Next Step : For PLO, a Long Climb Out of Chaos : The Palestinian leadership is ill-prepared to take over health care, schools and welfare in occupied lands. And time is short.


During the hours after a Jewish settler killed about 30 Palestinians in a Hebron mosque last February, another human catastrophe unfolded--this one with little notice--on the West Bank. It was a disaster that tragically illustrated chaos within the Palestine Liberation Organization leadership, which soon will take control of parts of the occupied territories.

As the world recoiled at the slayings inside Hebron’s Cave of the Patriarchs, untrained Palestinian ambulance drivers with no radio equipment or paramedic skills took dozens of wounded survivors to the wrong hospitals, failed to perform basic first aid and contributed to a death toll that exceeded 53 that day, according to a monthlong investigation by Palestinian health experts.

One man who had been shot in a leg artery, for example, died after being driven more than 40 miles--past at least one hospital with an emergency room--without benefit of first aid.

Some of the injured died of treatable wounds because emergency room entrances were clogged with family members and blood donors, the study found. Still others, it said, could have been saved if the Israelis had provided more ambulances, better emergency room facilities and proper radio communications in the West Bank and Gaza territories it has occupied for the past 27 years.


“Had there been a proper first-aid and triage system in Hebron,” the report concluded, “it is doubtless that some lives would have been saved.”

The deaths documented the sad state of basic human services in the occupied territories and, according to Dr. Mustafa Bargouthi, the Palestinian author of the study, they also underscored the scant progress the PLO leadership has made in laying the groundwork for new and improved services in the areas where it hopes soon to begin autonomous rule.

Palestinian technocrats have been waiting months for their political leadership to approve plans for an emergency health care system that would include inexpensive paramedic training in the territories, Bargouthi said. Instead, the leaders have been negotiating with potential international donors for a costly medical infrastructure that will take years to complete.

Health care is only one of dozens of critical social needs that Bargouthi, a physician and public health expert, and other Palestinians in the territories say their political leaders in Tunis, Tunisia, and their negotiators in Cairo have yet to address. Among the others are education, telecommunications and social welfare in the future autonomous zone.


As a senior U.S. official put it recently: “There is a race here against time. . . . Everything must be done to help the Palestinians get their house in order before a final agreement is signed, or else they will be unable to bring the visible changes they will need on the ground to make this thing work.”

Late last week, the Israeli and Palestinian sides, meeting under American and Egyptian mediation in Cairo, said substantial progress had been made on the deal to launch autonomous Palestinian rule in Gaza and Jericho, the initial step in the long process of building peace. The agreement could be signed Wednesday.

In interviews with several key Palestinian leaders and professionals in Jerusalem and throughout the territories, it was clear that money is only a part of the problem.

Most of the Palestinians assigned by PLO Chairman Yasser Arafat to build the basic structures of a new society share a growing frustration with their leadership. All complained about poor communication, a lack of coordination and priorities that differ vastly from those of the PLO leaders who are negotiating the political deal.

Arafat’s handpicked representatives agreed that the need for a semblance of bureaucratic order is urgent. Most also conceded that they have yet to meet that need. And, they admit, ominously, that if they fail, most Palestinians will abandon Arafat’s PLO in favor of the more radical and fundamentalist Islamic groups that oppose the PLO’s peacemaking efforts.

“We have a very limited window in which to succeed, or else it will be total chaos,” said Hassan abu Libdeh, deputy director of the PLO’s powerful economic committee, which is overseeing the Palestinians’ nation-building efforts.

“And as yet, no, I cannot say our house is anywhere near in order.”

The inadequate emergency health care system is a critical case in point, according to Bargouthi, who is a member of the PLO’s negotiating committee on health, education, culture, women and information services. It was his West Bank-based Health Development Information Project that conducted the study on Hebron’s post-massacre emergency care.


