ous visits t o me dical schools it has
been observed that the me dical libraries in t his Region are one of the
weak points. The faciliti e s of a well-organized library are an important
instrument in forming the future m.edical doctor. A librarian consultant
during some months in early 1961 visited five countries .dth a view to
finding out what could be done to s t rengthen library facilities. It is
not only ·t.~e number of b ooks and journals tha t make a good library;
other factors may contribute more to the education of the student.
EM/RCll/2 page 20
The organization of the library, the system of catalogLLing and indexing,
the physical facili t ies, the presentati on of new books, the training of
the librarian and his staff, all these are import,:mt considerations when
developing this ~~cillary service,
21. Assistance to undergraduate medical training through visiting pro-
fessors and lect~rers in a variety of subjects is continuing.
as emphasi zed previously, priority is being given to the fields of public
health, social and preventive medicine, rather than to the basic sciences.
22, The postgraduate training facilities in the Region have been directly
and indirectly assisted and strengthened. A professor of r,latemal and
child health has served in the High Institute of Public Health in Alexan
dria and a profess or of sanitary engineering in the School of Public H.ealth
at the American University of Beirut. For the first time two \-JHO fellows
followed the DPH course in Alexandria. Twenty-one fellovls studied at the
American University of Beirut. The policy of t he Office is to provide as
much training as possible inside the Region. An important development in
this direction has been a 1:JHO-assisted project i n Israel, in which now for
the first time a DPH course is being given to nat ionals of t~is country,
FEIUlWSHIPS PROG~
23. It is fully justified that the fcllm-lships programme should be
stressed since fellOt;ship s complement special projects of assistance to
l"iember Governments. Some fellowships although not di rectly conn"cted
¥lith a project :ire compatible .vith ';.'EO ' s objccti ve, 'lhich is to strengthen
the health services of the country, Others are :'l.1varded for training
abroad Hith the aim of providing Governments 'With qualified staff to
teach their countrymen at home.
24, The nwnber of fel1mvships a"larded in the Region since the Office
was opened in 1949 , by the end of 19CD had reached 1629. Last year a
record of 221 fellowships were mvarcle d compa:c-ed ,-n. th 217 i n 1959.
Another record set in 1960, ~~ich is perhaps more significant to the
NUMBER OF FELLOWSHIPS AWARDED BY WHO EMRO 1949-1960 (FELLOWSHIP EXTENSIONS ARE
NO T INCLUDED) --,
YEAR COU i;T RY
191'.9 1950 1951 195 2 1953 19?1'. 1955 1956 1957 1958 1959 1960
ADEN - - - - 1 - - - - - - -CYPRUS - 1 - 3 2 - - - - 1 I'. 3 ETHIOPIA I'. 13 10 9 6 1 5 3 7 B 5 7 IRAN 8 10 7 27 34 16 29 15 3,{. 38 27 13 IRAQ 1 2 3 13 19 6 9 7 12 18 16 12 ISRAEL I 2 9 15 I 2 7 7 5 10 11 1 I 10 JORDAN - 1 5 2 4 3 6 3 5 B 13 18 LEBANON 1 4 8 6 17 8 B 9 1 B 17 15 1 ) LIBYA - - 1 5 6 I'. 7 3 9 5 1 ) 12 PAKISTAN 7 4 12 12 14 4 13 I'. I 1 10 20 19 SAUDI ARABIA - 2 4 3 3 1 4 4 5 1 14 1 I'. SOMALIA - - - - - - 5 1 6 9 12 12 SUDAN - 1 5 1 8 5 7 7 20 19 25 28 TUNISIA' - - - - - - - 12 II'. 12 I 9 22 UAR EGYPT 10 7 10 9 31 18 33 11 26 38 12 17 UAR SYRIA - 4 10 5 16 6 22 10 17 6 8 8 YEMEN - - - - - 2 12 2 2 - 3 13 TOTAL 32 51 84 110 173 81 167 96 196 201 217 221
• Tunisia has belonged 10 Ihe Region only since 1956
1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960
Figur~ 1
TOTAL 1
14 78
258 118 100
68 1 2 I'. 65
130 55 45
126 79
222 112
34 1629
300
200
100
o
Numbt'r
.~ · ~
. , ~ • .~ • , ~
55
· ! • ~ .. : ~ · · l
Fi9ure \I
NUMBER OF FELLOWSHIPS AWARDED FROM 1949 THRalGH Number
~ ., ~
1960 BY SUBJECTS (EXTENSIONS EXCLUDED)
I IJ \ · I
~ · · : .! · , ~ '': • \" ! · · ~ : · • : · ! i ~ ~ w ~ w . i : . ~ ~ · · .. · ~ ~ • • · : . ~ · ~
~ . . ; ~ { i /; • ~ "
· ~ ~
.~ · :~ ... ~ !! ~
.. : , ~ . • ~
IJI] I1Iii1Iil : :. ; l .. .. .x r t .. ~ . .< i ~ .. ~ ~.
~ ; .~
~ ! 1 . • . ~ . . ... ... Q ,
150
140
130 1--=:".------1
120
"0 1-_____ 100
; ! l ': i § .
i .. . ! . , . .. <
.! " ~ . ~ ..
C_~.61. DitU'H
90
80
70
60
50
40
30
20
10
o
Fi\lure m
FELLOWSHIPS FOR UNDERGRADUATE STUDIES UP TO END OF 1960 Numb.r 60
55
501----------------------------------------------------------------4J~50
45 45
4 0 Ii) Modoc ine ED Environmenla l San ila lion --------------------------------------. .f.;: -·,,0
35 III NU " "'9 tl' E.l ens ions .t::". i"" ~5
30 Ii) Phar macy ------------------------------""------.F.,-: .. ~----{':'H-----_f .. ~-4;: -~O 25
~.
1956
r .: --- ::; ~---Ell___
'" 1957
F
lW 1958
..
..
..
t::: 1959
25
IS
- 10
5 ..
~ 0 1960
EM/RCll/2 page 21
development of the Region i tseli , is the number of intra-Regional fellow
Ships, that is, those awarded for visits or studies in countries within
the Region. This figure is 107 compared with 103 in 1959. In these
two years, the number of intra-Regional visits increased by 50% over all
previous years. This in itself is an indication of the success of the
policy of the Office, as 1.;ell as of the efforts of the Governments, to
foster professional and technical training wi thin their own countries and
to provide facilities for health personnel closer to the area where these
people later on will have t o work. It i s evident that this training is
not only cheaper but also more generally realistic and applicable than
that provided far aHay from t he place of .!Ork. It is worthwhile to note
that about 50% of the fellowships are of two to seven months' duration
whereas another 25% are for twelve months , or for an academic year, The
others, besides a feH short f ellowships of less than two months, are mostly
long-term undergraduate fellmlships of several yea rs I duration.
25. The difficulties inherent in the fellowships programme are well known,
and it is clear that there is still considerable roam for improvement •.
Apart from the individual selection of f ellows, their knowledge of language,
their prope~ utilizat ion and the arrangerrent of an appropriate programme
and place of study, there are t·,ro main points which should always be borne
in mind and on which the Re t ional Office places particular emphaSis when
requesting the cooperation of the Governments :
(a) To consider the fellow ship s progr amme not only as an opportunity
for individuals to incre<:.se their knowledge and experience but also as an
inst rument for Governments to put into practice long-term health plans.
Fellowships prograrrmes should be adjusted and priorities set according to
.the fields . and programmes Hhere better traine d personnel are most needed,
This entails in i tseli coordination of the various fellowship schemes
whether national, international or bilateral.
(b) To use fully the r esources of the sponsoring agencies in the .
process of selection. I t has been mentioned on various occasions .that
EM/RClJ/2 page 22
j:.he WHO Regional Office staff is available for continuous advice in the
selection of candidates and it should be stressed that the Governments
have been asked by the Organization to include a WHO representative on
each Selection Committee as a non-voting adviser.
26. Arrangements have been made in the last twelve months for as many
fellows as possible to visit the Regional Office. This is not only for
the purpose of discussing with them their programme and to ascertain their
experience, but to develop professional conte.ct between the fellows and
the technical staff which is beneficial to both, These visits are usually
planned for the end rather than the beginning of their studies.
COMMUNICABIE DISEASES
MALARIA ERADICATION(l)
IEVELOPI C:IT :.l-ll EXPE .. Ell(z
27,' Since 1956, when malaria eradication programmes started in this
Region, both Governments and international bodies have gained a great deal
of experience; following is a summary of the various aspects.
28, Administrative and Financial Aspects. The most outstanding difficulty
when planning such programmes is to convince the Governments that full
administrative and financial powers should be accorded to a governing Malaria
Eradication Board. This is necessitated by the nature of these programmes
which should run with military precision following a pre-fixed operational
ca:l.endar, Delays in recruitment and training, in adequate remuneration to
attract the best personnel, tardy filling of financial commitments, delays
!in procuring local supplies and in clearing through customs and distribu
ting imported supplies, interrupt the progress of the programme. The ser
vices of the WHO malaria administrative and manageroont advisers have proved
(1) See: Document EM/RCll/4
T he ma lar ia survey boa t on a ri\'er of the Sundcrba nds.
MALARIA ERADICATION (EAST PAKISTAN)
Blood smea rs collected fro m lrihal children in the ROlo langar Fo rest will undergo mi c.: rosco pic examimu ion to ascert a in if they carry parasites.
S" ili n p for rhp "P.~ I n n ,;> r ,., t i"n ... l 'l" "'"
An entomologist cross ing a ba mboo hr idge on his way 10 the nt.!x l area likely to pro \' ide a bret.!li ing ground fo r ma laria mosq uitoes.
Children in the Garo Hill , are examined on their way back from school : a medica l a",iliary takes a blood sampk from a young "suspc.."Ct ·' for fu rther Il l icroscopic t.!xam ination and Jiagnos is.
D ra \\<ing up the operation maps (IRAN) Examini ng schoo l children (LEBAN01")
!-inal in:-,uuctions to mala r ia units ( IRAN ) Spleen examination (WEST PAK ISTAl'l
Last check-lip or eq ui pment (Fgypl. UAR ) Giving fi rst prc,c riptions ( I RAQ)
Look ing for por"iles (EAST PA K ISTAN) Check-lip of fie ld sur,e), ISUDAN)
~LARIA ERADICATION
Patient and persistent search fo r malaria cases (and vector mosquitoes) in remote villages and areas throughout the Eastern Mediterranean Region - where malaria operations already mobilize 20,000 doctors and auxiliaries. The relatively large surface pt.''- capit a to be sprayed , and the great distances and bad roads between v illages or settleme nts, are thE" main difficulties faced by malaria eradication teams in this Region whe r e t ravelling absorbs as much as a third of their wo r king time .
\J p 10 the nex t , ill agc (ETHIOPI A)
nnr. .-. tn. n nn r (;. III"Vpi ll;IIW,· ( InR nA N\
REGIONAL MALARIA ERADICATION TR AINING CENTRE, CAIRO, (UAR) .-Students from the Cent re. Identify mosquitoes captured on human or ammal baits du ring a (\ night observa tion» in the Ik ld : di:;sl.!..:t ion of t h ~i r sal ivary gla nJ~ (where the ma laria palasi tes lodge) make it possible La identify vec tor ~pcl..:i l: ~.
A n entomo log ist f rom {hI.! Centre is about to collect in a tubl.! for icknlifll.:alion purposes anopheles mosq uitoes from a donkey ba it.
O ut in chase of a nopheles. a ma lario logist and mosauito catchers ex.a mine their fi nd.
EN/RCll./2 page 23
to be of value in establishing administrative, management and financial
regulations that are suitable for every country and which, when supported
by legislation, give the Malaria Eradication Services the necessary auto
nomous powers.
29. The Regional Office has helped to organize \.nth Headquarters a course
for future malaria administrative officers, and has offered facilities for
their field training in Iran. All these activities are aimed at maxinrum
eff'iciency at minimum cost so that economic gains will result from changing
an adynamic and more expensive control programme to one aimed at eradication.
30. Legislative and Health Educational Aspects. It has been realized
that the status of the Malaria Eradication Service and the financial
administrative regulations that are developed for this Service, together
with the role of the public, the medical profession, and civic bodies,
must be defined by law or presidential decree. Pakistan, United Arab
Repu'.:>lic (Provinces of Egypt and Syria) and Ethiopia have dra\-ID up such
laws; other countries are only now beginning to do so. It is iJilportant
that in all countries undergoing eradication programmes a revision be made
of the existing health 1m-IS regarding malaria and new ones developed in
line with the concept of eradication and t he operational activities in
volved. Needless to say, the pUblic, through health education, should
be awakened to the need for su~h l~ 5islation and to the fact that a law
abiding and well-informed com.rrrunity can effectively contribute to the
success of eradication programmes. Unfortunately some countries of this
Region have only recently come to realize the importence of these measures
in saving much time, energy and money in connexion with their eradication
programmes. It is encouraging that many Governments have requested the
Regional Office to pr ovide them 1·1i th models of nalaria eradication laws
lJhich are in force in other parts of the \vorld, a..1'ld it is hoped that all
countries of the Region will ultimately develop such law·s.
31. Health education is not only intended to inform the public as to
how they should cooperate with the staff of the Malaria Eradication
EI1/RClJ/2 page 24
Service, but also to give them an understanding of the heal t h , social
and economic values of a mala ria eradicD.tio!"_ programme, at the national,
regional and interna tional level. The inte rnati onal concept i s dictated
by the fact that no countr:{ can ::n2.int2.in a successful malaria eradication
progrc>Jn:ne ·Hhile one neig.ll.oouring country is s·~ill malarious, or even be
entirely secure Hhile :r,e.laria still exists a'-"1ywne re in the 'tTorld, Unless
this is realized at all social levels, by Jjj.nis ·~ers and local Governors
alike, there is a very poor c':J.2.llce t.'1a-c eradication i-Till be successful.
For this reason health education 3.ctivities a:::--e nOl-l following the lines
already described.
32. Operational Requisites. In pl~~~ng malaria eradication progre~es,
apart from.establishing the a drrQnistrative and financial regulations and
other legislat ion , consideration should be given t o the functi onal struc
tures of the Service, wr~ch should include divi 8ions dealin£ 1.n.th opera
tions, epidemiological evaluation, heo.lth educ2.·::.i on, adJninistration and
finance. Decentralization at regional and zonal levels, 2.S Hell as at
the sector and sub-sector levels, has t o be ef fected in orde r to assure
thorough checking of all a ctivitie s carried out ·o:,r a squad. l eade r il1
charge of a sprayil1g t eam or a surveillance agent i n charge of active
surveillance, for 1,'i t h out such checking, re-checkLng and cross checking,
any plan is doomed to fcilure . This is 2.1so the reG-son for stressing
the importance of the establishment of geoEr aphi cCl.l reconnais sG-" ce to
enable every field operntor responsH)l e for a certoin sub - sector to have
a map shm·l.ing the locati on of each village under his j"J.risdiction, and
a sketch map of the preJl1ises to be spr ayed or visi ted in eecch villo.ge
and in areas lying betl-leen these villages. No reove r, each house should
have a card on lVhich the date of spraying is registered as 1-1ell as the
monthly visits of the surveillance a gent.
33. In the administration of a malaria eradic-.tion pro gr cunme t he im
portance of assigning specific responsibilities to e~ch category of
employee in the Balan "" S r adica tion Service is being :r(;alize d. Forms
EYvncll/2 page 25
for recording the ac t ivities of nalaria personr.el are nov~ being used in
all country programmes. The development by '-IHO of standard quarterly
forms for surveillance and other ol)eratiom'.l activities, to be filled in
by the Malaria Eradication Service, have helped a gre<'.t deal in fcllowing
up the progress of the 'lOrk, and evaluating its quality.
3L.. Training. Both lmO and Govero.ments are realizing the importance of
training in modern tecr~Diques and procedures of key personnel such as
malaria eradication officers, epidenioloGists, entomologists, sanitarians,
senior laboratory technicians, administrators and health educators. The
Regional Office has established, apart from the Regional Ealaria Training
Centre in Cairo and the Training Centre in Nazareth (Ethiopia), two new
Training Centres in Pakistan during 1960. The curricula of the courses
for senior malaria officers as well as for junior personnel (sector chiefs)
are standardized. Specialized courses for technicians (blood and entomo
logy), health education assistants, administrators, assistant statisti
cians, as .1ell as refresher courses for epidemiologists, entomologists
and sanitarians, on the new techniques and procedures, are being supported
by the Regional Office, and all national training institutes have been
benefi ting from the i'ffiO advisory services end publications in the various
fields. The GovernwEnt of SuOen has requested the est~blishment of a
training centre in Sennc:.l' wi th assistance from iVHO and US-ICA. Nego
tiations are already under way to start the centre in eQr ly 1962.
35. During this period forty-thr ee fellowships 112.ve been a"Qrded to
personnel attending the Regional ; ;alaria Eradication Training Centre i n
Cairo, and to those attending courses in Jamaica and Yugoslavia. The
success of a training progr= :e does not depend merely on the syllabus,
but first and foren os t on the selection of s tudents attending the courses.
A great deal also depends on the calibre of the teaching staff. They
must have t.1-je abili t:r to infuse the trainees I minds rTi th the social and
adrJ1inistrative philosophy of eradica tion , serve as examples in their
devotion and dedication to their \-lork and be able to inspire confidence
EM/RCll/2 page 26
in the train~es and develop their initiative. In the large countries
pursuing malari.J. eradication, the tI'2.ining activities nre carried out by
malaria institutes. The di r '?c+:"r s C' ~ the se institutes are members of
the Malaria Eradicd ion !.dvisor.r Committee so that close coordination of
the training .J.ctivi ties Hi th the development af t he malari.J. eradication
pro~mme is ensured. In-service training of all graduates from the
Training Centres is the responsi".)i li t y of the Kal1:'.ria Er.J.dication Ser-
vices. A probati onary system i s followe d, and graduates are appraised
biannually befor e assigning them full r esponsibility.
36. The Regional Office, r e.J.lizing the importQllt role of entomologists
in mala r i ,_ e r adic.J.-Gion pr ogr2.IL'1!eS , h.J.s orgQllized with Headquarte rs an
orientation refre sher c ourse Fhi ch ,las held at the Cairo Reg;i.onal Training
Centre (Hay - June 1961) for ,';HO entomologists. This is to be followed
by similar courses for n~t ional ent omologists.
COORIJINATION ACTIVITIES
37. The Malaria Eradicati on Coordination Unit in EI-lRO is actively eng2.ged
in stimulating coordination not only at ~ inter-country level but also
at the inter-regione. l an d i nter-agency l e vels.
38. Inter-countr'J coordination i s maintained through conjoint planning
of operation s i n f r ontier o.reas, a s 1"ell as exchcmge of info!'l1Ultion on the
eradication activities an.d t he epiderri ol o:;i co.l evalua tion carried out in
stra tegic villo.ges l :liing ,Ji thin a strip of ten Jdlometres, on each side
of the b order li:le s . Exc..Da!1 Ee :Jf visits , whenever possible , is welcomed
by nGighbouring cO·ff.k·l e s to al laH sto.i'f m8l1lbe rs of the l-ialarie. Eradication
Servi ces to disCUSG C0r:Jl"'.O!":. probl~:~.s .
39. At inte r-reeiono.l l eve]., b oth n2.ti onal repro sen t a ti yeS from countries
in th is Region a:l.d 1iJr-iO s',~". ff men:~)ers, are invited to pa rticipo.te in Re-
gional Ib b .Tia Conf er ences of nc:i ghbourin g ;-:;e gi ons. During the period
under r evie,,), Pakist:-.n p::c r ticipo.ted i n the Fourth Indo-Burma Border Con-
ference. Ar:' ongensnts ,:tr c 'oei:l.g r:nde to hold c. similar meeting
EM/RClJ./2 page 27
by the end of 1961 in Pakistan for neighbouring countries including
Afghanistan, Iran and India.
40. At inter-agency level, very close cooperation exists between the
UNICEF Area Diroctm"s, :k"7r"st':nktiv8s .:'.nd oth"r U:lICEF offic~rs in
the fwgL'n, and the 'VJHO Regional and field malaria staff. Coordination
between VJHO and US-ICA activities in the malaria eradication field has
been strengthened at country level through joint visits of the Regional
Public Health Administrator (Malaria) and the US-ICA Chief Nalariologist,
Washington, to countries ,mere US-ICA is participating in such programmes
(Ethiopia, Jordan, Libya, Pakistan, Suda.I1 and the United Arab Republic
(Egypt). The Regional Office staff also participated in the \VilO/US-ICA
Conference held in November 1960 in Cairo, and resolutions regarding co
ordination at country level especially in the planning, training and award
of fellowships, "ere adopted.
THE: STRATEGY IN DEVELOPING THE P.EGIONAL MAURIA ERADICATION PROGRAMME AND THE STATUS OF COUNTRY PROGR.~ ·IES
41. The status of the malaria eradication programmes in the countries of
the Eastern Medi terrane an Region during 1960/61 is shown in Table I(l).
With Pakistan, Province of EV';J t (UAR), and Tunisia (the latter1s pre
eradication survey is completed, but implementation is awaiting further
negotiations) coming under eradication schemes, the whole northern block
of countries in this Region on both the Asian and African continents has
been pursuing malaria eradica tion or will soon undertake such programmes.
