WORLD HEALTH ORGANIZATION
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World Health Organization Yale Model United Nations Korea May 17 - 19, 2013
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Table of Contents History of the Committee 3 Topic I: Climate Change and Human Health History 3 Current Situation 7 Bloc Positions 10 Questions to Consider 13 Topic II: Addressing Health Issues in the Gaza Strip History 14 Current Situation 17 Bloc Positions 22 Questions to Consider 24 Role of the Committee 26 Suggestions for Further Research
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Glossary 29 Notes 31
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History of the Committee
After the Second World War, a committee of 18 members of the United Nations created an outline of the World Health Organization (WHO), to replace the previous health organizations that had been set up under the League of Nations. The WHO Constitution came into force on 7 April 1948 and the organization held its first World Health Assembly in June that year. April 7th is now celebrated as the ‘World Health Day’ every year. The WHO operates with three branches: the World Health Assembly, the Executive Board, and the Secretariat. It convenes every year in Geneva. The ‘World’ in ‘World Health Organization’ reflects the global objective with which it was set up- “the attainment by all peoples of the highest possible levels of health.” Initially, the WHO focused on issues like malaria, tuberculosis, women and children’s health, nutrition and environmental sanitation. These original areas of focus remain important, but the organization has now grown to cover various other health-related issues, including HIV/ AIDS.
Topic I: Climate Change and Human Health Topic History
The United Nations has called on the World Health Organization to address the negative impacts of climate change on human health since the first United Nations Conference on the Human Environment in 1972. Over four decades later, millions of people worldwide die each year from diarrhea, malnutrition, extreme temperatures, and other factors directly or indirectly caused by climate change. It is important to assess previous efforts and commitments made by the WHO to determine what the strategy should be to mitigate or counteract these effects in the future. In a prescient statement that still resonates today, the United Nations Conference on the Human Environment noted that “developing countries could ill-afford to put uncertain future needs ahead of their immediate needs for food, shelter, work, education, and health care. The problem [is] how to reconcile those legitimate immediate requirements with the interests of generations yet unborn.”
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The tragedy is that at least one generation has been born since those words were first uttered, and people are still dying from the same climate-related problems as before.
The UN Conference on the Human Environment The first time that the United Nations convened to discuss climate change was in Stockholm in 1972. A proposal called for the establishment of an intergovernmental body to oversee the human environment, as well as an Environment Fund based on “the polluter must pay.” The World Health Organization was identified as one of the principle bodies responsible for several of the recommendations for action at the international level. Recommendations 4, 9, and 52 concerned water resources, Recommendation 7 called for providing personnel for national public service, and Recommendations 15 and 21 addressed soil research, pest control, and agro-research. One of the major health-related climate worries in the early 1970s was pollution. Finger pointing between the industrialized and developing countries may find its origins here. The developing countries believed that the
industrialized countries exploited both international resources and the natural resources of the developing countries, and called for greater responsibility on the part of the industrialized countries. For their part, the blame placed by the industrialized countries is made fairly clear by Recommendation 12, which claimed that WHO “should provide increased assistance to governments which so request in the field of family planning programmes,” and “should promote and intensify research endeavor in the field of human reproduction” to prevent the negative consequences of population explosion. In its Declaration of the United Nations Conference on the Human Environment, the UN affirmed that man-made degradation is harmful to the “physical, mental and social health of man.” Their solution was that developing countries must “direct their efforts to development,” while the industrialized countries should “make efforts to reduce the gap between themselves and the developing countries.”
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The Earth Summit Ten years later, Agenda 21 still had yet to be implemented. The 2002 World Summit on Sustainable Development in Johannesburg was a renewed effort to achieve the goals and limits listed in that declaration. The lasting achievement of this meeting was the creation of the Partnerships of Sustainable Development. Participants included all the major groups identified in Agenda 21. This included not only governments and NGOs, but actors with specific interests in local development – such as business and industry representatives, scientific communities, local authorities, workers and trade unions – as well as those who are at the greatest health and/or economic risk from climate change, such as children and youth, farmers, indigenous people and women.
The 2009 United Nations Climate Change Conference (COP 15) The Copenhagen Summit led to the creation of the Copenhagen Accord. While the document is not legally binding (due to the controversy discussed below), it does ask for
“commitments” from the blocs. First, developed countries “shall provide adequate, predictable and sustainable financial resources, technology and capacity-building to support the implementation of adaptation action in developing countries.” Further, the “Annex I Parties (committed) to implement . . . the quantified economy-wide emissions targets for 2020,” and the Non-Annex I Parties “will implement mitigation actions,” with Least Developed Countries taking action “voluntarily and on the basis of support.” Five countries at the Conference blocked all efforts to adopt the Accord by consensus decision. Venezuela, Bolivia, Cuba, Nicaragua, and Sudan, who claimed that the decision taken by the United States, China, Brazil, India and South Africa to circumvent the formal structure of the UNFCCC made the Accord “undemocratic” and “not transparent.” Although a compromise was eventually reached, the failure of COP 15 to achieve a binding deal has been blamed by some on the developed countries, and by others on the developing countries. This divisiveness poses a serious threat to mitigating the effects of climate change on human health. As Barack Obama said at COP 15, “We World Health Organization 5
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know the fault lines because we’ve been imprisoned by them for years... And we will be back having the same stale arguments month after month, year after year, perhaps decade after decade, all while the danger of climate change grows until it is irreversible.” Somehow a solution must be found that will placate all of the relevant actors and allow for words to be translated into action.
economically restrained by any cut in carbon emissions, wanted recognition of historic pollution by countries that industrialized earlier. The Consultative Group on International Agricultural Research demanded inclusion of and responsibility on the part of the agricultural sector, eager that industrialized industries would not be the only ones taken into account as the discussion moved forward.
