Palestinian Non-Government Organizations in Lebanon (Ajial Center)

Non-Governmental Organizations in the Palestinian Refugee Camps in Lebanon

(posted on November 5th, 2001)

Annexes
List of Acronyms

1. Introduction

1.1. Who did the study?
The study was prepared by a Palestinian non-governmental organization, the Statistics and Documentation Office (Ajial Center), which is based in Beirut, Lebanon. Mr. Salah Salah, the director of the center, supervised the study.

1.2. Aims
The purpose of this study is to provide stakeholders and interested observers with a picture regarding both the type of services provided by non-governmental organizations in the Palestinian refugee camps in Lebanon and their distribution. It is the hope that such information will shed light on the capacity of these organizations, the challenges they face, and the extent to which their services contribute to the various needs of the Palestinian refugees in Lebanon.

Outlining the challenges faced in answering these needs will be instrumental in assisting these organizations to formulate their policies and future plans and will provide funding institutions with a more focused assessment of the needs that they might be interested in being involved in.

The lack of reliable information regarding the NGO community involved with Palestinian refugees in Lebanon highlights the objectives of this study and might assist in the alleviation of the severe social and economic problems that are faced by the Palestinians living in Lebanon.

1.3. Methodology and difficulties encountered
The study is based on a survey of the NGOs engaged in various types of service provision for the Palestinian refugee population in Lebanon. Interviews were conducted with senior members of all relevant NGOs. The questionnaire was pre-tested and the interviewers were subjected to a training workshop before they went into the field.

Meetings were held after the data were collected for analysis in order to assess the problems faced during the fieldwork. The main problems faced in this endeavor can be summarized in the following points:

1. Some organizations refused and others were hesitant to divulge information about their respective organizations.
2. Some of the interviewed officials were not very knowledgeable about some of the activities of their organizations.
3. There was a tendency among some organizations to exaggerate and overestimate their activities.
4. The lack of reliable and detailed data about the NGOs engaged in activities with the Palestinian refugees in Lebanon made it difficult to assert that all NGOs and all the rendered services were covered, although all effort was made to cover all aspects and sectors.

2. History of Institution Building Pertaining to Palestinian Refugees in Lebanon

2.1. History of Palestinian refugees in Lebanon
The history of Palestinian refugees in Lebanon dates back to 1947, just before the proclamation of the state of Israel when approximately 120,000 Palestinian were forced to leave their homes in Palestine. While some figures estimated the refugee numbers at 120,000, UNRWA estimated their number at 127,600.(1)

By 1999, the number of Palestinian refugees in Lebanon reached 370,144 (10.6% of the overall population size of Lebanon)(2) and their fertility rate is 4.5.(3) In addition, it is estimated that the number of unregistered refugees reaches around 42,000.(4) Out of the entire Palestinian population in Lebanon, 164,455 constitute the population of the refugee camps (excluding Al-Meih Meih and Dbayyeh where the Palestinian population there is not known due to the influx of large number of Lebanese into these camps).(5) As indicated in Figure 1, the largest is Ein Al-Hilweh with a population of over 40,000.

1. UNRWA Annual Reports to the United Nations.
2. UNRWA, Figures of 30 June 1999, Public Information Office, UNRWA Headquarters (Gaza), August 1999.
3. Madi, Yousef. Demographic, Economic, and Social Characteristics of the Palestinian Refugees in Lebanon, 1999.
4. Annual Report of World Refugee Survey, 1998, p. 151.
5. Madi, Yousef. Demographic, Economic, and Social Characteristics of the Palestinian Refugees in Lebanon, 1999.

Palestinian refugee camps in Lebanon are located on only 1134.2 dunums* of land (145 persons for every one thousand square meters). This high population density was the reason behind the creation of population concentrations adjacent to refugee camps. Approximately 55.38% of the Palestinian registered refugees now live in the refugee camps and in over twenty population concentrations scattered all around Lebanon, as indicated below in figure 2. The growth of population concentrations in Lebanon resulted from the increase in the camps populations, the besiege of refugee camps which rendered the mobility of camp residents rather difficult, and to the fact that a sizeable number of refugees are employed in agriculture and, as such, moved outside refugee camps to areas closer to the farming areas.