It is hoped that in these countries, comprising a population of 130.1
million living under mala:cia risk, eradication schemes vlill successfully
eliminate this scourge from an extensive geographical block which re-
presents the greatest load of malaria in this Region. The progress of
malaria eradication activities in t hese countries is shown in Table II. (2)
(1) See:
(2) See:
page 33
page 34
EM/RCll/2 page 28
During 1960 cradicQtion activities covered 19.9 million, while in 1961
these will be extended to cover 23.4 millions. It is gratifying to note
that the countries neighbouring this block which lie in other Regions,
(India, Burna, Afghanistan, Turkey, USSR), are undertaldng similar pro-
grammes. Pre-eradication surveys a re progressing satisfactorily in both
Saudi Arabia and Sudan, the two countries Which lie adj acent to the
northern block where eradication programmes are in progress, and it is
expected that by the end of 1961 in the case of Saudi Arabia, and by the
end of 1962 in the case of Sudan, comprehensive plans of operations will
be developed for these countries. For financial and technical reasons
the future eradication programmes in both these countries will be carried
out by stages over a period of ten to tJ.,elve years.
42. Realizing that before eradication schemes can be implemented in
certain African cOWltr.i.es the rural public health structures must be deve
loped and various technical problems such as nomadism solved, vJHO has re
commended the establishment of pre-eradication programmes. These pro
grammes, now proposed for Ethiopia and Somalia, idll extend for two or more
ye~rs to meet the objectives referred to above. In Ethiopia, although
US-ICA is contributing to the development by stages of a malaria eradication
programme, the I'JHO pre-eradication programme will be confined to the Blue
Nile Basin Where very little is knaim about the epidemiology of malaria
and Where the rugged terrain, the sparse distribution of villages, and
the shifting habits of the population need intensified study. It is hoped
that during this year a plan of operations for a pre-eradication programme
in the Whole Republic of Somalia, including the ex-British territory, can
be developed. Two-thirds of the population are nomads, and although this
poses a difficult problem, certain promising l eads are now apparent which,
after trial and evaluation of the results, will help in developing an
eradication scheme in thi s C01l..11try.
43. Yemen, as well as the British territories south of Saudi Arabia and
along the Persian Gulf, [-.2.[; a collective malaria problem, necessitating
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EE/RCIJ./2 page 29
long-tenn planning . Limited m~l [ria control activities ~re being carried
out there, but the stress is nm·/ bGing lcid on the trc.ining of field st2.ff
for ma~ria eradication activities.
44. The re are five countries Oond t erritori0s in the Region, namely, Aden
Colony, Cyprus, French Somalilo.nd, Kmvait end GOo zn Strip , where ma~ria
has e ither been er~dic~ted or has never existed. However, no clnim t o
total freeder.! from malnria c:m be certifi0 d until :m i ntensive evaiuation
is nude by the national authorities lvi th the gui~nce end help of a I-lHO
tecrn. The i nvasion of Gnza Strip by k . phar oensis ~te in 1959, r esulting
in 181 cases of m~laria, and the possible i nvasi on of Kuwai t by A.stephensi
from Southern Iraq, serve as a reminder that the malari~ 80ntinel service
must be alert to the possibility of the re -introduction of the disease in
to arens so f a r clnimed to be free from it.
PROGRESS OF jvji\Lf.PJ:.!; ERADIC.~TIO l'! PROBCTS
45. The progress of work in each cOlll1tr:r of t he Eo.stern jv;editerrene:m
Regi on under eradication is fully c overe d i n the document prepared for t he
El eventh Session of the R8ei ono.l Committee , Table n(l) gives a summary of
. the eradication activities by cOlll1try during 1960/61. From this tc.ble
it =y be seen that eradicdion activitie s during 1960 covered a popula
tion of 19. 9 million ou t of which 9. 5 million re ache d the consolidation
phase . During the first six mont hs of 1961 the total n~~ber protected
increased to 23.4 milli on out of vmich 13. 8 million reached the consoli-
dation phase. This shOrTS that mor e end mor c; area s arc mGeti ng too
criteria f or disc ont inuation of att~ck measur es end their freedom from
ma~ria is bdng consolid~.te d by active survci ll:mcG oper.:: t ions . The
cost of these surveillance operations, al thoug.h not yet accurately esti
mated, is i n gener:.:l taken as 65% - 7 5;~ of the cont of oper ations during
the attack phase . Both L"be.non end I sr:lel, and the l-lhol e western p2..rt
of Jordan have reache d t his consolidation phnse, and t he strengthening of
surveillance , ctivitie s vTill soon bri n( about a successful issue to thc se
(1) See : page 34
EV/RCll/2 page 30
eradication &chemes. It has been found from experience that there is a
cert~in amount of reluctance on the part of a number of Governments ade
quately to finance these surveillance ['.cti vi tics vmen the incidence of
malaria has dropped to a very low point; this is very poor policy as the
whole purpose of the proer~e will be defeated and all previous effort
and expenditure .. Jill be wasted. In the interests of the Governments con-
cerned, and in complianc e wi th the resolution (1) adopted at the Ninth
Session of the Regional Committee , the Regional Office has established
an Inter-country Field rt,alaria Evaluation Te= i-li th Headquarters in Beirut,
to guide the national mala ria serVices in strengthening surveillance acti-
vities. The Governments of Iraq, J orcb.n, L0b:'.non and Province of Syria
(UAR) have already availed themselves of the advisory services of this team,
and are submitting quarterly surveillance reports on the standard l'lliO forms
developed for this purpose, thus indicating their keen interest in success
fully completing their eradication schemes.
!.ii. Routine entomological studies are being carried out to assess the
susceptibility level of local vectors to the insecticides used, as rrell as
to determine the residual effect of these insecticides "men applied to
various structures and unde r different climatic conditions. The incrimi-
nation of A.fluviatilis as a malaria vector in Iran, and its apparent role
in transmitting ma1E.ria in Se.udi Arabia lihere its resistance to dieldrin
has been confirmed, in addition to the discovery of high dieldrin resistance
and a fair degree of tolerance to DDT in A.pharoensis in the Province of
Egypt (UAF.), constitute valuable entomological contributions.
47. More investigations l .. ere carried out during the period under review
on the toxicity of primaquine vmen used for r adically curing malaria. It
has been shown that although a certain number of persons , .. ho took the drug
showed some toxic symptoms, ye t the vast majority treated during a course
of fourteen days (adult dose 15 mgs. daily) even on an ambulatory basis,
(1) EM/RC9/R.4
have shown gvod results.
El1/RCll/2 page 31
The trials on the use of chloroquinated common
salt to stop malaria transmission among nomadic tribes in Iran, have given
very good results, and ha ve drawn attention to the possibilities of using
this method in other areas in this Region.
FINANCIAL IMPLICATIONS
48. There is no doubt that the financing of malaria eradication programmes
is of major concern both to Governments and international agencies. During
1960, $13,550,000 was spent on antimalaria activities in fourteen countries
of the Region, out of which the total international aid (advisory services,
supplies and equipment.) amounted to $3,044,000. Needless to say, any
decrease. -or freezing of this international aid at that level Hill jeopar
dize the progress of the regi onal pro gramme and the scope for extension.
The readiness of US-lCA to subsidize the programmes in Ethiopia, Jordan,
Libya, Pakistan and Province of Egypt (UAR), and its a greemant to hell) in
establiShing a training c entre in Sudan, has been greatly· appreciated by
these Governments. The future policy of UNICEF in contributing to malaria
eradication was discussed at the UNICEF Executive Board iri June, and the
indications are that this agency, realizing the importance of these pro
grammes to the health and welfare of the greatest mass of the population
including mothers and children, Hill continue to give assistance. The
WHO Regional appropriati ons f or the year 1961 for seventeen malaria pro
jects in operation Ha s $1,115,000 under the Malaria Eradication Special
Account and $131,000 under Re gular and Te chnical Assistance, rnalci.ng a
total of $1,246,00 0 . During 1962 an expansion of 1,\1f{O activiti~s are
expected in Ethiopi a , Pakistan, Saudi Arabia and Sudan, and this would
necessitate a fur ther "mo bu dget a r y increa se.
49. The World Health As sembl y a t its Fourteenth Session, in an endeavour to
ensure 1.IHO' s financing of these programmes on a more solid footing, and to
allow for the expansi on of its advisory services whene ver needed, deCided(l)
(1) Resolut ion 1-1HA14. 14
EM/RCl1/2 page 32
that the costs of the malaria eradication field programr;:e should be in
corporated in the Regular budget over a three-;\,ear period. It 1-Ias also
decided that transitional measures mmld be taken t o preclude placing too
heavy a burden on certain cOW1trics carljQn g out malaria pro&rammes and
t hat eligible states Hould receive in 1962 , 1963, 1964, credit s on a
sliding scale t01-lards the payments of thei r shares in the additional
H:,rO Regular budget,
so, Moreover, the Horld Hee.lth Assembly in thankin£, all countries thE.t
had contributed to the }lalaria Eradication Special ;\ccount(l), e}qJressed
conviction that voluntary contributions \.;ould remair: e ssential to t he
success of the malaria eradicat i on progr amme in order to p rovide additional
resources for broader prosecution of the programme and t o p rovide funds
for the payment of credits to Nembe rs Jreeting the criteria for eligibility,
51. WHO has recently developed a plan, i n consultation wi th Governments,
for the issue of malaria eradic2.t i on postage starnps. The L~tention is to
provide the health aut horities Hi th the me ans t o obtain additional income
for their eradication schemes, Md at the smne time provide funds for the
HHO - Halaria Eradication Spe ci al Account, In t his connexion, the Govern-
ment of Libya has already announce d its decision to issue special =laria
eradication stamps next year, 20% of the p roceeds will be donated to "i.-rnO
l1alaria Eradication Special .:lcc ount. The GOVB~Ent of Pnkis~1n i s also
making arrangeJrents to issue such a starrv next j,pril, o.nd the Government s
of Iran, Jorck1.n, Kuwait, Tunisia and the United .\ rab "i\epu'olic are planning
to do so,
(1) rte solution \JHA14.27
. TYPE
TABIE I
EN/RCIJ./2 page .3.3
STA'rUS AND DEVELOPl1ENT OF NALABIA P::DGRiJill'ES, 1960
POPULATION ERADIC!~TION
COUK'i'RY I I under i protected .commence-l Complete-i Total malaria 1 by all ment of : ness of
t-___ +-___ --+-i _____ ~Ir--.=.n::..-s""k~ ! r:et.l1ods jattack ! attack
IRAn 21,000,0001· 13,000,000 : 10,068,400 I 1957 11971~~*
Eradication
TOTAL
PreErad.
TOTAL
PreErad. Survey
TOTAL
Control
TOTAL
!~ radi
cated Nonn.al1y Free
IRAQ 1 6,500,000 4,514,000 : 4,514,000 ; 1957 I 196~: ISRAEL i 2,140,000 2,1L$),000 I 2,140,000 i 1950 I 1963:' JORDAN 1,506,860 1 787,000! 780,000 i 1959 196>~ lEBANON 1,627,5861 683,000 683,000 I 1956 196~ LmYA 1,340,0001 31,000 _11J OOO ,1960 1963 PAKISTAN 90,000,000 87,128,000 14,367,144 ,1961 197Jh'l* TUNISIA .3,783,000, 1,914,000 1,914,000 1962 1972 " U.A.R. I I I
Egypt 126,080,0°°11 18,355,000 . 5,443,000 1962 1972~ Syria 4,561,000 1,570,196 +---f,349,644 19561964*
ETHIOPIA SOMALIA
SAUDI ARABIA SUDAN
ADEN BAHRlmJ QATAR T. ST.4.TES YE}EN
158,538, LUi 1130,122, 196 31,290, ltH:l
20,000,000 10,000,000 1O0,000 I 1961 1,980 ,000 1,776,000 i 247,500 1963
7,000,000 I 11, 390,00Cl :
18,390,000 ' I
800,000 : 137,853 [
40,000 i 85,000
4,9:10, 000
5, 562, e53 '
I 5,000,000 I
11,390,000
16,390,000
660 ,000 1 137,853 \ 35,000 85,000 I
3,500,000 i i
522,)00 1.,,035,275 I
137,853
137,85)
1961 1963 1 1972~
1972'H,
! I
j
i i
j
ADEN COL. 1.38,UJo 138,400 1 138,400 Hal,Brad.since 19501 CYPRUS i 550,000 550,000 I: 550,000 Ha1.Erad. since 1949\ FR.SOM. I 67,500 67 , 500 67,500 : Hal.Brad.since 1957 01'..2.::, ST;'iIP I 337,000 : 337,000 i 337,000 I Hal.Erad.since 1951 KlJ\-lilT : 207,000 : - - Free from 1'1alaria , 1 I
TOTAL IJ.299i 900 1,Onl.900 ; 1-2.°92.1.900 -* Country-wide 1
Gllium TOTAL ,205,771,199 163 ,798,9h9 137,726,016 -~~By stages I F===================d=== ========_========== ==h====== ====='---______ __'.
TABlE II
PROGRESS OF MltLfLlUA ERADICATION
'Ot':l
J::~ <1> ::0 o w~
~~ N
r-------~----------r_--------_r------------------------------------T_------- . --.------------------.----~
1960 ACTIVITJES :i.961 ACTIVITIES
Population protected by
Nill'iBE R OF TOTAL I POPULATION
COUN'l'RIES POPULATION UNDER . I ------1'01-"':' ation p rotected by
I RicH
IR.A;)
I SfulliL
JOIillA!'!
LEB;"u~OH
LIBYA
PAKISTLN
U.A. R. (Egypt)
21,000 , 000
6, 500, 000
2,140 , 000
1, 506, 860
1,627, 586
1, 340 , 000
90 , 000,000
26,080 , 000
I'.llLAIlIA nICK
13,000 , 000
4,5U,, 000
2,lLO,OOO
787 , 000
683 , 000
31, 000
87,128, 000
18,355, 000
Spra,dng I La rvic. I Consolid. Tota l
5,868, U)O
2,779 , 000
'J3 , 072 12, UIO , 00()
106,000 260 , 000
29 ,196
12,247 31,000
4,200 , 000 1O,06B,)JJO
1,735,000 4,514,000
2,140 , 000
520 , 000
653, 804
2, U (0 , OOO
780, 000
683, 000
31,000
Sp ray:' n t( I "--"arvic. I Consolid.
5,080 ,000 6,620,000
1, 69 LI, (jOI.l 2, (320 ,000
53 , O(l! , 2, 140 , UCU 2 , HiD , 000
107,5")0 ',:.67 , ()(;\J 520,000
30 ,Ou,) 683,000
31,( J C' 31 ,000
1, 3 )O,COU
331,000 331,0 00 I 6 '19,00U
Toi al
ll, 'roc, 000
4, 51b,000
2,14C , 000
787 , 000
68:; ,000
31,000
1,300 ,000
649,000
U.A. D. . (Syria) 4, 561, 00( 1,570,1961,092, 736 1 3,200 \ 253,70ell,349, 6 L41 5'(> , 9i151 3 ,2001 990,27111, 570,196
Tm~ISIA 3,783,000 1, 91 4, 000 Pre-eradi9ation suryey comp1eled, but i:J1ementati.~tJl. ~.aitin, Governmenf's decision
5 2,44l ; ====
TUBERCUIDSIS
El1/ RC1J./ 2 page 35
52. Considerable attention has b een given by 1<JHO to the p roblem of
tuberculosis during the year under review, specially with regard to
domiciliary therapy, which "as discusse d by the Re€,ional Committee last
year. The resolution(l) adopte d by the Conmd.ttee in 1960 has guided
the operations of projects during the year.
53. The WHO Reg'ional Prevalence Survey Tenm ha s completed its work in
Iraq, Jordan, Libya, Tunisia and the Syrian Province of the United Arab
Republic. Countries have created their own national teams wich were
trained by the ltrrlO team to continue t heir surveys. The Libyar. national
team has concluded surveys in the provinces of Tripoli and Fezzan. The
other national teams are continuing their work. Paki stan, Sudan and the
Province of Egypt (DAR), Qalyub area, also are continuing .. lith their sur-
veys. Considerable experience has nm., been gained in methodology, .. rhich
will be useful for modifying future policy with regard to the most practi
cal and efficient utilization of surveys.
54. Although the Regional Epidemiological a.'1d Statistical Centre is still
mainly concerne d with tuberculosis projects its scope has been broadened
to deal with "ork in other fields. The prevalence survey reports on
Cyrenaica , Libya(2) and on J~~, Jorctan(3) have been c ompleted and pub
lished. The processing and analysis of survey reports, including those
of national survey teams, continue.
55. llJhile WHO assistance to two Training and Demonstration Centres
(Jordan and Sudan) has been wi thdralVll, two others are being planned
(Libya and Saudi Arabia). :''ffi0 technical pe rsonnel .rill assist the
tuberculosis control programme of Kuwait beginnine; tJois year. The com-
pleted Somalia Tuberculosis Centre was inaugurate d in early 1961. It
(1) EI1/RC10/R.8 .
(2) EM/m/58, EM/ST/14 - February 1961
(J) EM/'lB/64, El';jST/15 - Hay 1961
EM/RCll/2 page 36
is gratifying to note that these tuberculosis centres have succeeded in
creating an awareness and interest in the control of tuberculosis in the
respective countries, so that efforts have been exerted to extend tuber
culosis control services to other areas within these countries. The
most recent examples of this trend are Ethiopia, Jordan and Pakistan.
56. Preliminary information has been obtained on the effects of single
drug chemotherapy from the Chemotherapy Pilot Project in Tunis, which
terminated in December 1960. Problems cormected with treatment,
especially microbial resistance to drugs are also being studied. The
problem of drug resistance appe~rs to be increasing throughout the world,
so that chemotherapy studies using various drug regimens are needed to
point the way to the most effective and prac t ical treatment appropriate
to each country. These circumstances also emphasize the necessity of
establiShing ldthin each country, facilities for the bacteriological
diagnosis of sputum, and for performing drug sensitivity tests.
57. The Tuberculosis Control Pilot Area prograrr~e in Sousse, Tunisia,
has demonstrated the value of the mass mobile approach combined with the
static clinic approach. The experience already gained in Sousse will
guide the conduct of similar progr ammes in other governorates of Tunisia.
58. The increasing interest in tuberculosis, and the desire of most
Governments to expand their t uberculosis control services has made it
imperative to train, I\D. thin the shortest possible time, health workers
in methods of tuberculosis control. vlHO has provided numerous fellow-
ships abroad for this purpose . HOvrever, it was reali zed that it woutd
be more fruitful to have health vlOrkers train for a certain pe riod in
condi tions similar to those of their Ol.ffi country. The combined experience
already obtained i n Tunisia with the Chemother apy Pilot Project, the
national pilot area proj ect in Sousse and t he prevalence survey initiated
by the WHO Regional Survey Team, made t his country a sui table place in
which to establish an inter-Regional Tuberculosi s Training Centre. Pre
parations have been made, therefore, begirming in January 1961, to
The T B Demonstration and Training Cenlre in Addis Ababa is set a midst a grove of eucalyptus treeS. A native mud-hut (tokul) has been built nearby for demonstrati ng home hygiene and preventive measures to the patienl~ .
j " 1 ... "iI •• i-i1','
;
An Ethiopia n technician from the TO Centre gathers data and information on household conditi ons. Home visitors then call on patients and teach their families appropriate preventive measures.
TB CENTR E
ADDIS ABABA
( ETHIOPIA)
T he den"c, cI(J ~I.:I~ crowded d i .... lrici of Djeb..:1 Lahmar, Tunj" \\as se~ected for the chemothera py res~nrch pr0jecl on 1 U,
In a tent L' rcctcd In Ojch-.: I Lahl1l ar to hou,,1.: X-Ray .lnd l1la~:- examination units of the TH chemothera p ~ projl:'ci. it I,,'hnlclan checks r..:-cord5 nr <Jltt! n d~tn l s ,
TUBERCULOSIS CHEMOTHERAPY PILOT PROJECT
/ -----A )tlu ng pa l lent 1<>: given a lu ocn:u lin tes t in Ih~ same te nl.
(TUNISIA )
A mOl h\,: I recei\ es 151.mia/id tablt the nccc ... ,jt~ of re-gllbr drug-la k
"-j
Upon arril,. u1. the tcam confers \\·jt l1 \ i ll agl: <luthcl ilil''>;. c;..p lain ir. g \\(Irk to he done :Ind a~"ing their coopcnllion to ensure allcr~Janc~ of \.ill<lgcrs.
TUBERCULOSIS PREVALENCE SURVEY <W EST PAKISTAN)
)n the ilrS1 day. villagers arc rcgi'> tc rL'd. A \VHO 5l::l1 iQic ian i,;arcfLl\l~ check.s th at indi\ idua l ,IHis arc hUed in propl.:rl~ \\-jlh all information. I\-luch of the \.\ork is done at ni l.!h l
, .fI. ..... .. --
-' ... . .....
BILHARZIASIS CONTROL
(IRAQ)
Bilharziasis snails In the Eastern Mediterranean Region are prolific breeders . They are hermaphroditic and fertilize themselves i" the absence of a partner. Under favourable conditions a single surviver could produce a progeny of over 50,000 snails within four months.
Colk:ct ing by ha nd·nets spc~imens o f b il harzia sis "nail .. fro m irr igat ion strea m .:; ,
Feedi ng parasitc -carryin~ snails (Bul inus) kept in aq ua ria for further st ud y.
