WORLD H E A L T H O R G A N I Z A T I O N

REGIONAL OFFICE FOR THE

EASTERN MEDITERRANEAN

Ninth Sess ion --

SUB-COImII TT3Z 9 -- - - -- - - .

Uldl i . 4 1 ORGANISATION MOXDIALE

U . DE LA SANTE

BUREAU R~GIONAL DE LA

R : Dr. ' . Ztsrladian ran)

Technical m a t t s r s :

( f ) T:,e ques t ion cf i h a t .

( a ) ? " a l a r i % f:raLication pro;?Panm.es i n the 3as t e rn b d d t c r r a n e a n %<ion .

( h ) S-rallpox c o n t r o l .

( c ) i 7u t r i t i on .

( d ) Com~dnity water s113plv iil coun t r i e s of tke Tasterr , '%di tor ranean 'emion.

( 3 ) Io?.izin% r a d i a t i o n i n -!c?i-ins an6 qr ' c i i r h e a l t h .

E . ~ C 9 ~ / ~ r o ~ .fdin/2 page 2

Present :

Government - France

I r a n

I s r a e l

Representat ives

D r . " .Faure Ill lo . N . Trannoy

Dr. 3 ' . Ztenadian D r . -. Khabir

D r . S . Btesh 3 . 5 . Syrnan

I t a l y Mr. P . Kslan

S e c r e t a r i a t

Sec re t a ry t o t h e Sub-Comqittee D r .&.I-I .Taba, Recional Direc tor

Rspres-n ta t ive of t h e Uirector-Gensral Dr.?.Dorolle, Deputy Di rec t c r - General

Deputy S e c r e t a r y t o t h e S u b - C o m ~ t t e s D r . H.Z1 Balawani, Deyuty Xugional Direc tor

Chief , d> idewio lo< ica l and S t a t i s t i c a l Dr. TJdsfy O3ar Sec t ion , ZFRO

Senior Ti-;gi onal Malaria Adviser, r:I'TO D r . '31. Far id

Re5ional Environmental S a n i t a t i o n Adviser 'lr. '. P c n ~ h i s 3 ' P O

Peoresen ta t ives of t h e IJnited Nations and Technical Ass is tance Board -- Tinited :'ations Qiv i s ion of Narcot ic 7 . . r . 8.;. David

3rilgs

Tcc??nicsl -;ssistance Pcard 'Ir . . . Svmofids

Renresenta t ives of "on-Governinantal Organizations - - --- .- . -

I n t i r n a t i o n a l Confederation of Midwives Iliss il. F a i l l a r d

I n t : rna t iona l Council of Nurses i s I?. Tussbs;un

I n t - r n n t i o n a l Union of " r c h i t e c t s M r . W.F. Ve.ttf>r

? ' ledical :Tomen's In ternc i t ional D r . V.J. Pe terson Associa t ion

TECHI9ICAL DiATTERS (Item 16 of the &en&)

e ouestion of :;hat. (Docunent ~::1/~C9/13) ( f ) Th.-- The REGIO:iAL DIFBCTOR s t a t ed th2t documnt ~:/RG9/13 had been p ~ ~ a r e d in

aompliance vdth the resoLution adopted by the Regional Combittee-at i t s eighth session

and dealt with problems connected with the chewing of khat, the consideration given 'CQ

the matter by internzt ional control organs and the preliminzry wialyt ical studies.

Refore khat could be c l a s s i f i ed as an addii:t.i.-n-oroducim drug subject to interna%ional

control fur ther extensive studies a-rould be necessary. So fay labor$hory studies

indicated t h a t the main zlkaloid containeC'in the leaves rr2.s d-nolpseudbephe8rine.

He hoped t o give more dzta.iled ' i n ~ o r ? i a t l ~ n particu%a$ly ?bout t h e u s e of kha i , : 38~ the

Eastern Zediterranem Region a t a Yit'er session of the Committee.

:'s DAVID (Narcotics Division, UN) speaking a t %he inv i ta t ion of the Chairman,

explained tha t t h e consideration of the ques t ion 'b~c? been wstponed by the. United

Nations Commission cn Narcotic Dkgs &ti1 PRO hadcompleted i ts technisa l re?ort.

The Cornmi s s i on would t h ~ n be able t o decide .ifhat f&tlier . action should be tz.ken.

D r BTZSH ( I s r ae l ) s a id t h a t t h e r e w?.s no-l?&rge s c a l e coiiiimrcial r~roducticn of khat

in I s r a e l xhere it had been introduced'by himigrants from' Yemen who grew it i n t h e i ~

backjrards f o r f m i l y use. F u l l infonxation had been obtained as t o mhere it was grom

and i n what quant i t i es and it h2d been decided tha t n? speciaJ. control measures mere

call.ed f c r . I f . howevar, VHOIS report indicated' t h a t control was necessary t h z t would

not be d i f f i s u l t .

Dr FAURE (France) s a id t h a t zlthoug:~ khat -;ieanot grown i n French Somaliland

it const i tuted a grave s o c i z l problem because badly :xiid vex-kers cmetimea spent un

t o one-thircl of t h e i r earnings on it thereby &epriving themselves and . the i r families

of food and. paving t h e way f o r tuberculosis: hence t h e au thor i t i es i n French SomaLlland

LOOKed forvmrd xr,ri%h great i n t e r e s t t o ?mIiO's re?ort and con.clusrons,

The CWLIRI~A~Y emnbasized the e f fec t s wllich the use of b a t might have on nutri t ional.

levels .

