W O R L D H E A L T H ORGANlZATlON

BUREAU REGIONAL DE LA MEOITERRANEE ORIENTALE

MTNUT%S OF THE THIRD MlZETZPIW)

Held at. the Buildingf of .the Nu~sinff Institute, Sulaibildiat; Ituwait

on Sunday, 4 Octpbe'r 1964, at 9 a.m.

CHAf RMAN: Mr. Y . JASSTM HI JJI (Kuwalt)

I. A w l Report of the Regional D i r e c t o r to the Fourteenth Session of the Regional Committee; statements and reports by mp~esentatives of Member States

~ M / R C 1 4 A f i l n . 3 December 184

0RI:CtXNALt . ENGLISH

Representatives of Member States

Government

CYPRUS

ETEII OPIA

FRANCE

IRAN

IRAQ

KUWATT

I;EBANON

LIBYA

PAKISTAN

SAUDI ARABIA

S CMA LT. A

SUDAN

SYRIAN ARAB RE PUBLIC

TUNISIA

UNITED ARAB REPUBLIC

~epresentative, Alternate or Adviser

DF . V . Vassil.opoulos

Ato Hailu Sebsebie

M6dec in Lieutenant-Colonel Y;"?.emstarrt

Dr. A.H. Samii Mr. Z. Wvidian

DF. Sabih Al-Wahbi Dr... Salwn . Ta5-aA.-P$n

Mr. Yaussef JassP~,Hkjji ~ . - - & ~ - - R z t ~ ~ $1 - ~ a & i ~r&Fi.ta- .-9rnk*p DG M . . At4dukk&kl Dr. Aly Onsi Dr. Nabih Farhat

Dr, Jam11 Anouti . -

Dr. Abdul Megid Abdel Hadi

Colonel A .F .Me Borkwnuddin Dr; 9 ;- Mahfiz A 1 1 Dr. Hamid A11 Khan

H .E . Mr. Abdullahi Issa Mohamd Mr. Adan Farah A bray

Dr. Ze in El A bdin Ibrahirn

Dr. M.T. Hachicha

Dr. Mohammed Abdel Wahab s w r y Dr. Sayed Sweilim Dr. Hashem Mahmoud El Kadi Dr. Abdul A z l m Hussein El Gholmi Dr. Abu El Fotouh Shaheen Dr. Imam Zaghloul El Sayed

UNITED KXNGDa4 OF GREAT BRITAINAND N0RTHERNIFET;AND Dr. C.R. Jones

YEMEN "

Rewresentatives of AssocSate Member Sta tes

QATAR Dr. Mahmoud El Mished

vorld Health Organization

Secrexary to the Sub-Committee Dr. A.H. Taba, Regional Director

Representative of the Dfrector-Geneml Dr. P.M. Kaul, Assistant Director- General

~eputy-Secretary t o the Sub-Committee Dr. A ,A. El Halawani, Deputy Regf om1 Director

pnlted Nations and Specialized Aaencies

UNITED NATIONS AMD TECHNICAL ASSISTANCE BOARD (WNTA3) M r . S. Kar

l.NMED NATIONS CHILDREN'S FUM> ( WCEF) Mr. K.G.F. Middelmann

UNITED NATIONS REZlXF AND WORKS AGENCY FOR PALE3TINE REFIJGEES (MA ) Dr. M., Sharif

Bebresentatives and Observers of IntermatSonal Non-Governmental, Lnter-Goverwentgl and National Organizations

LEAGUE OF ARAB STATES Dr. Ghaith El Zerikly

IN'TERNATIONAL ASSOCIATION FOR PRF,VENTION OF 3LINDNESS Dr. ToufPc Turk

IWRNATIONAL DENTAL FEDERATION Dr, George Soudah

Mr. Mohammed El Pad1

lXAGlJ3 OF RETD CRpSS SOCIETIES Dr. Sabih-Al-Wahbi

US NAVAL MEDICAL BESERACH UNIT N0.3 (NAMRU 3) Dr. J.D. Northway

I. ANNUAL mPO3T OF THE XiEGTONAL DTH3CTOR TO TI33 PO- SmSION OF TKE REUIONAL COMIUWEF,; STATEMENTS AND REPORTS BY mPRESEMTATIVES OF MEMEER STATES: Item 5 of the Prov&si~nalUAganda ;fTl&mnem E M / R C ~ ~ / ~ )

The CHAIRMAN asked the Regional Director t o introduce his report on the work

of WHO i n the Region during the period from 1 July 1963 to 30 June 1964.

The W I O N A L DIRECTOR said tha t , since'the ' f if teenth anntversary of the

establishment of the Regional Office for the Eastern Medlter~anean had fal len . .

within the p e ~ i o d under review, he had attempted in the introductfon to his report

(document No. EM/Rc14/2) t o review the main achievements, and shortcomings., of WHO'S

work in the Region since ~ t s 'inaeptinn,

It would be seen that considerable progress had been made in the improvement

of health services In the countries of the Region - in a number of cases w i t h

assistance from WHO. Thewle had been a definite change in the nature of WHO asSi'st. - . . . ? . - . . - -

ance to countries. Originally it had bken provided mostly to meet 3medlate-needs

part icular ly f o r the prevention or control of c o d c a b l e diseases, and f o r the

t raining o f s taff . T h a t type o f assistance was still continuing and about 4.5 per

cent of the budget was allocated t o assistance to cnuntries for the control or

eradication of communicable diseases. 'But the peroentwge had formerly been larger

and it was decreasing each year. Now new f i e l d s were being entered and assistance

with education and t r a i n ing - which had always been Important in the regional

programe - was increasing. In the previous year 3 per cent of the regional

budget had been devoted t o education and training, and the provisfon f o r 1966 was

somewhat more.

Most of the governments in the Region now had long-term development plans

covering five years or more. They included a l l fields of development, especially

economic and soclal development, and the long-term national health plam had been

well integrated into them. WHO had assisted in drawing up those health plans t h rqup

the regional office advisers, the WHq representatives and other field staff, and

consultants. Care had been taken to provide f o r the gradual expansion of rural

health services and for the progressive in tegrat ion f nto the general health sekices,

at rmral, provincial or central level, of spec i f ic comnicable dfsease contml pro-

granmes. The long-term plans also included proviston fo r training of health per-

sonnel, of which there was still a great shortage in the Region.

In ear l i e r years WHO assistance i n eduoation and training in the Region had been

mainly confined to felZowships and to the txlalning of auxiliary personnel. That, is

being continued, but assistance t o faoultiea of medicine was growing i n imporbance.

Dwling the past ten years the number of medioal faculties had grown substantially;

in 19641 there were 33, whereas fifteen years previously there had been only 12 ., Most of .that expansion had taken place in three countries of the' Region but others

had established OF were plannfng to establish schools of medicine w i t h assfstance

from WHO* To $tve one example, about five years previously the Government of

Tunisia had decided t o open a medioal school in Tunis and WHO at the request of the

Government, had sent a team of medioal educators t o review all aspects o f the situa-

t ion , including physical poss ib i l i t i e s , availability of teachlng hospitals and student

potential.. La$er WHO had provided another oonsultant team, expert in medical school

organization, t o asclist the Government in planning the schoo2. The school had opened

in September 1964 and WHO is sending three professors to teach -sic soiences.

Similar assistance had been given or would be glven to other countries,

WHO was also providing assistame with post-graduate fmining. Help uontinues

t o be provided t o the High Institute o f Public Health in Alexandria and plans are

underway for assistance to the post-graduate Sohool o f Public Health and Hygiene in

Teheran.

WHO had also spansored meetings to bring t~gether medlcal eaucazors from various

obuntries of the Region and some from outside the Region to exchange views and

experience. One sljoh meeting had been held in December 1963 in Alexandria and it

was hoped to convene others in the future. A t the Alexandria meeting suggestions

f o r the expns ion of medical eduoation work in t h e Region had been recommended and

provision had been made i n the regional budget fer a medioal educator to assist

govemen t s and the Regional Office with the programme.

As regards fellowsh~ps, it would be seen from the charts oppositeepge 20 of

the peport that WHO had awarded 236 fellowships i n 1963 and that in the last f i f teen

years 2488 fellowshiw awardla had been made. They covered t raining oP awrilisrle#,

undergradxiate studies and post-graduate training.and specialization, The Eastern

Mediterranean Region had been the f i r s t region t o provide fe l lowsh i~s fop under-

graduate medical .studies. They were awarded only to students from countries where

there was no medical school and quite a number of such fel lowship had gone %o

Ethiopia, Libya, Saudi Arabia, Somalia and Yemen, Some of the doctors trained under

those fellowships had al~eady returned t o the i r countries and more,were going back.

each year*

The fellowships prowamme was being oonstantly evaluated, We extensive

evaluation had been M e in 1960 and another, covering two countries only, in 1963.