The 2011 United Nations Climate Change Conference
Rio +20 United Nations Conference on Sustainable
At the 2011 United Nations Climate Change Conference held in Durban, both developed and developing countries agreed to create a legally binding treaty by 2015. There was also discussion about the Green Climate Fund, which would distribute US $100bn/ year to help poor countries adjust to climate impacts. Not all the countries were happy with the outcomes of this conference. Although climate change is a global problem, the aims and objectives of individual countries make all such discussions extremely political. India announced that it “will never be intimidated” by the large developed states. The People’s Republic of China, which stands to be severely
The Rio +20 summit in June 2012 had both its positives and negatives. Although it’s still too early to determine how large its impact on climate change will be, it is certainly heartening that over 740 voluntary commitments have been made to date to support sustainable development. Yet while 283 of these are towards Education, 14 are committed to biodiversity, forests and other ecosystems, and 16 will be for green jobs-social inclusion, not a single voluntary commitment has been made to date towards human health. It is time for the WHO to convene a committee that will directly address the negative health impacts of climate change.
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Current Situation Climate Change While the phrase “global warming” still sparks heated debate and fiery dissent, world leaders have tacitly acknowledged the Earth’s steady temperature progression for almost a quarter-century. The phenomenon of climate change was formally recognized by the United Nations when the United Nations Environment Program (UNEP) and the World Meteorological Organization (WMO) created the Intergovernmental Panel on Climate Change (IPCC) in 1988. The data provided by the Panel has brought the importance of climate change to the attention not only of decision makers in the 195 IPCC member countries, but also to government leaders in non-participating countries and authorities of other supra-national intergovernmental agencies. No-table recognition includes the formulation of the United Nations Framework Convention for Climate Change (UNFCCC) following the first IPCC Assessment Report in 1990, and the joint awarding of the Nobel Peace Prize to the IPCC and Al Gore Jr. in 2007. Climate change is expressed in several disturbing trends. Oceans are rising.
Heat waves are occurring more frequently, and lasting longer. Glaciers are shrinking, both subtly and less so. In a highly dramatic example from July 2012, a 46 square mile ice island – twice the size of the island of Manhattan – broke off of one of Greenland’s two largest ice sheets connecting the Greenland ice sheet to the ocean. All of these events have serious and worrying implications for the future of Earth’s most valuable resources. The IPCC predicts desertification of Amazonian tropical forest in Latin America, extensive species losses in Europe, and increased coastal flooding in Asia, to name only a few conclusions from their 2007 report. But all of these environmental changes are associated with secondary risks that are directly under the umbrella of the WHO’s concerns: those posed to human health. The Drivers of Climate Change Heat waves are occurring more frequently, and lasting longer. Glaciers are shrinking, both subtly and less so. In a highly dramatic example from July 2012, a 46 square mile ice island – twice the size of the island of Manhattan – broke off of one of Greenland’s two largest ice sheets connecting the Greenland ice sheet to the ocean. World Health Organization 7
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One way to track this increase is through global atmospheric concentrations of carbon dioxide, methane and nitrous oxide. By comparing current measurements to samples obtained from ice cores, scientists have determined that current concentrations of these gases are much greater than they have been in millennia. The carbon dioxide increases may be mainly attributed to the usage of fossil fuels, while methane and nitrous oxide are mainly a result of agricultural activity. Industrialized countries generally use more fossil fuels than developing countries, which are more likely to depend primarily on agriculture. These considerations become important when attempting to determine which countries have been most responsible for climate change. Climate Change and Human Health The health of a human population is inextricably linked to the health of its environment. In a 2009 report entitled “Protecting Health from Climate Change: Connecting Science, Policy and People,� the World Health Organization identifies the following determinants of human health as placed at risk by climate change:
1) Access to Clean Water Globally, there are 2.2 million deaths due to diarrhoea every year. There are several causal pathways, but two of the most common ones are poor hygiene and contaminated water. Additional threats are posed by standing water, which leads to an increase of infectious disease. 2) Infectious Disease The combined increases in temperature and rainfall mean that stagnant, standing water warms to the ideal conditions for vectors, especially mosquitoes, to proliferate. Vector-borne diseases like malaria and dengue fever are already endemic in many regions around the equator, but the WHO predicts that the diseases’ seasons will become longer in duration and more intense. 3) Food Security Crop yields are expected to decrease in many developing countries, which will be especially disastrous for subsistence farmers and populations that lack the capital to buy food. In the 2009 report, the WHO reported 3.5 million deaths globally from malnutrition each year; this figure can be expected to worsen with climate change. Furthermore, malnutrition increases the risk of infectious disease, especially in children.