EM/RClJ/2 page 37
establish this project, and it is expected that, by the secor,d half of
the year, the first courS6 will take place. Besides students from the
Region, the Training Centre will receive students from other Regions.
Arrangexoonts have already been made to give field experience to doctors
taking a tuberculosis course in the Forlanini Institute of Rome.
59. The last WHO-assisted mass BCG progri.Ul1lTle in the Region terminated
in the Sudan in 1960. BCG vaccination programmes on a more limited
scale will be started in Saudi Arabia and Yemen.
60. An interesting plan to include tuberculin testing and BCG vaccina
tion in the routine activity of a maternal and child health clinic will
be realized in Yemen, under the direct charge of the staff of the Health
Centre and Training School of Sana !a. This will be a demonstration not
only of the feasibility of integrating simple tuberculosis control proce
dures in a non-tuberculosis clinic, but also of the necessity of deviating
from conventional patterns and ad~ting a tuberculosis control programme
to the possibilities existing in a given area. Integration of BCG
vaccination into permanent centres, such as tuberculosis centres, mater
nal and child health .centres, and other health clinics is being emphasized
in all tuberculosis programmes.
61. The necessity of maintaining BCG vaccination espeCially for contacts
of tuberculous cases assumes grea ter importance in the face of the pro
blem of microbial resistance to current anti-tuberculosis drugs.
ENDEi";O-EPIDEHIC DISEASES
BILHARZIASIS
62. The threat of bilharziasis to health and economic development in
a number of countries in thi s Regi on , is well recognized. The major
objective in dealing .lith t he disease is to interrupt transmission of
the infection. In theory the links involved in the chain: population
infected - snail intennediate hosts - population exposed, .would seem
EN/RCIJ/2 page 38
easy to break, but in practice it is not so. Poor sanitation, faulty
habits arising from low standards of living and lack of health education,
create a situation favourable to the prevalence of the disease and thus
form part of a vicious circle, for the poorer members of the community
are the most vulnerable, and they constitute the majority of the workers
upon whose efforts its prosperity ultimately depends.
63. Reforms providing all manner of economic and social services in the
rural areas are under way in many parts of the Region where bilharziasis
is endemic, but before such improvements become effective and permanent
the chain of transmissi on must be broken or at least weakened through
specific preventive measures which in turn will assist in reducing suffer
ing and hastening the process of such developments. The main emphases
in the control of the problem in the Region have been: (a) the control
of the molluscan host and (b) chemotherapy to obtain parasitological cures
of the affected population.
64. The consensus of opinion is that, in the present state of our know
ledge, the control of snail hosts of bilharziasis presents the most
effecti ve single method of dealing with the pr oblem. Stress has been
placed on the fact that faulty irrigation practices can cause flooding,
excess seepage water and overloading of drains, with a resulting increase
in snail population, while good irrigat i on practices can both reduce snail
breeding areas and make molluscicide application easier. Field experience
has shown that modification of agricultural practices can reduce snail
breeding areas. Reco~~endations on design and construction, operation
and maintenance of irrigation systems should include selection of the
most economical cross section of earth canals giving the maximum water
veloci ty, wi thin topographic limitations. Provision of rigid inverts
should be considered along the centre line of the bed of canals wherever
possible, as an initial step for hard surface lining and eventual covering
of canals in selected portions of the course . Adequate water management
to minimize waste, especially at the ~mter users l level, effective weed
control and removal of aquatic vegetation, are essential.
EM/RCll/2 page 39
65. Factors governing the natural increase or decrease of snail densi-
ties are extremely complex and far from being fully known. Before
mollusciciding operations begin these should be studied to ensure maximum
decrease in transmission at minimum cost. In areas where tenq:>erature
and dryness cause hibernation or aestivation of snails and reduce human
contact with infested water, as in the endemic areas in Iran, Province
of Syria of the United Arab Republic, and parts of Libya, Sudan, and
Tunisia, the period of transmission each year is relatively short. But
in areas where the tenq:>erature and hydrological patterns are more uni
form, either because of meteorological conditions, permanent bodies of
water or. the installation of irrigation systems, as in Iraq, the Egyptian
Province of the United Arab Republic, irrigated areas of Ethiopia, Sudan
and Yemen, the periods of transmission are continuous. In the fo:noor
type of area it is possible that a single application of molluscicide,
nade at the critical period in the snail-parasite cycle, will prevent
transmission for a year. In the other type of area it is necessary to
apply molluscicide two or three times a year to achieve the same end.
Even so, if multiple applications are not correlated with the seasonal
hydrological and snail infection cycles, much effort and expense on
control will be wasted. The biological factors involved vary not ooly
from country to country but often from one location to the other within
the same p·rovince. Thus there is a basic need for studies to elucidate
the essential factors involved before control measures are undertaken.
Lack of such considerations explains the recorded failures of molluscici
ding .operations in certain areas.
66. In undertaking snail control it is important to realize the repro
ductive capacity of the snail hosts of bilharziasis in the Region. Both
Bulinus and Biomphalaria are hermaphroditic and will fertilize themselves
in the absence of a partner. Approximately t1venty eggs are laid in a
single clutch and the adult snail averages a clutch every twenty-four
hours for the first four months after it begins to lay eggs. At
EM/RClJ/2 page 40
moderate temperatures, the eggs 1.ull hatch in about a lieek and the young
will reach sexual maturity about a month later. It is possible, there-
fore, for one snail to lay about 10,000 eggs per year with the result
that a single survivor could produce a progeny of over 50,000 snails
within four months and if infected liould transmit disease in about three
weeks on a massive scale.
67. During the past two years, reports have stressed the need for re
search on the ecology of the snail intermediate hosts of bilharziasis in
the Region and in this respect bilharziologists have an important lesson
to learn from the illuminating developments in the closely allied field
of mosquito ecology. The famous maxim of Ross that Itin order to control
malaria we must learn to think like a mosqui tolt, applies 'tTi th equal force
to the snail hosts of bilharziasis in spite of the basic differences in
the epiderriology of the two diseases.
68. Copper sulphate has bean pre-eminently the molluscicide of choice
in the Region. However, sodium pentachlorophenate and to a lesser ex
tent dinitro-o-cyclohexylphenate have also been used. Sodium penta
chlorophenate has been demonstrated at the Warge Al Arab project, in
the Egyptian Province of the United Arab Republic, to interrupt trans
mission at a reasonabl e cost, Out the problem of prevention of r e
infestation of habitats freed of snails has not been solved. Due
possibly to the gaps in our knowledge referred to above, it has not been
possible effectively to interrupt transmission in many areas in this
Region where molluscicides have been in use for a considerable time.
Recent surveys have indicated, however, that ' oasis bilharziasis' in
Saudi Arabia consisting of scattered and circumscribed foci of infection,
temporary breeding grounds such as the 'hafirs! and !fula' (excavated
and natural depressions) in the Sudan and in parts of Iran, or the
!magils! (rainwater pools) in Yemen, ' birkhas' (masonry pools) in
'bustans' (gardens) in the Hejjaz and Nejd, and certain seasonal single
mountain streams and springs in a number of other arid areas, would lend
EMjRCl]j2 page 41
themselves admirably to control by the judicious use of the known
molluscicides at reasonable costs, The difficulties in such cases are
the lack of adequate public health organization, trained personnel, tech
nical guidance and supervision, but these the Regional Office would be
most willing to assist in overcoming.
69. A promising new molluscicide, Bayer 73, an aromatic acid amide, is
now being tested, It has a low level of toxiCity to mammals but is
toxic to snails at low concentrations (one part per million) and kills
snail eggs and cercariae at the same concentration. WHO is stimulating
research on other newer molluscicides, investigating possibilities of
using two or more toxicants together to determine their synergistic
action. A compound that would eliminate '-Teeds and snails in a · single
operation might be valuable in certain circumstances. Therefore, studies
on promising herbicidal compounds and the possible maintenance of resi
dual action of herbicida]jmolluscicidal combinations are being encouraged.
Possibili ties of field trials wi th t Aqualin t are being examined in the
Gezira irrigated area of the Sudan and the Egyptian Province of the United
Arab Republic, Incorporation of molluscicides with materials from which
they could be released slowly, the development of devices to deliver con
stant amounts of solution into flowing water, and use of autanatic dis
pensers which compensate for variations in water flow, are planned to be
used in the Irrigation System of the Egyptian Province of the United Arab
Republic.
70.. The need for more active and le ss toxic drugs for bilharziasis is
acutely felt. 1{!HO is promoting research on various aspects of this
problem and the essential fields relate to: (:1) protection from cer
carial invasion of the skin or the destruction of immediate invasive
stage of. the parasites. Cercaricidal substances of value in topical
application, or effective drugs 'tvhich would concentrate in the skin are
needed; (n) control of developing and maturing schistosomes through
drugs which concentrate in lungs or prever.t maturity and migration from
EM/RC1Jj2 page 42
the liver to the mesenteric veins; (c) rendering sterile or destrqying
or shifting the worms from egg laying sites, or a combination of these
phenomena. Studies on the physiology and detailed metabolic require-
ments of schistosomes are required. WHO is endeavouring to find means
to foster coordination between laboratory workers and the investigating
physicians in the Region concerned with the general problems involved.
Efforts are also being made to coordinate research on standardization
of screening techniques and the careful control of clinical trials both
in treatment centres and in the field, of promising curative drugs or
those causing long suppression of egg laying of the parasites.
71. In a related field is the need for improvements in immuno-diagnostic
methods. Because of the relative simplicity and specificity of these
techniques for epidemiological surveys and their importance in the eva
luation of chemotherapy and other control measures, there is a pressing
need for standardization.
72. An intriguing problem 1-1hich faces bilharziasis workers is that
existing methods of investigation do not yet permit an accurate assess
ment, even of the effect on the individual, much less the correct deter
mination of the medical, economic and social effects of this infection on
a communi ty. In this regard quantitative i~~ormation is needed on worm
burden, pathogenicity, immunity, morbidity and mortality due to bilhar-
ziasis. Validi ty of aetiological relationship betvTeen bilharziasis and
certain pathological considerations, e.g. liver and bladder carcinoma,
cor pulmonal and cardiovascular complications, are still sub judice. - . The hypothesis formulated by Ferguson in 1911 has received support from
several workers: Ibrahim (1948) , Hakar (1955), Halawani and Tamami (1955),
and more recently l-lustacchi and Shimkin (1958) who came to the conclusion
that available data .,ere consistent with the hypothesis that S.haematobium
is associated with cancer of the urinary bladder.
however, needed to clarify this association.
Further research is,
EM/RCll/2 page 43
73. It is planned to emphasize, subsidize and coordinate research on
the above-mentioned aspects of bilharziasis in order to fulfil the
reconunendations (1) of the Regional Committee at its Eighth Session and,
in keeping with thep:res0nt WHO policy, (2) to stimulate and assist effec
tively in the development of medical research in a world-wide context.
Operational research and ecological studies have been included as
objectives in WHO-assisted field projects in Iran and Iraq. The larger
pilot programme which has started in the Province of Egypt, United Arab
Republic, with the material assistance of UNICEF has a much wider scope.
This is the first UNICEF-assisted bilharziasi s proj ect, and on its
success depends the continued participation of the Fund in this new
field. It is expected to develop not only on a long-term basis as a
research project but also as an inter-country training centre, to suppq
staff for control programmes in areas where bilharziasis is endemic and
threatens to hamper agricultural and other national development progralIIllleS.
74. A recent study of the problem in the Sudan has indicated the need
for a well-equipped field laboratory in the Gezira irrigated area, and
the establishment of a field demonstration and training centre in Zeidab
district in the Northern Province of the country. The Sudan seems to
possess the necessary potential for making significant contributions
in the field of bilharziasis control. Plans are under way to provide
assistance to Saudi Arabia in the establishment of a bilharziasis con
trol programme in the Nejd ,and for certain important foci of Taif, Wadi
Fatima and Tabuk in the Hejjaz. A short-term consultant was appointed
to demonstrate control measures in Yemen during the year and similar
assistance is being considered for Libya, Somalia and Tunisia.
(1) Resolution EM/RC8/R. 8
(2) Resolution 1:1HAll.35
EM/RCIJ./2 page 44
SMALLPOX
75. In several countries of the Region smallpox is still endemic and
is proving to be a recalcitrant problem. Consequently, the Reg~onal
Office has continued to give all possible assistance to the Governments
iri their smallpox control and eradication campaigns and in the produc-
tion of a potent and heat stable (lyophilized) vaccine. These acti-
vi ties have been in accordance with resolutions adopted by the World
Health Assembly, the Executive Board and the Regional Comrrittee for the
"Eastern Mediterranean.
76. A detailed paper has been prepared for the Eleventh Session of the
Regional Committee, outlining the recent developments and the present
situation of smallpox in the countries of the Region. (1) To this is
annexed a table giving data on the numbe r of cases of smallpox in the
countries of the Region during the past three years, as well as the final
report of the epidemiologist of the 1-lHG Regional Smallpox Survey Team
which visited a number of countries of the Region in 1959/1960.
17. It is particularly noteworthy that mass vaccination campaigns against
smallpox have been carried out during the year under review in Lebanon
and East Pakistan.
78. WHO assistance has been provided to a number of laboratories of the
Region in the fonn of equipment, supplies, and fellowships, for the
production of freeze-dried smallpox vaccine.
79. Three bacteriologists and a laboratory technician from three
countries attended in November 1960 a Training Course on Dried Smallpox
Vaccine P·roduction at Lagos (Nigeria). This course had been sponsored
and organized by WHO c,'1.d ~ simiJ:.i"' C(;U:CS2 is being planned for November 1961
at Bangkok (Thailand). A irmo Inter-Regional Confe rence took place in
New Delhi in November 1960, attended by six participants from five ·
(1) EM/RCIJ./5
" Budding nur,\l.!s" treat their schoolmates with aureomycin o i nt m~nt. T he antibiotic must be applii:d regularl~ . and it i~ important in trachoma l:ontro l projects to ensure that this is cnkientl~ done in all the schools.
TRACHOMA CONTROL (EGYPTIAN PROVINCE, UAR)
Demonst ra tions showi ng mothers how to appl)' antibiotic ointment tak~ rlace regularly in the Syndion health sub-centre. Q alyub area IUA R ).
Members of the pupils' "hi:alth committee prepare antisept ics ~I nd abso rbant cotton for the treatment of eye diseases .
.. ; -.-, \ :
,:-.
- ..
~f-"''''~'[~i '';; .,;r';.=-. N'::l " ~~;~::/i~f :t; ~ '?,: An insect-control team ca rries out a door-w-door survey of mosquiw - brcl..:J ing places in Riyad.
The WHO-assisted ellv ironment31 san itation project a lso gives spec ial attent ion to improving
ENVIRONMENT AL SANITATION (SAUDI ARABIA) sanitation on the Mecca pi lg ri-mage route.
Special spraye rs are used to destroy ad u lt flies in Riyad subu rbs .
EM/RCll/2 page 45
countries situated in the Asiatic part of the Eastern Mediterranean .Region
All aspects of the smallpox problem, with particula:r;'regard to Asia., were
thoroughly discussed by the participants with highly qualified experts
provided by the Orgwization.
COMHUNICABLE EYE DISEASES
eo. Trachoma is especially widespread and relatively severe in all
countries on the North African coast and on the Arabian Peninsula. It
is a;Lso very common in certain neighbouring countries such as Ethi<:>pia,
including Eritrea, and along the Nile river up to Shendi in the Sudan.
It is relatively widespread in Iraq, in the southern parts of Iran and
in I,rest Pakistan where, however, precise prevalence rates are not at
present known. Trachoma is also found in certain other parts of the
Eastern Maditerranean Region, e.g. on the West Bank of the Jordan Valley
and in the southern part of Lebanon (see map).
81. Conjunctivitis, closely related to trachoma, is also very cammon in
these countries and generally appears in seasonal waves, once or twice a
year. The occurrence of these conjunctivitis waves is supposed to be
one of the main factors preventing the early spontaneous healing of the
trachoma. This consideration has l ed to a therapeutic trial, directed
mainly against conjunctivitis, which is being carried out in a certain
area of the Egyptian Province of t he United Arab Republic.
82. The usual treatment of trachoma and other comm~~caole eye diseases
is still the application of antibiotics according to the intermittent
treatment schedule , i.e. twice a day on five consecutive days monthly
in Six cycles. Sulfonamids and tlre tardtl sulfonamids have been
administered systematically in re search studies in Erit rea,
83. Virological research has continued, particularly in Tunisia and in
Ethiopia. Success has been achieved in the further isolation of virus
strains from trachomatous persons and in the preparation of vaccine.
The vaccination of volunteers .mich was recently carried out in Eritrea
has so far produced encouraging results.
EH/RCIJ../ 2 page It)
84. The iV!:O-assi sted com:nuni cabla eye disease s control p~" ojects are in-
creasing in number. A control project in Ethi opia proper Ivas tennina-ced
end 1960 but those in Tunisia and the EbYDtian Province of the United
Arab Republic which started some years a go are continuing in operation .
A ne w project started in Iraq at t~e be gir~ing of 1961 and other control
prcjects .. .1.11 follow during the year, e . g. in He st ?akistan in ApriJ../11ay,
in the Sudan and in Jordan in July and August/September r e spectively.
In Kuwait and in other cow:tries, -". G. i n Ir=.n ::::ci Lib~:c. wher ,,- t r .::cho;;\'.
cont r r)l ·::.ctiviti8s start" d i!1 c.. !'!~.ti onel ':asis s or.1~ tir,.:; ::'t:,0 , ' :;-;Q-r.ssist0d
LEPROSY
85. During three months in the l-linter, a vJEO consultant visited Iraq
and conducted a thorough l ep rosy survey of the whole country. He gave
simple and prac t ical r ecorrur.endations to the Gove rnment , aiming at the
control and eventual eradic~tion of the disease . In several countries
of the Region l eprosy is an important public health problem. In Ethiopia,
for a number of years, a large scale programma has been in oper ation with
HHO and UNICE F assistance . iI. similar P-::'ojcc t has also been planne d for
Pakistan and is expec t ed to start in the autur,ID of 1961,
86 . Here also emphasis is being placed on the training of personnel,
Several \'JHO .f ellowships have oe ::m awarded to me dical officers f or trainin g
i n this fie ld, Participants from CO'.JJ1tries of the Region have been in-
vited to attend the Leprosy Conference in I stanbul in Jlovember 1961 and
the Leprosy Traini:1g Course in the Philippines in Novemocr!December this
year, Both 2.re being orgcmize d nnd sponsored by the Organization .
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PUBLIC REALTH ADMINISTRATION
GENERAL
EMjRCIJ./2 page 47
87. National public health services continue to develop at the central,
intennediate and local level. More and more attention is being given
by Governments to plans for tre expansion of their health services.
These plans are in some cases documents fonnulated by the Ministry of
Health and used as a 'prograrrrrning guide. In other cases they form an
integrated part of the country's overall social and economic development
plan. It should be recognized, however, that these plans should provide
not only for the establishment of field services and institutions such as
hospitals, but also for the traiP~ng of more personnel for ' expanding
services.
88. Pakistan's second five-year plan (1960-65), as well as the five
year plan for the United Arab Republic (1960-65) both came into force
during the year. Iran's Plan Organization prepared its third five-year
plan (for the years 1962-67) to continue the activities of the present
second five-year plan. Ethiopia, Sudan, Tunisia continue to follow
their specific health plans or programming guides.
89. The Province of Egypt (United Arab Republic) has continued its re
organization of health administration which has resulted in the dccentra-
lization and strengthening of governorate health departments. Pakistan
has reviewed its health administration as Hell as its medical education
through a Medical Reforms Co~~ssion. Some of the recommendations of
this Comrrdssion are already being applied by the Ministry of Health, some
are under study. WHO has continued to assist central health authorities
through .the services of public health advisers to Hinistries of Health.
At the end of the reporting period Saudi Ara'oia, Somalia and Yemen had
such advisers, while in Ethiopia and Pakistan the services of I'ffiO Area
Representatives are available.
EM/RclJ/2 page 48
LOCAL HEI.LTH SERVICES
90. Local and rural health services have, during the past year, gained
new impetus in the Region. In Ethiopia twenty-four health centres have
been established in various parts of the country since October 1960.
Personnel trained at the WHO-assisted Gondar College are serving in these
health units which offer comprehensive curative and preventive services
to an increasing number of the village populations. The Government are
paying special attention to the supervision of the work of these auxi-
liaries and WHO has provided staff for this purpose. In 1-lest Pakistan
the first ten rural health centres were opened in December 1960 and
January 1961. This is the initial step towards the establishment of
300 health centres in East and West Pakistan during the next five years
in accordance with the country's second five-year plan. Some of those
now opened, will serve as teaching and demonstration units. The rural
health schelOO • .n.ll develop in close cooperation ,nth the country-wide
community development programme (Village AID(l~. UNICEF, with ltJHO tech
nical guidance, is materially aSSisting both the Ethiopian and. Pakistani
projects,
91. The WHO-assisted rural health project in Northern Lebanon, in Halba,
started in October 1960 and is in full operation. The Government expects
this local health unit to be a model for the health services in all dis-
tricts (qaQas) of the country. In the Province of Syria, United Arab
Republic, the WHO-assisted rural health project has been reviewed, and
inter-ministerial negotiations are under way for its coordination with
Uni ted Nations-assisted community development projects, The health
assistants and sanitarians of the Benghazi Health Training Institute in
Libya have now been given work i n municipal and rural health centres and
are meeting a strongly-felt nee d for improved preventive services, P:te
parations for a rural health demonstration area project in El-Huda, Sudan,
are well advanced and the Government plans to start the project 1-lith
UNICEF and WHO assistance in 1961.