The. report, of the consultant who made the study indicated that on tbe whole results

had been sa t l s fac tosy - extremely so in one of the count~ies , where the former fellows

had all been employed by the Qovsrment, some of them in highest execut~ve pasts in

the Ministry,of.Health. Similar evaluations w e r e plamed f o r other countries. In

Novembewl 1963 a meeting had been held a t the Ragtonal Off ice to which national fellow-

ships off icers f r o m all countries of the Region had been invited and.whlch had also

been attended.by.medica1 eduoato~s of the Regional Office and Headquarters. . The

national wlepresentatives had explained their ppablems and t h e i r a t ten t ion had been

L r a m t o WHO fellowship rules'and pol ic ies . It was considered that the report of

the meet ing would help considerably to make the fellowship's programme rncre ef f ip i ent ,

WHO was also providing oons&derable assistance tn t rainin= nurses, of w k b h ' there

was a great shortage in the Region. That aspect of WKO aid, which was mch appre-

ciated by governments, extended from the t raining of auxiliaries to nursing education

a t univers i ty level,

As previously mentioned, assistance in comunicable disease control, although

decreasing, still constituted a large part of WHO'S r:ork in the Region. Considerable

assistantle was . given with malaria erhdicat ion canipaigns . It wcruld be seen from the

charts opposite pages 30 and 31 of the report that, of the countries where malaria

existed some had p~e-erad ica t ion programmes, whereas i n majority the e r a d i c a t i ~ h

programe was already in operation. It was gratifying to no te - tha t the eradioation

prograrqme In Pakistan - the largest i n the Region - was being aotively pursued,

particularly in view of the importance of that programe.to the global eradication

e f f o r t in that part of the world.

Of the 171 millfon population riving under malaria risk f n the Regton, mre than

45 million were already protected by eradication operations, and the number was grow-

ing every year. The eradication pxlograme was being oontinuously assesfled, tn order

to evaluate its efficiency and to determine the problems requiring solution. There

weFe : a number of "problem areas" i n the Region, for instance in scuthem B a q . and

southelm Iran where the vector, Anopheles.stephensi, was r e s i s t an t t o dleldp* end

highly tolerant to DDT* WHO had been assisting both countries,to make an epidemio-

log ica l survey of the situation and tondiv$se appropriate measures f o r dealing with

the impoptant problem creeted,

I n view of ' the Importance of coordlnat ion of eradit ion operations between

nelghbouring countries, WHO had S ~ O ~ S O T ~ ~ a number of border meetings, whf ch had

also been attended by WHO experts. Pakistan had participated i n meetings with

Tndia and Burma and with Iran, Afghanistan and Tndla, and there had also been meetings

between Iraq and Iran, Syria and Turkey, Sudan and Ethiopia e t c ,

In the control of tuberculosis, which was an 2rnportan-b prijblem f o r a l l countries

of the Regfon, WHO assistance was continuing; the number of indxvid-1 control pro-

j e c t s had somewhat decr~eased, but advice from the Regional Of f ice was &lven In

acoordance wf th countries ' requirements. The main development was that a new pattern

,f projects .has been set up, under whioh national p i l o t amas were established in

which various measures of control were tried out to find those mdst suitable f o r

application throughoul; "Le country* BCO Vaocination was continuing in a number of

oountries, in some of whioh t h e m e of dried vaccine had been Introduced. WHO was

helping with the assessment of the tuberculosis grogxla'mnies, fncluding the BCG vaccin-

ation campaim.

As regards other colrrmunicable dlseases,'there was no need to refer at the

present juncture t o measles and diarrhoea1 diseases, which w e ~ e to be dlsoussed

under other items of the agenda, However, durlng the period u f i d e ~ review two train-

ing courses on enterfc Infections had been organized by WHO in Teheran and Alexandria

for epidemiologists and baoteriologists having a special interest in the control of

those diseases. In connect$onwiththe course in Alexmdria, he t o o k t h e opportunity

o f thanking Dr. A . Kamal (who was present in the Conference Hall), for his valuable

oontrfbution as projeot leader.

There was a correction to make to mge 42 of the report, on dimoh. it (was stated

that an epidemic of typhus had ocourred In Yemen. The relevant papagraph had been . . ' .

inserted on the basis of information received by the Regional Off toe, but further

epidemiological investigat3ons had proved that the outbreak was not typhus.

WHO had provided a gqod deal of assistance in oancer control, r adh t ion protect-

Lon, occupational health and especially community water supplies, . A survey of the

water supply of Sana'a had Just been completed, with WHO aid and it was hoped to assist

the Government with its water supply programme f o r t b a t city. West Pakistanhad a

big pmgrame *hich was being carried ou t with help from UNTCEF and the United S t a t e s

Agency f o r ~ n i e r n a t i o m l Development with technicai advice from WHO. Water supplies +.

did not 'generally fall within the purview of ministries of health but they could

bring to the attention of governments the fact that technical assistanae from WHO was , -

available ' and' thee. @;overnments might seek heip fo r water supplies p r o g r m e s from ., ' , .

, , . . . . , . . . other agencies such a s the Special Fund of the ~ n l t e d Nations and the ~ n t e r n a ~ . i o n a l

Development Assoaiation (~DAA) an a f f i l ia te o f &-ld Bank.

Inter-country progpamrnes were growing In importance in the Region. Sore o f them,

although not all, took the forq of seminars and training aourses. A seminar on vital

and health statistics, which had been attended by national .s.t;atisticians and by pub2Lc

health administrators,, had been held in.Damscus. Participants from the Region had

wttended an inter-regional seminar in Dacca on the health aspects of Industrialization. r,'

Training courses were being held in B e i r u t for laboratory technioians and pl3ychlatric

nu~ses, an4 there w a s also a oourse f o r medical librarlam, given w i t h the assistmoe . . . , , . , . - ,

of the American ~ k v e ~ s i t ~ of Beirut. 'plans f o r the future f ncluded a seminar on

food hygiene, zoonoses control. and ve.t;erina*iy public health practice t o be held Late

October in Lahore. A t the end of November an fnter-regional seminar on malaria

eradication in T r i p o l i , Libya, would be attended by participants from the Region,

In conclusion, he thanked all the governments of the Region f o r their close and

fruttf'ul collaboration, which had made possible whatever sucoesses the Regional OffLee

had achieved. ' H e also thanked the agencies - UNJCEF, the United Nattons Technical

Assistance Board, ILO, FAO, UNESCO and the Economic commissions fo r Africa and f o r

~ s i a and Far East md other United Nations and International bodies that w e r e co-

operating In health and related activities in the Region.

The CHAIRMAN thanked the Regional Director f o r his comprehensive report and

expressed the wish that the activities of WHO would continue to be as successfU as

,In the past. , He then opened the, item for. dfscussion.

Dr. EL BORAX' (Kuwait) conveyed to t h e representatives present the greetings of

the people and Govermmevlt of Kuwait and welcomed t he Representative of Qatar, whlch

had recently become an Associate Member of the Organization. He also welcomed

D r . Kaul , Assistant' Direckor-General of WHO, who was repxles ent ing the Directowl-General

He expressed his grief at the death of Dr. A.T. Shousha, who had been the first

Regidnal Director. Dr, ~housha's death was an irreparable loss t o a l l Arabs and t o

WHO, f o r he had been a good leader, a highly esteemed colleague and a dear friend

and teacher. D r . Shousha had well understood the health problems fachg WHO and had

done much %o combat diseases in his own country,

He congratulated the Chairman on h i s e lect ion and thanked the Regional Director

fof- his comprehens1v.e Annual Report, from which he was pleased to note that every

e f f o r t had been made to cover the interests' of all countries of the Region,

It would be seen from the report t h a t some governments had made cansidemble

progress in education and training. However, others had been less successfU and he

f e l t that the Regional Office sh.ould take more, active measures to meet the p ~ l o r i t y

needs of countries where there were no faculties of medicine, The facul t ies exis t ing

i n the Region had f o r the most p a r t been s e t up by the e f f o r t s of the countries them-

selves.. H e was aware of the technioal and financial d i f f i cu l t i e s involved, but

thought that action shauld not be deferred, otherwise the gaal of one doctor t o 400

population, already attained in other regions, would never be reached, Consideration

should also be given to the na-hre of the f'uture doctor, his quality and the services

he would render t o the community, and pioneer efforts i n that connection should be

made by the leading oountries of the Region. The basic objectives of medical.

education were to awake an interest in the human being, the family and the commmity

as well to impart scientific knowledge, for a competent practitioner had to k aware

of the soc ia l and health needs of the c o m i t y in which he lived,

The assistance given by WHO to post-graduate publio health t r a in ing was appre-

ciated and an tncrease in it would. be-welcomed.