EX I/Rc~F$"L&O&M~/'~ page 4

He suggested t h a t the Sub-Committee adopt a d ra f t resolut ion on the l i nes of t h l t

a2wroved by Sub-Cornnittee A.

It was so agreed.

(a ) hialaria Xradication Programnes i n the Eastern Xeditermnean Region (Document KF;:/RC9/4]

D r FAKm (~ io r ld Heslth Organizntion) intro6ucing document E ' y ~ ~ 9 / 4 s t a t ed t h a t it

summarized the e f f o r t s by goverlliilents i n t h e Region t o implemsnt resolution '61~~8.30

and WO's assistance through the Regional Office t o nat ional eradication services.

Malaria was s t i l l 2. major problem i n the Region since it threatened 67 p r cent (about

127 million) of i ts inhzbitants and though i n 1959 38 mill ion had been crotected by

eradication or control zleasures 90 mil l ion s t i l l remained without protection..

Eradication ?rograE~nnes now covered Iran, Iraq, I s rae l , Jordan, Lebanon 2nd Syria

and p-eliminnry surveys begun l a t e i n 1958 i n Libya, Tunisia and Egypt were ex;?ected

t o be comrileted by the end of 1959. It was hezrtening tha t Pakistan xhere the probler

was grea tes t , as w e l l as Ethiopia, Saudi Arabia, Somalia and Sudan had alrezdy agreed t c

such surveys t o s t n r t l a t e 1959 o r e a r l y 1960, though a few countries and t e r r i t o r i i

and they included Yemen, the Aden Protectorzte and Persian Gulf t e r r i t o r i e s , had not

yet responded. t o the progrzpe owing t o l ocz l circumstances.

The success of czt~paigns of l imited duration la rge ly depended on e f f i c i e n t odmini-

s t r a t i o n zdapted t o t h e i r special requirements and the need for echninistrative reforms

and e f fec t ive l eg i s l a t i on could not be too strongly emphasized. The Regional Office

was trying t o help by offering the services of qua l i f ied administrators. Eradication

prbgrammes were regarded as an i n t e g r a l p e r t of general public health a c t i v i t i e s and

needed the collaboration not only of the mhole medical profession b u t of the c i v i l i a n

administration 2nd the ?ublic: hence the need foy intensive health education.

Table V in t h e Rer~ort shoved an encouraging increzse in the number of t ra ined

personnel for which there would be ye t a g rea t e r demand i n countries changing over

from control t o eradicat ion progr?.xrnes since the techniques were different . That neec

had been foreseen by governments and the Organiz,?tion m d the i ialaria Ins t i t u t e i n

Tehem,- the ?:IHO Regional Training' Centre in Cairo, the 2<lalaria Trzinirl. Centre i n

L'thio-ia a s % e l l as fellouuships granted f o r courses i n Jamaica would a l l hely, in

t ra in ing prsonnel: Assistcnce "to them had been siven a high ~ r i o r i t y by the Regional

Direc.tor.

The appemance o f re s i s ' cmce by cer ta in l o c a l vectcrrs i n specif ic are-$ t o dieldr in

and DDT pointed t o thee.urgent need f o r eradic.ztion ;,rogrmms and fur ther entomologica1.

studies.

Another technical. problem in the Region was the spec is l ecology of the great

n-rs of inhabitants :leading a nom.dic l i f e . Iran was conducting research on

~omdism. f o r which c grant had been given.

iiJHO, real iz ing t h a t governments neeckd not only technical guidance but a lso su:>plior

trans?ort and insecticides, had established effect ive 00-ordinltion irsith other in te res te i

bodies such as UNICEF and ICk whose continued sumor t T?a,~ a matter f o r c r ~ t i f l c ~ . t i o n .

He a l s o hoped t h a t substant ia l assistance woulc! be forthcoming from I!ESA txlt as the

fund's f inanc ia l posit ion i n 1960 was not a s i?romising as a n t i c i g a t e d m d a s the Tuture

scope of VlHO's help de?ended upon substant ia l cpntributions, it was hoped th3.t more 2nd.

rixore governments would continue to give t h e i r f i nanc ia l supnort. Otkierdse the use of

the fund would be l i n ~ i t e d t o the ~ n ~ s t v i t z l ?rejects ~ h i c h could not be finance& fron

elsewhere. IZSA was designed t o s u p ~ l e m n t and not to supplmt resources derived frozl

the re@lar budget and the expanded progrli:me of technical assistance. The Regional

h r e c t o r on behalf of the Director-General w i shed to take the o ~ w r t u n i t y of thankinn

the Governments of Iraq, I s rae l , Leb+non, Libya, Saudi Arabia, Sudan znd Tunisia f o r the

contributions already made t o the fund.

In view of the need f o r inter-country co-rdination of programmes particul?.rly i n

f ron t i e r areas and f o r t h e expeditious exchange of info.mation the Regionzl Director

~ 1 3 s props ing t o i n i t i a t e an inter-country evalu&tian ?reject t o serve a group of

neighbouring countries.

Ei,:/RC9B; :.. &'C-;.?k?Zl/2 page 6

The DEPUTY DIRECTOR-GENEFULL outlining the f inancial posit ion of : . M A s ta ted Vhzt

the t o t a l income.up t o 25 September 1959 ~vas $ 8 527 559, out of which eight mill ion

had been contributed by a single State , the thirty-three other Uember S t a t e s - allovrancc

being made f o r i n t e r e s t and exchange losses,- had only contributed sbae f ive hundred

thousand dollars. Cut of those thirty-three, nine cane from the Zastern ;Zediterranem

Region and three -itere reuresented i n the present Sub-Cornittee.