(1) Agricultural and Industrial Development
COMMUNITY IEVELOPMENT
EM/RC1J./2 page 49
92. WHO has actively cooperated in inter-agency activities in the field
of community development. These include the Arab States Training Centre
for Education in Connnuni ty Development (ASFEC, Sirs-el-Layyan) and the
annual regional informal inter-agency meeting on community development
held this year in Beirut. The new United Nations-sponsored connnuni ty
development project in Durlliyya, Saudi Arabia, is assisted by WHO experts
in WHO projects in Riyad.
93. Coordination of assistance by United Nations and specialized agencies,
inclUding WID, is expected to develop also in such other fields as urbani
zation and housing. vJHO has already assisted in an Urbanization Survey
Mission in the Mediterranean area and has, during the year, cooperated in
similar activities under the aegis of the Economic Corrunission for Africa
in Addis Ababa.
HEALTH LABORATORY AND REU TED CERVICES
94. Several Governments of the Region, recognizing the importance of
developing health laboratoI"J and related services within the frame of their
health services, have rec;.uested the assistance of the Organization, and
this has been provided on a large scale through fifteen projects under
taken in nine countries. i.JHO specialized advisers and cCl1sultants have
been assigned in some cases to assist in the organization of laboratory
services,; equipment and supplies have been provided, either from WHO
funds or on behalf of the Governments on a reimbursable basis; training
courses and fellowships for laboratoI"J technical personnel have been made
available by the Organization. Particularly outstanding examples of pro-
jects of this kind have been the preparations for the establishment of a
central public health laboratory at Riyad (Saudi Arabia) and Islamabad
(Pakistan), of a vaccine production laboratory at Amman (Jordan), of a
virology research laboratory in Cairo (UAR) , of blood bank services in
Khartoum (Sudan), R:l;ynd (Saudi Arabia) and Baghdad (Iraq).
EM/RCD/2 page 50
95. The greatest problem to be solved is the general shortage of quali
fied personnel. Assistance is provided for the improvement of national
training facilities as well as through the award of feilowships for
training abroad.
HA'lER.i'IAL Ai"JD CHILD HEALTH
96. '{HO assistance to exclusively maternal and child health projects
in the Eastern }1edi terranean Region continues to diminish as the policy
of the Organization is now to increase support to the maternal and child
health aspects of health programmes of a broader nature such as the rural
health projects in Lebanon, the Sudan and t!"i.e Syrian Province of the United
Arab Republic, the health training centres in Ethiopia, Libya, Somalia and
Yemen, and projects aimed at urban and rural community development, At
the same time attempts are being made to incorporate, wherever possible,
adequate teaching on meternal and child c.:?re in the training of nurses,
both professional and auxiliary, and of health assistants, as ·vlell in the
curricula for medical urldergraduate and postgraduate education.
97. A close follow-up of nationC'.l maternal and child health demonstration
and training projects previously assisted by HHO has been carried out as
in previous years. The service activities and training programmes of
these projects have been reviewed in relation to the changing needs of
the countries concerned and to the general health plan wherever such a
plan has been formulated. The need for specialized maternal and child
health auxiliaries has been critically and realistically assessed by
national and international personnel in countries ,·,here there is a
shortage of nurses in the health services including hospitals and dis
pensaries, lack of supervision, and shortage of adequately trained
medical officers who are willing to work in dispensaries and health
centres,
98. Such revie .. ;s have shown thilt although in most of the countries
maternal and child health "auxiliaries" have been trained with a view
MATERNAL AND CHILD HEALTH (TUNISIA)
A WH O ad viser ex pla ins to st udents how to use a registra t ion ca rd to l:heck a falll il v's hea lth sta tus. T he MC H Centre la unched a $u rvcv in the dist r ict o f B~ lIcvue (Tunis) to in vl;s l ig.1tc th t.: li vi ng stand ard s o f son1e 5,500 fam il ies.
i\ \V HO adviser and T un i -; ian counte rpa rt gather daw on a fami ly's hcahh stat us. T he~ especia lly inq uire a bout ch ild ren"s d ie t a nd advis~ young
mothers how 10 make t he best usc of i nexpensive local food stu ffs.
A paedia t rician in oha rgc of the W HO - assisted M C H Cent re. Tun is. we lcomes young mothers seeking ao \'i t..:c fo r their chi ld ren.
. '/I;;;JI· ,~~
Women and ch ild ren ca ll ing .1 1 the MC H Centre ge t free drugs. indud ing vitami n;;;, from the Centre's pharmacy.
NUTRITION (PAKISTAN, TUNISIA, UAR, YEMEN)
Rout ine medil.2:11 chl.!ck-up (Pak istan ). As growth is the ma in indicato r o f the nutritional and hea lt h ..; tate. regu lar weighi ng in MC H Cent res helps ('va luJtc chi ldren's food nceus.
r
Home ecuno mics course (P rovince of Egypt - UA R). How to make rccipies a re taught to future mot hers b~ a home econom ics i
Nutrit ion demonstrations (YemenI Pakistan. Tunisia'). The pro per usc o f loca lly ava ilable foods
produced carrots a nJ other nut rit ious 'ura l healt h centre of the Qalyub area .
Nutrition Survey (Province of EgYPl-UAR) . Pe riodic med ical check-up of ch ild ren often shows clinical signs o f nu t rit iona l ddkicncc::: (shortagl: of proteins. vitamins , etc.) most common in a spec ific area.
...: of a \vell-ba lanced diet. especia ll y during th(' \.veaning period. arC explained to youn g mot hers.
A \\tH O Adv iser lu the D t.!ntJ I A ssiqanh' School. O mdllrman , Slld ~n l. Ir.:ctures on teeth rUlKl ions. 1 \\c ln: studcn tloi hu\e en foiled for l\\ c-yem of tra ining. DENT AL HEALTH (SUDAN)
Sudanc:-.r.: .jcnt3 1-a'lsis tanl trainees prac tising teeth l"l)l1servJ tion. treatment and extrac ti on. Equ ipment wa S supplied by \ VH O .
EN/RCll/2 page 51
to assisting more hi~~ly qualified professional personnel, owing to
shortage of the latter they have been obliged to work as professionals,
and have not had the necessary technical guidance and administrative
supervision. Thus, a short training of twelve to eighteen months has
proved to be insufficient and a period up to three years seems necessary
to cover sick nursing, midwifery and public health nursing including
maternal and child care. Auxiliaries having this 1ol1(:,"ertraining may be
appointed to hospitals, dispensaries, health centres,. maternal and child
health sections of health centres or to isolated maternal and child
centres, depending on the needs, the health plans, and the budget.
99. The Regional Office assisted in the study on joint vIRO/UNICEF train
ing programmes for permanent health services benefiting women and chil
dren in the Eastern l1editerranean Region, undertaken for the Joint
Committee on Health Policy which met in May 1961. One of the points
clearly brought out in this study of training programmes for physicians,
nurses and other health persannel was the need for one or more insti
tutes in the Region where they could be trained in paediatrics, public
health, maternal arid child health, public health nursing, paediatric
nursing, etc., under Caridi tions similar to those existing in their own
countries. Local institutes such as this are needed to supplement the
training they may receive i-Then abroad on lJHO .fellowships or otherwise.
100. The institutes in the Region and those abroaa should cooperate in
exchanging information on the respective countries and, where possible,
through an . exchange of lecturers. This ""auld enable the health per-
sonnel to become adapted to t heir D>,m local conditions at the end of
their study and to l·mrk acc ording to local needs, priorities, and accord
ing to available resources.
101. A vrno professor of social paediatrics has been assigned to the
maternal and child health department at the High Institute of Public
Health, Alexandria, UAR. It is hoped that this department will develop
along lines .1hich will make it sui table as a centre of postgraduate
EH/RCll/2 page 52
training in the field of maternal and crild he alth for othe r countries in
the Region. To give an adequate service and to be of optimurJ'l. use as a
training centre for the country and for the ;',egion the paediatric, child
health or maternal and child health institute or depal~ment needs to i nte
grate all aspects of child care: hospital and clinical p['.ediatrics,
"social" paediatriCs, the maternal and child health centre activities
as well as the home visiting e.nd follov7-u~ service of the child and the
family as a whole . This involves close coordination betHeen the medical
faculty, universit~' hospital service and out-patient department, the pub
lic health department including the maternal and child health department,
the school or institute of public health, the mat e rnal and child health
and c(]JlITlunity health service in the area, and so on.
102. The majority of the children in this ReGion a re attended by gene r al
practitioners or by physiciilIlS l·rllO a re a ssigned to dispens2.ries, health
centres and even maternal and child health centres, but have ha d no spe
cial lmowledge of paediatrics or child h:::alth. The undergraduate train
ing of medical students i n these subjects, and t he strengthening of
departments of paediatrics at medical facultie s i s therefore considered
essential for the i mprovemen t of child health and for the reduction of
infant a'1d cl1ild mortality in t his Region . For t hi s purpose "imO and
UNICEF assistance is bei ng given and ',nIl continue to b e given to Govern
ments who request it. For exarrr) le, at the Chi l dren's Hospital, Ki'.rachi,
the \\'110 paediatrician is actively i nvolved in the traini ng in paediatrics
of undergraduate me dical studeYlt s " t the DOH i'iedical College, Karachi,
and has also assisted the natiorlal pae diatriciCl.l1s a t the hospital in
organizing a refresher course in paediatrics f or general practitioners
in Karachi. Assistance i n paediatric nu rsing i s 1'.l so being given by
1.f100 paediatric nurses at t his hospital Cl.l1d at the Children's Hospital in
iUTlITlan , Jordan.
103. It should be stressed he r e the. t paediatric care and paediatric
trcining in hospital 2.re of limite d value in reducing infant and child
EM/RCll/2 page 53
morbidity ar.l mortality unless they are associated with care (follow-up)
and training in child health centres and at home.
104. Research in all a~ects of dh.rrhoeal disease, viz. paediatrics,
nutri ti. on, environmental sanitation, public health laboratory ,\-lork, epi
demiology, statistics, public health administration, health education,
public health nursing, etc., is being systematically organized. A
Regional study on diarrhoeal diseases has been initiated and experts
(national and international) in the above-mentioned specialties in the
countries which have shown an interest have been approached for contri
butions. Although many facts are available which point to the diarrhoeal
diseases and related problems as being a maj or factor in infant and child
mortality and morbidity i n this Region, definite and reliable statistics
have so far been very difficult to obtain. It is hoped that this Regional
study will make a useful contribution to the global study on diarrhoeal
diseases being conducted at 1-IHO Headquarters. A "iRO Advisory Team on
Diarrhoeal Diseases consisting of an epidemiologist, a bacteriologist and
a sani tar"Y engineer accompanied by a staff member of the Endemo-Epidemic
Diseases Division of vmo Headquarters, visited the Regional Office, Israel,
and the Sude::1 from April to the end of June and is expected to visit the
United Arab Republic in July, .. ;hen a specialist in paediatrics will join
the team. The Regional Advisers in Maternal and Child Health and Environ
mental ,sanitation were requestr::d to act as ccnsultnnts to the team in
their respective fields, 2Jld accompa'1ied the team on some of their visits.
105. On the basis of the HeacquC'..rters and Re gional studies it is hoped
a preventive and control p::'ogrD.:r.r;;c of thi s di sease complex may be planned,
wi th a resulting r eductio'1 in i Y'fant 2.l1d child deaths and an improvement
in infant and child health ~n tllis 1?S \,ell as in other Regions.
106. School Health. The Regional Office has been requested to evaluate
school health programmes in a few countries in this Region. As a broad
outline of the policy was given in last year1s Report, only one or two
aspects of such progra'llTOOs will be mentioned illld enlarged upon here.
Er-I/RCll/ 2 page 54
107. The School Feeding and School 1'ulk Programmes. As nutrition is
essential to health, the school feeding and milk programme should be part
of the School Health Service, and the tendency to separate these two pro
grammes under different technical and administrative national organizations
should be discouraged. The school health personnel should take an active
part in the supervision and technical guidance of all nutrition and feed
ing activities carried out for school children in coordination with nutri-
tion institute and other departments concerned. Nutrition education
should be an important component of the health education activities re
lated to the school health service, at te~cherst training institutes in
the academic school curriculum and in other health education activities
carried out for teachers and pupils in the schools. The school health
service should give advice on the local foods .... lhich could be used in the
school feeding prograrrune and encourage the teaching of nutri tion as an
aspect of health education. This work should be coordinated between the
health depar~ment, the department of education or whoever is responsible
for the school health services, and the nutrition authorities.
108. IIlhenever a dietary and clinical nutrition survey is to be conducted
in a country the school he::.lth service should be actively involved.
School medical officers should, wherever possible, be trained by nutri
tion experts in the country as well as by"JHO and FAO consultants, in
the recognition of nutrition deficiencies a.mong school children. The
final findings of all such surveys should be made available to the school
health service, which should t hen, on the basis of these findings, assist
in the planning and the implemento.tion of the school feeding and nutrition
education programmes. Health teaching on the existing deficiencies and
on the available foods Hi th which these deficiencies could be counter
acted would then be practical and therefore effective.
109. Coordination of School Health 1ri th Existing Health Services in the
~. \ii th the shortage of health personnel and health facilities in
most of the countries of the Region the school health service, to be more
EvifRClJ/2 page 55
effective and economical, i.e. to cater to the maximum number of schools
and of school children should, wherever possible, ·coordinate its own .
activities with the othe r activi t i es of the health department at all
levels.
110. Among the health services which should be we ll coordinated with the
school health service is the mate rnal nnd child health service. The
maternal and child health centre in the area where the school or schools
are situated should be aware of and i nterested in the school health acti
vities which are really a continuation of their own activities. Maternal
and child health clinics should be used whereve r possible, particularly
for school girls and for boys in primary schools. This may seem to be
contrary to the tradition so far establishe d in many parts of the world,
of separating school health and maternal and child health into two water
tight compartments, but many countries are beginning to realize that the
integration of such services is more econ om:l.ca l and, if well organized
and well accepted, will produce constructive results.
Ill. Public health nurse-midwives or au..uliaries working at maternal and
child health centres are supp ose d to be trained in school health work and
should, under the supervision of the school medical officers and maternal
and child health medical officers, assist in school inspections, i~ guiding
teachers in performing their health act ivities, in health education, and
so on. Maternal and child health personnel should be invited to be mem
bers of school health committee s and he alth education councils, and should
in their turn request the cooperat ion and assi st ance of the school health
service in every possible way . Mat e rnal and child health personnel could
be particularly useful in giving health teaching to school girls in tipper
classes of- secondary schools (.mo are the mothers of the future), by
means of l e ctures and of giving them the opportunity to observe the acti
vities of the maternal and child hec.lth centres.
112. Regional Office and fi eld s t aff have given assistance to three
countries in connexion with their surveys on the health needs of children
EH/RCll/2 page 56
undertaken on UlU CEll s recommendation as pru;t of the general survey on
the needs of children. One of the c01h'1tries was also assisted by a 1'1HO
consultant.
113. UNICEF Drugs and Diet Supp lements. liational and international per-
sonnel worldng in heQlth services related to mothe rs and children in the
different countries of this ~egion have; been requested to reply to a
questionnaire on the use of drugs and diet supplelr.ents which are provided
by UNICEF. Among the points on which they were requested to provide in
formation were: (a) the usefulness of each item on -the list in the pro
motion of rnatemQl and child health as well as in prevention and treatment
of disease in the area, (b) any item or items 1-IDich they considered
should be stopped or substituted by one more suitable for the tJ~e of
health problGl'lls dealt In th at their centres; (c) instructions provided
on the use of the drugs and diet supplements by doctors, nurses, maternal
a.'1d child auxiliaries, mimdves, daya s, e tc., worldng at maternal and
child centres, and the languaLes in which these instructions are gLven.
UNICEF RegLonal Offj.ces have ShOlID an i nterest in this investigation, the
results of 1-Jhich Hill be com.rrlUnic2.ted to them as soon a s replies from the
majority of the countl~es have been r eceived.
114. Seminars, Six maternal and child he alth vlOrke rs or health ad..'llinis-
trators from this Re gi on participat e d in t he seven-vlee k ':!HO maternal and
child health travellin g scrninar in the USSR organized by Headquarters,
The Regional HatemCLl end CJ-.ild Health /;.dviser also a ttended the seminar
\-lhich proved to be very successful. The s econd nati onal m~ternal and
child health semin2.T in Paldsten was he ld i:. D2.cca , ECLst Pa ld.stan, \Vi th
the material and administr ative 2.ssistan.ce of UrH CEF and the technical
and administrative assi stance of ('JHO fie ld sto.£f in Pakistan, It is
hoped that this and subsequent seT:'inars Hill st i;;rulate the devolopment
of maternal and child health along sound lines in Paldstan as a -whole,
NUTRITION
EH/RCll/2 page 57
115. Nost of the families in this Region vlh o are in a 101-1 income bracket
spend 60% to 80% of their small earnings (in cash or kind) on food. Yet
this nourishment is generally not sufficient in quantity or quality to
maintain he alth. I t is no wonder that Governments are showing an in
creasing interest and activity in iIq:')roving the nutrition of their people.
The urgency for this is illustrated by the fact that more than one-third
of the population in the Region dies before the age of five. Much of
this mortality is due to under-nutrition and malnutrition in early child
hood. Anaemia in women, especially if pregnant or lactating, is pre-
'Valent throughout the Region. This is partly due to the low intake. of
iron, protein and c2.1ories. Both mother and child nee d better food for
reproduction and groVIth, and the continuous attention e specially of
maternal and child health workers. Simple methods such as t he periodical
weighing of children might be used as a means of evaluating the quantity
and quality of the nutrition in .the community.
116. As nutrition is one of the major problems in the Region, the follow
ing basic principles are reconm:ended for considera tion. In planning
programmes, it should be noted that the field of nutritior, is so broad
and is related to so many p roblems that it would not be possible to start
at once an overall campaign to e radicate under-nutriti on and malnutrition.
The concentration should therefore be on a few crucial object ives to im
prove the nutrition of the mothe r and child; measures to improve nutrition
should be centrally planned and locally adapted by public health workErs
specialize d or trained in nutri ti o:1; all "mrkers in public health and
other fields related to nutrition should cooperate in designing and carry
ing out ti:ese measures. In addition, it is recommended that the :Hinistry
of HeaJth should, in cooperation with ministries of e ducation and agri
culture, establish a well-defined national nutrition education pro~e
adapted t o geographic and socio-economic conditions. A central institute
or division of nutrition in the Hinistry of Health should be responsible
EN/RCll/2 page 58
for the appraisr.l of the nutritional s t.:>.tus of popuhtion groups through
clinicc.l, biochcmicC'.l c.nd di e t ary SurV0YS, s t udies of vi te.l statistics
3l1d c.nthropometri c mensurel7l~nts . To improv0 the nutrition~l status of
the noedy popul..:l.t ion group s a~propriat;::; mcC'.surc s should be devise d by the
J'flinistry of H"alth in co operation ",ith other ¥;inist ries. Care sh ould
be taken that the public health aspects of all nutriti on projects 2.re
fully realized nnd the results CV2.lUQtc d by p3 riodical fol low-up of the
nutriti onal stntu s of the people . Rc s ccrch should be undertaker. espe -
cinlly nt tre communi ty l eVel to stimul ate ::.pplied nutrition nnd to
develop practical methods appropriata to the loc.:>.l conditi ons.
117. Present Si tuation . I nform2.tion on nutrition in Irc.n, Iraq, Libya ,
Tunisia and the Province of Egypt, Unite d .• rab Ropublic, has been collected
by the Regional Nutriti on Advis.;; r during visits to these countries, Dat.:l
on f ood c onsump tion end nutri tional sktus are avai l abl e in these countries
as well as in Ethiopin c.nd PQkistan. HOYTove r , more knowledge is needed
on infant feeding end 1-1eani:1g p r ac t icos. The Regional i.dviser included
informe,tion on the si tU2.t i on in a report on 1I ;lJutri t ion and H0ci th in the
Countrie s of the E:lstern Heditcrrmean Region of \ IHO" (1) prepared for t he
"Free dom from Hunger Campaignll un<ierte.ken by Fl,O. He assi s te d in pl..:l.nning
the national nutrition 5urveys which have n Oi-T been starte d i n Pnkistan and
the Province of Egypt, Unite d ;crab Repu·olic . Surveys on goitre, growth
and aribofle.vinosis in Pakistcn a.'1 d Lubc.non have be en completed b:{ a i,mO
short-term consultant . (2)
118. In the field of education c.nd training, h :1c.lth workers in Lebanon,
Libya and the Sudcn have been C'.w'2.rde d ,JHO felloHships in nutrition.
AHards i n the future are envisaged for Iraq, Paki stan c.nd Tunisia.
Training in nutrition is given i n schools for nurse s , s;;mitarians, mid
wives and home visi tors , e.nd for !1l8diCf'.l students, home economists and
teachers. Ne.tional coordinati on is necessary.
(1) Document EH/ NUT/14. English only. (2) Documents El'!/ I'mT/ 12 and EM/rrlrr/13
A second-year stLIdent from the College atlends a young patien t recently hospitalized.