We noted th.t t r a t n h g of auxiliaries was reoeiving particular, attentian and that * ,"

kn some count~$es the educational requirements fo r admission to trairdng courses had

&en raised. Kuwait, hourever, was,urgently i n need of m o m assistance for traintng

~ u x i l l a r y wo.rkers such as rafliographers laborebtory teahnicians , assistant p h a ~ c i q t s ,

assistant health Inspectors and dental assiatants,. and for that reason would l i k e to

gend 20 to 30 students after they had obtained their intermediate school certificate

$ o t r a i n in other countries of the Region or in o t h e r regions. That would be in . .

bddition to thd' f ellovahips tha t Kuwait would normally receive and the Government

would share the expense.

As regads malaria eradicatl~n, two main problems atood in the way of sucoess - the resistance to insecticides of certain vectors and the evey-increasing development

of major irrigation plaw. Although the work undertaken had led to a dramatic

reauotion in the incidence of malaria,,and probbly to its e~adioation from some

oountries, it would be necessary t o accelerate the programe in order to overnome . .

thoae problems and f o r that, addit tonal. budgetary provf sions would be required. . I

iMaLa~ia was not a health problem in ~ w & i t and no indigenous oases had been reported . ,

during the year under review; however, control measures, including ' Insecticide

iampling and spraying had been carried out during the last two years.

As regads tuberculosis, his Government was interested i n the s tudies in several , . . . , : . , ' : , ' ,

WHO-assisted projects in ~ f r l c a and As'3.a. '&I& indicated that slmuitane&$ BW &d

. , .' . . ', ' + , . . : ' , . aafe as public health procedures. If %hb& fihdings were conrimed by the ksearch . < . *

at p~resent be& undertaken, it would be pos$ible to makc B C ~ ~acclnation less costly, I ' - . . t o integrate 2% mre easily into the work of the general heilth services and Lo

improve popuiation coverage. Tuberaulos is was the m o ~ t important public health pro-

blem in ~uwait and the health authorities were hoping that the seientifio advances of

recent years -would enable t h e m to eradicdte t h e diseade . It 'was, impbrtant that the

tuberdulosis 'contkol ' project in Kuwait, whiah' was being comied b i t with WHO ass isth

ance, should go forward without hindyesnee, dtherwlse all the c~untry's health pro-

rngrwmmes would be adversely affeoted, Good progreas had been made with the project,,

but one pwlabLem w.as causing grave concern: many tuberculosis pat ients oame from

neighbouring countries to avai l themselves of the free treatment given in K u w a i t ;

whilst waiting f o r admission to hospital, they l lved w i t h friends or re la t fvea an8

so spread the infect ion. Thus,, Kuwait 's tuberculosis problem extended beyonl its . . boundaries and for. that reason he would propose that a meeting of the health authori-

I '

ties conoerned be held under the auspices of the Regfond Office at wMch the matter

could be discuss@& .' It would be an advantage if such e. meetf ng could be held at the

end of the sub-~ommittee's session.

E M / R C ~ ~ A ~ ~ T I . 3 page 10

It was distuxlbing t o note from the report that progress 'in lep~osy control had . .

been slow. In Kuwait there was a leprosariwn in which 22 cases of leprosy were

detained, 7 of whonl were Kuwaitis, but anotwer 3 cases had recently been discovered

by chance. It would be & ~ h appreciated if the WHO oonsu1.tant who was going to

advise Saudi Arabia on leprbsy contr'ol could also pay a short v i s i t t o Kuwait.

As regads venereal diseases, h i s Government hoped that the programme o f research

in to the social problems involved .in venereal disease control in one country of the

Region would materialize and that some conclusions would emerge from ft t h a t would be

useful t o Kuwait. In his view the g~eatest obstacles in the way of venereal disease

control was the a t t i tude of the public, which c o m s e d the moral and the health issues.

Only when venereal diseases carried no s t i p would it be possible f o r physicians,

officials and contacts to co-operate in the Interests of control and f o r those'who

became infected t o seek medical aid without fear.

H i s Government was hoping f o r useful recornendations from the sernlnar on food . .

hygiene, zoonoses control and veterinary public health practice that was shortly to

be held in.Lahore. In the last few months rabies had begun to be a danger an Kuwait.

His Government was awaiting with interest the results of the latest t d a l s of the

combined vaccine against brmcellosis and foot-and-mouth disease.

General revaccination against, smallpox had been carried out in Kuwalt every four

Years since 1956 and it was planned to continue. those regular revaccinations. Kuwait

provided regular Snformation to the Regional Office on the quantity, type and origin

of the yellow fever vacclne used for vaucinating intermatiom1 travellers. As r egads

communicable eye. diseases, his country was a w a i t h g t he arrival of a WHO consultant to

continue the pilot pro Jec t which had been started a few years previously.

He regretted that the report appeared t o .make no mention of po l iowel i t i s .

Kuwait was continuing mass vaccination and was hoping for a decrease in poliomyelitis

morbidity and mortality that would confirm the value of ltve polio vaccine, in spite

of the problems regarding its use that were still unsolved.

In view of the spread of cholera El Tor and the danger It represented to trade

and traffic, his Government hoped f o r more effect ive control measures and a greater . . ' , ,

eontributfkn from 'the Regfon t o research on the dlaease.

H i s Government regretted that researoh into the therapy and control on bil-

harziasis were not making progress. In oonnection with onchooerciasis, It hoped '.' ,

that more p~ecautlon would be taken t o confine the disease to the infectedrareas.

H i s country was taking a great interest in improving the natiqml vital and

health statistical services. A new health s t a t i s t i c a l officer had ,been appointed

in t he Ministry of Health to develop health statistics ?nd to t r a l n personnel.

Kuwait had taken part in the seminar oonvened in Damascus in October 1963,

Kuwait was a l s o improving its health laboratory services and requeated the

begional Off i ce to ~rovide help in connection with th,eir planning, ftmctioning and

aevelopment, with the training of personnel and with the operation of blood b d s .

The WHO publication on the staffing of public health and outpatient nursing

e ~ v i o e s b d 4prompted Kuwait to folloy some of the reoammendations oontained therein

find his country was looking forward t o the forthcoming publication on the staffing ~f : b

mspital nursing.services. Tee school of nursing ebttached.to the 41 Sabah f lospital

lhad now been in operation f o r three years. The nursing curricuLum was being improved

1w modern methods of nursing education and practice were baing followed.

Kuwait had s e t up a health eduuation s ec t i on six years previously and was using

pudio-visual aid and radio and t e lev is ion programe on a wide scale . Attemps were

[being made to introduce health education into nutrition, cormmicable disease control

$and social medicine work. Kuwait was looking forward to the book being prepared by

UNESCO and WHO which would bf; of asslstanoe in introducing health education in schools.

Maternal and child health centres in Kuwait were being run. in aooordance with

:the latest recommendat ions. As regards pharmcy and medioal s tores , a consultant

had visited the country and submitted a report on the establishment of a quality

oontrol ' laboratory and a pharmaceutical indtlstrialization plant, both of whioh were

t o b set up in 1965. Already rm pharmacy and medical stores sewing the whole

oountry had been developed in a new building connected with the A 1 SaMh Hospital

#which would be opened by the .end of 1964.

Xn 1967 ~ u w a i t ' had started a' temporary centre f o r radto-therapy f o r aerncer and

another ourative centre with modem equipment would be ready in a f e w months.

Kuwait had established nutritfon servfoe and oocupational health service seotions

and the staff of the la t te r was 'shortly to be increased. The country also had a

rehabilitation and physiotherapy depaxltment with fully qualified staff.

H i s country would be grateful. to receive some fellowships In radiation prote~t ' ion.

As regards environmental sanitation, hz stressed the necessity o f t r a l n i n g I .

suff ic ient engineers and technicians for the maintenance of water supply and sewerage

aystems and of paying more attention to the health hazards arlsing from the increasing

introduction of synthetic organic chemicals into t h e h u m environment. The problem 0

of air a@ water pollution should receive omtinuma study. As regards housing,

Kuwait ' had planned a housing pyoprame which would lnalude the prwiaion of piped

wawr, sewerage and el&ctricity.

R e expressed his appreciation of the.helg given by W C E F to sanitation projects

in the Region and thanked the Regional D i m c t o r , his Deputy and his assistants for

the wowlk whfch W H ~ had carried out in the Region.

EM/X 1 4 ~ f i i n page 12

Dr. AEJOUTI: (Lebanon) began by thanking the Regional Director and h2s staff f o r

the excellent Annual Report 1963-64 they had prepared.