The Director-Gener?.l f e l t the posit ion t o be unsound. I f contributions did not

increase no expansion could be envisaged i n 1960, and indeed the pmgr&me t i h t have

t o be cut i n t h s t year. He therefore renexed h i s appeal to States f o r contributions

or pledges f o r the not-too-distant future. It :as regret table t h a t appeals t o industry

labour organizations and foundations had had'but a negligible resu l t .

D r BTESH ( I s r ae l ) s a id t h a t i n I s r a e l where a policy of eradication had been

a~proved, t h e pmgrmme should be i n f u l l swing by the beginning of 1960. I n 1958 t h e n

had been only t~zenty czses of malaria, 80 per cent of whichhad come from one region.

Nevertheless there was some ground f o r concern because there had been sporadic outbreaks

i n areas where it had long been ext inct . Somatimes they had been caused by therapeutic

transfusions and a f t e r the s t r i c t regulations introduced three years previously had

only occurred i n hospi ta l s where t h e rules had been ignored. I n other instances there

had.baen a relapse 7rit.h p t i e n t s who hgd come from malarious areas i n other countries:

t hosehod been carefu l ly studied t o ansure t h a t they h-d not been provoked by mosquitos.

The t h i r d category of cases was more disturbinp because they indicated the existence

of some small f o c i which might cause trouble o - x i ~ ~ t o the presence of prrrasite car r ie rs .

They were tr-ying t o learn more about those ca r r i e r s bu t it was d i f f i p , l t orring t o the

Seed f o r :.e'xznining m a y thousands of s l u e s . He. hoped t o give fur ther information on

t h a t ..question a t t he . qext session.

The :.Iinistry-:of Health in h i s country did not t h i n k it necessary t o introduce any

spec ia l l eg i s l a t i on because of t he co-operative a t t i t ude of the ~ u b l i c and the recog-

n i t i on of the need f o r control by loca l authori t ies . I n addit ion there were more

EYkRCpBj- ' &Qf@%n/2 page 7

doctors per hezd of populztion than in any other country i n the Region a d 7 0 Jer cent

of t n e people >-?ere insured against sickness. Relatively frequent medic?l exxninctions

ma&.cdntrol6ossible.

:::,:--:-- H i s Government whole-heartedly sup~3orted the Reglonnl Directorls plan f o r an

int@r_~countrji evnku2tion project.

He, t h a ~ b d t h e Deputy Director-General f o r h i s statement and undertook t o br i rg

the Director-General's a ~ p e a l t o the notice of h i s Government.

D r KKkBIR (Iran) emphasizedthe gravi ty of the problem of malaria in h i s country.

In 1950 with ;;Hots help the S in i s t ry of Health had launched a widespread caIUp3ign i n

r u r a l d i s t r i c t s m d three years previously had s t a r t ed on an era6ication programe in

which t e n n i l l i o n r i a l s had been invested. He xrelcomed the Regional Director 's

evaluation ~ r o j e c t which v i t a l l y necessary f o r the success of the cvpa ign s o a s

t o es tab l i sh whether the plan i t s e l f o r i t s administration had to b.e modified.

Dr ~~~ (World Health Org&nization), thanking D r Btesh fo r h i s interest ing remarks,

s a i d t h z t the Regional Direwtor looked fonrard t o the time when the sm11 existing foc i

i n I s r a e l ~ v o u l d be eliminsted. I s r a e l l r a s fortunate i n having a comprehensive medical

service and svstern of insurance and should be able t o achieve eradication iwithout

d i f f icu l ty .

The Fleglonal Director f e l t t h a t the tesifl~whichwould be conducting the evaluation

survey would f i l l - a lonz f e l t need, f t was to opercte i n Iraq, Syria, Lebanon and the

Jordan and would help to disseminete inform3t-on on f r o n t i e r areas. It was hoped tht

another team would l a t e r be working i n Pakistan.

The CHAIfCiiiN suggested t h a t the Cormittee zmrove z draf t resolution on the l i n e s

of t h a t ado?ted by Sub-Committee A.

It was so agreed.

@j allp pox control f Docunten.ts Bl/RC9/5 and Add.1)

D r O W (World Health Organization) introducing the report on slnallpox control

sa id tha t t h e main problems i n endeddc areas, and the disease 1v3.s endemic i n a t l e a s t

six countries and t e r r i t o r i e s of the Region1 were t o ensure t h a t the vaccine was natent

andto organize e f fec t ive vaccination which on a n ~ s s .scale was regarded as the best

rfiathocl of control, . I f 80 per cent of the peoyle were v a c c i n ~ t e d successfully,

eradication was ensured and any outbreaks c&d be eas i ly arrested.

Another problem i n the Region m s t h a t the diseose was sometimes brought i n frorn

outside and t h a t there were no quarantine ba r r i e r s betvieen countries of the Region and

adjacent ones. I11 the previous three years many such cases had occurrzd and had

created new foci.