NURSING COLLEGE, KHARTOUM <SUDAN)
Nurse counlerparts and sludl:nts from the Nursing Col lege carrying ou t a vilhlgc health educat io n programme.
Proba tioners enjoying a lecture at the new WHO - D<si.<ted Nursing College .
Todd lers engrossed in play organi zed by a n ussis ta nl nurse from tht: T ripoli S,-=hoo l. Specia l em phasis is PUI on child Cetn.:.
An aSl\isla nl nurse gels pr:lCIil.:a I exper ience in the obstetrin il se rvices under the sup( n 'ision of a c linkal nurse instructor.
NURSING SCHOOL, TRIPOLI (LIBYA)
The programme of this WHO-assisted nursing school is adapted to local needs and res\)urCes in order to provide professional nurses and assistants
for Libya's e xpanding health services.
Mid-te rm L'xa minatio ll fo r ass istan t nurses.
EM/RClJ./2 page S9
119. Close cooperation with FAO, UNICEF, national nutrition institutes
and university depar1:.Jrents has continued in all activities aimed at
improving the nutrition of the people of the Region. The report of the
FAO/\<JHO Nutrition Cormni ttee for the l'Iiddle East, with its many recommenda
tions has been widely distributed, and will no doubt stimulate public
health nutrition activities.
NURSnw
120. A highlight of the year's activities was the 1<JH0 Regional Nursing
Seminar held in Lahore through the courtesy of the Government of Pakistan.
Information collected and ideas exchanged between the nurses of the Region
both in the months of preparation and during the Seminar brought into
focus specific goals Which, when attained, would further strengthen and
accelerate the development of nursing in the Region.
121. One of these goals was recognized as being the creation of a section
within the organizational structure of each central health authority. As
both Ethiopia and Iran had well-developed sections, the participants from
these countries were able to provide first-hand kno'IVledge on their value.
Furthennore, during the Seminar a panel of doctors and nurses presented
the subject nPlanning on the National Level" which illustrated the various
facets and functions of the nursing section. The presentation was made
particularly interesting by the use of proverbs familiar to several count-
rius of the Re; t,ion. Some; of these ,mr \j "An army without a general is
not an annyt', depicting the need for the section to give overall direction
and guidance in nursing; II No light or lock means chaos or disorder",
indicating the need for licensing nursing personnel to ensure protection
of the publlc and of the profession; "Bette r count your soldiers before
you declare war", illustrating registration as an important function of
the section - a country must know of its nursing resources in order to
plan efficiently for expansion or extension of health services that require
nursing personnel. "Many small threads to gethe r can tie a lion" was
EM/RCll/2 page 60
another proverb quoted. This demonstrated the need for careful consi-
deration of many factors in planning nursing services and emphasized the
importance of qualified nurses assisting 1.n. th planning on the national
level. Finally, there was the question of the great need for coopera
tive effort and support for the nursing section and the development by
each country of a strong professional nursing association.
illustrated by the proverb tlOne hand cannot clap".
This was
122. In considering the quality of nUrsing education it ,las recognized
that the clinical practice areas provided the major portion of learning
experiences for students 8..'1d that generally these 1'le re far below the
level desired. The improvement of these areas, particularly with respect
to carefully and well-equipped nursing services, was an important goal
and it Has incumbent on nurse educators to assist in this improvement.
It was considered that students would be called upon to meet service
needs for some time to come and this was acceptable as long as the ex-
perience was arranged so as to provide for learning. To thi send auxi-
liary personnel should share in meeting service needs and staff nurses
should participate in the supervision of students .mere clinical instruc-
tors were no'c available. There 1"las a nee d for close cooperation between
educational and service personnel.
123. The curriculum should be considered .. ri th a view to determining
whether nurses were really being prepared f or the services they would
be expected to give, as well as ensuring that the nurses would make a
maximum contribution to the health of people. If comprehensi ve nursing
care was to be the goal, mental health , public health and the social
aspects of nursing would have to be integrated throughout the basic curri
culum and realistically re12.ted to both theory and practice. Furthennore,
it was agreed that with the marked short2.ge of professional nurses in all
countries, nursing 8.uxiliaries should help in giving nursing care. How
ever, the kind of care to be given re~1ined the responsibility of the
nursing profeSSion, and students in basic training must be prepared in
EM/RCll/2 page 61
methods of teaching and supervision in order, as graduate nurses, to be
able to train and guide this group. They must also be helped to develop
sld.lls for active and cooperative team rlOrk.
124. The value of group participation in promoting ideas and solving pro
blems was demonstrated and apparently appreciated as there was much dis
cussion on planning for seminars and work conferences to be held at a
national level. TNRO assistance was requested in the planning and con-
vening of these meetings. The hope was expressed that the Organization
would sponsor another seminar in the near future - the theme to be
"Basic Nursing EducationTT.
125. These were some of the main subjects that were discusseci during the
Seminar. However, there were many related topics included in the
report. (1)
126. Further news of nursing in the Region during the period under review
is that the Government of Iraq is planning to develop a Higher Institute
of Nursing in Baghdad. The Higher Institute of Midwifery in Iran, ' during
the four years of WHO assistance, prepared a staff of q~alified national
teachers and administrators competent to carry on the project, and WHO
staff has therefore been withdrawn. The Red Lion and Sun Society School
of Nursing at Rey now has a national faculty of twelve qualified nurse
educators. This school, which has grown considerably in professional
stature, can continue for the most part with advisory assistance only.
The main assistance required is in the deve lopment of nursing services
administration in the clinical practice areas. In the past year the
Firousabadi hospital has been able to p rovide all clinical experiences
in the curative aspects of nursing. The Uni versi ty of Alexandria, UAR,
selected forty-five from among eighty-four young women who applied for
aam.ssion to the Higher Institute of Nursing. Active planning is under
way to place mid~~fery on the post-basic level and to increase instruction
(1) EM/Nurs.Sem./22
EY/RC1J./2 page 62
and practice in teacbing and administration which are responsibilities
that the graduates are being called upon to assume. Pakistan has
introduced in selected hOS',bIi t als the training and e~-:l loyment of an auxi-
liary nursing group ,.mom t hey call "NAIDS". This group has less educa-
tion than that required for professional nurses, but many continue studies,
planning later to enter nursing. iVIeanwhile their assistance in hospitals
reduces the service load of students and makes it possible to p rovide
better learning experiences for them. A neH national four-year curri-
culum which includes mate rnal a...'ld cbild health and midln f ery is being
tried in 1dest Pakista..'l .
127. The Nursing College in Khartoum, Sudan, has move d into the new
building which was construct ed especially for it. Student admission has
more t han doubled over the previous acadeJT1ic year In th a current total
enrolment of t"\,enty-four. Graduates have been aosorbe d in the health
services and there is an increasing demand for them.
128. The first qualifie d nurse trained in Libya graduated from the Tripoli
School of Nursing, and is working with t he inte rnational team i n the
school and clinical p r actice al~as . The second course continues for
twenty-one assistant nurses . Education of the public concerning nursing
is continuous and the nursing services are being strengthened for the
training of students. The Government ha s reque sted further 1-IHO assistance
in the e stablishr1'18nt of a s econd school patte rned after the Tripoli one
in the Province of Cyrenai ca.
129. In the United ,:lrab Republic i n the latter part of the year, a nursing
education programme s tarte d in the Syrian Province with assistance from
the Organization in studyi ng nursing resources and needs, beginning with
staff in-service treining a t the Damascus Gene ral Hospital. Plans have
been finalized for assi s t ance t o the Ahmed Nahe r Hospital School of
Nursing in the Egyptian Provinc e .
EM/Rcll/2 page 63
130. WHO nurses have also hel ped t o develop nursing as part of the
progr2lTlJ1les in maternal and child health in Libya and Tunisia, in tuber
culosis in Ethiopia, Somalia and Sudan, in the venereal diseases project
in Addis Ababa, Et hiopia, in psychiatry and mental health in Iran, paedia
tric nursing in Jordan and Pakistan, training of health personnel in the
Ethiopia, Somalia, Sudan, Province of Syria, UAR, and in the Yemen.
MEDICAL REHABILITATION AND PHYSIOTHERAPY
131. The countries of the Region are gradually paying more and more atten
tion to the question of medical rehabilitation. 'VJHO medical rehabilita
tion consultants have visited Iran and Tilllisia to assist in r1_""'ning for
long-term programmes. Clos e cooperation exists with the United Nations
Bureau of Social Affairs which is resp onsible for the social and vocational
aspects of rehabilitation, and with UNICEF which has provided supplies
especially for projects serving physically handicapped children.
132. A surgical consultant visited Ethiopia!s Kolfe rehabilitation centre
to advise on various aspects of orthopaedics, including the physical re
habili tation of leprosy patients. vmo has continued to assi st Pakistan
through the service s of a p~ysi C' therapy tuto:::' and, during the pas'b year,
also with a prosthetics technician. The School of Physiotherapy in
Pakistan is now well e stablishe d D-l1d i t is expected that the supporting
services such as a brace vlOrkshop will soon be fully operative. A WHO
physiotherapy tutor is expected to be r ecruited for Shiraz in Iran. In
Israel and Lebanon acti vi tic s formerly sponsore d by WHO are continuing;
the Lebanon, which is contempl a t ing an extension of these services, has
reque sted "rno assistance f or the futur e .
HEALTH EWC.~'fIO ;'; OF THE PUBLIC
133. The importance of enli ght eni n g the ,)Ublic on health matters so that
they may asSU1l'.B more r e sponsibility in the promotion of individual, family
and community health, is being given p rominence.
EVVRC11/2 page 64
134. Furthermore, t he p resent trend - strongly encouraged by the Regional
Office - is to integrate health educati on into all programmes and not to
consider it as a separate br~~ch of ) ublic health, dissociated from the
cultural and social background of the public for which it is intended, the
latter approach having proved i n the past to be ineffective. Accordingly,
increasing emphasis has been placed on the health education aspects of
maternal and child health, mental health, malaria eradication, tuberculosis,
public health nursing and communicable eye diseases, as ,.el1 as of small
pox and bilharziasis. Papers prepared for the Regional Nursing Seminar
in Pakistan and for t he Hental Health Group VJeeting in Alexandria, illus
trated the health education aspects of t hese subjects, and it is recommended
that health education should be t aken into consideration at all such con-
ferences.
135. The Re gional Offi ce has continued to stress the importance of
strengthening the health education services in the various countries and
of prope rly staffing them vii th qualified professionals. This would .irnply
the development of national leadership and appropriate use of all pro
fessionally trained staff already available , particularly forme r 1rJHO
fellows. Advances in this respec t have been made in the United Arab
Republic where, in t he Province of Egypt , t he Director of the Health
Education Section of the }Iinistry, and the Director of Health Education
in t he }la1aria Eradication Programme, and in t he Province of Syria, the
Director of the Health Education Section, have received pr ofe ssional train
ing under the auspices of WHO . The t,w officials in the Province of Egypt
were assigned to their r espective posts in 1960 .
136. Other action characteristic of the present policy is the effort being
made to raise the educational and professional standards of all potential
health educat ion speCialists.
health education methodology.
EmphaSis has continued to be placed on
A technical guide vIas prepared and distri-
buted to all HHO staff and to some Governments i nterested in establishing
standardized r equirements for selecting personnel, granting fellowships
EH/RCll/2 p~6e 65
and choosing suitable candidates for specialized training in health edu-
cation. The HRO professor of health education assigned to the Radassah
11edical School, Hebrew University , Israel, has extended his teaching
activities to the special course l e ading to the l'iPH degree.
137. In the malaria eradication programme great importance has been given
to the training of the personnel in healti1 education methods and techniques.
This has been particularly evident in the Regional Halaria Eradication
Training Centre, Cairo. However, this activity should be strengthened,
Curricula revised to include health education under every subject should
be adopted by both the regional and the various national training centres,
138, During the period under revien th;; Regional Adviser in Health Educa
tion visited seven countries of the Region to advise the various Govern
ments on the most appropriate methods of strengthening their health edu-
cation services. An acute and ever-increasing need is felt for qualified
health education specialists. There should be a strong Health Education
Section in each Ministry of Health to support the various programmes in
progress, and particularly those relating to the training in health educa
tion of the public of health personnel, t eachers, social workers, camnrunity
development and agricultural \'lOrkers,
139. To cope with the above it is recoJTll7lcnded that: (a) ~VHO or the Govern
ments grant more fellm,ships in health e duc a tion to help create the desired
national leadership j (b) Governments reque st I,mo advisers to assist in
the organization or developm;;nt of their health e duca tion se rvices, when
the required qualifie d counterparts are traine d,
140, In summary, i'lHO's policy is to emphasize the training of all health
personnel in health educa t ion meth ods ; to give he alth education training
to teachers, social workers, and other community personnel; to develop
high leve'l national leadership through the award of f ellowships; to
integrate health educati on into the preventive medicine courses in
medical schools, to eneourag8 and p romote research and studies in health
education.
EI1/RCll/2 page 66
jJjENTAL HEALTH
141. A Mental Health Group Heeting, sponsored by the Regional Office, was
held in Alexandria in December 1960, and was attended by seventeen Regional
mental health experts. This ,.,as indeed an opp0 rtuni ty f or general orien-
tation, coordination of concepts and for the appraisal 8nd planning of
programmes. Moreover, it helped to foster professional and personal re
lationships. It is gratifying t o find that the conference also fulfilled
one of the aims of the Regional Office, that of stimulating the interest
of national experts in Regional matters as a whole and specifically in
Regional health problems.
142. In view of the priority and immediacy of the need for trained personnel
of all categories, traiI'ing progrrunmes are being given priority in the pro
motion of mental health services. It ha s already been pointed out that
more attention is being given t o the ecological concept in training, to
enable trainees to apprehend more realistically the role of culture in
health and the implication of such a role when organizing their work and
evolving their techniques. It is therefore felt that initial training
wi thin the Region should precede and. herald any formal post-graduate
training abroad on WHO f ellowships. So far, two post-gre.duate students
have fulfilled this requirement by tr~ning f or three months at the Lebanon
Hospi tal for Ment al and Nervous Disorders in Beirut, and have now proceeded
to the United Kingdom f or formal diploma studies. This system has evi
dently also contribut ed to a better evaluation of candidates and of their
fi tness for such studies. Countries are of course free t o develop their
own post-graduate progrrunmes ~~d the Regional Office is encouraging them
to do so.
143. Training of Nurses. Funds have already been allocated for the
training this year in Bcirut of Regional psychiatric nurses to meet the , emergency situations in many countrie s wher c rapid developments are taking
place. The course is limited to six months and the training programmes
Life III the nc\',,' Ho:-.pi lal fo r Mental and Ner\'olls ni~orde r s. Kllwan. is mainly fo\:u o;ed o n the r~n.:ation cen tre where socia l rehabilit ation and occupat ional thera py arc pursued wi th i nte n sit~.
MENTAL HEALTH (KUWAIT)
Thi .... room fOi occu pat io nal Iherap~ p ro\'ldes fe malc Inmatc~ wit h crea ti v(, act ivi t ies ..;u ilcd to thei r tas te a nd abilitii..'s .
Hydrotherapy is just alloth~r woru for flln to t hi s boy frol11 SCiUlli Arab i:! . who wa ... left wilh hoth kgs pa ralyse.:d afte r poliomye-li tis. He IS t rl'a l ~d at a Ld.>aneo.;e Ce.:ntre fo r the reh;·lhilitat ion o f handicapPl'd children . wh ich \\a~ assisted b) \ \ 'HO.
POLIOMYELITIS
(LEBANON, PAKIS TAN)
Oernonstration of the.: t reat ment o f :.1 cerebral p~dsy and 1.\ paraplegia :u the ompat ient s departmen t or tht' J innah Cent ral Hospita l. Karach i. \"hl:r~ a \VI-lO-ass istcd
s\..:h ool o f physiothera py was c ... tabli shcd .
EIvI/RCll/ 2 page 67
and facilities have been carefully scrutinized. The trcinees on finishing
could be utilized if needed for implcrronting in-service training in th(;ir
awn countries.
144. Public Health and l'iental Hee.lth Integration. The next step envisaged
is the integration of mental health and public health by probing ways and
means of liaison. It is conceivable that the concepts of prevention,
health education, 8pidemiologic.:tl studies, the structure and dynamics of
domiciliary services and above all of e.dministration, may not be clearly
comprehended without the incorporation of some of the valuable experience
gained by public health men in the field of their practice. For this
reason it is suggested that a study group of mental heal th/pu1:J1i.c health
experts should be sponsored by the Regional Office early next year. In
this respect it is also felt that the orientation in montal health matters
of general duty doctors in key positions in state services is highly
desirable, especially for those in countries where such practitioners are still faced with a wide range of neurotic and early psychotic cases. As
the latter project could not possibly be dovetailed in its aims to the
public health/mental health study group, it is felt that a separate train
ing programme emphasiz:ing the concept of psychogenesis, the management of
neuroses and of emergency cases and the use of common drugs in psychiatry,
should be dealt with as a soparat0 project.
145. The Problem of Chronics in Mental Hospitals. Recognizing the im-
portance of the problem of chronics in mental hospitals 2J1d especially of
the serious depletion of funds involved, a small group of specialists from
the Region will meet in Teheran tow.:trds the end of 1961 to discuss these
problems. The organization of a sp8ciCll unit in mental hospitals with
specially trained staff for the rehabilitation and r8socialization of chro
nics on lines similar to those in the Lebanon hospital will be the concern
of special study. Working p.:tpers dealing with the clinical aspect of
chronici ty, the role of tranquilizers eJ1d methods of rehabilitation in
general, are being contributed by two eminent specialists fran abroad.
EM/RCll/2 page 68
146. Children. The year 1962 is marked by the Regional Office for the
launching of mente.l health service s for the child. The intention is to
stimulate and reorient the interest of Governments in the direction of
children, since so far efforts a rc still being largely concentrated o~
the adult population. Special emphasis ,vill be placed on the development
of such services within the fr~ework of paediatric s ervic es in general.
Kuwai t is perhaps the most appropriate place for a preliminary study group
to deal with the organizational side of this project in which the school
health service will naturally have a prominent place.
147 • Clinical Psychology and Social Hork. The organization and the ela-
boration of the ecological concept of clinical psychology and social work
will be a topic for a small conference early in 1963. It should be
stressed in particular that social work has a great affinity to cultural
patterns and should therefore be elaborated according to prevailing commu
nity styles and traditions.
148. Epidemiological Studies. The introduction of epidemiological methods
and techniques will be the topic of a seminar late in 1963. Due emphasis
will be given to case-finding, field techniques and proce ssing of data.
For demographic r easons, Kuwait offers the hi ghost validity for such a study.
149. Provincial Services. The re is a growing need and interest in many
countries of the Re gion for the d0vGlopment of provincio.l mental health
services. It is believed that as ffi~ initial step the general duty doctor
may be the appropriate spearhead for such services. A six-month training
programme in mental health for suitable medical officers working in the
provinces, as for examplo, the one conducte d by Profess or Rodger in Glasgow,
may enable them to deal and assess the situation in advance and so prepare
the soil for more specialized pl~ng. This may, however, involve the
real risk that the general practi tioner may lose his orientation and pers-
pective by inadvertently assuming the role of a specialist.
reason, training in the Region may be more appropriate.
For this
150. Reorgan~zation of Mental Hospitals.
EM/RCll/2 page 69
Mental hospitals which have
failed to respond to the process of change and are in consequence incapable
of serving a changing community rr~y raise one of the most difficult pro-
blems in development. The experilnent of sending a team of one expert and
one nurse to such a hospital has proved its worth and in view of this ex
periment this type of service would be furthe r pioneered as a prototype
for the reorganization and modernization of such hospitals in the Region.
151. Regionalization of Training Centres. The experience of this Office
has led to the belief that a s a policy t.nd a philosophy, the different
countries of the Region can contribute effectively in their own way to the
establishm<:nt of ref',ional centres for r egional training. This is a matter
which is largely a functi on of the inherent historical, cultural and econo
mic realitie s and potentialities ~nich in their a ggregate may contribute
more to the promotion of a ce rtain project. Pakistan and TuniSia, f~r
example, may make r eal contributions to the social studie s and techniques
and in the case of the former to demogr.:J.phic problems in general. Iran
can a1so.provide the best possibilities for occupational therapie s. On
the other hand, bec.:J.use of certain historic and contempore.ry factors,
Lebanon . may bo able to make valuable contributions in training personnel,;
the United Arab Republic in fi e ld work, drug addiction and recreational
therClpie s. Finally, Kuwait is in possession of SOOE i~ort=t features
which may heighten the v2.lidity of epidemiologic .:J.l work and the Sudan may
provide useful hints for extra mura l work and f or c ommunity development
in relation to the promoti on of health. The r esource s of other countries
should also be probed and use d to t he full.
152. The Implications of the Proce ss of Change . The important influence
of economic and s ocial cho.nge on tho nature and trend of hoal th and its
problems. and of the implicc.tion of this on poliCies and on planning has
made it necessary that l ate in 1962 or oa rly in 1963 a small group of
Regional experts should de.:J. l wi th the chanf',ing concept of he alth in chang
ing cultures and the implicati on of this on the structure of health services.