It was most important that c a r e h l appraisal. of the situation be made f r o m time

to time; the introduction to the Report pointed out that some 580 health projects

had been 1aunr;hed in isolated outposts and &trcpolitan areas of the Region. OveF

100 pyojec-ts were i n o p e r a t i o n while as many were planned, covering a wide range of

public health activities including the control of oomtmmioable diseases and pioneer

studies of the emerging problems of the Region such as occupatlonal diseases, radia-

t i o n hazards and social dfsorders related to tribal settlements w i t h particular

reference t o the nomadic l i f e of bedouins in the desert.

Before health problems could be dealt with e l f iciently , health education projects were essential, to en&& -that the dangers of non-oomplimoe with health atamhrds

were mde clear. For all t ypes o f health education, whetheli by television media or

' discussions, the l a t t e r being more'effectlve in small p ~ u p s , the presence of health

experts was essential. There was no doubt t b t the Eastern Medtterranean populations

were much in needof health education, even tn the rioher classes. The Regional

Office was responsible f o r emuring that health workers wePe .trained, ,He expreqsed

warm thanks to the Regional Dlrector for all'his e f for t s in that field and stressed

the need f o r long-term plans for the training of higher level health workers.

H i s country pxloposed that an international training cehtre for qual i f ied health

educators be set up in the Lebanon, w i t h the'co-operation of the Regional Office of

the Organization, for the benefit of all the corntries of the Reglan.

Dr. . VASSILOPOULOS ( ~ y p m s ) also congratulated- the ~ e ~ i o n a l Director and h i s

ataff on the clear ptcture of the progress made contained i n the Annual Report and

expressed appreciation of the sumnary of the a c t t v i t i e s of the Region sinue its

inception 15 years earlier. It was g r a t i e i n g to note that more than 580 health

projects had,been lawched during t b t period, 100 projects were in operation at the

present time and mny others planned.

There were serious problem in the Region due to malnutrition, poverty and ignop-

ance as well as devastating pestilences. It was enoouraging to nclte that the Organiz

at ion in general and the Region in partiuular was foousing its a t t en t i on on those

obstacles to progress. With regard t o medical training, the problem was less one of

numbers than one of concepts and new orientations. Furthermore, the public health h

problems of the Region were frequently quite different from those of the more developeu

countries of the West and it was essential that d-octors be made familiar with local . .

pathological oonditions , social problems, and rural envi~onments .

It was a great achievement that of 171 million people at risk, more than 45

million were now under protection f rom malaria. He emphasized the importance of I birleeriance work foilowing malaria eradication an& deplored the' fact that, due to

$he fi~esenb- momlous situation there had been a disrupt ion of the maintenance service

tm Cypms whioh m i g h t well give rise t o unexpected set-backs .in the futuse.

While expressing appreoiation of the leadership o f WHO in stimulating c o m n i t y .* ,

water supply schemes, he mentioned that in his country, in addition to all the main

towns, 92.5 per oent of the vi l lages had piped water supplies and 61.4 per cent of

the rural populatim had a house-to-house water supply.

With regard t o tuberculosis control, the problem was a very minor one in Cyprus.

I pilot area project completed by the end bf 1963 had confirmed that the prevalence

of both infection and the disease were very low.

The problem of infantile diarrhoea was of papamount importance in all the

oountries of the Region. It was hoped that since that would be the subject of the

bechnlcal discussions at the present Session, csncrete steps towards the prevent-

Lon of the disease, particularly in its virus-caused fomn, would result,

While a fairly satisfactory standard of health had been reached, Cyprus firmly

'believed that the improvement of environmental sanitation was t he foundation of any

sound public health pmgrame and was putt in^ plane into effect including a five-year

development programme for ' the promotion of the health of the people.

Be then referred to four WO-assisted schemes whioh had had to be suspended

because of the unfcreseen events whloh had taken plaoe in Cyprus at the end-of 1963.

Unfortunately there was a relationship between such political situa.t;ions and the

development' of health services ,

In conclusian he said that while the efforts of the Government and appropriate

authorities of eaah country to promote the health of thei r peoples within the X i m i t s

of their technical and eoonomic posa lbilit ies were most praiseworthy, the progress

made could not have been achieved without the guidance and assistance of the World

Health Organization, in collabo~atlon with other international organizations.

Dr. SANII (Dan) first oongratulated the Chairman on his election and thmked

the Government of Kuwait f o r its warm hospi ta l i ty , Be also expressed h i s ~ o v e m e n t ' ~

appreclatfon of the work ca~ried out by-the ~ ~ g i m l - . ~ f f i ~ e , from which Im had

greatly benefit$ed. The fact that the mmhmM-phad increased from 12 t o 20 in

1964, with Q ~ t a r as ap Associate Member, was proof a f t h e confidence the countries

of the Region had i n the work of the Regional Office,

E M / R C ~ ~ A D ~ . 3 page 14

Iran f u l l y supported the Regional ~ i r e c t o r ' s view that long-term health planning

had been one of the most important activities in the Region ove r the past f f f teen

years, and firmly believed that the ,participation of health a u t h o r i t i e s i n nat ional

development boards was essent ial . He was pleased t o see t h a t the subject of health

planning was t o be discussed at the Eighteenth World Health Assembly. Countries of

the Region should continue to share t h e i r experience in health planning and the sub-

Ject should be permanently on the agenda of the Regional committee. In Iran greater

Impetus had been given to the matter by the creation within the Ministry of mblic

Health of the post of Under-Secretary i n the un i t of national planning.

The increase in the number o f i n t e r - coun t ry projects during the pas t five years

was also an important aspect of the work accomplished. Referring t o the Medical

Education Conference which had taken place in Iran in October 1962, he said t h a t his

country had already taken steps towards the implementation of the recommendations of

that Conference.

St re s s ing the problem of the e o r t a g e of trained personnel, he said that h f s

country favoured the setting up of a regional information centre t o cover a l l f i e l d s r .

of health education and suggest ways of solving t ra , ining problems, to avoid duplica-

tion of work in the various cow-t;rles. Furthermore,use was planned of the services

of militam conscr ipts who, af te r a period of training, were provided w i t h transport

and supplies and desptched in mobile groups of o.ne physician and three assistanss, *

to areas where no other health service was available.

The Regional ~lrector's report contained an excellent account of the activities

and achievements in the f i e l d of malaria eradication.

In conclusion, it could be said that on the whole, in spite of socio-economic

problems and limited resources, the e f f o r t s made i n the Region had been successful.

Thanks t o the co-ordination carried out by the Regional Office and i t s unstinted . ,

efforts, Iran looked forward t o even greater progress being made in the future .

Dr. HACHICHA (Twisia) thanked the Government of Kuwait for its hospitality and

congratulated.the Regional Director on the clarity of his report,which showed how the

Regional Off ice was ass 1st ing man's progyess and making possible the gradual attainment

of the ~rganization's noble objectives. H e also referred t o the great loss suffered

in the death of the much respected first Director of t he Regional Office. In that . . . . .

connect ion he f u l l y supported the proposal Dr. Al-Wahbi (1 rag) had made Furthermore, . . he suggested that Dr. ~housha's name be given to a hospital for t r a i n i n g medical s t a g ,

as a t r i b u t e to the competence and knowledge which he had plaoed at the disposal of

the c d u n t r i e s o f the Region f o r a imost a decade.

Much remained t o be done to solve the pxloblem of the shortage of qualified staff

in s p i t e of all the efforts made by the ~egional Office which were muoh appreciated

by all, H e a l so thanked the Regional Director for his effor ts t o stresa the Import-

hnce of the pale of doctor in the pommunlty, showing a tme understanding of the

situation. 4x1 the countries of the ~ e $ i o n owed much to theip Regional Director, , . . .

and he hoped they would continue t o benefit from his oompetent, advice fo r many years

t o come.

The main problem in Tunisfa was the training of teaohers, *although there' was

also a great shortage in the various .categories of auxiliary medioal services. The

need f o r mral health workers was increasing as health standards were ralsed. Lab-

ora to ry workers were also needed. The& wepa 500 rural health centres in!Dmbsia

which were playing a growing r6le i n ru ra l medf cine. A tuberculosf s vaocinatf on

campaim had been startsd in 1963 and a t the end of two months, 2,000,000 children

aged between three months and ten'years had been vaocinated. BCG vaccinatims in

schools involving some 700,000 children were planned. Progress had also been m%de

in environmental hygiene and the provis3on of .water supplies and ~ t h the preventive

and ourative aspects of the fight against commmicable diaeaaes were the subject of

oonatant e f for t s bx the health authorities. The situation with regard t o malaria

was not serious in Tunisia since the mintenance and surveillance stage had heen

reached.