* A dunum is 1000 square meters.

Since 1948, the Palestinian refugee population in Lebanon has constantly been confronted with severe difficulties on political, social, and economic levels. Their miserable living conditions can be traced to a number of reasons. The most important and direct reason is their forced expulsion and uprooting from their homes in 1948. On the one hand, they lost the security and stability that a state usually provides for its subjects. On the other hand, their refugee status led to serious challenges that ranged from being treated as second-class citizens with many of their rights removed away from them, to being exposed to numerous social, political, and economic problems often associated with refugee populations and politically unstable communities such as a high crime rate, appalling health conditions, unemployment, inadequate educational services, and poor nutrition and sanitation.

The source of income of Palestinian refugees in Lebanon depends on five primary sources: employment with UNRWA, remittances from relatives employed in the Arab and foreign countries, employment in Palestinian associations and organizations, employment in agriculture and in Lebanese institutions and companies, and employment in the "camp economy" which consists of small shops and enterprises within the camps.

The political strife that characterized Lebanon in the 1970s and 1980s, in which the PLO was a major player, further worsened the overall conditions of the Palestinians in Lebanon. Not only did the refugees suffered tremendous loses after the PLO’s evacuation from Lebanon; their situation also became even harder and more difficult. Their chances of employment dwindled, the Lebanese army surrounded their camps and their movement became highly restricted. Moreover, after 1982, the services that were provided by the various PLO institutions almost totally disappeared and were not replaced by any alternative; so did the services of international humanitarian organizations that opted to reduce their activities significantly.

The situation was further aggravated by the constant Israeli shelling and attacks on the refugee camps in Lebanon and by the military conflicts that occurred between the Palestinians and various Lebanese groups which led to thousands of Palestinian losses. This situation left almost thirty thousand Palestinian families without their breadwinners, six thousand without homes, and thousands without any source of sustenance.

2.2. Development of institutional work that target Palestinian refugees
In the first two years after the expulsion of Palestinians from their homeland in 1948, the International Red Cross was the main organization that assisted Palestinian refugees. It provided them with basic necessities such as tents, clothes, water containers, and food. It was not until 1950 that the United Nations took over the responsibility when the United Nations Relief and Works Agency for Palestinian refugees (UNRWA) was established. After its creation, UNRWA whose mandate entitled it to establish a strong institutional presence in the camps largely catered to health, educational, and other humanitarian needs.

Despite the efforts of UNRWA, its work and resources were not sufficient to cater for the basic requirements and needs of the Palestinian refugees. This was particularly evident in a number of Palestinian population concentrations that were not recognized by UNRWA as refugee camps.(6)

(6) It is estimated that as many as 15,000 Palestinian refugees were dismissed by UNRWA from the list provided to it by the Red Cross.

The severe conditions emanating from the lack of basic services were aggravated by the policies of the Lebanese government who, worried of permanent settlement of Palestinian refugees in Lebanon, imposed hard restrictions on them. Housing development was prohibited, restrictions were enforced on the employment of Palestinians, and martial law was imposed on refugee camps. Thus, between 1959 and 1969, no organizations were permitted to operate in refugee camps. Camps were put under constant military surveillance, and severe restrictions were made on the movement and on the social, economic, and political activities of the Palestinians.

In addition to these restrictions and limitations, the Lebanese law prevented the provision of such services as health and education to non-Lebanese, including the Palestinian refugees. Thus, in the midst of this environment, the Palestinians had only UNRWA to rely on despite the fact that UNRWA’s coverage was relatively limited both with respect to the services provided and to the number of people covered.

It was not until 1969 that the situation improved following the Cairo Declaration, which allowed for the establishment of institutions and organizations to serve Palestinian refugees. As a result of this Declaration, the PLO embarked on a campaign to establish a number of such institutions and organizations. Camp committees and a number of other organizations engaged in health, education, culture, sports, etc. were created in and around refugee camps.