In pursuance of the decision by the Eleventh Eorld Health kssernbly the Regional

C o i t t e e had ca l led upon Ilember States t o provide i n f o m l t i o n enabling the Director-

General t o carry out 'his study of t h e f inancial , adninis t ra t ive and technical mli- cations of the hssenbly's resolution. The useful information supplied had been

tabulated i n Section IV, Part 1 of the Repor$ from aihich it would be seen t h a t in cer ta

urban areas a h1gW proportion of the popu l~ t ion had been. successfully vaccinated and t h

there had bees no d i f f i c u l t y i n pe~suading peoale t o accegt X t . It had also been

ascertained t h a t vaccination services exls ted alnost everywhere though there was no

permanen* body of vaccinators. In most countries t ra ined personnel could be brought

togekher Eal r ly quiokly o r t ra in ink courses arranged. L i t t l e information about costs

nau been received apart from Ira&.

Fourtean countries i n the Region had laborator ies producing 1mph vaccine and 0 t h :

imvorted the i r suo;>lies. Information about production and imports could be found on

pages 10 and 11,

%XI0 had Gready published a report based on infomation from various countries i n

the world on the organization of a srnallnox eradication service and.%& docwent would

be c i rcu la ted t o a l l in te res ted States. The Regional Director had already arranged fol

a team t o survey t h e ~ o s i t i o n in cer ta ln areas and t o advise governments on methods

of control. After v i s i t i ng four countries it had already been estzblished tha t

although legisla$ion on control mas lnore o r l e s s universal it was sometimes not enforced,

par t icu lar ly i n ru ra l areas.

Section V , par t 4 in the Report indicated the present criterion f o r S U C C ~ S S ~ U ~

vaccination and gave deijails about the properties of freeze-dried vaccine &ich i n s

considered t o zive the best r e su l t s i n rzixote rural. areas.

The Regional Director wished to dram special a t tent ion t o the operative paragra?hs

of the resolution ado?ted by Sub-cownittee k ?.nd t o em9hasize t h a t the f u l l co-oprctlo!?

of Governments was e s sen t j c l i f eradication were t o be achieved.

D r SYl.ikN ( 1 3 ~ a e l ) thanked Cr O;wr f o r h i s in te res t ing remarks. In I s r a e l snlll:>ox

was not a major problem though the authori t ies by no means minimized the importmce of

routine measures and regional control. During the past decade there had not been a

s ingle case'ancl. vaccination prccedures xera regarded as sa t i s fac tory since more then

60 per cent of the p o ~ u l a t i o n was covered and the proportion was higher f o r inf?.nts

because responsibi l i ty for .vaccinat ion had been transferred t o IlCH centres which

service8 the. whole country. There was therefore no specixl problem of control i n n r a l

areas. A n additipnal guarantee was t h a t on admission t o school children had t o ?resent

a c e r t i f i c a t e of re-vacoimti.on and a l l nem iiduigrants had t o be vaccinated. In the

circumstanoes there m s no need f o r mass ca;,~paigns which could not ea s i ly be conducted

without special personnel, There had been practic?.lly no instances of objection t o

vaccination on re l ig ious groun&s . I s r a e l did not produce freezc-dried vaccine because the existence of pro?er trcns-

port and re f r igera t ion f a c i l i t i e s ~ a d e ';hat cnnecessary.

Recognizing the poten t ia l imi.ort-nce of s m z l l ~ o x his Delegation endorsed ths

P ~ O P O S ~ ~ S concerning erzc:ication 2r.d supported the resolution adopted by Sub-Comaittee

D r FAURE (France) sa id t h a t although there had been no cases of smal l~ox during

the past t en yec rs i n French Somaliiland and in spi te of the soutine vaccination of

p rac t i ca l ly t h e ' v b l e sectentery pop la t ion every three years a po ten t ia l danger d id

e x i s t amonw monadic t r i bes who frequently escaped vaccination and more particular&

&ring %heir movement .across. f.rsntiers.

D1- ::22IR (Trsr) 225.4 t h - t !n sp i te of c e r t l i n d i f f i c u l t i & s 80 per cent of the

population in Iran had novi been vaccinated.

The CH;.IR;ihN observed t h a t the j i f f i cu l ty in using freeze-dried vaccine was i ts

r e l a t ive ly high cost. Research was in pro,"ress a t the Teheran &s t i tu t e t o evolve a

cheaper product: such ?uork could be very bdnef ic i l l t o other countries in the Reglon

and deserved s u p o r t .

D r OliAR (World Health tirganieztion) agreed t h e t in I s r a e l there was no need f o r

mass cmnaigns. The information contained i n the re-3ort about re l igious ob.jecticns

t o vaccination derived from tha ansvmrs su??lied by governments t o the Director-Genera.

ques t lonnaire . Nomadisn presented a public health problem i n 211 iifrican countries and caused

d i f f i c u l t i e s in ~.cliieving comprehensive v~ccin,?t:on. Outbreaks of smallpox in recent

years had a l so been t raced t o the movement of pilgrims acmss f ront ie rs . If ski-

tanems campaigns could be conducted i n a q a c e n t s t a t e s ;?regress t m a r d s eradication

could be made.

The Regional Director vielcorned the information about the campaign i n Iran.

He zgreed with t h e Chaiman on the need t o deyise a chenper vaccine than tha t

prepared by the L i s t e r In s t i t u t e technique,

The CHAIIt?%N suggested tha t the Sub-Committee approve a similar d re f t resolution

to t h a t adonted by Sub-Comuiittee A.

It was so agreed.