In conclusfon, he stressed the need f o r a centre of health statistics. Tunisia

had requested the Regional Office for teohnical assistance in t h e setting up of such

a oentre. With the oo-operation of WHO the isations of the pegim, united in t h e i r

efforts, could hope to progress.towards the solution af their health problems,

Dr. EL SMMI (~ordan) after congratulating the Cha imn on his election and the

Regional Director on the clarity of h is report , stressed the need f o r long-term plan-

ning, as set .forth iri the Introduction, if prog~ess was t o be mde in spite of t h e

shortage of qualffied'personnel and financial pesourues. He also emphasized t h e

need f o r progre~a in publio health standards to accompany economic industrial and

awicultural development, and the irnpoxYtance of collaboration with WHO.

With regard t o mhlarla eradication, it was essential t ha t before launchhg on

such Ijrog~ammes, countries should give sufficient thought'to ,the budgetary implicat-

ions thereof to. ensure tbt the programmes could be carried threugh t o completion. . . , , , .

He then referred to the economic obatsaAe@ to speedy in the supply of . , ,

. ,

drinking w a t e ~ aid the p<oblah of the disposal of h&mn waste, sneehtial f o r ~ u b l i o . .

health.

~ ~ / ~ ~ 1 4 ~ / h i n . 3 page 16

Co-operation between the various countries was also essen t ia l i n connection with

a g ~ i c u l t u r e , education ant health. Close co-operat ion was a l s o important between

medical and ve te r inan services. He referred in tha t connection to the valuable

co-operation between WHO and FA0 In organizing the seminar to be held at the end of

October 1964 t o study such problems . With regard t o agr icul ture , studies were

necessary fo r the appraisal of various ' types of food since the standards i n force i n

developed countries could not always be applied. The Ill effects of the use of

insecticides also required careful study.

studies were aiso necessary i n connedtion with vari-ous types of pharmacerltioai

products on the mrlret to ensure that they were not harmful-. Manufactu~ers shbuld

not be allowed to export products that they w&re prohibited- f rom seliing on their home

market.

He welcomed the Representative of @tar and hoped that tha t country's collaborat-

ion w i t h WHO would be most f r u i t f u l ,

Expresstng grief at the loss o f Dr. Sheusha he said t h a t the Region had l o s t one

of its most competent leaders in the field of public health.

Finally, he thanked the Government of Kuwait f o r its hospitality, and expressed

his cwmtry ' s ' gratitude to the Organization f r~ the extensive assistance received, i n

the hope that their common e f fo r t s towards the achievement of the ideals of WHO would

one day be fulfilled.

Dr. AL-WAHBI (Iraq) cong~atulated the Chairman on his electlon and the Regional

Director on the excel'lence qf his report . The outline of *the a c t i v i t i e s of Wle

Region during the previous fift&en years was most useful. However, it would have

been of even greater value if that summary was given i n a booklet form with statistics

of the results obtained. , Such a t e x t would p~ovide useful public informt ion

material about the Organization and ceuld be given wide-spread circulation as a

reference document to show the populations of the various countries what the Organiz-

at ion was doing f o r them. He placed that suggestion before the Regional Directoxl f o r

h i s :-considerat ion.

The need for ' co-operation among the countries of the area in connectiori w i t h

medical t r a in ing bad been r ight ly s t ressed . It was reaaonable t o spend one-third

of the ~egion's budgek on training because the shortage of humn resources at a l l

levels , and particularly nurses, was the most acute problem. In his opinion the

stage had been reached where not only quantitiy, but a l s o quality, should be consider- i

ed. Teams of experts should be set up to re-appraise the situation, if necessary

reviewing teaching techniques. Such studies carried out a t the Faculty of Medicine

i n Baghdad had proved most useful. Their aim should be t o attain the highest poss ib l6

standards to ensure thst the most effectfve use was made of the funds spent.

With ~sgard to the t raining of dockors, WH0,could p l a y an importgnt part serving

!ae a!+ intermediary for the exqhange 'of. tsaoher* between the various countries of the

Pegton in an attempt. to achieve more unlform standards from ohe countrgr to another.

@O had certain responsibilit~es in ensuring miform teach$% sterndads also- in the

p i n i n g of megical-wsshtants. Re.apologised to the Regional D i r e c t o ~ f o r entrust-

kng him with addittom1 Xaboux9s but felt.th@.t such a task could only be oarried out

the Organization.

Study tnissions and fellowships had played an important pea& in the history of

the devel~pment of the Region, as covld be seen from the figures contained in the

((-1 Report. He would however, be gratehl if the Regional Direotor would provide.

$@,om i n f o r m t i ~ n in explamtiop of the decrease in the numhx of fellowsh$p awards Y

in 1963 as compared w i t h previous years (reference page 21 o,f the A n n u a l qeport).

The. budget expanded from year to year and it seemed unf~rtwlate that . there ~hould

be a decrease.dn the number of fellowships awarded.

As Lo malaria eradioat ion, he a~mmari'zed the difficulties encountered An Southern

Tran and Iraq and &tressed the need for b s f c sc len t i f l c rosearch to asce&ah the

real cause of the. probleni. Regular meet ihgs between the health authorit f concerned

,in' Iraq and' b a n .were most u s e m but' would be even more so if #&y were extisnaed to

tiover a broader area. Turkey and the Syrf an ~ k a b Republic hkd been invited to atteM

$he la& meet i ~ g but' had unfortunately not sent representatives . HB strsssed the

usefulness OF such mestirngs in avoiding averl&pping of ef rolyts and providihg valuable

opportunities for the 'exchahge' of ihfornhtion amohg malaria eradication expe~a..'

With reference to the outbreak of oholera in '~ebst Paklstan which Dr. El Borai I '

(Kuwait) had already mentioned, there was a serious d&er, and'it was essential that

'the organi~a*idn a i a' whole iive ca*eMl attkhtion to the'-4ppbblem,' as Dii. K&.,-, the

~ss'i$ta&' ~ i ~ & c t - o r - b e n e ~ a ~ , had kdbi8ed "ibhld' be h e .

The fundamental question of techniques should not be forgotten. A t a t i m e when -, I <,:. .

general trends in health eduqatioq were being changed, the replacement of former . . 4

techniques by modern methods should not be overlooked, prtlcular study being given

$0 the matter throughout the Region. He would revert to the subject later awing . .

th='dib& bidn ' on the pkerra&e and Budg;% &timatea.

Colonel BORHANUDDIN (~akistan) after oongratulating the Cbwimn on his election

md . . welcoming.Qatar I . .. to assooiate membership of WHO, expressed the gratification of

h i s delegation .at being able t o attend ,the present session Kuwait, whiod was both . - . ' . , - % . . the richest country in the i o r l d and an ideal welfare state. It was inspiring to

see .the. at$eqt ion paid by the, Qovemunent t o the .health and welfare of the , pqpulwtion

H5a delegation was grateml f o r the hospitality extended to a l l those attending the

session and also to the Mihistep of Publdc Health f o r havlilg found the time, despite

his numerous gressing duties, to grace the opening meeting with h i s presence. The

session would provide W e numerous' experts in various branches of health end medicine,

gathered together from insfde and outstde the Region, with a valuable opportunity

both to obseme the great deve1opmnta;l work being c a d e d . ~ u t by thebGovement of

Kuwait and to aoquire usefhl knowledge of the plans and programmes being implemented

in other member .countries.

The Annual. Report of the Regional Director g&ve a comprehensive picture of act-

i v i t i e s in the Region and showea that commendable progress had been mde, ~ r t i c u l a r l y

in the oontrol and eradication of communicable diseases, public health adminlst&tion,

hospital servioes, and medical education. In his own oountry, the campsigns for the

eradication of smallpox and cholera were progressing satisfactorily, and the mlaria

eradication program was also continuing according to schedule. The lmplenkntatlon

af the r u r a l health program, which was being actively pumued, would require long-

term assistance fo r the provision of the neaessary msdgcal staff, for example through

an agreement Between a medical college In Pakistan and a unLversity abroad, the cost

to be financed '3y WHO. H i s Govermmen* also needed assistance for the establishment

of an epidemiological unit under the Biostati~tics Section of the Health Division.

Also, more heXp would be required f o r t b cormnunity water supply programme. He also

asked for more prssistanae pwrticularly in the form of fellowships f o r higher training

abroad., In t h ~ t connection, he suggested that-the FundB available through savinge

from the overall allocatioq t o aw member country m i g h t be used to grant fellowships

to candidates from that country.