ElfJ/RCll/ 2 page 70
153. Research. In the present circumstances of r apid evolution the need
for research is ell the more important. It is keenly felt that the
Regional Office should sponsor and affilinte one or more centres (mental
hospitc.ls and public health institutes o.t the beginning) in order to be
able to investigate and to thro1-l light on some of the major problems that
have real bearing on mental health work. Thi s may create added incentive
for Regional cooperation and participation as well. As has been pointed
out in the Introduction to this ~eport, the need for research into the
possible role of virology in the c.etioloE;Y of neuro-psychiatric conditions,
is perhaps one of the main preoccupations at present.
VITAL AND HE~·J.,TH STi,TISTICS
15~ Lack of accurate busic vital and health statistical information
remains an obstacle in pointing to trends in the health picture of the
Region. The need for such d.e.ta is constantly felt in fr<IDling Government
and internati onal action aimed at reducing the burden of disease. For
example, programmes for the control or eradication of infectious diseases,
for promoting maternal and child health, environmental sanitation, mental
health, need accurate vital and health statistics in order to be effectively
carried out and eValuated.
155. The creation of an efficient cent~.l health statistical set-up and
the development of a health statistical system to meet the various needs
for information in a country is a long-term process. It involves such
factors as appreciation of the need for such inforrnation, allocation of
necessary funds, avnilability of statistical personnel and equipment,
availability of medical personnel and the cooperation of the medical pro
fession in supplj~ng reliable rec ords on mortality and morbidity.
156. Public health administrators in the Regi on are becoming increasingly
aware of their dependency on statistica l data in planning health programmes
and in deciding upon priori ties for various possible health measures. fl
EN/RC1J/2 page 71
barrier to the development of health statistics, however, is the scarcity
pf professional statisticians. Statistical education in most countries
of the Region is either non-existent or has been available for only a few
years, and other Government agencies, especially in the field of economics,
are competing for the services of trained statistical staff. Another
illlJortant obstacle is the insufficiency in many areas of medical and other
health personnel.
157. The situation in these various respe cts differs greatly from country
to country. Some countries of the Region have fairly well developed
statistical services, in others they are entirely lacking. An occasion
for evalua ting the present position and the immediate and future needs in
the various fields of health statistics on the basis of national and inter
national expe rience, }rould be a Regional Conference on Health Statistics,
with the participation of health administrators DIld statisticians from
each country.
158. WHO has taken an active inter e st in assisting Member Governments to
develop national health statistical services, and the Regional Office
will continue to provide the services of advisers, and fellowships for
statistical studies at universitie s and other educational centres, or for
practical training in countrie s where the health administrations have
ample statistical se rvices.
159. Statistical advise rs have been provide d to the Ministry of Health
of the Province of Syria, United .\ rab Republic, since 1958, and to the
Ministry of Health of Pakistan from January 1961. New vi tal and he alth
statistical projects a re planned to start in Iraq, Libya and the Sudan.
Statistical advisers were provided by vJHO t o tuberculosis projects in
Pakistan and Tunis, and for the Re gional Tube rculosis Survey Team.
160. A total of 17 fellowships in health statistics were awarded during
the year. 14 of these f ellowships were for the training of statistical
assistants at the Inte rnati onal Statistical Educe.tion CEmtre in Beirut
for the academic year 1960/61.
EM/RCll/2 page 72
161. The Regional Statistical Adviser has continued to assist in the
planning and evaluation of proj ects and in rendering advice to countries.
The Epidemiological and Statis tical Cent r e , established at the Regional
Office early in 1960 has processed and anal yzed statis ti cal material from
various tuberculosis and communicable eye disease surveys. This Centre
and the Regional Statistical Adviser ~re generally at the service of the
countries of the Region.
162. A consultant in Arabic medical terminology has reviewed and finalized
the Arabic version of the Internati onal Statistical Classification of
Diseases, Injuries and Causes of Death. It is expected that this impor-
tant tool for t he improvement of health statistics will be ready for dis
tribution to Nember States in the near future.
ENV IRONN8NTAL SAlIJITATION
163. In applying t he policy tovJards environmental sanitation adq:Jted during
recent years, two general paths have been fo llowed. On the one hand, the
aim has been to as si st with Government plans for p r oviding basic sanitary
facilities to countries of this Region, .,here they are l.:l.cking. On the
othe r hand, attenti on has been given to developi ng a specific programme on
communi ty wate r supply Iii th the aim not onl y of providing this indispen
sable element but also of stimulating t he f urthe r development of environ
mental sani ta ~ion in gener.:;l.
164. It is well known. t hr. t the proviSion of basic sanitary facili ties is
not a simple t r.sk. There <,.re 2. numbe r of preDamtory activities which . ,
must be carried out if the final stage is to be successfully reached.
These activities involve the r ecognition of the ey~sting needs not only
by the people concerned but also by the Gove rnments , as ,"Iell as a true
assessment of their value in t erms of economic possibility; the training
of technic0.l pe rsonnel to he l p the people obt2in these f ncilitiesj the
building up of an a dequate and strong administrdi on t o ensure t hat t he
El4/RCll./ 2 page 73
technicians are use d to the best advo.ntage; economic deve lopment to pennit
continued improvemont in the fi eld.
165. All the se concomi tan t activitie s ha.ve been considered and every effort
has been m.:l.de to give t o each the attention and the sha re it deserves. In
this r espect, health education, t~ining of technical personnel, develop
ment and strengthening of public health administration o.nd collaboration
with community development p r ogramme s have continued t o be the pillars
on lffiich we are building environmental so.nitati on.
166. As health educati on is dec.lt with in de t ail in another part of this
Rep ort(l) further comment s a r e not nece ssary. On the subj ect of techni
cal pe rsonnel, the training of sanita ri.:ms is being continued in Ethiopia,
Iraq, Libya , Saudi Arabia, Yemen, Olld recently also in the Province of
Syria, UliR. l.[i th the i ncrea se in the numbe r of this type of worker,
thought is being given to devel oping Regional centres for more advanced
training than that now a.vcilable for s 20ni t a rians in the individual
countries. This will be of help in providing supe rvisors and better
qualified technicians.
161. Considering the continuous increase of technica l pe rsonne l f or pro
moting environmental sanitation as well as othe r health work, the develop
ment and strengthening of the public hee~ th administration is becoming
more and more pressing. I n 0. numbe r of countries of the Region progress
has already been made in this di rection. It is expecte d that such acti-
vities will soon be under way in most countries and that they will keep
pace with the tmining cnd prope r use of personnel for public health work.
168. In the field of corrmruni ty wa t er supply, activities are gaining
momentum. . A second Inte r-Re gi onal Seminar was held in Addis Ababa with
the participation from our Regi on of Ethiopi a , Iran, Iraq, Pakistan,
Saudi Arabia, Somalia., Sudan .:md the United Arab Republic, and nine
El'VRClJ/ 2 page 74
countries from the African Region. The purpose of the Seminar was to
examine the latest information on the financing, management and organiza
tion of community water supplie s and to exchange views on l·mys of promoting
new construction and improving existing systems. In the meantime, WHO
experts are helping the Governments of Paid stan and the Syrian Province
of the United Arab Republic vii th their community water supply deve10prren ts.
A short course for water supply operators is planned for the autumn of 1961
in Pakistan, It is expected that additional activities of the kind will
be undertaken and assistance l.n.ll be increasingly requested.
169. The coming into existence of the International Development Associa
tion (IDA), which is an affiliate of the International Bank for Reconstruc
tion and Development, is expected to have important consequences in the
RegLon. The possibility of till s Association providing loans for coinmuni ty
water supplies brings hope of strong support in a hitherto weak spot in
the programme.
170. It is recognized that the promotion of environmental sanitation calls
for the preparation of qualified sanitary engineers. This need is empha
sized still further ldth the development of the community water supply pro-
grammes. Training activities for sanitary engineers are now under way in
three countries of the Region: Lebanon, Pakistan and the United Arab
Republic (Alexandria).
171. In addition to postgraduate courses for sanitary engineers, there
is an increasing need for short courses for personnel who need to refresh
their knowledge and acquaint themselves vlith new deve1oprr~nts in their
speciali ty.
172. The question of housing in relation to health is on the list of
priorl ties in the RegLon. Rural as well as urban housing problems need
study and especially some practical solution. The Report and recommen
dations of the 1<lIlO Expert Gommi ttee on Housing are expected to be of great
interest and help.
T decohaltot hcra r y of a deep cancer t.:3SC. The gamma ray emitt ing co ball source is located iff the tOP part of the arra ra1 us. above the patient. A technician watches the patient through a thic k lead glass duringthetreatmenl. CANCER CONTROL (IRAN)
Oaily exami nation at the Cancer Institute. Tch..:ran. requires four qualified pathoJogi:-'b. who ca rr} Ollt cancer diagnos is through microscopic examiniltion of sam ple~ from the pat ient"'.
In the Ins tit ute"s laborator,... an " autotekn iton" is used for the preparation o f sa mples from patienls fo r micros(opic examination. This robol-appa ratus performs alone the work o f seve ra l tcdm icians.
The control post of an up-to-da te rad iDlherapy apparatus lIsc:d fur the treatment of va rio us cance rs. A young pat ient, ly ing unde r (In X -ray e m itt ing appara tus. is watched by the attend ing nu r:-.c through a lead glass to avoid radi iltion ex posure.
Ta ki ng blood from a vol unteer in t il t: ma in s.<.:rv i('i: of th t; blood ba nk se t up \\ill1 \VHO as~j ~ l anl.:l: in K hanoll nl
Laboratory It:c hnicia n opera tes a distill ing apparat us su pplied by W HO.
BLOOD BANK (SUDAN )
P reparation of the b lo od do no r se ts. Mak n urs~::. are sharpe nin!; a nJ check in g needles.
EH/RCll/2 page 75
CAl'l"CER CONTROL
173. The first interest in cancer control shown by the World Health
Organization was in 1955 when a cancer control project was started in
Iran at the request of the Government.
1958, and resUlted in the establishment
WHO assistance continued until
in Teheran of a modern and W6+1
operated cancer institute. Two similar projects are now under study:
one in Khartoum for the Sudan, and the other in Damascus for the Syrian
Province of the United Arab Republic. In the Egyptian Province, a
national cancer control programme is being planned.
174. The satisfactory results obtained and the evident interest shown by
the various Governments have induced the Regional Office to extend it?
activities in this field and to carry out a study on the problem of cancer
in the Eastern Hediterranean Region. A questionnaire has been sent. to
all the Governments of the Region with a view to collecting the necessary
information. Local conditions inherent in each country, Buch as specific
incidence of certain forms of cancer and existing facilities for the sur
vey of endemo-epidemic diseases, have to be taken into consideration
before plann~ng a programme.
175. A cancer control program~e comprises various stages which cannot be
attained simultaneously. The mOo 'L important of these stages are: patho
logical diagnosis, treatment by surgery and radiation, cancer registra
tion, statistical and epide~iological studies, cancer detection at its
early stage, clinical and experimental research, education of physicians
and the public, and medical care of incurable patients.
176. The assistance given by the Regional Office consists of providing
experts to complete or create centres for the diagnosis and treatment of
cancer, or to carry out epidemiological studies. Fellowships are also
granted for the training of national personnel. Five fellowships have
already been awarded for physicians to specialize in the pathology or the
treatment of cancer with radiation.
EM/RC1J.j2 page 76
177. A paper(l) on cancer giving ~ detailed account of the problem will
be submitted to the Region('.l Committee at its Eleventh Session.
RJillIATION MEDICINE
178. Steady an1 rapid developments in t he use of atomic energy nnd its
by-products, as well as the ever grol-ling number of resulting hazards to
the population of the countries of the Region necessitated the apPQintment
in October 1960 of a Regional Adviser on Radiation and Isotopes. His
essential function is to advise: on 111e pr()tection of workers nnd the
public from r~diati on h2zcrds.
179. Radiation hazards may occur from:
(a) Atomic energy ins~llations (mines, reactors, factories). The
Atomic Energy Health and Safety Departments assume the protection of
workers, but in case of accident the environment will be contaminated
and then the measures to be t aken for the safety of the population con
cerned will largely be the responsibility of the public health services.
(b) Use of radioisotopes in industry, medicine and agriculture.
The protection of users is entrusted to the public health se rvices and
more particularly to the occupational health department.
(c) Medical use of X-rays. The public health services are res-
ponsible for the dose distribution to personnel and .:11so to the various
~roups of population examined.
180. It .Jill be remembered that during the Tenth Session of the Regional
Committee, the public he a lth role in the disposal of radioactive waste was
discussed e~d the attention of Member States was drawn to the responsibility
of their health authori tics In t h regard to the protection of the public
against hazards resulting from radiation. (2) They were also urged to
(1) EMjRC1J.j6 (2) Resolution EVJjRC10!R.7
El'l/RCll/2 page 77
organize wi thin the Hinistry of Health a central se rvice for radiological
protection. This service should include radiologists, radiobiologists
and health physicists who would advise on measures to be taken in all cir
cumstances, under normal conditions and in case of accident. They would
ensure close cooperation with the Inte rnational Atomic Energy perso nnel,
and provide guidance on the app lication of international safety norms.
This service should have adequate equipment for the measurement of distri
buted doses and even a research laboratory, which could also be used for
some epidemiological studies.
181. WHO could assist Governments in the education of personnel by granting
further f ellowships or by providing experts. Six WHO fellowships were
granted last year for the training in radiology of three physicians and
three technicians, and a physician was awarded a f ellowship for speciali
zation in radiological protection. A WHO consultant in radiology has
organized in Teheran a six-month training course in the use of X-ray
equipment: six physicians and el e ven technicians have thus become
specialized.
le2. The Regional Adviser has already visi t ed several countries of the
Region. In the Lebanon , a preliminary study was carried out with a view
to organizing a Regional Training Course on the Medical Use of Radio
isotopes; in the United Arab Republic (Province of Egypt), a survey was
conducted with r egard to the prote ction of personnel using fixed and
mobile X-ray units and to the doses r eceived by the population during
mass radiological examination.
183. In addition to this, the Region.::!.l Adviser represented the Organiza
tion at a Symposium on II Nuclcar Ship Propulsion with Special Reference
to Nuclear Safet~1 at Taormina. This Symposium was jointly sponsored
by the International Atomic Ene rgy Agency and the Intergovernmental
Maritime Consultative OrganiZation. He also represented the Regional
Office at the IIJournees Nedicalcs de Beyrouth" during mich he presented
a paper on liThe Physician =d the Use of Radioisotopes".
EM/RCll/2 page 78
184. As the cooperation between the Regional Office and the Internatimal
Atomic Energy Agency has entere d a more constructive stage, the partici
pation of the Office in the organizati on of a Re gional Training Course
for the Use of Radioisotopes in lk, dicine, t o be held by the HEll. in Cairo,
is being envi saged.
EPIDEi'IT OLOCICl.L SECTION
EMRO r S EPIDEMIOLOGICl.L Ii~TELLIGENCE SYS'IEH
185. No change occurre d in the geogmphical area served by the Epidemio
logical I nte lligence System of the Region,,- l Office during the peri od under
review, except f or the addi ti on of the f ormer Bri tish Somaliland ,men it
became united wi th the nOH Republic of Somalia.
been i n the HHO African Re gi on .
The a r ea had previously
EPlDEMIOLOGI Ch.L INFORl'1Jl. TION A.l'ID QUI~llAN'i'INE NOTIFICATIONS
186. Althougb. some improvorr.Gnt "as noticed duri:lg t he pe riod under revie"
on the part of some Gove rnments in the fulfilmcn t of thei r obli gations
illHler the Irternationci S.:tJ1..itary Regulati ons, yet certain countries con-
tinued to experience difficulties in this respe ct. In some instances,
official n otific<ltion on upiciernic outbr eaks wa s unfortunately delayed.
187. Accuracy i n r c.po rting is e ssential if t he "Regul ations are to be
properly applie d, but on l y a fm'T countric s send t he no tificati ons provided
for unde r Articles 3, 6 and 8, ISR in s tric t conformity wi t h the stipula-
tions of the s e art icles. The majority limit themselve s t o supplying the
Heekly number of cases and deaths from qua r antinable disease s occurring
in their territorie s without mD.king a f orm<'.l notifica tion thD.t a local area
within their te rri t ory h:ls b ecome infecte d or free . Th..is ha s r e sultGd in
a del ay in the Hi thdrawal of the quarantine r e strictions enforced by the
countri es of arriva l and it Has onl y ,,-fter the Office ha d cctlle d their
attention t o t he fact that t he infecte d local area had been de leted from
EM/RCll/2 page 79
the lIlist of infected areas ll published by l·mO in the Weekly Epidemiolo
gical Record that measures were taken for the removal of the restrictions.
However, it has been noted that certain countries have started to lift
these restrictions ... hen the infected local area was deleted frem the lllist
of infected areas II , especially as t oo task of the quarantine administra
tions has been made easier after Headquarters decided to publish, as from
15 April 1961, a list of lIareas no longer infectedll appearing immediately
after the lllist of infected areas ll •
188. Some countries continue to delay sending their notifications of
enforcements, change or withdravlal of quai'antine restrictions. This has
been particularly observed during the cholera epidemic in Afghanistan and
West Pakistan, .men the Offi ce was awal~ of the e~Jorcement through com
plaints received from the countries due to the fact that the measures
taken exceeded those p r ovide d for in the International Sanitary Regulations.
INTERNATIONAL S.~~IT&~Y REGULATIONS
Application of the International Sanitary Re E,ulations: Information collected under Articles 3, 4 and S
189. During the period under revieH, no cases of quarantinable diseases
have been reco rded in the follov;ing countries and territories of the
Region:
Aden Colony Aden Protectorate Bahrein Cyprus French Somali land Iraq
Jorcla.TJ. Kuwait Lebanon Somaliland un , Province of Syria Trucial Sheikhdoms
Summary of Outbreaks of Quarantinable Diseases of Special Interest
190. The major epideJ71.ics ,dth l'1hich the countries of the R.eE;i.on had to
deal were the cholera epidemic in Hest Pakistan and Afghanistan, and the
yellow fever epidemic in Ethiopia. HOHever, 7 cases of plague Here re-
ported in Iran and 5 in ICenya; 23 cases of relcpsinf:, fever were reported
E~!i/RCll/2 page 80
in the Sudan. A table showing the smallpox incidence in the Region
appears on page 81.
191. Cholera in Pakistan. The epidemic had started in itlest Paldstan
during the "eek ended 21 Nay 1960 in Sial kot district (Lahore Division)
and succesively spread to other parts of the country reachin§, its climax
during the first week of August with 969 cases, beginning to recede
during the week ended 17 September, and after a marked new increase during
the week ended 22 October, finally dying out dudng the 'Heek ended 17 Dec
ember, after a total of 7,473 cases and 1,225 deaths had been reported.
Pald.stan declared \liest Pakistan free from cholera from 19 January 1961.
In East Pakistan, chole ra incidence vias low at the beginning of the period
and remained low until the end of 1960.
192. The table which follo"s gives a comparison of the cholera incidence
for the years 1959, 1960 and the first half of 1961 :
Cholera in Pakistan
Four-Heekly East Pald.stan I'lest Pakistan Periods 1959 1960 1961 1959 1960 1961
I 1,286 1,481 lLl 0 0 0 II 756 398 2* 0 0 0 J .'L
III 611 487 52:' 0 0 0 IV 1,103 2,686 6/ 0 0 0 V 1,371 1,670 0 3 0 VI 227 297 0 98 VII 85 80 0 197 VIII 105 92 0 2,638 IX 235 47 0 3,096 X 1,532 19 0 279 XI 4,728 120 0 715 XII 4, 813 456 0 404 XIII 3,183 468 0 43
20,035 8,301 0 7,473
* Provisional figures
193. Yello ... Fever in Ethiopia.
EM/RCll/2 page 81
At the end of 1959, yellow fever had
been reported in epidemic form in the Blue Nile and Upper Nile Provinces
(Sudan) and in the vlollega and Gojjam Provinces (Ethiopia). Early in
1961, an unusual mortality rate had been observed in the Bako-Tchenche
region (in the Gamu Goffa Province, Ethiopia). A certain number of
deaths were reported from the area around Bako. A health officer,
immediately dispatched to the area, took 16 samples of blood. The sam-
ples were examined at the Pasteur Institute of Ethiopia, Addis Ababa,
and the Pasteur Institute of Paris. These were found positive to the
sero-neutralization test with yellow fever virus, Investigations made
in Kooray area, west of Bako revealed that an epidemic had broken out
killing 11 policelTEn out of 35 men. The clinical information indicated
clearly that yellow fever was involved. According to the population
many more cases had occurred and the total percentage of fatalities was
considered by the local authority to be 70%. On 13 February, a notifi
cation .TaS received of the occurrence of 21 cases and 11 deaths of yellow
fever in the province. According to the infonnation gathered by April,
it would appear that more than 3,000 deaths had occurred within the
triangle Dime, Bulki and Jenka <,.lone. 200 blood samples .. lere collected
by Dr. Seri e , the Directo"t' of t.h.e Pasteur Institute of Ethiopia from 24 different localities of the province.