The PLO organizations and the organizations established by Palestinian factions had a positive impact on the living conditions of Palestinians. Unemployment decreased, health and education facilities were established, and the living conditions improved compared to the pre-Cairo Declaration period.

However, after the forced evacuation of the PLO from Lebanon in 1982, the situation deteriorated both with regard to the institutions themselves and to the living conditions of the Palestinian refugees. With the exception of a few organizations such as the Palestine Red Crescent, almost all PLO-created organizations collapsed and, as a result, the Palestinian refugees residing in camps were left mainly with UNRWA to cater for their needs. Refugees living in population concentrations are denied many of the UNRWA services because most of these concentrations do not enjoy any legal status.

Despite the effort of UNRWA and other organizations, the conditions of the Palestinian refugees have evolved from bad to worse. Housing problems became more acute, the economy deteriorated, and the social environment reached an alarmingly unhealthy level.

This environment led many institutions to extend a helping hand to the refugees. However, only in the aftermath of the Oslo agreement interest in the refugee situation in Lebanon increased. As indicated in figure 3, the vast number of organizations working with Palestinian refugees in Lebanon was established in the 1990s.

To date, there are 46 Arab and 20 foreign NGOs who assist the Palestinian refugees in Lebanon. Some provide multiple services; others are specialized in one sector. The foreign NGOs’ role is primarily a funding one, with the exception of a few who are involved directly with refugees. Arab NGOs are more involved in the actual provision of services.

The next section will assess the overall conditions of the Palestinian refugees and will examine the extent to which the current efforts by the NGO community contribute to the amelioration of these conditions.

3. Overall Situation

3.1. Needs
As indicated above, the conditions of the Palestinian refugees remain very serious in spite of the efforts of UNRWA and other international and local organizations. Following are the issues that need to be seriously addressed and tackled.

3.1.1. Political requirements:
The departure of the PLO from Lebanon left the Palestinians refugee population a target for revenge and intimidation by official and non-official Lebanese. They are discriminated against and their human rights are often violated. Their camps are constantly under siege by the Lebanese army and their movement is restricted. In addition, numerous obstacles are put before the Palestinians wanting to establish institutions that could help them improve their living conditions and develop the various spheres of their lives.

3.1.2. Economic needs:
The economic situation of Palestinian refugees in Lebanon is very severe. Unemployment rate is extremely high and it is estimated at 60%-70%. Over 60% of Palestinian refugees are below the poverty line.(7) Moreover, 36% of refugees are without any source of income.

(7) A report published by UNICEF in April 2001 sets the median monthly income at US$ 200 which is even below the poverty line that is estimated at US$ 681.

In addition to the obstacles put before the Palestinians seeking employment, and the severe human, social, and economic ramifications stemming from the frequent Israeli shelling of Palestinian refugee camps and population concentrations, the deepening economic misery of the Palestinian refugees is attributed to a number of other factors. First, the Gulf war led to the loss of a major source of income especially from the remittances that were sent to families by Palestinians who used to work in Kuwait and other Gulf states. Second, the breakdown of the PLO in the aftermath of the Oslo agreement left many Palestinians without the support that was usually provided to them by the PLO. Third, the continuous reduction of UNRWA’s budget overburdened large segments of the population who had to pay themselves for the services that would have been covered by UNRWA otherwise. Fourth, the lack of adequate and sufficient income generation programs and efficient vocational training opportunities prevented many Palestinians from finding a satisfactory livelihood.

3.1.3. Social needs:
As earlier stated, the social conditions of the Palestinians in Lebanon are alarming as a result of the severity of the political and economic conditions they live under. Housing conditions are very poor and often unavailable. Whereas the number of refugees increased by four times, the number of housing units increased only in areas outside refugee camps because the Lebanese government forbids housing construction inside camps. Moreover, the internal displacement of around six thousand families left many people without proper dwellings.