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4) Climate Refugees It is possible that the health problems and social stressors associated with climate change can be exported to new areas, introducing new concerns or worsening existing conditions. When populations are forced to move to find an environment that is able to support them, the influx of people further constrains existing resources in the host country. This can lead not only to health problems like malnutrition or infectious disease due to overcrowding, but also to social tension and civil strife. Areas like Southern Europe are already experiencing the stress as Tunisians and Egyptians travel north to escape food shortages. The WHO report predicts that an increase in flooding and the gradual sea level rise will both pose a risk in the future. This is currently a concern of the 10.7 million people in the island nation of Tuvalu. 5) Air Pollution and Extreme Air Temperatures Urban air pollution is responsible for 1.2 million deaths worldwide every year. In conjunction with heat waves, unclean air is a leading cause of death for cardiovascular and respiratory diseases. Furthermore, levels of both
ozone and pollen are increased during warm temperatures, to the detriment of those who suffer from asthma and other respiratory disease. Many different actors—states, companies, and international organizations—have proposed various solutions to the problems explained above. The major solutions to the problem of climate change fall in two groups: economic and energy-based. On the one hand, economic solutions focus on incentivizing private and public sector cutbacks in their contribution to global climate change. On the other hand, energy-based solutions focus on providing economically viable alternatives to the fossil fuels industry. For many political forces, addressing the root cause of the health issues related to climate change is the more expedient solution. Yet we see that the health issues related to climate change persist; various conflicts, most especially buck-passing and finger-pointing between states supporting different and conflicting solutions, have plagued the implementation of these solutions. In addition, no small amount of controversy has surrounded some proposals. For example, France has long been a World Health Organization 9
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proponent of nuclear power as a source of alternate energy, but this staunch support has been challenged by the political mood after the recent Fukushima disaster, especially in neighboring Germany, which has a large anti-nuclear movement. In addition, beyond issues of energy source, the energy requirements associated with addressing health issues are extremely different in different countries. This naturally pits developing countries, where cheap power is needed quickly, against developed countries, where there is less pressing need for power and more money to develop alternate solutions.
Bloc Positions
One of the more troubling aspects of climate change is that all people do not experience its negative impact on human health equally. Societies found along the equator and less-industrialized countries that rely primarily on agriculture or fishing for their economic stability, often experience the negative effects earlier or more severely. Yet these are generally not the countries with the greatest CO2 emissions, meaning that these inhabitants suffer disproportionately for the amount of environmental damage that they are causing.
The UNFCCC attempts to account for this discrepancy by dividing countries into three separate parties, as well as choosing to include certain key observers. Parties: I. Annex I The countries of Annex I include “the industrialized countries that were members of the OECD in 1992,” in addition to the Economies in Transition parties. While Annex I countries account for 19.7% of the world population, the average Annex I CO2 emission is 16.1 tCO2-eq/cap. These figures illustrate the complex moral and economic problem facing the Annex I countries in the face of climate change. First, despite representing a minority of the world’s population, Annex I is contributing disproportionately to climate change. Secondly, its citizens are not experiencing the negative impact of climate change on human health nearly as much as the Non-Annex I countries. This means that Annex I governments must be convinced to invest in more energy efficient industries and curb their citizens’ consumption and energy use to curb a problem that as yet is not directly affecting them. A popular rejoinder
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to the order that Annex I must reduce CO2 consumption is that, instead, the Non-Annex I countries should industrialize and focus on population control citation needed. Even within Annex 1 countries, however, there is controversy over the cost and speed of reforms relating to sustainable initiatives, with Western and Northern European states tending to be more progressive while the United States is more conservative. Furthermore, because many of these countries are democracies, large lobbying groups retain significant amounts of power and influence on the policies adopted and embraced in these countries. II. Non-Annex I The Non-Annex I countries are mostly developing nations. As represented above, Non-Annex I encompasses 80.3% of the world population, and average carbon dioxide emission is 4.2 tCO2-eq/cap. Included in Non-Annex I are the countries that the UN classifies as Least Developed Countries (LDC), which represent “about 12 percent of the world population, but account for less than 2 percent of world GDP and about 1 percent of global trade in goods.�
The USGA created the LDC category in 1971 to ensure that these countries would be given special consideration in global discussions, since they lack the social and economic capital to compete with wealthier nations on the world stage. This is of particular importance in the discussion of climate change. Some of the LDCs, such as Bangladesh, Kiribati and Tuvalu, are frequently mentioned in warnings concerning countries that are likely to experience severe negative effects from climate change. It is in the Non-Annex I countries’ best interests to halt climate change as quickly as possible, since they have the most to lose. Many of them are located along the equator, putting them at particular risk for the five health problems listed above. Furthermore, the tCO2-eq/cap of the Non-Annex I countries is a fraction of that of the Annex I countries, meaning that measures to alter or restrict industry pollution would be easier for the former group. Observers: III. Pro-Development Intergovernmental Organizations and Non-Governmental Organizations Some of the observers, especially the
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development banks and technologically-minded organizations, are interested in promoting industrialization and development. Obviously, they must also be mindful of worsening climate change and its effects; but if CO2 caps are too stringent, for example, their business will be more difficult to carry out. IV. Pro-Conservation Intergovernmental Organizations and Non-Governmental Organizations The pro-conservation IGO and NGO bloc has roughly the same interests as the Non-Annex I countries, but for different reasons. While the Non-Annex I countries wish to halt climate change out of concern for the health of their populations, this bloc is driven largely by other ecological concerns. Their allegiance might be said to lie more directly in line with the future health of the earth, rather than with particular groups of people.
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Questions to Consider Keep in mind these questions: • What measures should be taken to stem climate change and reduce future health problems related to climate change? • How should existing health problems that are a result of climate change be addressed? • If it is determined that money or resources should be given to the Non-Annex I countries, how will it be decided where the money should go to? How will it be determined who should pay? • Both overpopulation and CO2 emissions contribute to climate change. Will these receive equal consideration? How will each be addressed? Keep in mind the hidden costs; for example, if it is determined that a decreased birth rate should be encouraged, how will the necessary health education be implemented? Where will the money come from? • How should the existing divide between developing and developed countries regarding climate change be addressed?