194. Smallpox Incidence in the Region. The following table shows totals
of snallpox cases repo rted during the period under review as compared to
totals of the preceding period:
Countries
Aden Colony
Aden Protectorate
Ethiopia
French Somali land
July 1959 to
June 1960
20 (4)
59 (7)
357
110
July 1960 to
Date Inclicate<i
1 (1)
1
757
o
Imported to 27 May 1961
To 30 April 1961
To 27 May 1961
To 27 !ofay 1961
El1/RCll/2 page 82
C01mtries
Iran
Iraq
Kuwai t
Huscat and Oman
Pakistan
East
Hest
Karachi
Qatar
Saudi Arabia
Sudan
UAR Egypt, Cairo
Yemen
July 1959 to
June 1960
337 1
0
0
1,Ll5
793 121
0
51
364 1
D
July 1960 to
Date Indicated
270 To 8 April 1961
0 To 30 April 1961
0
0
495 To 6 Hay 1961
965 To 20 Nay 1961
164 To 3 June 1961
0
24 To 3 June 1961
156 To 3 JU:'1.e 1961
0
D
() Figures witbin brackets are imported cases and are included in the totals
D Data not available
195. Article 8, ISR. Some countries failed to advise the Regional Office
of the enforcement of me~sures ag~inst a local area, especially during
the cholera epidemics lmich prevailed in Afghanistan and West Paldstan,
although Article 8, para.l(b) specifies that the notification should
indicate the measures lmich a country has decided to app l y to arrivals
from an infected local area. In some inst~~ces countries of the Region
failed to answer enquiries from EERO or <l11Sv18red with such a delay that
the information given was of no avail. In certaL~ instances, it was
noted that actual requirements of same countries were different from
those which had been notified to the Organization.
196. Article 13. paragraph 1. ISR.
EWRCll/2 page 83
In accordance with the information
collected <hlring the period. 4 smallpox cases were landed frCJl1 vessels
coming from foreign ports at Aden. Chi ttagong, Port-Said and Suez. Sudan
reported the intro<hlction of a smallpox case (a pilgrim) at Geneina
coming from Mauri tania, as well as two other cases one of which was in
the scabbing stage and the other had recently recovered. Cases of re
lapsing fever were also reported at Garora (on the frontier with Ethiopia)
Tokar district, Kassala Province~
197. Article 21, paragraph l(c), ISR. The Government of Kuwait desig-
nated Kuwait Airport as an airport provided with direct transit area.
198. Article 23. ISR. During the epidemic of cholera which broke out
in Afghanistan and West Pald..stan, international travellers from India,
East and Hest Pakistan and Afghanistan, as well as from territories where
no cholera had been reported (Iran and Trucial Sheikhdoms) were. subjected
by certain states to measures in excess of the maximum permitted by the
International Sanitary Regulations, as was the case during the cholera
outbreaks in India and West Pakistan in 1958. These excessive rreasures
consisted of the banning of land travellers to enter a state, or the
banning of the landing of aircraft; the imposition of a cholera vaccina
tion certificate showing two doses of cholera vaccine. A state required
that the vaccination certificates should be signed by a Goverrunent Medi-
cal Officer and bear the seal of the Pald..stani Ministry of Health.
Passengers ldthout the required certificates would be isolated in quaran
tine until five days had elapsed before being allowed to enter the country.
Other countries required that a traveller should stay outside the infected
terri tory for five days before being allowed to enter. The attention of
the authorities responsible for the enforcement of such excessive measures
vm.s called to the provisions of Article 23 which provides that the sanitary
measures permitted by the International Sanitary Regulations are the maxi
mum applicable to international traffic, which a state may require for the
protection of its territory against the quarantinable diseases. Unfortunately
EM/RCIJ./2 page 84
in spite of repeated representations following complaints received from
states, the countries responsible for these excessive measures continued
to maintain them in force un t il the cholera situation showed some improve
ment. A state in reply to our representation stated that it based its
action on Article 39, paragraph 1, and if necessary paragraph 2 of ISR
in view of the exceptionally serious dan ge r of transmission of infection
and the nature of the vaccination certificates.
199. Article 37, ISR. During the period under review, a state in reply
to our representat ion follOl·ring the .enforcement of cholera restrictions
against arrivals from Rangoon, where no cholera had been reported, replied
that the measures had been taken ow'...ng to the impossibility of distin
guishing a passenger coming from the infected local area among t hose em
barked at Rangoon .
200. Article 70,ISR. The follmving countries notified the Organization
that their territory was a yellm.; fever r eceptive area:
Iran as from 16 October 1960
Yemen as from 7 March 1961
201. Article 72, paragraph 1, I SR. Some states in tho Region, although
not notified as yellow fever receptive areas, require d yellow fever vacci-
nation certificates in respe ct of arrivals from Ethiopia . itepresentations
wp.re made and measures were wi thdra .. m in one case.
202. Article 103,ISR - Season of Periodic Mass Congregation. The Saudi
Arabian Health Authorities,basing themselves on the provisions of Article
103, imposed for the season of periodic mass congregations, which started
on 1st Ragab 1380 '19 December 1960) and ended on 30 Zil Higga 1380
(13 June 1961), in respect of all travellers arriving in the Kingdom
during the season the following requirements:
Smallpox: A valid vaccination certificate is required
of all arrivals throughout the year.
Yellow Fever:
Cholera:
EM/RC1J./ 2 . page 85
Arri vals from the yellow fever ememic zone or
from a country, only part of which is included
in the ememic zone, are required to possess a
certificate,
All arrivals are required to possess a vaccina
tion certificate showing two injections at one
weeki s interval, Arrivals from infected local.
areas are further required to possess a certi
ficate showing that prior to arrival they have
spent five days in an area free of cholera. Time
spent on board a vessel may be considered as a
period spent in a cholera-free area.
203. The Sudanese Health Authorities reported on 2 April the detection at
Geneina of a smallpox case amongst pilgrims arrived from Tchad. The
patient came originally fran Nauri tania, and was not in posseSSion of any
health docurent or inoculation certificate, Another case, originating
from Mali, was detected in the scabbing stage and another · showed signs
of recent smallpox infection,
204. At the request of the Government of Saudi Arabia, <l HHO Public
Hc:tith Adviser was appoint0d to the He~lth l.dni.nistration of &udi
:.~':>i:l which fncilitat.:::d the work of the Section,
205. ISR Appendix 3. During the period under review the following centres
were designated by the health administratiore as yellow fever vaccination
centres:
Country
Libya
Centre
Benghazi
Tripoli
Government Bacteriological Laboratory
Quarantine Centre in Tripoli seaport
Health Office, Municipality of Tripoli
EM/RCll/2 page 86
Country
Libya
UAR, Province of Egypt
Qo.t<lr
Centre
Sabha
Cairo
Medical Officer deputized by the Director Medice.l Service
Vaccination Cent re of the Vaccine Production Laboratories at Dokki
Alexandria Port Quarantine Office (instead of Municipal Department of Health)
Doha Public Health D9Partment
III ADHINISTRATION MID FINANCE
PERSONNEL
EM/RCll/2 page 87
206. There has been no major change to report in the staffing of the
Regional Office during the period under review. Arrangements are in
progress for the post of Regional Adviser in Public Health Laboratory
Methods to be filled shortly. The post of Regional Adviser in Radia-
tion Medicine was filled at the end of 1960. The post of Regional
Adviser in Statistics, which fell vacant towards the end of 1960, was
filled in March 1961.
207. The post of Adviser in Communicable Eye Diseases has been tempo~
rarily filled since April 1960. ~.Ji th the departure of Dr. 1!lasfy Omar
towards the end of the year, to fill the important p ost of country Public
Health Adviser in Saudi Arabia, the post of Epidemiologist fell vacant.
Dr. Omar had been at the Regional Office since its inception and although
his absence is regretted, it is gratifying that he is still in the Region
and is making very useful contributi ons in the field of public health.
208. The post of Adviser in Community Development, approved as from 1962,
and also the new post proposed of engineer in Environmental Sanitation
to assist the Regional Adviser in Environmental Sanitation wi til the deve
loping Community l~ater Supply programmes, are two positions which it is
hoped will be filled before the end of the year.
209. Governments have expressed appreciation for the assistance of 1'lli0
Administrative Officers under the Malaria Eradication programme. It is
proposed to increase the number of such project posts to five, one of
which will be a substitute for the Regional Office post, . which will be
abolished.
210. At the clerical level, it is porposed to establish one more post
to cope 1d th the increased work resulting fram translation and documenta
tion in Arabic, as requested by the Governments.
El'i/ RC 11/ 2 page 88
211. It is Gratifying to note tho.t GOV2rnrne::1ts app r eci 2te the useful role
of Area Repr esent atives in the c ountr:;' , 2.nd the number of positi ons is
maintained as in the p r e vious ye2 r at six.
REGIONAL OFFI CE BUILDnG
212. The alterations unde r Vi~y on the roof of the bu ilding to pl"('1vid~
f or new office spe.ce and 0. confe rence r oom he.ve occn compl c; t ed and it is
hoped that Governments Hill be able to make contributions t o the de cora
tions and fittings s o that the artistic and cultura l traditions of the
Region can be well rep r esented.
BUDGET iJID FINilNCE
213. As in previous years availabl e funds have been used to the best ad-
vantage through close and effective budget contr ols. SavinGS reali zed
from delays in implemcn tati on or r e c rui t m2nt have l1l2.de it possible to
finance other essential activiti es (including fellowships) r equeste d by
GovernIlEnts for "nich ther e was no budgetary proviSion.
214. The f ollowin g table shows the establishe d and p roposed budget
ceilings under the various sources of funds as f ollows: ( a ) the re\~sed
Regular budget for the year s 1961 and 1962, and that pr opose d for 1963;
(b) the revise d budget fo r the biennium 1961-1962 under the Technical
il.ssi s t2Ilce fun cb , and t he t ento.tive budget for 1963, (c) t he estimate d
requirements unde r the ;'ial C'.ria r:: r adico.tion Speci al Account for tr.e peri od
1961 through 1963; (d) the e stimated r equi rements for 1961, 1962 and
1963 under the Special i.c count for Conmruni t y ~"Jater Suppl y .
215. Detai ls concerning expenditure and personne l ~re ~lso given in
figures IV, · V and VI.
216. The total amounts budgeted unde r all fund s fo r the Re6~on f o r the
years 1961 through 1963 remain on the same l evel at aoout $4,150,000.-
F;9ur~ I Y
PROJECTS AND FIELD POSTS 1951-1961 IN THE EMRO BUDGET Number Number 280' ___________________________________________________________________ 280
240 24 0 Legend
m PrOjects
200 Po~ls 20e
160 16 C
120 ____________ _ 12 J
80 ___ ---1~ 80
40
o 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961
f'igure V
NUMBER OF POSTS IN FlEL D PROJECTS IN THE 1961 BUDGET
OJf
figure Vi'
ESTIMATED BUDGET REQUIREMENTS
A. Distribution(~,)of expendilures
1961
$ 4,168)70 12.7'/.
Legend
B. Source of funds
1961 $ 4,168,170
Malar ia
eradica ti on ~Pf'c 'dl acCo..Jn r
S 1.175.939
Technica l asslslance
S 1.021,177
Rflgular
S 1,932,870
. Community Water Supp ly
(s pec ial a ccou nt ) $ 38,184
1962 / , S 4,182,269
4.6'!.
Suppl i~S and equlpmenl
1962 $ 4,182,269
Malar Ia eradication ~,.al account
S 948,742 . , Technical
assistance • 1.161,688
Regular
$ 2,037,100
, . . , . , , " I ' " I '
" . I I
Ff'l l owshipS,
Seminar!. and
train'tng courses
1963
S 4,154.446 3.6'/, 10J'!.
FIeld Siaft
1963 $ 4,154,446
Malaria r rad icat ion .. , ~~ial account S 789.1 75
Techn lcat
ass is tance t 1,11 7.662
Regular
• 2,207,000
• , .. Communi ty Wat.r Supply (spec ial acc o unt) $ 34,739
••• Co mmunity Water Supply (special acc ount) $ 4 0, 609
EM/RCl1/2 page B9
1961 1962 1963 T T :iii
REGIONAL OFFICE
lvEO Re gular 421,580 439,465 445,730
FIELD ACTIVITIES
1'JHO Regular 1, 511,290 1, 597 , 635 1,761,270
IfHO Technic al Assistance 1, 021,177 1,161, 688 1,117,662
M8.1aria Eradication Special Account 1,175, 939 948,742 789 ,175
Special Account for Corrununi t y "I'Tate r Supply 3 8,184 34,739 40,609
4,168,170 4,182 , 269 4,154,4!.P
217. It should be not ed that in accordance vn. th . Resol uti on :'i1LU4.14 of
the Fourteenth i·lorld Hee.lt h Assembly, a dministrative and ooer at ional
services co.sts for the malaria e radice.tion progr runme have been included
under the Regular budget as from 1961. The costs of 'the malaria eradi-
cation pro grarrune >-lill be incorp orated i n th e Re gular budget by stages
over a three-year period a s fr om 1962 in c omplie.nce with Resolution
WHAl4.15 of the Fourteenth v'!orld Health Assembly.
HEDICILL SUP?LI ..:S M D EQUIP~:El'I T
218. During the period unde r r eview, purchase aut hori zatj.ons f or me dical
supplies and eguipment , books, journals ::md ne riodicals cove ring 3,645
items amounted t o $683 , 72$ .
219. The tabl e on the follOwing .:ncEc shows the expenditure on supplies
and equipment from 1954 to 1960 inclusiVe .
220. Increase d interest has beem demonstrated by Gove rnments of the
Region in purchases made on t heir account by thc Horld H02.lth Organiza -
tion. Reimbursable purchase s ,lere processed i n the Re gional Office for
Jordan, Saudi Arabie. , Sudan and the United Ar ab Republic (Province of
EM/RCll/2 page 90
Country
Cyprus
Ethiopia
Iran
Iraq
Israel
Jordan
Lebanon
Libya
Pakistan
Saudi Arabia
Somalia
Sudan
Tunisia
UAR-Egypt
UAR-Syria
Yemen
Ei'ffiO
Total s
1954 $
165
14, 064
44, a97
393
16, 000
2, 07 8
11,401
9, 8:xl
68 , 444
15,902
16,409
199 , 553
SUPPLIES AND E(}UIPi·£ NT
1955 1956 1957 ~ ~~ I"
y>
812 350 400
22, 552 19, 850 36,230
49 , 305 3, 610 35, 383
15, 066 14, 550 6, 570
5, 617 550 27 , 500
19,436 2, 305 13, 640
30, 956 11, 830 31, 900
7, 543 470 2,455
19, 630 3, 8)JJ 15, 445
9, 546 8, 575 29 , 810
4, 000 50 10, 500
31,105 25, 350 75,900
2, 700 1,200 42 , 355
34,2 46 21,145 79,255
13, 900 4,100 54, 854
25, 000 8, 000 u6 ,080
20,425 9, 880 14,650
311, 842 135, 655 522 , 927
1958 1959 1960 ~ iW $
27 , 836 25, 895 12, 844
15,606 16,192 2, 494
3, 325 11,115 5,870
18,000 2,300
12,035 7,807 11,378
1, 980 12, 800 7,770
9, 880 4, 944 4,715
11,13 4 40, 582 392, 624
13, 400 5, 678 2, 842
6, 200 1, 804 14, 000
24,172 17, 997 45,737
17, 635 35, 235 4,510
39 , 612 30, 890 19,737
12, 690 5, 09u 2, 573
7GO 16, 86u 2, 203
6, 890 24,875 79 , 681
221,175 257 ,772 611,278
EH/RC1l/2 page 91
Egypt). The equipment and sliJplie s thus provided consisted, among
other things, of surgic::!.l end diagnostic instruments, X-ray fiJJns :md
vaccines,
221. The Medical Supply Officer visite d Lebanon to helD the Government
in organizing their medico.l stores services; S[:udi Arabi::. for the same
purpose; Cyprus to assess the medic~l stores m~nagement ,nt h a view to
possible placement of trainees from other c ountries under the super-
vision of the Director of Nedical Stores. He also worke d out a pro~
gramme for training pel's ens from vari ous c ountries in the most efficient
and economical administration of supplies and equipment.
EM/RCll/2 page 92
IV PUBLIC INFORl"iATION
222. Outstanding public informati on activities during the t"mlve months
under review were the press and radio cove rage of the 2cgional Committee
meetings held in Tunis and the Nursing Seminal" in Lahore; the prepara
tion of materio.l for ~'Jorld He;?, lth Day's widespread observances, and the
increased production of picture stories and feature articles on health
projects.
223. Further contacts with press c olumnists, science editors nnd corres
pondents resulted in an increased numoer of requests for information and
calls for news material. Press cuttings compiled during the past year
give evidence of the groHing inte rest aroused by h'BO-assisted activities
among journalistic circles in the Region.
224. A new method of approach to the s ome,,rrE:t diversified press of the
Region, through special press notes distributed to single COThltries or
groups of countries, lvas devise d and proved to be 0. workable news relea
sing pattern, ivhich had the advantage of ensuring that editors in a given
country got more material of specific interest to them. Such press
notes (28 issued during the year) usefully complemented the press re
leases (42) on subj e cts of more general interest distribute d throughout
the Region.
225. The Info:rn12.tion Unit, t hrou&1. clos er contac t s ,r1 th national and
international news agencies, took another step to ensure wider use of
its production. A munber of agencies w'ere supplied i,Ii th news items or
pictures covering events of special interest to t hem - this resulted in
more \,lHO news being picked up by the daily press from agency despatches.
226. Pres s releases on the p rocee dings of Sub-Committee :l of the Regional
Committee were sent by 'tJire or urgent mail to mem'oer c ount ries but,
naturally, got J11zximum play in the TUJ1isian pre ss, which made extensive
use of the material produccd. Direct contacts with local editors also
resulted in the puolication of features and intervie,ls covering the main
EH/RCll/2 page 93
items on the annual session!s agenda.
Tunisia came to more than 9S columns.
The t otal p ress coverage in
227. Special programmes on the session were carried by the loc~l station
and radio outlets abroad. The Tunisian weekly nevTsreels included a se
quence on the opening session and the regional representatives! visit to
President Bourguiba. Technical Discussions on tuberculosis chemotherapy
afforded a good opportunity to pr)Quce a TV film on the subject, which
included footages fram a locally produced film on the Tuberculosis Control
Pilot Project in Djebel Lahmar, Tunis.
228. The Regional Nursing Seminar in LP.hore (Pakistan), which focused
public attention on the importance of 1,mO-assisted activities in nursing
and related fields, also rece ived widespreo.d cove rage in the press of the
Region, Pakistani newspapers in particular carrying daily despatches on
the proceedings. T1-1o l aading dailie s, thE; Pakistan Times and the Civil
and Military Gazette, published special supplements with material supplied
by the public informati on officer. The local radio, in addition to pick
ing up the daily press releases, broadcast talks on topics included in the
Seminar! s agenda and featured t he opening meeting .. r.i th a 10-minute news
reel item and recordings of the main speakers.
229. The Inter-Regional Corrununity Hater Supply Seminar, Addis Ababa, and
the l'iental Health Group I'leeting convened in Alexandria, also afforded good
opportunities to put Hl-1O-sponsored meetings in tbenews - and on the air:
a 20-minute round t able discus si on on community .water supply problems
was recorded f or the UN Radi o (English service ), and a is-minute programme
on mental health features in the Re gi on lTas broadcast by Radi o Alexandria.
230. Reports on \iorld Health Day observance s and press clippings indicate
the increasing popularity of t he Day from year t o yee.r. The trend, .
noted in past ye ars, of using the Day 2.8 a gen0ral public hc;;2.1th event,
continued. The pattern of observance t h roughout the Rc gio:l wa5 more or
le S5 the same: pronouncements by health ministers, top officials and
EM/RCll/2 page 94
other leadi n g pe rsonalities; group discusGions, pu'oli c mee tings, radio
talks and f er:.ture s, press coverage, etc.
231. Over 4,000 information kits or, accident pr evention (a 2,000 inc.;:'8 2.se
over the previ ous year) ,/Dre issue d and despatche d t o a revised list of
government officials, social ,·;elfare organizati ons, ;ne dic2.1 associations,
press outlets a nd information media. Some SOD capti one d photo s on the
same subj ect, including pictures shot f rom 2. r egi 'Jnal an gl e , Here distri-
buted to weeklie s end chulies like ly to gi. ve a proI1inent p lace to the
suoject. Twenty leading peri odicals with wide circulati on were given
exclusi ve a.rticles, and fourteen radi o st2.t ions Here supplied with re
corde d inte rvieHs, r e.dio sta.temcnts and drane. t i zed scri;Jts relating to
the World Health Da.y t heme . An e~hibit, c onsis ti~g of mounted pictures,
graphs and captions onmme hazar ds and road accidonts, Has s e t up in the
WHO premises, Al(;xandria.
232. During the year under review, a.lmost all r adio stations in the Re
gion have broadcast p rogrrunmes on hea lth sub,i ects, by r e l ay,reproduc
tion of 'l-lEO r ecordings , or ~)y usi ng r lldio scri" ts 2nd infonnati on
supplied by this Unit. Amon g other outle t s serviced, the UN Rd.dio 1-laS
f e d vii th mater J. al which 1,as mo.i nly u ::;e; d in its ['.;:'a.':;ic shortwave progr.::unme
beame d to the Jvii ddle J::ast.
233. Radio r 8cordings, including int erviews Hith 18a.ding ioJ1lO malaria.
advise rs i l: the fi e ld, .·re Te prepc.l"ed OJ' c. :,adi o pr oduc er t ouring this
area on a j;J'JiO assignment. The r e su l 'i;i ng montags vTaS use d, in one fO ITI
or another, by morc than 40 French-speaking radio st 2tions, includin g
t he UN Broa dcastinL, G3ne vCl . It i::; prop osed to ca rl",;{ out similar radio
progr 2ll1lT!B s in Ai'a.bic an d English , i n the l'ut ur u .