K :/Rc?$ P-ogJUn/2 page ll

(c) Nutrition (Document ~.yRC9/6)

The REGIONAL DIRECTOR s ta ted tha t document Ki/~C9/6 provided a ' comprehensive

review of the nut r i t ion s i tua t ion i n the Region: a f i e l d i n which WHO Tias co l l abora t a -

c- losel j with UNICEF a d FAcf. gu t r i t i on was gaining in imgortance with the rapid grovvth

of pop.l.ation due t o improved henlth Conditions. The main ep?hasis i n the paper was on

t ra in ing and it sought t o draw the at tent ion of governments t o the need f o r preliminary

surveys before embarking on measlres t o iinprove nutr i t ion.

D r SY:,Uili ( I s rae l ) thanked the Regional Director f o r h i s valuable i n i t i a t i v e i n

focusing a t ten t ion on the fundamentel problein of :nutr i t ion and honed t h a t a l l 1,iember

countries u~ould make a'determined e f fo f i to ef fec t impr&ements. The ?aper consti tuted

a first s tep i n assessing the problem and he welcomed the aapointment t o t h e ~ e g i o n a l

Office of an adviser on nut r i t ion .

Social fac tors la rge ly determined the l eve l of nu t r i t ion and unfortunately con-

s iderat ions not connected with health sometimes influe.nced,.-food.pol~cy. Hevuhole-

heartedly subscribed te-the statement contained in the fourth pamgraphuf ,the intro-

duction which useful ly brought the f a c t t h a t hsa l th services viere n o t always i n a

;?osition t o give lend.

A t one geriod there hadbeen severe rationin," in I s r ae l but sustaim-d e f f o r t s had

been made t o ensure a well-balanced d i e t and an adequate intake of calor ies , Though

rationing had now ceased the Government s t i l l cont inuedto subsidize cer ta in basic

foodstuffs such a s milk and breed so as t o ensure t h a t the ?oar were adequately fed.

In addition some foo&tuffs such as aargarine and f lou r hcd been enriched sand surveys

had demonstrated t h a t t ha t move had eliminated cer ta in d i e t e t i c deficiencies. Hw;fever,

some pers i s ted pa r t ly a s a resu l t of the prejudice, ignorance and cooking habits of

cer ta in grou?s of the population and notably ainong iinmigrmts.

X survey -was being conductedwith UNICEF assistance on nut r i t ion levels , the seconc!

par t of which :-uould be devoted t o c l i n i c a l investigations on protein and anaemia de-

f ic iencies . Such subjects required a grea t deal of research and h i s Delegation had

consequently been in te res ted i n the s c t i v i t i e s s u ~ g e s t e d i n the Report.

The au thor i t ies in h i s country viere giving special a t tent ion t o par t icular ly

vulnerable groups in the y o ~ u l a t i o n such a s pregnant women, infants and children.

Aclvrce and help could be eas l ly provlded sang t o the extensive ine&cal servlces

under whose care they came.

D r FAURE (France) sa id he had l i t t l e t o add t o D r Symants comments. He merely

wished to say how m c h he agreed on the importance of health education in nutr i t ion,

par t icu lar ly i n cer ta in areas. where f-ood habits, and sometimes rel igious principles

prevented populations from us ing readily- ava"ilab1e and abundant food supplies badly

needed t o maintain health.; Tha%,i~as +he ccse in French Sonaliland &ere protein

de'ficiencies, p r e d i s ~ s i n g t o . tuberculcisis, which was 3 major problem. there, were

found i n populations l i v ing i n the v i c in i ty of an abundant a d re+.cJily,accessible

f i s h su?-?ly. The increase of .the protein content of the d i e t demmded a break with

t r ad i t i on which had to b e brought- about by health education.

Decision: The Sub-Committee adopted a resolution along the l i n e s of

resolution E ~ I / R C ~ B / R . ~ ,

(d) Community water supplies i n countries of the Eastern i41editerranean Region e L 4 . PONGHLS,.(Vorld He3lth Organization) i ~ t r o d u c i n g , t h e document, polnted out t h a t

it deal t with problem of great concern t o the Region.

The introduction b r i e f l y recorded the in!>ortance of water, not only t o the pilyslcal

existence of man but to h i s soc ia l and economic condition, s t ress ing t h a t the water

supply should not only be 2ure but a lso abundant 2nd accessible.

The paper went on t o c l l l a t tent ion t o ce r t a in general dzta on the provision of

water i n the area. There were several reascms f o r the f a i lu re to provide adequate

water so f a r (page 11 of the document) but none f i n a l l y eliminated the possibi l i ty ,

m d t h e f i r s t guarvltee of ultimate success mas the desire ~f a l l people fo r a pure,

adequate and accessible water sunaly.

Part IV ccntained an account of the progrmne fo r comnunity -@ater s u p ~ l i e s ,

s t a r t i ng with a paragraph on the role of WHO and other internat ional b i l a t e r a l agencies

and including a l i s t of multi-phased a c t i v i t i e s of TWO a t various levels 12-13).

It was hoped t h a t the as t~bl i shment of a silecial accomt bo qrovi.de assistance t o

Governments i n the develwpent of community water s u p l i e s (WiA12.48) would give the

progra-me nevi impatus. It was a l so hoped tht help would be available from outside

sources though self-help wzs the keystone t o future, l a s t ing success (page 13).

The f i r s t need was fo r a survey of exis t ing conditions age 14) ? r io r t o the

deyelogent of 2 deta i led -3rogranne. However, 2 s t a r t had already been made as

indicated i n Part V, paragra?h 1, pending the orepz~at ion of a wider qrogrswne;

proposals f o r f u h r e a c t i v i t i e s followed i n paragraph 2.