The problems facing the youth is one of the major challenges confronting any effort at easing the suffering of the Palestinians in Lebanon. The youth in camps live under severe conditions. Educational opportunities are very limited, future employment is gloomy for them, and the economic conditions of their families are rather difficult. This environment, coupled with the absence of any cultural or youth activities inside the camps, puts great stress on the refugee youth who, as a result, resort to violent and anti-social behavior. They are distrustful of all foreigners. This distrust is reflected on the relations they have with various organizations and projects that are active in the camp setting.

Youth organizations, especially clubs, also suffer from lack of facilities. Of the forty-one clubs, twenty-three are sports clubs and eighteen are primarily cultural and social clubs. Most of the twenty three sports clubs do not have any playgrounds nor proper trainers, and most clubs do not have real headquarters nor do they have any financial resources.

In addition to the problems of the youth, the increasing number of Palestinians immigrating to Europe and the United States has had its toll on many families who were left alone without support.

The problems facing the thousands of children of martyrs are also a major issue that requires serious consideration. Many of these children are exposed to psychological and psychosocial disturbances whose implications can reach every segment of society and every facet of life.

3.1.4. Health and education

3.1.4.1. Health
The cost of medical treatment is very high, and secondary health care is rarely covered or subsidized. Moreover, there is scarcity in health human resources and in medical equipment.

The current available services do not cover all the Palestinians in Lebanon as indicated in table 1 below:

Table 1: Health coverage by various service providers according to gender

In addition to the shortages in coverage, significant services are not provided by UNRWA: kidney dialysis, open heart surgery, cancer, venereal diseases, and some laboratory utilities such as a CAT scan are nonexistent. In addition, geriatric treatment is also not available.

Bad sanitation and environmental health risks are also prevalent despite the efforts of UNRWA. Sewage treatment is not optimal, and drinking water is not available to all.

3.1.4.2. Education
The educational system faces major shortcomings, most important of which is that pertaining to dropouts, especially in the secondary level where the rate reaches 35%. The high dropout rate is correlated with severe social problems amongst the youth.

In addition, vocational schools are neither sufficient nor properly distributed. Graduates of these schools rarely find adequate employment because the experience earned in these institutions does not always qualify them for adequate employment.

The educational system is also deficient in cultural, extra-curricular and summer activities. Consequently, children do not find places for leisure or for spending their spare time except on the streets where they are often exposed to damaging influences.

3.1.5. Infrastructure:
The overpopulation in camps, the long years of war and violent conflict, and the lack of cooperation by the Lebanese government puts a heavy burden on UNRWA who is already suffering from budget cuts. Many roads need maintenance, electricity supply and telephone lines are not sufficiently adequate to meet the growing increase in population.

3.2. What are the responses and by whom?
The actors involved in the provision of services to refugee camps can be divided into four main categories: UNRWA, the PLO, foreign NGOs, and local NGOs.

3.2.1. UNRWA

3.2.1.1 Education
The role of UNRWA in the provision of services can be classified in the following services: education, health, and social services.

In the educational sector, UNRWA’s role was rather fundamental. It has 73 elementary and primary schools, two secondary schools and one vocational training institute. During the 1997-1998 scholastic year, over 38,000 students were enrolled in the elementary and primary schools, and over 600 students in their secondary schools. As for UNRWA’s only training college, the Siblin Institute, there are approximately 600 students who are enrolled in its two-year program.

UNRWA is also involved in higher education through its scholarship program. In 1997-1998, over one hundred academically distinguished students benefited from these scholarships.

3.2.1.2. Health
UNRWA’s health services are equally significant and its role in this sector is also the most prominent. These services cover the main health categories: primary health care, secondary health care, and environmental hygiene.

The provision of primary health care to Palestinian refugees in Lebanon is the most comprehensive of UNRWA’s health services. They cover almost all refugee camps and concentrations and they are run and administered by UNRWA itself.

There are 18 UNRWA run health centers, 6 health posts that cater primarily to mother and child health, pediatrics, school health, health education, as well as treatment of contagious and non-contagious diseases. In addition, UNRWA has 24 specialized clinics, 17 clinics for dental care, 15 clinics for non-contagious diseases, 15 laboratories, and 3 x-ray centers.