23 4. Specic:l 2.ttention Has s iver, durin g t he yc o. r t o t h::: f a st-developing
televisi on ne tvlOrks i r_ the P..0"i on :md they <Jer e pl'ovi de d wit h films on
seve ral health topiCS, some releas e d by HI1O . The film "Stop.Halaria Nou1l ,
vrhich giv8s ~.n e xcc:ll",nt account of t he c'Jc.rld-Hide l'l:::.laria ('; raciic ::.ti ·.,n
EM/RCll/ 2 page 95
battle, was thus shown in an Arabic version ever the United Arab Republic
television network. It had earlie r beon ShC1fn to t e l evision viewers in
Iraq and Lebanon.
235. A two-man t eClm of the UN Fi1m Division, previously briefed by the
public information officer, made a short fi1m for American t e l evision
stations on the tuberculosis control project, Addis Ababa. A German tele
vision producer was assigned to make a ri1m de a ling with the eye diseases
control project, which was shmm on television networks in Germany with
an estimated viewing audience of ten million. Another ri1m on eye dis
eases control, .Ii th a special appeal to Eastern Hedi terranean countries,
lIOpen Your Eyes ll , was su:)pli.::d by Headquarters in Arabic, English and
French, for distribution to re ~ional television stations,
236. Some fifteen new ~icture stories "mre prepared during the ye ar by
specially assigned photographers , on subjects including higher health
training (Egyptian Province , UAl't ), mat erna l and child health (Tunisia),
rural health (Lebanon ), tuberculosi s control (Jordan, Pakistan), malario..
eradication and nomadi sm (Somalia), training of sanitarians (Ethiopia),
bilharziasis and eye diseasas control (Sudan) cmd midwi fery (Syrian
Province, UM1) . Altogether 1,100 now pictures have been added t o the
photo files and over 2,000 photographic prints .vere distributed to news-
papers, magazines and other use rs. Somo 40 widely circulated periodi-
cals in 15 countries published picture storie s supplie d by this service.
237. Besides the ex.l-)ibi t on health Hork in the :i.cgion, 1mich was dis
played in Tunis on too occo..si on :)f the Roc;lom:.l Comr;uttee SeSSion, a
special photo exhibit vms S8 t up in connexicn vii th the centenary cele
brations of the King Edward He dical College , Lo.hore, and the NHO-sponsored
Nursing Seminar convened in th.:J.t city. The r_o.t ;;rial displayed included
nearly 200 pictures en nursing in countri es represented at the Seminar.
AN NEXES
ANNEX I
?ROJECTS Il Y COUNTRIES
EM/RCll/2 Annex I page i
The following statemen t shows t he status of projects in the Easte rn
Hedi terrane an Region as of 30 June 1961:
Planning - Funds designated and included in current prograw~s (1961-1963)
In Operation - HHO staff in the fi e ld
Completed
TA
Regular
UNICEr'
Country No.
ADEN 2
CYPRUS 1
6
10
11
12
lS
ETHIOPIA 3
4 , 0
- International staff or other ltJHO assistance .Ii thdravm (includinc; all projecta completed between 1.7.60. and 30.6.61.)
- Techr~cal Assistance Funds (Category I only)
- Funds from ~JHO Re fr,u lar Budget
- Funds frorn United lJa tions Children I s Fund
Project Source Status of Funds
Haternal and child health, Regubr/ Planning Aden Prote cto rate UNICEF
Nursing education TA Planning
Tuberculosis control TA Planning
Leprosy cont rol TA Planning
Rural health Regular Planning
Veterinary public health Regular Cor;pleted
Public heal th laboratory Re gul ar Planning
Public health administratim TA In Operation
Vene r eal disease s cont r ol " j U::"ICEF .1. ... ' .I. ~ In Ope r ation
Tuberculosi s control TA/ UlUCEF In Operation
EM/Rcn/2 Annex I page ii
Country
E'l'HIOPIA ( Contd. )
IRAN
No .
9
III
16
23
25
26
27
1
7 21
22
25
26
28
30
37
38
).+2
Proj ect
Health training centre , Gondar
Malaria pr e -eradication survey
Communicable eye diseases contro l
Maternal and child health, Eritrea
Supe rvi sory team fo r he:J.l th centres
r:ental health
YelloH f ever
Halaria eradic2."'u ion
Nutrition institute
Midwifer .f education
Radiol ogy, Firousc':Jadi Hospi tal, Tehe ran
C ol1ununica ble eye dise a ;-3es control
Puolic health laboratory
1'1ental health
Industrial and occupational health
Nursing education, Re d Lion and Sun School of Nursing,
Bilharziasis control
Rehabili tation services, Shiraz
Source Status of Funds
Regular/ I n Operation UHICZF
NBS], In Opel'ation
Re gul ar/ Compl ete d UnCEF
TA/UNICEF Planning
Re bular/ Planning tJNI CBF
Re£u:l ar Corr~J leted
~eguJar In Operation
"'""SAlT'''; 1 .::....J · r In Oper ation UYI CE?
T:t Planning
Reguhr/ In o-pcrati on DiUGSi<'
~·tegular Completed
Til. Planning
ReE;ular In Operation
Re gula:c In O;Jeration
Til. Planning
Tj"l. In Ope r ation ~ey
1',:. I v, Operation
Regul ar In Operati on
Count!"J
IRAN (Contd.)
IRAQ
ISRAEL
JORDAN
EM/RCll/2 Armex I page iii
No. Project Source Status of Funds
43 Assistance to provlnoial facul ti es of me di cine
:1.E fular Planning
45 ~ir pollution control ReGul~r Planning
5 Leprosy cOlltrol Re&ular Completed
11 Halaria eradicatiol". . Re£Ul;:,r/ In Operation U1H CEF/ HESll.
15 Bilharziasis control Til.
15 COmImlIllCable eye disease s Regular/ control UNICEF
23 School health services Til.
33 College of Ne dicine , BC'.ghdad R.e~lar
34 Vi tal and health statistics Re Gular
35 Training of health personnel TA/UNICEF
37 High Institute of Nursing, Regular Baghdad
38 Virology l aboratory Regular
HE:.3A
In Operation
In Opei"ation
Planning
Planning
Planning
In Operation
PlarLYJ.ing
Planning
Planning ~ Nalaria eradication
2L! Nental health Regular Planning
25 Hadassah He dical 3chool, J e rusalem U) Anatomy
26 Hospital administration
Regu1ar/ In Operation Reimbursable
TA Planning
29 Hadassah I'!edical School, Regt:lar J erusalem (B) .Preventive and
In Operation
Social I'ledi cine
32 Evaluation of a national health programme
5 Tuberculosis control
6 Halaria eradication
11 Conmunicab1e eye diseases con trol
Ti:/UNICEF
Ti/UNI CEF/ 1\'~3A
T;JUNICEF
Planning
Completed
In Operation
In Operation
EM/RCIJ./2 Annex i page i v
Count ry
JORDAN (Con td.)
KU\ofAIT
lEBANON
LIBYA
No .
21
23
24
25
1
2
4
6
4
7 10
24
31
32
34
39
41
h2 2
3
6
Projec t
School health se r vices
Production of vaccines
Assistance to Chil dren 's Hospit~l, Arnm<m
Public health advisor y servi;.;e s
Tubercul osis contr ol
Cormnuni cable eye diseases contr ol
Nursing education
Vital and health st atistics
Rural he alth uni t
Halaria eradication
Nursing education
Nedi cal use of radioi sotopes
Rehabilitation of the physically handicappe d
Leprosy control
Dedal health
iurteri c an Uni ve rsi ty, Bei rut
Bl ood bank
hunicipali t y healt h se r vices
Naternal :md chi l d health , Tripoli tania
i~ursing education , Tripoli
Communic abl e eye diseases cont r ol
Source St atus of Funds
il.egul ar Planning
Regular/ Planning UlUCEF
T.A/mJICEF In Opera tion
Regular Planni ng
ReEUlar Pl anning
Regul a;.' Pl anni ng
Regular Pl arming
RCEUlar Pl anning
TA In Ope r aticn
loIS s.A/ mJICZ F In Operation
Regular Pl anning
Regul ar Planni ng
Rerrula r Planni ng
T!' ,~ Comp l eted
TI, ,. Pl aI1_'1ing
Regular In Opemtion
n.egular Planning
Re[:ul a r Planning
Regul ar/ Comp l eted m.JICEF
Regular/ I n Ope ration UNICEF
Regul ar Planni ng
Coun~ry
LIBYA (Contd. )
PAKIS'I'AN
~o. Project
7 JIealth Training Institute, Benghazi
Source of Funds
Tli
8 Nursing education, Cyrenaica TIvu~ICEF
9 Malaria eradication NESA
12 Hate rnal and child health, TA/ UNICEF Cyrenaica
13 Vital and health statistics Regul a r
21 l1aternal and child health T!,
22
23
advise r t o the Govenunent
Tuberculosis control demonstration and training cent re
Health centre, Fezzan
22 Sanitary engineer, 1,Je s t Paid stm
23
25 30
32
33
34
36
37
38
39
Children IS Hospi tel, Karashi
Physio t he rapy school, K;:.rachi
Nursing education, East Pakistan, Chittagong
Tub e rcu losis contr ol (Prevalence Survey)
Public Health I ns t itute , East Pakistan
Assi st ,,:ncc to teaching sanitary engineerin g
Halari a eradicc'.tion
j.ssist ance to n:edic c:.l schools
Assi stc'Ulce to nutrition insti tute
Leprosy control
T1JUllICEF
Re gul a r
TA
ReGular/ UN ICa
Re6ular
Regular/ UiI!ICE?
Regular/ UNI CEF
!·lESA
Regular
TA/UNICEF
Re gul ar/ UiUCEF
EN/RCll/2 Annex I page v
Status
In Operation
Planning
In Operation
I n Operation
Planning
Completed
Planning
Planning
In Operation
In Operation
In Operation
In Opemtion
In Ope ration
Planning
Planning
In Operation
Planning
Planning
Planning
EN/RCll/2 ;.nnex I page vi
Country
PAKISTlDr (Contd.)
SAUDI .!C..!ffiIA
SOl'l\LIA
No. Projer.t
41 Smallpox control
42 Adviser on ],: ::-'ostheties a?plieation
Source of Funds
TA/ m:I G2F
43 Vital and ]:e2.1"':.h sta t i sties Tft
48 Assistance to the national RebUla::-' health laboratcries at Islamabad
L~9 Ealari a er<:dieation traini ng i;LS.':" centres
50 Tuberculosis control (Pilot area, Ral"ml"dndi)
51 rtural health
4 Malaria er.:ldication
5 Envir onmenta l sar.itation
7 Public health labor~,tory
11 Naternal and child health
13 Tuberculosis .. oc trol
15 Heal th Assi stants' and Sanitarians ' Institute , ~yad
22 Blood Bank , rtiyad
23 Public health adviser (epiderriologist)
24 Bil harziasis contro l
25 Nursing education , Riyad
26 Corr~unity development (heo.l th asp ect,, )
2 Nalaria eradic2.ti on
TA/UlHC3F
He gular/ Ui\jIC£F
EESA
Til.
Regular
Ttl
::i.eguL:r
Re£ular
T.':"
Tic
Regul2.r
Ti .
ilegul 2.r
!vIESA/TA/ :r;iI CSF
8 Tr aining 0: health personne l Re e;ular/ U1UCBF
Status
Pl.:lnning
In Operation
In Operation
Planning
b Operation
Pl anning
Planning
In Operation
In Ope ration
Planning
Plarming
Pl anlli.:1 g
In Operation
Comp l eted
In Ope ration
Planning
Planning
Plan. 'ling
In Operation
In Op e ration
Country
S0l1ALIA ( Cont d. )
SUDilN
Ho. 2roject
11 Tuberculo~is control
13 Rurd hed th trairJ.ng centre
14 Public heal t h adviscry services
&ou.·ce of funds
TAjUNICEl
T1'.
Regul ar
Maternal al1d child health and T.AjmiICEF training of mzdical auxi.~.ia:rJ
16
19
20
pe rsonne l
Lepr osy control
Srr,a11pox cor. trol r.md eradication
Organizatien of re clic 1.'. l care
Til.
TA
TA.
5 Bi lharziasis central T:. 6
7 a -
12
15
16
17
19
23 26
28
Hal arla pilot project a:1d e r&.dication
Nursing education , I\hartoum
UK I CSF/ r!ESA
Regular
'r'Jbcrculosi 5 cont r ol den:on - Til. stration a:1:i training c entre; , ·,lad Hedan
Leprosy cO:1trol
Corrw,ur:::'c ::.b 1e eye cliseaszs control..
Ve:1ereal rJ.::seases contro l
D'2ntal assi s t2l1ts I tr~;.ir:i..l1g
Ibral her.lt h demonst:~ati on
are 2,
Blood baLk
Onch oce :~ci:,sis cont:ul
3mall uox c ·~nt::,ol
:ie§,ul ar
TJv'1J1lI CEF
TAjUN ICEF
Regul1.r
'L'l.iUlE CEF
Rcc:ular
EM/RCll/2 Annex I pa ~:e vii
Status
In Oper1?tion
i'lanrJ.ng
Planning
Planning
Planning
Planning
Planning
Planning
I n Operation
In Operati on
1n Operati on
PlanninG
Plannin g
Planning
I n Ops ration
Pla11!1ing
Comp l ete d
Planning
Planning
EH/RCIJ../2 Annex I page viii
Country
SUD.AN (Contd. )
TUNISIA
UAR (Egyptia'1 Province)
No. Project
30 Radiation and isotopes service (Kh~.rtoum)
Source of Funds
Status
Planning
32 Malo.ria eraclico.tion training 118 SA centre
Plcnning
3 Communicable eye disee.ses control
6 Maternal and child health
9 Tuberculosis chemotherapy pilot project
17 Nalaria ere.dic ~'.tion
18 Envirorunental sanitation
20 Public health labore.tory
22 Ophthalmological centre, Tunis
2L( Tuberculosis control
26 Production of pho.rmaceutice.ls
27
28
29
30
23
27
30
37 38
l1edical educ .:ttion
Tube rculosis control demon stration and training centre
Heclical reha'Jilit2.tion centre
Venereo.l dise2.ses control
Nalaria er2.dicc.tion
High Ins ti. tute of Public Health, Alexandria
Premature I n fants . Unit
Virology research laboratory
Centre for SCG.1i tar:\, engineering research of the Universi~ of Alexandria
'fA/UNICEF
TA/UNICEF
Regular/ UNICEF
l~SA/TA
TA
ReGul 2.r
Regular
Regular/ m:IC;;:: F
Regular
Regular
Regular/ UlHCEF
Regular
Completed
In Operation
Completed
In Opera tioD
Plarming
Planning
In Operation
In Operation
Planning
Plarll1:ing
In Operation
Pl arming
In Opera ti. on
MESA/mnCEF In Operation
Regular In Operation
Regulc. r/ UN ICE l"
Regul a r
TA
Planning
Planning
Planning
Country No. Project
UAR 44 Concentrated sera production (Egyptian plant Province) 48 Drug control l aboratory-(Contd. )
49 Bilha rziasis control pilot project and training centre
50 Nursing education
51 Rehabili tation of tuber-culosis patients
52 Dried smallpox vaccine production
53 Typhus control
UAR 2 l'1ala1'ia eradic 2. tion (Syrian Province) 4 Bilharziasi s control
15 Vi tal and health stati stics
16 Rural health unit
30 Public health and endemic diseases l aboratory-
32 Blood bank
33 C2.ncer control
34 Rural environmental snni tation
37 Nursing education, Damascus
39 Training of sanitarians
43 !1unicipal water supplies
YEMEN 3 Public health admini stration
5 Bilharziasis control
7 Maternal and child health
Source of Funds
TA
TA
P..e€;ular/ UiHCEF
TA
Regulo.r
Regula r
TA
T1l/UESA/ UNICEF
Regular
Regular
Til.
Regular
Regula r
Regular
J.egular
Regular/ UNICEF
TI>..
TA
Rerrular
Regular
negul=
EM/RClJ./2 Annex I page ix
Status
Planning
In Opere.tion
In Operation
Pl2.nning
Planning
Planning
Co~leted
In Operation
Planning
In Operation
In Operation
Plannin g
Planning
Planning
In Operation
In Operation
Planning
Planning
In Operation
Completed
Planning
El'.1/RCll/2 Annex I page x
Country
YEjvEN (Contd. )
IN'lERCOUNTRY PROJE CTS
No . Pl'oject S01)TCe
of Funds
8
13
15
16
5
7
15 16 19
22
34
42 45
50
Health cen tre and trainiEg school, Sana ' a
Cor(lJTlu.TJicable eye disE:Clo;es control
Local health services (a) Health ceEtre , Taiz (b) Health centre, Hodeida
Smallpox can trol and eradic a ti on
Highe r I nsti t ute of NurSing, Uni versi ty of ;'.lexanclri.:l
Arab States 'l'raining Centre for Educ.:lti on in COf(lJTlunity Deve lopme:-, t
Nur sing Seminar
Smallpox survey teen
Re&ional malaria er('.dic 2.tion training centre
Adviser in health education
Sani te.ry sngi neori IlL, fi e l d training
Gr oup meeting on vi ta l and hea.lth sta ti ::;'ci c s
TiL
ReGulo.r
Regular
T;i.jUX ICEF
Regular
Regu12.r
Regular
Regular
Regular
Seminar on food hygi ene and Regul ar zoono ses control and veterin.:lry public l1ealth ;:>r.ctice
RegLon2.1 tuberculosis prevalen ce survey te em
Hedical educr. tion conference
Parti cipation i n educ ationC!.l meetings
Seminar on training of auxiliary heal th personnel
Regular/ lJi;ICE F
Regul ar
Regule.r
Rcsu12.r
St::.tus
I n Operation
Planning
P12.nning
Pl anning
I n Operati on
In Operati on
Compl eted
Comp leted
I n Oper ation
In Ope:ra t i on
In Operati on
Planning
Planning
Completed
Planning
In Operation
In Operati on
Country No. Project
INTER- Sl Epidemiological and COUNTRY statistical centre PROJECTS 55 Assistance to medical (Contd. ) libraries
56 Community water supply
58 Malaria eradication evaluation team
60 Group fellowships in public health administration (USSR)
61 Training course for laboratory t echnicians
63 Training in mental health (a) Training course for
general practitioners (b) Training of psychiatric
nurses
66 Rural housing
67 Nental health group meeting
71 Regional conference on malaria eradication
72 Training course for water-works engineers
73 Health protection of popula-tion - High Dam lake area
74 Neeting on. rehabilitation of chronic psychiatric pati ents
75 Regional tuberculosis demonstration and training centre, Tunis
76 Pharmaceutical and medic .?l stor:'s adviser
77 Group meeting on communi ty water supply
Source of Funds
Regular
Regular
Regular/ C'ilSSA
MESA! He gular
TA
Regular
Regular
Regular
Regular
J.lESA
Regular/ CHSSA
Regular
Regular
Re gular
Re gular
Regular/ CHSSA
ErJ/RCIJj2 Annex I pace xi
Status
In Operation
In Operation
Planning
In Operation
Planning
Planning
Planning
Planning
Completed
Planning
Planning
Planning
Planning
?lanning
Planning
Planning
ANNEX II
ru-l/RCll/2 Annex II page i
AGREEI>ENTS SIGNED BETlollEN 1 JULY 1960 AND 30 JUNE 1961
CYPRUS 10
ETHIOPIA 2
ETHIOPIA 14
ETHIOPIA 16
ETHIOPIA 23
ETHIOPIA 25
IRAN/UN ICE F/l
IRAN 1
IRAN 21
Leprosy Control Sxchange of letter Short-term consultant
Leprosy Control Plan of opera ti on
l'1alaria Eradication Training Centre Plan of opero.tion
Communicable Eye Diseases Control Plan of operation
Maternal and Child Health, Eritrea Plan of operation
Supe rvisory Team for Health Services Plan of operation
ExpanSion of Nate mal and Child Welfare Services Add.I to plan of operation
I>lo.laria Eradication Exchange of letter Additional provisions
Nidwifery Education Exchange of letter extending validity of plan of operati on
EH/RCll/2 Annex II page ii
LVJJ 26
IRAN 42
IRAQ 5
IRAQ 11
lRAQ 18
v .. -'\Q 25
J OEillAN
J O:IDAN 6
JO~'IDAN 11
JORDAN 23
-----------Public nee_Ith Laborator y !une::1d.''llents t o pl an of oDer 2.tion
l'tehabili tati on Services, Shiraz Plan of operati on Exchange of l e t- t el' , short-te n ;l consultant
Leprosy Contro l E:::change of l ette r, short - t er::: consul t ant
Jilalaria Eradication Plan of operati on
Communicab l e Eye ~i sease s Cont r ol Exchange of l etter Provision of personnel, equipr~_ent and supplies
Bl ood 3ank Exchange of letter, short-te rm consultant
The basic agr eement be t,-le on t 1l0 GO'IO,:.:"':'Ea t of Jordan :.nd ~friO vms c onclude d i n Sep t ember 1960
Nal aria Eradicati on Pl~"'l of operation
Communicab le Eye Diseases Control Exchange of lett e r , provision of supplies
Producti or. of Vaccine s and Anti sera Exch8nge of lette r, p r oduc t ion of toxoi ds