In conclusion h e asked representatives t o the Sub-Coimnittee t o regard the proposals

emanating from Headqulrters f a r t h e world-wide mprovement of environmental sani ta t ion - including comnunity water supplies - as a stimulus to additional work and not as a

subs t i tu te f o r it,

D r SE&N ( Is rae l ) observed the importance of water su?plies in the en t i r e Eastern

,iediterranean Region. In I s rae l , water was basic t o develoument. However, h i s

:ountry was i n a s l i g h t l y d i f fe ren t posit ion from other countries of the Region i n tha t

75 per cent of a l l households were supplied with a safe ?iped water supply; consumption

rm high, (7115 l i t r e s fnr cr-pita ? ~ r (??y) I A l l c i t y water sup-ilies and some ru ra l

3ugplies were chlorinated and subject t o regular bacter iological analysis. 'iiater had

Long ceased t o be a fec tor in the transmission of disease, there having been no outbreak

)f waterborne disease f o r the past eleven years.

In t h a t connexion, he wished t o c r i t i c i s e the s t a t i s t i c s i n Tables I1 and 111.

'he r e l a t ive ly high death r a t e i n I s r a e l from i n t e s t i n a l diseases among children under

'ive ydars, and the number of typhoid cases since 1955, none of which mere f a t a l ( the

able was inaccurate i n showing LO deaths) did not point t o inadequacies of the water

EL:/RC~B/ Pr&g23.n/2 page 14

supply, which as he h a d explained was very good, and no longer a f a c t o r i n the trans-

mission of diseasei The high inci6ence of en te r ic disorders in I s r a e l was due t o

deficiencies i n food handling and ciimatic factors .

It was i ~ p o r t a n t t h a t .thz Health Bdmillistr2tion should lay a leading role i n the

def in i t ion of water SUD~LY pol ic ies , In I s r z e l the :!inistry of Health had t o @prove

211 new water systefis, supervise ax is t ihg systems and define noiicy. SIore surface

water was gradually being used which made even g rez t s r vigilance necessary.

In another f i e l d of environmental sani ta t ion - sewage disvosal - cen t r a l guidance

>-?as a l so impr t an t . There too the :.:inistry was taking pa r t i n the nat ional co-ordina'

of swage disposzl work. iiuch remainsd t o be done both t o extend hygienic adt!~ods of

disposal and t o maintain exis t ing d i s ~ ~ o s z l syste;;ls which tended t o break down ~vhen

urban cen t r e s expanded too rapidly. Finzncizl problems and problems of high cost of

processing plante to enahle sewage t o be used vrith sa fe ty were gradually being solved

i n several par t s of the country.

The National 32tgr-, Plan had given the Ah in i s t r a t f lm- the experience i n e q l o r i n g

the use of water resources of a l l kinds, so t h a t his Govzrnment was in a posit ion t o

make assistance available t o any countries i n the Region .will ing t o accept it.

k3sistance %aould be provided i n the lo rn of t ra ined technical personnel, including

hydrologists and v - t e r engineers; t ra in ing of water su?ply, i r r i ga t ion and san i ta ry

engineers, vvhich could be ?rovided a t t he In s t i t u t e of Technology and. fo1lo:red by a

period of p rac t i ca l t ra in ing i n t he f i e l d ; short courses f o r qua l i f ied personnel;

loan of experts i n water supply and water resources development and help with surveys

and development on the spot.

The CIWIKt&N thanked D r Syman for h i s offzr of assistance. A l l members of the

Sub-Com.uttee were pleased t o hear of the 3rogress made i n I s rae l .

idr PONGHIS thanked Dr S p a n f o r h i s comments. The Regional Office h2.d noted- .dt

lea sure h i s o f f e r of aid.

EL~/RC~B]- l?oQiip/2 page 15

In connexion v i t h the s t 2 t i s t i c a l t?.bles, he e q l a i n e d t h . t , as the d0Cui32nt

indicated i n Par t 11, the s t a t i s t i c s were merely indicative of trends, and could not

of course be r e l c t ed t o water p r i t y alone. It should a lso be linked with the

question of abundance of su?i,lies.

Decision: The Sub-committee then adopted a resolution along the l i n e s of

resolution E:~/Rc~A/R. 8.

(e) Ionizing radiat ion in medicine and public hesl th i (Document E%i/~C9/8)

D r El ULA:7fi"NI, Deputy Regional Director, introducing the document s a id t ha t i ts

object was t o c a l l t he a t ten t ion of health administrations i n the- Region t o t he public

heal th hazards of ionizing radiation.

The introduction consisted of a p r e l i r ~ i n a r y t r i b u t e t o the discoverers of thz tvro

main sources of ionizing radiat ion - X-rays by RoenLgen and radio-activity i n uranium

s a l t s by Becquerel, followed by a n account of the use made s f t h e i r discoveries and

steps taken t o protect the public u n t i l the disoovery, i n 1939, of nuclear f iss ion,

opened a new e r a of increased hazards t o a l l po;3ulations as a r e su l t of the contaminstio:~

of t h e i r environment, discharge of radio-active use of X-rays and mdio-active

isotopes i n industry and medicine. .The f i r s t steps t o deal with the new s i tua t ion a t

the in te rna t iona l l e v e l were then outlined.. Part 11 dea l t i n paragraph 1 vrith the

somatic e f f ec t s of radiat ion. The difference betweel, t o t a l and p a r t i a l exposure r~,reri:

widely kris;;n. T h t :,le<i-n ls tk ' l 23;e i;.zs 3C3-500 rcn, the most sensi t ive par ts of

the body being the blood forming organs, and the i n t e s t i n a l t r -c t , p a r t i c u l ~ r l y the

mucous membranes. The main charac te r i s t ics of radiation sickness were then enumerated.