As for secondary health care, particularly hospitalization services, UNRWA’s role is performed through contracts made with Lebanese hospitals scattered all over Lebanon: 3 in Beirut, 3 in Sidon, 1 in Tyre, and 1 in the Beqaa Valley.

Regarding environmental hygiene, UNRWA’s contribution is very essential. As it is the case in refugee camps in Jordan and in the Palestinian territories, garbage collection, supply of clean water, pest control, and wastewater management are tasks carried out by UNRWA.

3.2.1.3. Social services
In addition to the provision of health and education services to Palestinian refugees, UNRWA is also active in the provision of other services in the social sector and in humanitarian relief. UNRWA’s relief and social services target hardship cases, in particular. In 1998, approximately 10.3% of Palestinian refugees in Lebanon benefited from this program, which includes maintenance of households, supply of foodstuff, and poverty alleviation whereby hardship cases are granted small loans.

3.2.2. The Palestine Liberation Organization (PLO)
The PLO, along with other Palestinian factions, plays a significant role in the provision of services to Palestinian refugees in Lebanon. Unlike in other countries, the PLO, as a result of the 1969 Cairo Agreement with the Lebanese Government, was mandated to establish camp committees and organizations to serve the Palestinian refugees. As such, the PLO’s role was very important in assisting UNRWA’s tasks. In the education sector, the PLO covered for some of the gaps that were not filled by UNRWA. Its impact also covered other sectors such as the economy, culture and sports.

However after the PLO was forced to leave Lebanon, most of the PLO’s various institutions deteriorated. The situation even worsened after the unilateral revocation of the Cairo Accord by the Lebanese government in 1987 and as a result of the internal splits amongst the various Palestinian factions. Today the Refugee Affairs Center, which was the PLO’s main arm with respect to the provision of services, is defunct, and the Palestinian Red Crescent’s services are very limited due to its financial difficulties.

3.2.3. Foreign NGOs
The involvement of foreign organizations was very limited in the beginning. Before 1982, only two foreign organizations were engaged in service provision for Palestinian refugees. By the end of the 1980s, six organizations established offices in Lebanon to support various types of assistance and relief to the Palestinian refugees and to local NGOs working with refugees. In the 1990s, thirteen organizations became involved because of the peace process and due to the fact that restrictions became tighter on Palestinians themselves to establish local organizations. This became the practice after the Lebanese government revoked, in 1987, the 1969 Cairo Declaration which gave Palestinians a free hand to establish organizations and institutions without having to obtain a license to function.

Today, there are twenty foreign organizations existing in Lebanon that extend direct or indirect support to the Palestinian and other local institutions serving the Palestinian refugees. Moreover, several local NGOs receive assistance through direct bilateral relations from other international organizations who have no physical base in Lebanon.

The main contribution of foreign organizations is in financing various projects, programs, and services. Of the above twenty foreign organizations, twelve provide financial assistance and support to local organizations. The remainders provide direct services to the refugees through their own projects. Table 2 below shows the foreign organizations that are active among Palestinian refugees, and the type of service they provide.

Table 2: Foreign NGOs active with Palestinian refugees according to type of service and beneficiaries

As indicated above, most of the support provided is in the form of financial support to the health sector (six organizations), children (3 organizations), disabled (3 organizations), and loans (one organization). The remaining organizations do not provide financial support because they run and supervise their own projects.

3.2.4. Local NGOs
There are forty-six local associations in Lebanon who work directly with Palestinian refugees. Almost half of them were established in the 1990s. These associations may be divided into four main types: licensed associations, associations who have legitimacy by virtue of their closeness to the PLO, religious associations, and non-registered associations. Over forty percent are licensed, another 40% function without a permit, and the rest are de facto recognized because of their PLO status or by virtue of their religious standing.

Twelve of these organizations provide services in all Palestinian population concentrations, fifteen organizations render services in just one district, and fifteen organizations work only in a specific location or refugee camp, and the remaining four provide their services either in Beirut alone or in the population concentrations. As indicated in table 3 below, approximately 260 projects are being carried out by the forty-six organizations.