An in%erl-regional seminar on the health aspects of industrialization held in

Dacca in November 1963 and attended by representatives of twenty c x n t r l e s , inoludPng

flve frqm the Region, had been very successful. He hoped that a l l interested member

states would also be represented at the inter-mgioml semfmr on zmnoses and food

hygiene sponsored by WHO and FA0 in oollaboration with his Owemment and to be held

in Lahore, and then be followed by field v ia i t s i n Teheran,

He expressed his Oovementts apprecfation of the sustained zeal with which the

Regional Director followed the hlgh principlee of the Organization and wished him and

his staff increasing success for the f'uture. He thanked the Assistant Director- . , General f o r giving h i s time to attendhg the meeting. He a l s o conveyed t h e expression

of his (fever-nits gratitude to UNICEF, Technical Assistance B a r d and other inter-

national agencies, thanks to whose assistance the pace of pub110 health development

was increasing from year to year in his own country as well as throughout the Region.

Finally, after expressing his ~overnment 's sorrow for the demise of Dr. Showha, he

conveyed the warm greetings of hts people to the people of Kuwait and to a l l represent-

atives of member countries and internatlnnal agencies gatkered together at the meeting,

Dr. A3DEL HAD1 ( ~ i b y a ) after congratulatbg the C h a i m and Vice-Chaimn on

the i r election, thanked the Government of Wwait f o r the hospitality enjoyed by him

UXtpait ever since his arrlval. He congratulated @tar on I t s accession to

gasociate rnembe~ship and witshed it every success i n its endeavours to raise its

health standards . The death of Dr. Shousha, occurring at a t i m e when public health workers of

his stature were partioularly needed, was an breparable loss, and the least that

oould be done to honour his memry was t o accept the proposal made by the rewesent-

ative of Iraq

In connection w i t h the excellent r e p o r t by the Regional. Director f o r the period

~963-64, he thought that a brief outl ine bf achievements t o date in his own country

might be of ifiterest, In spite of the vast area to be covered, the Government was

determined to' provide adequate health services to the whole country under its five-

plan. A new hundred-bed hospi tal had been built in T r i p o l i and another was

uMer co&truction in Benghazi. Tn addition, three hospitals wem planned fo r

arnaller towns, apart from a 700-bed hospital which would be attached to the f i t u r e

school of medicine. A nursing schoalhad k e n started 2nBenghazl ih addition to

the existing school in T r i p o l i whose capacity has' now been expanded to 800 trainees.

'He waa'glad ts say t ha t young women were showing increasing interest in entering the

nursing profession. The malarla eradiaation programe to which a hundred thousand

dollars a year had been allooated under the five-year plan, was prog~essfng satis-

'5'ractorily w i t h WHO assistance . He endorsed the views of the Repxlesentative of Jordan regarding the problem of

Importation of pharmaceutical products, whioh was very serious fo r countries such as

his own t h ~ t had no laboratories fbr testing them. He hoped it would be possible

for the Regional Office to study the mtter with the v9ew t o finding an a p p ~ o p r i a t e

solution.

The proposal of the Representative o f Iraq for the issue of a booklet swr~narizing

the work of the past fifteen years in the Region ,would, he recognized, have great

p b l i c information value'lbut it would also involve expenditure which he thought might

better be devoted to other projects, for example, the award of at least one long-term

fellowship for undergraduate medical studi'es.

Dr. SHUKRY (UAR) af te r expressing his delegatton ' s patftude to the Govement

of Kuwait for its hospitality, congratulated the Chairrmn and Vice-Chairmen on their

election and @tar on its accession t o wasociate membership, He cornended the

Regional Director and his staff an the excellent report submitted and expressed his

confidence that f r m i t f i l co-opemtion between Member Govermnaents and the Regional

Off ice would conkfnue .

~~/RC14Ahln. 3 page 20

H i s deleption !,.ad been deeply moved by everything said at the present meeting

and the pyevious day regarding the death.qf Dr. Showha. He had indeed beqn one of

the world's p e a t leaders in. public healtn and the loss was irremmble 4

One of'the outstanding developments in h i s own country was the expnsion of

medical education fac i l i t i e s . There were now seven medical schools, compred with

three in 1952, and it was planned to.establish two more in order to meet the medical

mnpower.needs ?ot.anly of the United Arab Republic but also of other countries i n

the Region. Instit~kes~had been established f o r training sanitary engineering

personnel and radiologfsts. The number of nursing schools was steadily increasing

and they were now turning out 2,000 trained nurses a year.

In the ffeld of comnicab le diseases, every effort was being made to achieve

effective eraflication of smallpox; vaocination was universal and compulsory, dry

vaccine being used in the more inaccessible area, poliomyelitis vaccinationwas

also being conducted on a mss scale, fifxeen million doses, or enough f o r most of

the susceptible population, having been produced In the country ' s own laboratories.

In addition, a well-equiprpd poliomyelitis treatment and rehabilitation centre was

being e~tablished. Extensive studies were *may to determine the most effective

means of controlling typhus, which was a serious problem; the production of vaccine

had already begun. Mass trachoma treatment was being oarrSed out in sohools,

parallel with researoh into the best meane of cantrol. Xn regard t o tuberculosis

control, facilities f o r mass examination were being expanded and the number of

hospital beds Increased. Finally, research on the most effective way of con t ro l l i ng

bilharziasis, which was an irnpfiant problem, particularly in the rural areas, was

being conducted with i n t e m t i o n a l assistance. . .

Envirsnmental health was of great importance, particuLarly for communicable

disease control, so particular attention was being pald to the .prqvIsion of safe

drlnking water in ru~al areas. Under t he second five-year plan all amas of the

countxy were to be covered.

he mtional health programe had expanded rap id ly over .the past two years and

had. now reached a .hundred million pounds annually, o r as mach as had beex spent. on

t3e~lth during the 75 years preceding the revolution.

The p~oblern of cholera, already mentioned during the discussion, was imp;odant

t o the United Arab Republic as tpny pilgrLms passed through the country on t h e i r way

to Mecca.

N.E. A B b W H I ISSA MOJ3AWUD (~ornslia') conpa tu l a t ed %he Chairman on his

e lec t ion bnd thanked the Gwermmeflt and people of Kuwait for t h e f r hospitnliW, 'con-

veying to the Ruler, under whose wise guidance suoh outstanding health and soc la l

progress was being made, m e oompliments of his President and Oovemunent.

In h i s country the general health consciousness and demand f o r heal th services

was growPng rapidly and placing a great burden on the shoulders of the responsfble

authorities, who wezle therefore grateful lor the assistance provided by the World

Health Organizatiofl. Four years previously, on at taining independance, Somalia had

fwced a severe shortage of medical s t a f f and public health facilities, Despite those

difficulties, however, it had been possible t o miritain i n operation a l l existing

hospitals and other health uni ts , to expand some disease control activities, fo r

example i n regard t o malaria and tuberculosis, t o initiate some new health promotion

measures, and to train paramedical staff. U c k of statistical data had been a

severe bndicapt . no reoord was kept of births, deatb or sickness, and the t o t a l

population could only: be guessed. Moreover, two-thirds of the people were nomdio

or semi-nomadic and there was little knowledge of their health conditions.

The magnitude of the task facing his Govement would therefore be understood.

The measures being taken to accomplish it were briefly as follows. As from 1965

it was planned to establish a national health service based on the principle of

oentralized general control and regional decentralization of operations. At the

same t lme, with the assistance of a WHO team, a long-term health plan was being

developed covering three 'f he-year periods. During the first period efforts would

be concentrated on training health workers of all categories, t o the number of 5W,

)on health education ac t iv i t i e s and on the development of curative and,preventive

~services. The second five-year period would be devoted to achieving coverage of the

entire natAonal t e r r i t o r y with adequate health institutions, and t he third t o the

consolidatfon of the heal th services established. In the implementation of the plan

substantial assistance was expected from WHO and also f ~ o m UNICEF, Technical Assis t -

ance Board,: and other bodies, and in that' connection he took the opportunity of

oommending the 'help already received from them under the technical guidance of WHO.

It would be read i ly understood t h a t the first five-year phase of the plan,

du~ihg which the va'rious divis ions of the Ministry of Health were to be established

and staffed, would require an expansion of assistance under the WHO fe l lowship pro-

gramme.

ne concluded by stressing his Govement 'a desire to co-operate fully w$th WHO

and his confidence that I t s needs,would be given due consideration,

Mr. SEB3EBIE ( ~ t h l o p i a ) congratulated the Chairman and Vlae-Chairmen on thelr

election and expressed his confidence that they would guide the business of the Sub-

Committee t o a successful conclusion. He thanked the Government of Kuweit for wel-

coming representatives so warmly to its impressive country. On behalf of his Govern-

ment, he welcomed the admission of Qatar as an Associate Member. He shared the

general grief at the death af Dr. Shousha, in whom the world had lost an able and

experienced l e a d e ~ in the field of public health. After conpatulat ing t h e Regional

Director on so ably presenting his ~ e p o r t , he said that, as far as the assis-tanoe b 8

his own oountry was co~icerned, he need only s t a t e that his Government was satisf ied

with aqd gratefhl for it, and hoped that it would continue; the different projects

to whioh aid was being accorded could be seen by representatives f o r themselves wheh

they attended the next session of the Sub-Committee in Ethiopia.