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Topic II: Addressing Health Issues in the Gaza Strip Topic History
The conflict between the State of Israel and the Palestinian people has a long and complicated history. Any summary of its history, therefore, will necessarily miss much of the detail in the complex picture of the situation today, but we shall attempt a summary of the broader context and some of the history of health issues facing the Gaza Strip. In the aftermath of the horrors wreaked upon the Jewish people of Eastern and Central Europe in the Second World War, it seemed only natural to Western powers that the British Mandate for Palestine fulfill the mission of the earlier Balfour Declaration and become “a national home for the Jewish people.” There already was a Jewish population in the region, mostly recent immigrants who arrived around the end of the Ottoman Empire and in the first years of the Mandate, so the British government decided to partition the land between the two groups settled upon it, just like Ireland and India. The Arab states of
the region rejected this, and the unilateral declaration of the State of Israel by Ben-Gurion on 14 Mary 1948 did nothing to improve the situation; in fact, it triggered the first Arab-Israeli War and resulted in the displacement of thousands of Palestinians and the annexation of formerly Palestinian territories by Israel and the occupation of the West Bank and Gaza Strip by Jordan and Egypt, respectively. This created the first major health crisis for the Gaza Strip, as the displacement of 200,000 Palestinians into the tiny territory overwhelmed the currently available facilities. The refugees, not allowed to return to their homes and unable to leave for neighboring countries, have been a constant stress on the Gaza Strip’s infrastructure ever since. There has never been a single organization addressing all of the health issues in the Palestinian-inhabited territories. Because of the total control over entry and exit enforced by Israel, they can pick and choose who they will allow into the region,
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which often has less to do with actually serving the community’s interests and more with international connections. Before the Oslo Accords of 1991, foreign aid to the Palestinians was scant. Since those Accords, the intermittent aid to Palestine has now become a steady trickle. It still remains a trickle, however, and the security situation has, if anything worsened since the beginning of the Second Intifada. In 2007, after the split between Hamas and Fatah, Israeli forces effectively sealed the territory from all outside contact. Ever since, the health situation has been perilous. On 20 June 2010, Israel’s Security Cabinet loosened pre-existing blockade regulations to allow most non-military or dual-use items to enter the Gaza Strip; this represents a stark departure from more stringent prior policy. According to a Cabinet statement, Israel will expand the transfer of construction materials designated for projects that have been approved by the Palestinian Authority, which primarily focus on improving public goods for Palestinians such as education, healthcare, clean water, and good sanitation. Some projects are under international supervision.
The United Nations Relief and Works Agency (UNRWA) called for a complete lift of the Gaza blockade, expressing concern that the new policy would continue to limit Gaza’s ability to develop on its own. The U.S. government welcomed the Israeli Security Cabinet’s decision, expressing the belief that the easing would significantly improve the lives of Gaza Strip residents and prevent weapons smuggling. In July 2010, Israel’s foreign minister Avigdor Lieberman proposed that the international community should assume full responsibility over the Gaza Strip. He announced that he plans to discuss the idea, which was labeled a “personal initiative,” with the EU Foreign Minister Catherine Ashton . Lieberman proposed that units of the French Foreign Legion and commando units from EU member states be sent in to secure the Gaza border crossings, prevent the smuggling of weapons, and seal the border with Israel. Ships that underwent inspections in Cyprus or Greece would be allowed to dock in Gaza and unload humanitarian cargoes. The EU would help improve and build civilian infrastructure, and Gaza would become a fully independent entity. In January and February 2011,
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the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA) conducted an assessment of the effects of the Israeli Security Cabinet’s proposed measures to ease access restrictions. They concluded that the easing of blockade restrictions did not result in a significant improvement in people’s livelihoods. The assessment found that while there was a limited reactivation of the private sector as a result of the increased availability of consumer goods and some raw materials, the “pivotal nature of the remaining restrictions” and the effects of three years of strict blockade prevented a significant improvement in livelihoods. Food insecurity rates in Gaza remained at an alarming 52% of the population. While international organizations had funded over 100 projects to improve the “extremely deteriorated” water and sanitation, education, and health services in Palestine, OCHA found that there had been no improvement in the quality of services provided to the population of the Gaza Strip. The assessment concluded that the easing of restrictions was “a step in the right direction” but called on Israel to fully abolish the blockade, thereby allowing the import of construction
materials and the exports of goods. The OCHA also judged that Israel had international humanitarian and humans right law obligations to lift the general ban on the movement of people between Gaza and the West Bank. Israel allows limited humanitarian supplies from aid organizations into the Gaza Strip. In May 2010, according to the Israel Defense Forces (IDF) Coordinator of Government Activities in the Territories, humanitarian supplies for the year included over 1.5 million litres of diesel fuel and gasoline, fruits and vegetables, wheat, sugar, meat, chicken and fish products, dairy products, animal feed, hygiene products, clothing and shoes. International aid group Mercy Corps said it was blocked from sending 90 tons of macaroni and other foodstuffs. After international pressure, Israeli authorities said that they were giving the shipment a green light.
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Current Situation The current situation in the occupied Palestinian territory is characterized by years of occupation, political stalemate, violence, restrictions on access and movement, and persistent human rights violations. By the year 2020 the population of Gaza will swell to approximately 2.1 million, from an estimated 1.6 million people today. This substantial population growth rate will only place further strain on an already restricted, heavily urbanized, and underdeveloped living area. Fundamental infrastructure in electricity, water and sanitation, municipal and social services, is struggling to keep pace with the needs of the growing population. By 2020, electricity provision will need to double to meet demand, damage to the coastal aquifer will be irreversible without immediate remedial action, and hundreds of new schools and expanded health services will be needed for an overwhelmingly young population. Tens of thousands of housing units are needed today. Gaza is an urban economy, heavily reliant on intensive trade, communication and movement of people.