Table 3: Distribution of projects in Palestinian refugee camps and concentrations in Lebanon according to service provided and location

* Including a hospital.
^Seven projects are not accounted for.

The projects are distributed in almost all areas and they cover a wide range of services. As indicated in figure 3, below, approximately 45% of the projects are engaged in health and in kindergartens. Projects that focus on economic development or on education are rather limited in number. Income generation programs do not exceed three, and vocational training programs are primarily intended for women with emphasis on hairdressing, embroidery, etc. Very little effort is exerted to combat the severe unemployment problem amongst the youth, in particular, who are in urgent need for suitable careers that could help them improve their living conditions and the living conditions of their parents, and would move them away from future deviant behavior that is highly prevalent among the refugee camp youths.

Figure 4, below, provides a good picture regarding the available services in camps and in other Palestinian population concentrations. As indicated below, a number of areas are not covered by basic services while others are inundated with services. A case in point is kindergartens. Whereas Nahr Al-Bared refugee camp, for example, has 9 kindergartens, Mieh Mieh refugee camp has only one. Similarly, the coastal line is almost without any significant services, although the Palestinians in these areas do not benefit sufficiently from UNRWA because the UN organizations do not recognize them as refugee camps. Similarly, while there are five vocational training programs in Al-Buss refugee camp, none is available in Al-Rashidieh refugee camp.

The mal-distribution of services in the camps is a symptom of a major problem that characterizes the work of the NGOs in Lebanon. More specifically, there is a definite lack of planning and coordination and an improper utilization of available resources amongst the NGOs.

The following section will outline the major problems and obstacles confronting the NGOs efforts, on the one hand, and the refugees who are in need of such services, on the other hand.

3.3. What are the uncovered needs and problems?

3.3.1. Prioritization and planning

1. Rarely are programs and projects based on proper planning and on the basis of sound research.
2. Coordination is non-existent amongst some groups and ineffective amongst others.
3. Almost half the associations (22 in total) operate more than 50 kindergartens, whereas only 5 organizations merely provide services for the 5-13 year age group. Not a single organization caters for the 13-17 year age group.

3.3.2. Duplication of work

1. Often an oversupply of a specific service comes at the expense of others. For example, there are many organizations that have kindergartens, very few cater for the youth and for the old.
2. Lack of coordination between organizations such as UNRWA and the Palestinian Red Crescent undermine the proper utilization of resources and hence lead to duplication of some services while neglecting others. For example, some camps have UNRWA and PRC clinics whilst other Palestinian concentrations are neglected.

3.3.3. Coordination and cooperation between NGOs

1. Despite the efforts to coordinate between the various Palestinian NGOs (Palestinian NGO Forum and the Meeting of Palestinian NGO in Sydon), the lack of coordination persists. For example, data and other information about the disabled (those caused by birth or due to war) can be easily reached and, hence, planning programs to target these groups are not difficult once information is shared between the relevant organizations. The inability to address this and other issues, therefore, underlines the weaknesses of coordination and cooperation between NGOs.
2. In general, organizations tend to make their plans in isolation and without consideration to the work of other organizations working in similar fields.
3. Absence of coordination between Palestinian and Lebanese organizations.

3.3.4. Structure and mode of management

1. In general, organizations are run by a single individual whose decision is usually final.
2. The domineering approach of management prevents collective decision-making. This ultimately leads to a level of frustration and indifference on the part of the rest of the staff and their unwillingness to take initiatives.
3. As a result of the domineering management approach, an atmosphere of accusations and uncertainties often cloud the work of the organizations and impede their activities.
4. Public participation in decision-making is absent, thus many organizations loose the opportunity of vital voluntary work.
5. Some directors of organizations benefit financially from their respective organizations at the expense of service provision. This issue often leads to public distrust of NGOs and, consequently, to further decline in the overall developmental efforts.