Dr. J O W (~nited Kingdom) after congratulating the Chairman and w e l o o m l n g Ohtar

to Bssociate membership, said that the Regional Director was once again to be commerh

ed for a lucid and interesting report. He had been papticWly struck by the

c o m n t s on the search for suitadle means wherebi 'Am1 health semi& a o d d progns

ively absorb comrrnulicable disease control programmes. The slow growth of the rural

health servlcs had been holding up mlaria erwdication in the Aden Protectorate owing

to the diffioulty of finding suitable staff deeplte the existence of three tmining

centres for meddcal auxiliaries,

With regard t o the remarks of the representative of- Jordan on the o o n h s i n g

complexity of the present si tuat ion in regard to the impoh of drugs, he referred to

the work of the Dmg Safety Committee, whose Adverse D r u g Reaction Notices were now

being published. '1n addition, ihhe UnnitedhKingdorn was sett lng up a Safety of Dmgs

Committee with three sub-cornittees conoemed w l t h toxicity, clinical trials and

therapeutic efficacy, and adverse reactions.

Finally, he thanked the G o v e m e n t of Kuwait far its generms hospitality and . .

for° the opportunity to see its magnificent medical institutions, of which,he would

return to Aden Protecto~ate highly envious.

Dr. EL .MISHAD (@tar) expressed appreciation of all th& kind words sald about

the accession of Qatar to associate membership and gratification at being able to

attend, for the first time, a session of the Regional Cornittee, The medical and

health services of Qatar had been established only recently, but they were,. he thqu&h5

already quite effective and were free fop all ci t fzens; moreover, his .Gavement q s

doing its utmost to expebnd them still further. As a developing country, @tar hoped

that its participation fn WHO would be fruitful and would pemnit it to raise its healt

skahdards'to the highest possible level . ft was proud to belong to the ~rganizatibn,

to which It wished ever increasing aucAess f o r the future.

The REGIONAL bTRECTOR, on behalf of all his staff, thanked representatives for ' I

their appreciative remarks, which would be an incentive to even greater efforts in

t he future. tie' would comment briefly dn some of the points miled and reply to a l l

the questions put.

The ~e~resentwtive of Kuwait had clearly studied t h e Annual Repo& with great

aare and had mde very comprehensfve obsemrations which would provide useful guidance.

fie had stressed the iii,po~.l;ance of the 'educational side of the ac t iv i t i e s of WHO,

k r t i c u l a r l y medical training, and of the fellowships programme. He had r e f e ~ r e d

ko the f eas ib i l i ty df conducting K G vaccination without p r i o ~ tuberculin testing 4.

hnd also simultaneously w i t h smallpox vaccination. Both those p o s s i b i l i t i e s were

h t u r a l l y of great Interest t o countries in the Region and were actually belng carried

out as routine i n some countries of t he Region. However, it was understood tha t the

question had been fur ther considered a t an expert committee held i n Geneva last August;

P t s report was not yet available, but perhaps the Representative of the Director-

General, Dr. Kaul, could give some information regarding its findings.

The problem- of Immigration in to Kuwait , of persons . suffer ing f ~ o m tuberculosis

.was cer ta in ly very important. He had seen for himself that a considerable number

of the patients occupying beds in tuberculosis wards and also of those attending

out-patient departments were from neighbouring countries. The reason was, of course,

in some cases that they came to Kuwait t o get treatment, knowing tha t the health

services were well developed and i n other cases that they came to work, not knowing

at the time that they were suffering from tuberculosis, He would cer tainly support

the suggestion t h a t WH3 should sponsor a meeting of the interested countries i n order

t o seek a solut ion t o the problem.

Regading the request f o r assistance in developing public health laboratories,

he would ask the appropr ia t e ~ & i o n s l Adviser t o discuss the matter with the Represent-

a t ive of Kuwait and then t o v i s i t the laboratories concerned and see what form of

assistance would be most useful .

Referring to the remarks of the Representative o f Lebanon and others, he agreed

about the importance of health education. He could not, however, quite a p e e with

the Representative of Iraq that it was a f l e ld of act iv i t ies fall- i n t o nedec t ;

on the contrary, the Regional Office w a s trying t o strengthen it, though it was of

course a long-term programme from which immediate r e su l t s could not be expected. He I '

would study the proposal of the Representative of Lebanon regarding the establtshment

of a regional scilool to t r a in health educators, though he anticipated some difficulty

Prom t he fact t ha t hea l th educators could be of a wide range and of different gmdes,

He gathered t h a t the Representative of Lebanon had in mind heal th educatops of a

unfvers i tg level .

He greatly r e p e t t e d that, as stated by the Representative of Cyprus, some

projects i n that country had had t o be ternpo~ari ly suspended, but the reasons, as

had been recognized, were beyond the control of WHO. The Regional Office was i t s e l f

deeply concerned at the matter and o p e ~ a t i o n s would be resumed as soon as conditions

permitted. Indeed, following conversations w i t h the Representative of Cyprua, he

believed that some ~raJects could be re-started immediately.

~~/%C14A/hln. page 24

He had noted the remarks of the Represen~ative of Iran ooxi the impox'tance of

plamfng and his ~overmment 's efforts to strengthen their planning semices. . He

agreed that adequate p l & l u ~ i ~ ~ g wa$ the most important aspect of long-term heakih pro-

motion programmes.

The Representative of IPunisi~b had referred to his ~ovemment's efforts to promote

education and training a t a l l levels and to the need to s t r e w h e n its v f t a l and

health s ta t is t ical ' service. The latter was a field In which WElO planned to give

assistance to Tunisia, as would be seen during the examination of the ~roposed

Programme and Budget Estimates.

The Representative of Jordan had comented on several aspects of the programme,

He agreed in particular to the oomment that long-term health plans must be integrated

into overall development plans. The ~ e ~ i o d l Office did its best to remind Govern-

ments of the need to make adequate provision f o r the health oomponent in general

planning.

The problem of import of pharmaceutical p~oducts, mentioned by the Representatfvrv

of Jordan and t lbya, was very impol*tant throughout the world and not only in the

Region. It.had been discussed very thoroughly at the last two World Henlth.Assemb-

lles, a& the pertinent resolutions on the subject were included for consideration

unde~ Item 8 among the resolutions of regional i n t e r e s t adopted by th* Seventeenth

World Health Assembly and the Executive Board.

The Representative of Iraq had made some very constructive remrks whhh would

certainly be borne i n mind, including,his suggestion that a booklet should be Issued

s u m r i z i n g the achievements of the past f i f t een years in the Region. The possibi-

lity had already been t en ta t ive ly discussed wfth the public Information Officer and

he would now feel encouraged to go forward with it.

He agmed with-the nepreseqtative o f Iraq regarding the importance of evalurntiw

education and training.activities and reviewing curricula, some of which no doubt

needed radical adjustment, having been Jrnpo-ed many years ago f rom countries where , . ,

conditions were quite d i f ferent f romthose in the Region. Moreover, with the present . ,

rapid evolution of the sociological structure needs were constantly changing. He , ,

also agreed that the t r a in f ig of medical educators and professors should be given hi@ . . . . .

p~iority; it would be seen that a project in that field was Included In the Proposed

programme and Budget Estimates under "~nter-countv progmmmesl' . The Representative . . o f Iraq had asked the reason f o r the reduction i n the number

of fellowships arharded in 196? as compared with the p~ovlms year. There Vera mny

factors Involved, and one of them w a s the amount of savings available. The Represent-

at ive of Pakistan, it would be reaalled, had p~oposed that savings from proJects ir n

eaoh country should be used f o r awarding fellowships to oandfdates f r o m that country,

And that in fact was what was already done. The amount of savings - which were

[plostly due Go delays in implementing proJects,- for example &&rough recruiting

@$fffculties - was low I n the present year, and the figu~e for fellowships m i g h t be

iltower even than i n 1963. Another factor t o be considered was that the volum of

she fellowship programme could not be judged merely numerically, as the ffgures in-

W e d a11 sorts o f fellowships of durations from a month or two in some instances

bo seven o r eight years in the case of undergraduate medical studies. So though

khe figure f o r the number of fellowships i n 1963 was lower, he could not say whether

:expenditure was r ea l ly so. Another fac tor influencing the fellowships programme

was the new arrangement agreed to wlth the Technical Assistance Board whereby in the

oase of fellowships under Technical Assistance, f u l l provision for the entire duration

had t o be made at the t i m e of the award, which in the oase of an undergraduate medical

fellowship would mean an amount of about 16,000 dol lars , Thus the amounts avai lable

*urn savings would no longer cover as many fellowships as in t he past. However, he

would stress that the importance attached by the Regional Office t o the f e l l o w s h i p

programme was i n no way decreased and tha t requests would continue t o receive a l l

8possible attention.