The area has been essentially isolated since 2005, meaning that, in the longer term, its economy is fundamentally unviable under present circumstances. Gaza is currently kept alive through external funding and the illegal tunnel economy. The people of Gaza remain worse off than they were in the 1990s, despite increases in real gross domestic product (GDP) per capita over the past three years. Unemployment is high and affects women and youth in particular. Gaza’s GDP per capita is expected to grow only modestly in the coming years, making it ever more difficult for Gazans to secure a decent living. The challenges will only become more acute, particularly if the current political status quo continues. As a result of all these challenges the health situation is Gaza is deteriorating by the day. Lack of clean water, lack of proper sanitation, malnutrition and lack of access to healthy food, lack of proper healthcare facilities are all making the situation in Gaza a catastrophe by health standards.
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1) Water and Sanitation As highlighted by reports of the World Bank and the United Nations Environment Programme (UNEP), the situation in relation to water and sanitation for the Palestinians of Gaza is critical. With no perennial streams and low rainfall, Gaza relies almost completely on the underlying coastal aquifer, which is partly replenished by rainfall and runoff from the Hebron hills to the east, with the recharge estimated at 50 to 60 million cubic metres (MCM) annually. Current abstraction of water from the aquifer, at an estimated 160 MCM per year to meet current overall demand, is well beyond that. As groundwater levels subsequently decline, sea water infiltrates from the nearby Mediterranean Sea. Salinity levels have thus risen well beyond guidelines by the World Health Organization (WHO) for safe drinking water. This pollution is compounded by contamination of the aquifer by nitrates from uncontrolled sewage, and fertilizers from irrigation of farmlands. Today 90% of water from the aquifer is not safe for drinking without treatment. Availability of clean water is thus limited for most Gazans with average consumption of 70 to 90 litres per person per day (depending on the season), below the global WHO
standard of 100 litres per person per day. The aquifer could become unusable as early as 2016, with the damage irreversible by 2020. UNEP recommends ceasing abstraction immediately as it would otherwise take centuries for the aquifer to recover. Even with remedial action now to cease abstraction, the aquifer will take decades to recover. Meanwhile the Palestinian Water Authority (PWA) expects demand for fresh water to grow to 260 MCM per year by 2020, an increase of some 60% over current levels of abstraction from the aquifer. The situation with regard to treatment of waste water or sewage is no less problematic, with huge investment in treatment facilities and associated infrastructure desperately needed to cope with the existing demand, let alone for the future. At present, only 25% of waste water, or 30,000 CM per day, is able to be treated and re-infiltrated for use in green areas and some forms of agriculture. Some 90,000 CM of raw or partly treated sewage has to be released daily into the nearby Mediterranean Sea and environs (almost 33 MCM per year), creating pollution, public health hazards, and problems for the fishing industry. Work is on-going on the construction of new and refurbished World Health Organization 18
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waste water treatment plants to cope with both present and future demand, but these efforts will need to be accelerated. Some 44 MCM of waste water is generated annually at present, a figure which could rise to 57 MCM annually by 2020. In the short term, the Palestinian Water Authority recommends low-volume desalination of seawater and the reuse of treated wastewater, especially for agricultural use. Longer-term solutions to the challenges of clean water and sanitation for the people of Gaza include large-scale seawater desalination plant(s), completion of strategically placed treatment facilities, construction and rehabilitation of water and sewerage networks, the wholesale availability in homes, schools and health centres of water and sanitation systems, and a regime for the management of solid and medical waste that is able to cater for the needs of an urban population. An examination conducted in late 2009 in 180 wells revealed that, in 93 percent of them, the chloride level (which indicates the water’s salinity) was 1,000 to 2,000 mg/litre, four to eight times higher than the 250 mg/ litre amount recommended by the
WHO. Water with a chloride level this high is unfit for drinking. The pollution also affects the water’s colour and causes its repellent odour. In addition, an examination carried out by the UN Environment Programme on a number of wells in Gaza found that the concentration of nitrates was six times higher than the 50 mg level recommended by the WHO. This high level of nitrates is liable to cause anemia among children and methemoglobinemia (“blue infants” syndrome) among infants, which is liable to lead to choking and death. A study published in 2007, in which samples of 340 infants from Gaza were examined, found that almost half of them suffered from troubling symptoms of the syndrome.The Palestinian Water Authority estimates that almost 40 percent of the incidence of disease in Gaza is related to polluted drinking water. According to international aid organizations, 20 percent of Gazan families have at least one child under age five who suffers from diarrhoea as a result of polluted water. A UN study published in 2009 estimates that diarrhoea is the cause of 12 percent of children’s deaths in Gaza. The lack of potable drinking water is liable to cause malnutrition in children and affect their physical and cognitive development.