3.3.5. Distribution of services

1. Services are often distributed without consideration to the needs. For example in Al-Buss refugee camp which has nine thousand inhabitants, there are 14 projects: Burj Al-Shamali camp has only 20 projects although its population is seventeen thousand. This mal-distribution is also indicative of bad planning and lack of coordination. The same is evident in other camps such as Al-Jalil and al-Badawwi. In the former there are 14 projects, while the later has 21 even though the population of Al-Badawi is 8,000 inhabitants more than Al-Jalil.
2. Population concentrations rarely enjoy services. Not only does UNRWA refrain from providing services to these concentrations, NGOs also avoid working there. The entire coastal line between Sidon and Tyre, for example, has only seven organizations with a mere 11 projects between them.

3.3.6. Financial resources

1. Most organizations depend on foreign sources rather than on locally generated ones. This state of affairs renders them vulnerable to the political agendas of the funding agencies.
2. Reliance on foreign funding often restricts the proper provision of services. Once funds stop, many projects seize to exist.
3. Many projects are initiated on the basis of the demands of the funding agencies and not on the basis of priorities and needs.

3.3.7. Non-existence of services

1. There is a great demand of services targeting the youth:
1. Cultural and extracurricular activities.
2. Sports and cultural facilities are very scarce.
3. Centers for rehabilitating juvenile delinquents.
4. Effective vocational training centers that can assist graduates to find suitable employment.
2. Health services, primarily secondary health care, are very deficient.
3. Many services are not available in several areas while available in others (health centers, youth centers, centers for the disabled, etc.).
4. Income generation programs are very limited and they are restricted to very limited areas.
5. Projects targeting old people are non-existent, except for one run by the Women’s Humanitarian Organization.

4. Recommendations

1. A comprehensive survey to assess the actual needs of the refugees with respect to their economic, health, and social conditions and to determine the priorities. Available research focuses more on what is done and less on what should be done.
2. Coordination among NGOs is essential in the proper prioritizing of needs and in a more efficient utilization of available resources. Coordination will help in reducing duplication of work and will consequently produce more services to a wider public. However, in order for coordination amongst NGOs to be effective, the following conditions are prerequisites:
1. All NGOs need to be involved in this coordination effort and no organization should be privileged with a veto power.
2. Organizations need to be transparent and information and capabilities need to be shared.
3. Membership in the various committees needs to be based on democratic principles. It is important to alternate members and to keep bringing in new ideas.
4. It is important to separate between the political agendas of various groups and the services rendered. Political disagreements often occur at the expense of the services they are expected to provide.
3. On the basis of studies conducted by various bodies, special emphasis needs to be targeted to the following:
1. Income generation programs to help in reducing the alarming unemployment rate of over 60%.
2. Special consideration needs to be given to the hardship cases which UNRWA estimates to comprise 11% of the Palestinian refugee population. Consideration also needs to be given to the 60% of the Palestinians who are below the poverty line.
3. As a result of high unemployment and severe economic problems, the young segments of the population are exposed to a number of serious problems and social drawbacks that need to be seriously considered: drug use and other social misdemeanors, emigration and the exploitation of youth, violent tendencies, etc. Accordingly, it is believed that sports centers, cultural activities, and educational initiatives can be instrumental in curtailing these difficulties and other social problems associated with the youth.
4. Attention should be placed given to the thousands of families who were displaced from their homes in the camps destroyed during the Lebanese civil war and whose living conditions remain miserable.
5. Financial support for the "Emergency Fund Association" which helps in covering medical costs for refugees is urgently needed.
6. Improvement of the various infrastructure facilities in camps.
7. The overall health care system needs to be seriously addressed especially in disease prevention. Improvement in the health care system in this respect will help in reducing the general cost of medical treatment.
8. More reliance on internally generated financial sources will enable many service providers to be more independent and free in planning and programming their activities.
4. Organizational reform:
1. Staff selection has to be based on merit and not on nepotism or favoritism.
2. NGOs should publish annual reports on their projects and financial organization.
5. Public participation: Beneficiaries need to be more involved in setting and determining the activities of institutions. This can be achieved by properly and scientifically assessing the needs of the refugee population and by candid interaction between the institutions and the public.

List of Acronyms