The main l i nes on which present day research and treatment were procce6ing rrere the

graf t ing of bone marrow combined with an t ib io t i c treatment t o compensate f o r the f a i l u r t

of the organismis im~lunological functions. The a f t e r e f fec t s of i r r ad i a t ion viere

of ten considerably delayed and frequently took the f o w of malignant bone tumours.

Total i r r ad i a t ion gener,?lly resu l ted i n leukaemia as had bzen seen on the s i t e s of the

f i r s t atomic explosions, in Jqmn. The document .::entioned radiostrontium and cesiun

137 amom the sources of ionizing radist ion. Both were long-lived and bone-seeking.

The gr-vailing vie-;<, although it had been changed -recently, %is t h a t the genetic

e f f ec t s of radiation, de-l t with in ?cragraph 2, di f fered from the somatic e f f ec t i n

t h a t they folloxed a l i n e a r curve. Somztic a f fec t s rzquired a threshold dose, Tiherea~

m y dose seemed l i k e l y t o ?reduce genetic effects . For t ha t remon genetic e f fec t s

were most i.nportent and much research work on the subject was i n progress i n various

pa r t s of the T K T l d . The a f f i c u l t y % a s t o f i nd an zcceptable yardstick by which t o

measure the e f f ec t s . a t t r i bu t ab le t o mod3rn hazards. The biometriozl e f f ec t s of

ionizing radiat ions were a t p r e s e n t l a rge ly a mattsr of speculation.

iin analysis of t he sources of ionizing radiat ion followed in paragrc??h 3.

There were na tura l i n t e rna l and na turz l external sourczs. The la t ter . .var ied from

area t o area and were. being: studied both i n rcse-rch i n s t i t u t e s a l l over the world

?.nd by WHO as indicated l a t e r i n the ~?aper. The second group of sources. were the

man-mads sourc3s l i s t e d in t h e document. The d i f fe ren t t p e s of fall-out e f f ec t s

;-Jere enmerzted 2nd describad- i n knnek. I1 from which it cy7eared t h a t f al l-out from t k

troposphere 1m.s l e s s ;knpr?j.?nt than the. fcll-out from the stratosphere which affocted

the northern more th.m the southern hemisphere.

Par t 11, pa rq rzph 4, dea l t with medical uses of radio-active isotopes, a : f i f t h

paragroph with occup-tional ex?osure, and a s i x t h with rldio-active iifaste dis:josal

vhich was f o r the most part a hAz2rd of the future, a s the paragrz..;?h indicated.

Special study of methods of dis~jos-1 and permissible q u m t i t i e s would be necessary

and should be ca r r i ed out with the assistance of oceanogrq~hists.

P a 111 on nuclear energy and ?ublic' heclth, emphasized the necessity f o r

organizing theory courses and prac t ica l experiments and den~onstrntions in nuclear

physics. They iirould c a l l f o r collaboration between physics 12,boratories 2nd medical

schools. The Regional Office had already delegated a short-term consultant t o tour

the Region, He had reported the in te res t ing i n which radiat ion ins t ruc t ion

had been incorporated i n t h e medical curriculum i n Iraq.

EEI/IIC9!3!- &1?r?dh/2 page 17

The second ?aragra?h deal t with the information of the ?&lie, new tasks

devolving on the public health semices and tEe he l l t h educztion respons ib i l i t i es of

heal th personnel including nurses.

The a c t i v i t i e s of THO were l i s t e d i n P ~ r t T!J i n seven para&~a>hs. He ca l led the

Sub-committee's -?art icular a t ten t ion t o the ~ ~ a r a g r s ? h on the 1'952 v i s i t of a short-ten?:

consul tmt t o four countries i n the Region u ld the follouf-u? work t o be done in 1959

(pzragragh 41, t o the provision of fellowships (paragrx?h 5) znci t o the vrorlr of tho

jo in t TE~OJFAO Expert Committee on Radiocheinical methods of m a l y s i s (paragrqh 6 ) .

Par t V described the re1:;tionship of VYHO with other internat ional organiz-tions.

Par t V I l i s t e d the number of Ta3, ZRO fellovrships awx-decl between 1952 ~.nc!.l959.

Part V I I cont-ined rncre d e t c i l s about the jo in t T w c / ~ ~ ~ Expert Comit tee and i t s

very important re?ort.

Par t VIII-gave d e t a i l s of the questionnaire vihich had e l i c i t e d ;inuch inform-tion

of i n t e r e s t t o countr iss desiring t o mend or. enact laws 2nd regulations on rad io logic j i

protection.

D r SYWN ( I s r ae l ) thanlted the Regional Office f o r a document covering a l l the

e s sen t i a l aspects of the subject in a reai:.ily undorsLandable form. It w a s d i f f i -

c u l t t o f i n d r e l i ab l e information because textbooks on the subject were ral2idly d?.ti.rl

o r over-scientif ic. His Government would nnke goo? use of the document 2nd might ovsn

have it d is t r ibu ted t o public heclth v~orkers. He also congrltul2ted the Deputy

Regional Director on h i s i l luminating comments.

In I s r ae l , rndietion hazards had reached the stage where 2rotection had t o be

provided not only f o r technical personnel s q o s e d t o i r rad ia t ion but a lso f o r t!lz

public.