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2) Food shortage and Malnutrition Many Gazans are food insecure, due primarily to a lack of economic means rather than a shortage of food. More than half of the households in Gaza are either food insecure (44%) or vulnerable to food insecurity (16%) even when taking into account UN food distributions to almost 1.1 million people. While this is a tenuous improvement from past years, conditions are still dire. Households on average spend close to 50% of their cash on food. Eighty per cent of households receive some form of assistance and 39% of people live below the poverty line. This results from low levels of income per capita. As importantly, in a densely populated, largely urban territory, food self-sufficiency is not an option. Such a territory will always depend on trade, services and worker movement, all of which remain limited as a result of the closure. For as long as the closure continues, levels of food insecurity will remain high. Restrictions on access to agricultural land and the fishing limit of three miles from the coast remain challenges. Gazans cannot, or only with difficulty, access 17% of the enclave’s land, including 35% of its agricultural land, because it is located in the ‘buffer zone’ or in the high-risk,
access-restricted area near the fence separating it from Israel. More than 3,000 fishermen do not have access to 85% of the maritime areas agreed in the 1995 Oslo Accords. As a result, the fish catch has decreased dramatically over the years of closure. Overall, land and sea restrictions affect 178,000 people, 12% of Gazans, and result in annual estimated losses of US$ 76.7 million from agricultural production and fishing. Should the three-mile limit on fishing be lifted, the fishing industry would likely grow in size. Inland fish farming could provide employment and a cheap source of protein in the medium term and would complement sea fishing. While ultimately large scale growth will be based on sectors other than agriculture, in the short term and under continued closure, fishing has the potential to bring a ready source of protein to the diets of Gazans. 3) General Health and Mental Health Issues While some health indicators in Gaza are comparable to middle and high-income countries, quality needs to be improved. In 2010, there were 25 hospitals in the Gaza Strip with 2,047 beds, or 1.3 beds per 1,000 people. In addition, health clinics provide
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primary medical care. With 3,530 doctors in 2010 the rate of doctors per 1,000 people was 2.3 (similar to Cyprus), and with 5,910 nurses, the rate was 3.9 (similar to Georgia). Most health facilities are unable to provide safe and adequate services and need to be rehabilitated or upgraded. The infant mortality rate stands at 23 per 1,000 live births (similar to Nicaragua). While Israeli authorities permit the access of medical supplies into Gaza, there are frequent breakdowns of medical equipment resulting from power interruptions and water impurities, among other factors. For this and other reasons, many patients are forced to seek treatment outside Gaza for a wide range of medical problems, which is difficult due to the closure. Micronutrient deficiencies, especially iron deficiency anemia in pregnant women and children, remain at high levels in Gaza. A comprehensive causality study is currently being conducted, which will inform future action to reduce nutritional deficiencies. Additional hospital beds, doctors and nurses will be needed in the coming years to serve a growing population. Based on population projections, maintaining the current ratio
of 1.3 hospital beds per 1,000 people in the Gaza Strip would require almost 800 additional beds by 2020, for a total of about 2,800. Similarly, to maintain the current ratios of doctors and nurses per 1,000 people, the number of doctors would have to increase by more than 1,000 to 4,900, and the number of nurses by more than 2,000 to 8,200. The lack of medical equipment and medicines in Gaza is steadily increasing. According to figures of the World Health Organization, in January 2008, 19 percent of necessary medicines were lacking, primarily those needed in surgery and in emergency cases, antibiotics for initial care of children, and cancer drugs. 31 percent of vital medical equipment is lacking too. There is also a grave shortage of replacement parts for equipment and of disposable items, such as bandages, syringes, and plaster for casts. Even more concerning is the lack of suitable replacement parts for expensive medical equipment in the region: once a CT scanner breaks, it is gone for good. Add the frequent power shut-offs due to Israeli military activity and the situation looks especially dire for patients with urgent, expensive needs.
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Exposure to violence and uncertainties associated with occupation/settler-related violence in the West Bank and with the blockade in the Gaza Strip are having a profound impact on the refugee population. Stress-related disorders and mental health problems are increasingly affecting women, children and adolescents- the stress of occupation, the inability of men to provide for their families and the consequent reversal of gender roles have resulted in an increase of domestic violence. Tackling psychological and behavioural disorders, as well as domestic violence, has therefore emerged as a health priority. If there are so many problems and, in some cases, so many simple solutions, why haven’t they been implemented? Much of the blame here does lie on Israel’s shoulders as the state with the ability to control access to Gaza. Some also may be laid at the feet of governments refusing to cooperate with the Hamas authorities who govern the region. For these authorities, however, allegiance with Hamas is necessary for the maintenance of their authority, as much as they might desire to seek help from governments refusing to talk with Hamas. Yet there may not be time left for pointing fingers over the cause of the desperate health crisis in Gaza today.
Bloc Positions 1) United States For nearly two decades, the US government has worked with Palestinians who have renounced violence to create viable Palestinian institutions in preparation for Palestinian statehood, which the US government has defined as a national interest. US efforts with respect to aid have been complicated by a commitment to providing humanitarian aid to Gaza without indirectly benefiting the Hamas government. However, as the largest single contributor to UNRWA and WHO, the United States arguably relieves some of Hamas’s burden for providing services to all of Gaza’s citizens. This scenario, however, has created a certain friction between the United States and UNRWA officials, who have consistently urged the United States and donor countries to cooperate with the Hamas authorities. Concerns that UNRWA cooperates with Hamas led to new understandings between the US government and UNRWA, which included a stricter vetting process for UNRWA employees and tracking of US assistance funds. Although the United States remains concerned about international
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health catastrophes like that of Gaza, it has to balance such concerns with the political reality of dealing with proscribed organizations such as Hamas. 2) European Union The European Union has had a continued concern with regard to the deteriorating human conditions within Gaza. After the 2010 Israeli attack on an aid flotilla the EU has taken a stance to urge the easing of the Gaza blockade. The EU has continually called for an increase in the number of UN development projects in the Strip, which would allow the importing of building materials, which the Israel Defence Forces opposes for security reasons. Further some EU countries, including France, have come forward with varying solutions such as keeping a proposal that warships of EU countries patrol the Gaza shoreline to prevent ships smuggling arms from getting through. Such measures would allow the vital shipment of necessary aid and alleviate the concerns that Israel has, that aid ships bring in arms to help the terrorists functioning within Gaza. Since 1993 the European Commission and the EU member-states combined have been by far the largest aid contributor to the Palestinians.