Regarding the problem a;aas f o r malaria emdication, every effort would be made

.'to find a solutton. Discussions were already underway to a l l o w the epidemiological

evaluation team at present in Lebanon also t o o p e r a t e i n Southern Iraq and Southern

Iran. He also had in xind the possibility of expanding border co-ordination meet-

ings, whose value he fully recognized,

Regarding -:he problem of cholera El Tor, mentioned by the Representative of the

Unlted Arab Republic, the Representative of the Direotoxl-General could perhaps provide

some information. He knew that an inter-regional meeting on the problem was to be

held in Manila the following month and that representatives from Pakistan wem invi ted

t o participate.

He had taken note of the remarks of the.Rep~esentative of PakiLtan regarding

his'Govermmentts need f o r assistance in the fields of stat is t ics , eplderniol~gg and

barnrnunlty water supply,

He had seen for himself. the very encouraging developments in his Government 's

health services outlined by the Representative of Libya. The main dff'ficulty was

of course shortage o f qualified staff, so he was @ad t o note the emphasis placed

on training.

The Representative o f the United Arab Republio had referred to a number of health

projects i n his country. The Regional Office would be ready to assist in the develop-

ment if the projected centre. He had also noted with sstisfactiok the

developments in comz._lt:r ~ ~ l t e r supply, covering most of the rural areas, as had been

rnent ioned ,

~M/~~lkAflln. 3. page 26

A 8 mentioned by the Representative of Somlia, shortage of qualified personnel

was the main prohlem in that country, which was why most WHO-assis.tad projects there

included ah imp6rkan't t ra ining element. He was glad to note that the assista;nce' o f

the WHO planning team was appreoiated.

In E t h f opia, where, as mentioned by the Representative of that country, the

members of the Sub-C,oMnlttee would be able the following year, to see health develop- , .

men%# fo r themselves, the training of all categqr tes o;P staff was also vem wportant . .

and WHO had been assisting f o r some years past in the project in Gondar.

He agreed with.the remriirs.;of the United Kiworn Representative on the woblem

of! dwg safeky and efficaoy

Flnally , he again welcomed the ~e~resentative of Qatar, i i ~ h whose Government

the Regional Office looked foxward to close col~aboration.

Dr. KAUL, A ~ s 1 s t m - b Director-General, satd he would reply briefly on the t w q

points refesred to him by the Regional Director. As stated, the Expert Colranittee

on Tuberculosis had met i n August. Its report was expected to be published a t the

end of the present month, including its recornendations regarding simltaneous

vaccinAtion with K G and srmllpox vaccine and also regarding BCO vaccination without

previous tuberculin testing. However, he oould al~eady inform the Sub-Committee

broadly %kt, af ter studying data obtained from pilot field projects, the Exprt

Comniittee had found that simultaneous BCG and s&llpox vacc i rk ion was perfectly safe

It had also concluded that In the conditions existing in the developing countFies,

BCG vaccination without previous tuberculin tes t ing could be useful in c e r t a i n

vulnerable groups, the advantages g~eatly outweighing any minor risk.

Regarding cholera, WHO was greatly concerned at the recent oacurrence of outbred

over wide areas of Asia and was doing its bgst t o help fill gaps "'in knowledge o f the

epidemiology of the disease and perfect the t oo l s fo r its oontrol, Two niajor vaccfnea

studies were at, present being conguoted, one in Calcutta with WHO assistance and one

in the Philippines with the joint participation of the Philippine and J&pmese.Goverm.

rnents and the Organization, H e hoped somc data from those studies would be available

f o r considera.t;ion,at the inter-regional meeting which would take place 5n Mmlla the

following month and.,would be preceded by the meeting of a Sc ien t i f i c Group at Head- # -

quarters. TYI addition, an Advisory Group had been comti tuted which was a% present

operating in the Philippines but would be available to assist in any country where i t

was needed.

The CHAIRMAN, noting that there were no f'urkher obsepvatlona, invited the Sub- . > , . (..

Cormnittee to consider the following draft resolution which had been circulatedr '

The sub-~omrnfttee , Havlng reviewed the Annual Report of the Regional D i r e c t o r fo r the

period 1 July 1963 t o 30 June 1964; Noting with saCisfaction the progress made during the last f5f teen

years and especially 'during the last one;

Considering the transformations and developments which are taking place In the economic and social . s t k c t u r e o f most af the countries of the Region and their reprcussions on the health programme;

Realizing that these new programme trends w i l l require more spec ia l i s t s , technicians and research workers and that the i r t r a in ing constitutes a high priority o f nationql development and health plans,

1, REQUESTS the Regional Director t o contfnue to render advisory assistance t o Member Sta t e s i n the strengthening of their health services and particularly with their "programes for t r a in ing of medical and paramedical personnel;

2. ENDORSES the emphasis being given t o the f i e l d of medical education in general and to the trainfng of specialists in various flelds of public health in particular;

3. URGF3 govermments to give due consideration i n thei r national health planning schemes t o t h a new health hazards which are gradually appearing in Bhe Region and t o appr~priate researoh in these , f i e lds ;

4 .' COMMENDS th6 Regioml ~ i r e c t o r oh his clear and comprehensive report.

Mr. FARAH ABRAR (~onaalia) noted tkt i n his country, assistanoe was betng given

not only to advisory but also to operational services. He therefore proposed the

i n se r t ion o f the words "and, where nedessarn, operational" afler the word nadvisory"

in operative p r a g r a ~ h 1 of the draft resolution.

Dr. EL BORAI (~uwait) proposed two draf t ing ohanges to the Arabic t e x t of the

draft resolution.

The REGIONAL DIRECTOR wondered whether the Representative of Somalia could not

agree to leave paragraph 1 as it stood, since the proposed amendments would introduce

some complicated policy considerations. The operational assistance being provided

t o Somalia was governed by the resolutfon of the Fourteenth World Health Assembly

whioh authorized such aid in vkry special circumstances and fn the case of newly

independent oountries . In orde r for ass iatance under the Health Assembly resolution

t o con-binue,there w a s no need for any reference in the draft resolution now under

consideration, and t o re fe r o n l y to advisory services would be more oonsistent with

general WHO policy.

Mr. FARAH ABRAR (~omliw) said that, in view of the Regional ~irector's assurance

that operational ass I s tance to e l i g i b l e countries would in any case continue under

the provision of the Health Assembly resolution, he withdrew his amendment,

E M / R C L ~ ~ ~ $ ~ - 3 page 28

The CHAIRMAN noted that the changes proposed by the Represern%at%ve of Kmaft to

the Arabic t e x t wer .e generally acceptable to the Sub-Comittee.

Mr. DAVIDIAN ( ban ) proposed that the words "mdical and paramedical personnel"

at the end of paragraph 1 should be repleoed by "medical, paramedical and auxiliary

as he Understood tha t nurses were clqssed not as but as

auxiliary, unlike, for e x q ~ p l ~ , physiotherapists.

Mr. SEESEBIE ( ~ t h i o p i a ) asked whether the w o r d " paramedicalt' included public

health personnel.

Dr. EL BORAI (Kuwait) considered that ho i k r t the .wo& "auxiliaryw would

introduce an unnecessary complication.

Dr. AL-wNI (fraq) felt that , on t k e contrary, the Inclusion of the word would

help to clarify fhe draft resolution,

The REGIONAL DfRECTOR said he was of course entirely at the disposal of the Sub-

Committee, but he would personally be fn favour of leaving the text as it stood, since

the term "paramedicalt' was very general and covered all health staff that were not

"medicalt', i.e,, that did not have dfplomas in medicine or public health, for -ample

nurses, physiatheripists and phamcis t s and auxiliary staff. To Include the word

"auxiliary" would of oourse place particular ernphasds on the t raining of tbt oategory

of ataff, but he wondered whether that was really desired at the present st&& of the

~r~anizat ion ' s development, when the trend was rather towards leaving that responsi-

bility to Govermments

After a. further exchange o f views, Mr .,. D A V D I A N (1mn) agreed not to press his

proposal.

Decf sion: he draft resolution, with the amendment proposed by the Representative

of Kuwait t o the Arabic text only, was adopted unanimously.

The meet>ing rose at 1.45 p.m.