The medical professi6n was becoming more and more conscious of the danger of the

indiscriminate use of X-rays m% was r e s t r i c t i ng X-ray diagnosis and t r ea t s~en t t o

cases where they were absolutely inciis~ensable, taking care not t o expose pregnmt

women o r children. The Idinistry of Health rras bearing i n mind the possible dangers

of mass-radiogra@y a s used f o r the diagnosis of tuberculosis, and wes doubtful nhethe:

it should continue i t s intensive : r o & r ~ r n * f o r the t r e a t m n t of ringworm of the sc?.l.p

by i r rad ia t ion . The Regional Office night useful ly consider i n i t i a t i n g a project

t o evolve a d i f fe ren t treataent, poss ib lyby ora l drugs. The radiat ion spec i a l i s t s

had formed a s.mcial org?.nization contributing t o t h e protection of t he p b l i c .

Radio isotopes were being more and nore widely used in c l i n i c a l xork which was proceedi

i n three centres. The E n i s t r y of 3eal th rns concerned about t he possible harniful

e f f ec t s of the treatment being provided. h leukaeida r eg i s t e r had been s e t up in

an attempt t o r e l a t e cause and.effe~ct by s td , i s t i ca l methods. I n those matters ~:lodern

developinents were gredually being introGqced i n t o the thinking of the inedical professior

N e w l eg i s l a t i on f o r the protection of t he community ngcinst. . ionizi ,ng;~adiat ionwas being

preix.red and vrould be transmitted t o 3x0 i n due course.

He rstrongly urged '$840 t o pursue i t s e f f o r t s t o resolve the u n o e r t a ~ t y ab&i%the

y r m i s s i b l e dose of rediation, ?ossibly with t he +ssis tance.of t he Intemation%X

Atomic Energy Agency, with a view to determining in te rnc t iona l standards and r&xlations

For the time'being, h i s country was using what data uf?s avai lable from the Organiinkiion

and leads provided by t h e bni ted States Atomic Energy Cormlission.

In regard t o t ra ining, I s r a e l had received fellcu?siiips froinbhe. Regional Office

t o enable a san i ta ry engineer and an X-ray spec i a l i s t t o a t tend short courses. It

would be roost useful i f the Regional Office could help with the complete t ra in ing of

3 public health physicist whose services >;?ere rapidly becoming essen t ia l .

He had *welcomed the in fomzt ion regarding the t ra in ing of health personnel i n

matters of r-diation and agreed t h a t more inforrrction should be included in the medical

curriculum. Some s teps had been t&an i n t ha t di rect ion a t the University of

Jerusalem. He had been pleased t o hear t ha t the I r a q i medical curriculum %as so

cowplete in t h a t respect. It viould be !,articularly useful for engineers t o be b e t t e r

ins t ruc ted i n such matters. He f u l l y agreed x i t h the Deputy I3eghna.l .General on the

necessi ty of ins t ruc t ing auxi l ia ry health personnel in radiat ion protection, but

R/RC9B/ -Prog*/2 page 19

considered t h a t those in d i r ec t contact with t h e w b l i c should not be given such

ins t ruc t ion i n too much de ta i l , a t l e a s t u n t i l more agreeillent had been reached a t

the spec i a l i s t level.

The DEPUTY iiEGIONAL DDtECTOR sa id tb-~t the Regional Office was aware of the

rroblem of finding a l te rnz t ive treatment. f o r ringwon.1 of the sce lp a d , . in vie;+ of

. . progress i n medical mycology, r , ~ s ~ I I V ~ ~ L , ~ ~ izzlc;t Lyraclia%ion of the scalp i n fcvour

of ora l drugs.

The incmase i n leukaemie had been observed in many 9,;rt.s of .the world, especiz.11:~

among children whose mothers had been exposed t o X-rays during pregnancy. The d s e z s e

vms undoubtedly on the increase but it vms not c l ea r %*ether the increase was due t o

i r rad ia t ion . The subject was being studied i n several countries.

The Organization's suggestions on l eg i s l a t i on ; e r e based on present kriomledge

of the permissible dose. Both the Internat ional Cormission on R,?.diological Protection

2nd the Internat ional Commission on Radiological Units and lieasureinents were working

on the problem and the resul t ing recomendatlons should be acce$ed f o r a s t a r t ,

u n t i l more accurate knowladge became available.

On the question of public infonnztion, he f u l l y egreed with D r Syman on the

d e s i r a b i l i t y of preventing panic rniong the populction 2nd it f o r t h a t reason t h ? t

the suggestion .iias t h a t nurses should be given the r e a l fac t s .

The CHl,IR?XN suggested t h a t the Sub-Comaittee night wish to adopt 2 resolution

along the l i n e s of resolution K ; / R c ~ ~ / R . ~ o .

D r BTESH ( I s r ae l ) pointed out t h a t , as the only item on the Agenda of the

Sub-Committee was i o n i z k g radiat ion in medicine and public health, t h a t was the only

kind of resolut ion it could a6opt. The Sub-committee had not dea l t with any other

aspects of ionizing radiat ion.

- 9 ~ fio~.i.i.n/Z page 20

The CHAIRMAN assured D r Btesh that h i s statement would be recorded and taken

i n t o account i n draf t ing t h e Report.

Decision: The Sub-Cormittee adopted a resolut ion along the l i n e s of resolut ior

EM/Rc 9 A h . 10.

The Sub-Division on Programme ended i t s meeting a t 11.45 a.m.