3) Arab States The Arab League states have been substantial donors, notably through budgetary support to the PNA. 20% of the aid promised during the Paris conference came from Arab League states. However, most Arab states have been distancing themselves from the Hamas regime in Palestine and Gaza. While these countries like keeping the Palestinian issue alive for domestic consumption and as a tool to pressure Israel and the West when the need arises, in actuality, they tend to view Palestinian refugees -and more Palestinian radical groups like Hamas -as a threat to the stability of their regimes.
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Questions to Consider Delegates in the WHO should carefully consider each facet of these complex issues in debate and when writing solutions. A well-researched approach in addressing the issues would be expected. With regard to the “Health Issues in The Gaza Strip” a few questions, among others, a resolution must address would be: • What would be a long-term solution in using modern technologies in addressing the water and sanitation issue in the Gaza strip? (This an issue that the UN deems would contribute to Gaza being unlivable in the year 2020) • What mechanisms can be put in place to ensure that proper food aid, that is sufficient to sustain the entire population, reaches Gaza? This issue must take into consideration ground realities of the blockade and political concerns of other nations. • What can be done to increase the number of UN aid projects within the Gaza strip? • What measures could be taken to encourage the free travel of medical professionals to address medical issues within Gaza? • How can restrictions be eased to allow persons who have critical medical conditions to travel beyond Gaza for vital treatment? • What can be done to encourage more aid for Gaza?
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Role of the Committee The WHO is a specialized body of the United Nations and its main role is to produce guidelines and standards, to help countries address various health issues. Apart from being the directing and coordinating authority in international health, it also supports research programs. The WHO works closely with all its 193 member countries and 2 associate members to improve the people’s well being. The member states are also responsible to appoint the Director General (every 5 years) and approve the budget. The Health Assembly elects the Executive Board, which comprises of 34 members who specialize in global health. In order to achieve its objectives, the WHO collaborates with other UN agencies, private sector organizations and also partners with non-governmental organizations in different countries. The WHO creates and prioritizes programs in areas such as nutrition, environmental sanitation, parasitic and virus diseases, and epidemiological notification services. One example of these programs is the smallpox eradication initiative, which was proposed in 1958 and succeeded in eliminating confirmed cases of the disease by 1977. In the 1960s, the WHO promoted disease control and eradication against epidemics such as cholera in Asia and yellow fever in Africa. In 1974, the WHO launched a program that aimed to vaccinate children around the world against diseases like measles and tetanus. More recently, the WHO has created programs geared towards living healthy lifestyles and spreading the awareness of the health-hazards of environmental degradation. In the 1990s, WHO launched programs to promote healthy lifestyles and tobacco-free societies to prevent “lifestyle” diseases like cancer and diabetes. In 1993, the WHO joined the United Nations in a joint program to fight HIV/AIDS. The WHO, since its founding, has accomplished much by not only launching these world-wide programs, but also through education, coordination, and initiatives to connect the world health community.
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Structure of the Committee The World Health Organization is a General Assembly Committee that will follow standard GA structure (parliamentary procedure). GA structure includes formal debate, moderated caucus, and un-moderated caucus. During formal debate, delegates will speak in turn off the Speaker’s List. The original motion to open the Speaker’s List must set a speaking time. However, delegates may motion to increase or decrease the speaking time. During moderated caucus, delegates speak in front of the entire assembly. During un-moderated caucus, delegates may break into small groups to have informal debate outside of formal proceedings. The chair must recognize all delegates before speaking. Delegates need to be aware of their own country’s position on the topic debated. Each member state has the right to exercise one vote. Decisions on important matters, such as resolutions, will require a two-thirds majority to pass. Less important matters only require a simple majority vote to pass. Position papers are a useful tool for brainstorming ways to address the issues at hand. Position papers should be 1-2 pages long for each topic. The position paper should state the delegate’s position on the topic and include suggestions for how the committee should approach the topic. To be eligible for awards, delegates must send in their position papers by the first committee session. During the conference, delegates are highly encouraged to work with other countries in drafting resolutions. The three main parts of a draft resolution include the heading, the preamble, and the operative section. Before the sponsors of the resolution can bring the resolution to the floor for debate, the draft resolution must gain support from a certain number of member states as determined by the chair depending on the countries present.
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Suggestions for Further Research TOPIC I: Climate Change and Human Health • Gender, Climate Change and Health. o http://www.who.int/globalchange/GenderClimateChangeHealthfinal.pdf • Protecting Health from Climate Change. o http://www.who.int/globalchange/publications/en/ • Human Health Impacts and Adaptation. o http://www.epa.gov/climatechange/impacts-adaptation/health.html • A Human Health Perspective on Climate Change. o http://www.niehs.nih.gov/health/assets/docs_a_e/a_human_health_perspective_on_climate_change.pdf • Climate Change: Countries that May be Hit Hardest. o http://www.huffingtonpost.com/2012/08/14/climate-change-countries_n_1776064.html • Simon Caney, “Global Justice, Rights and Climate Change,” Canadian Journal of Law and Jurisprudence 19/2 (2006), 255-278 • David Miller, “Global Justice and Climate Change: How Should Responsibilities Be Distributed?,” Tanner Lectures on Human Values 28 (U of Utah Press 2009). • Stephen Gardiner, “The Real Tragedy of the Commons”
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Topic II: Addressing Health Issues in the Gaza Strip The best place to look for further material for research is the WHO website. In particular, here are a couple of links that might be useful: o http://www.who.int/hac/crises/international/wbgs/en/ o http://www.who.int/hac/crises/international/wbgs/highlights/febru ary2011/en/index.html The Israeli-Palestinian conflict is constantly developing and new issues may arise by the time of the conference. Therefore, it is very important to keep up with the news in order to stay updated on the latest developments. Most international news services will suffice for this. In addition, it is a very good idea to look at local news on the issues, as analysis of this may be constructive in building your arguments and anticipating arguments against your position. Some particularly good sources include:
• Aljazeera • CNN • BBC • The Guardian • Mondoweiss • The Economist • The New York Times • Foreign Affairs • +972 Magazine
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Glossary • Anti-Semitism – A political view which specifically targets the Jewish people with prejudice, hatred, and/or discrimination. • Assimilationism – A political view which says the Jews should adapt the culture of the majority and blend in with native peoples as much as possible. Often contrasted with Zionism. • Carbon Dioxide – A molecule made of a carbon and oxygen molecule. Very common in nature, but can, in large amounts contribute to the greenhouse effect driving much of global climate change. • Developed Countries – Countries that have fully mobilized the economy; oftentimes they are the leaders in innovation. Examples include the USA, Germany, the UK, and Sweden. • Developing Countries – Countries who have not yet utilized all economic resources available to them in the 21st century, but who are also making significant progress in mobilizing the entirety of their economy. Examples include Turkey, the BRICS states, and Kenya. • Epidemiology – The study of epidemics and their dynamics. • Fatah – The main branch of the PLO and the controller of the Palestine National Authority (PNA) with semi-recognition as its own state. • Greenhouse Effect – The phenomenon occurring when the sun’s rays are reflected back toward earth by a layer of greenhouse gasses in the atmosphere, warming it up and causing a variety of adverse climatic effects commonly referred to as “climate change.”
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• Hamas – the current governing authority in the Gaza Strip. Recognized as a terrorist group by most states and therefore stripped of legitimacy. • Intifada – From Arabic, it is commonly translated as “uprising”; The First and Second Intifada refer to periods of large anti-Israel activity by militant Palestinians. • PLO – the Palestine Liberation Organization; the oldest of the Palestinian authorities and the only one recognized by the State of Israel. • Pollutants – The components of pollution, can be either foreign substances/energies or naturally occurring contaminants. • Pollution - The introduction of contaminants into the natural environment that causes adverse change. Pollution can take the form of chemical substances or energy, such as noise, heat or light. • Undeveloped Countries – Countries that, for one reason or another, maintain a very low level of economic activity and are making very little progress on mobilizing their economy. Examples include Namibia, Sierra Leone, and the Seychelles. • Zionism – A political view espousing the need for a separate, exclusively Jewish homeland for the Jewish people. Developed in the 19th century as a response to European anti-Semitism; often contrasted with assimilationism.
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Notes
http://www.unep.org/Documents.Multilingual/Default.asp?DocumentID=97&ArticleID=1497&l=en http://www.unep.org/Documents.Multilingual/Default.asp?DocumentID=97&ArticleID=1503&l=en http://www.un.org/geninfo/bp/enviro.html http://www.un.org/jsummit/html/basic_info/basicinfo.html http://www.un.org/esa/dsd/dsd_aofw_par/par_index.shtml?utm_source=OldRedirect&utm_medium= redirect&utm_content=dsd&utm_campaign=OldRedirect http://unfccc.int/resource/docs/2009/cop15/eng/l07.pdf http://switchboard.nrdc.org/blogs/ddoniger/the_copenhagen_accord_a_big_st.html http://www.nytimes.com/2009/12/19/science/earth/19climate.html?_r=1&partner=rss&emc=rss http://www.un.org/wcm/content/site/climatechange/pages/gateway/the-negotiations/durban http://www.hindustantimes.com/world-news/Africa/India-gets-its-way-as-climate-summit-in-Durban-closes/Article1-780872.aspx http://usa.chinadaily.com.cn/china/2011-12/05/content_14213729.htm http://www.iol.co.za/mercury/leaders-need-to-focus-on-agriculture-1.1192908 http://www.uncsd2012.org/voluntarycommitments.html http://www.ipcc.ch/organization/organization_history.shtml#.UB2h4cie4Uo http://climate.nasa.gov/effects/ http://www.udel.edu/udaily/2013/jul/glacier-071612.html http://www.ipcc.ch/publications_and_data/ ar4/wg1/en/spmsspm-human-and.html http://whqlibdoc.who.int/publications/ 2009 /9789241598880_eng.pdf http://www.huffingtonpost.com/ 2011/02/22/environmental-refugees-50_n_826488.html http://unfccc.int/parties_and_observers /items/2704.php http://www.unohrlls.org/en/ldc/25/ http://planetgreen.discovery.com/travel-outdoors/8-countries-about-to-go-underwater-literally.html http://maindb.unfccc.int/public/igo.pl? mode=wim http://maindb.unfccc.int/public/ngo.pl? mode=wim&search=A
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