In the weeks since the massacre, Bargouthi said, PLO negotiators in Cairo have continued to ignore recommendations on the need for education and in emergency health care, focusing instead on costlier, higher-profile items such as buildings and equipment.

To illustrate, Bargouthi said the PLO recently sought and won a Japanese grant of $3 million worth of high-tech diagnostic gear, including four new kidney dialysis machines, for a hospital that has yet to be built in Jericho, a town of 8,000 that will serve as the PLO’s capital in the first stage of autonomy. But not a cent has been sought, he added, for such basic needs as paramedic training.

“Creating systems is the least expensive part of development,” Bargouthi said. “It’s much less expensive to train dozens of ambulance drivers than it is to buy a single ambulance.”

Echoing the sentiments of fellow technocrats working in the territories during many of the years that Arafat and his political inner circle have been in exile, Bargouthi accused the leadership of benign neglect. He said his committee sent 600 documents covering every detail of setting up a health care system to the PLO’s chief negotiators months ago but has yet to receive a response.

As with emergency care, that neglect has taken a human toll.

Even Libdeh, whom Arafat appointed to the task of creating the economic infrastructure of a future Palestine, cited a glaring example of the PLO’s failure to start a solid system: rehabilitation programs for the thousands of Palestinian prisoners who have been or will be released from Israeli jails--among them men who have been the backbone of Arafat’s organization.

The money for rehabilitation is there, Libdeh said. More than $13 million has been donated by the European Union and Switzerland. A detailed program for vocational training and psychological treatment has been submitted to the PLO leadership in Tunis. But no action has been taken.

“Why? I don’t know. Because we’re stupid?” Libdeh, who has a doctorate in statistics from Cornell and a master’s degree from Stanford, said with a laugh. “No, it is the bureaucracy.”


However, Libdeh, whose committee is the official conduit for the $2.4 billion in international aid the world has committed to the Palestinians, stressed that the PLO leadership alone cannot bear the blame for its failure to implement changes. “The international community has played a major role in this,” he said.

Of the $2.4 billion that was pledged during a fund-raising conference in Washington last year, Libdeh said, only $70 million has been delivered--a third of it in the form of a World Bank loan.

Most of the international aid is tied to a final autonomy agreement, which has been delayed by a spiraling cycle of violence involving groups opposed to the peace process and has produced a series of massacres that have left scores of Jews and Palestinians dead.

But the negotiations also have bogged down in disputes both petty and crucial. And countries such as the United States, which has pledged more than $400 million, will not release those funds until Arafat and Israeli Prime Minister Yitzhak Rabin reach final agreement on implementation of the initial autonomy plan.

Libdeh said the United States and other nations “are using this as a hammer to shape us,” insisting that his committee could do more if it had more resources to work with in the short term.

“Look, this process is a bloody one, and, since it began, no delivery,” he said. “The economy is worse. The standard of life is on a sliding scale downward. So what’s happening is, by the time the signing occurs, nobody will care anymore.”

Other Palestinians say money is the least of the factors to blame for the disorder.

“There’s a real chaos just in the way decisions are being made,” said Daoud Kuttab, a businessman and film producer who has been frustrated in trying to help build a Palestinian broadcasting operation that would help the PLO reinforce its message to an increasingly skeptical Palestinian public.

In the case of the television station, Kuttab said, Israel bears part of the blame; it has approved but not released the frequency needed for the station to go on the air. “But the problem also is political appointees rather than professional appointments. And I would put this in the category of indifference,” he said, adding that even if the frequency were released now, it would take weeks or months to get it on the air.

“Arafat and the people around him are simply too busy to pay attention to the broadcasting operation. . . . The PLO has put absolutely no money into this project. Their attitude is: ‘If it succeeds, fine. If it doesn’t, that’s OK too.’ But it is a very important tool to get in place here now.”

Asked whether he remains optimistic despite the frustration, Kuttab reflected the general mood of most Palestinian professionals.

“Yes,” he said. “I think we will look back on these days and laugh somehow. But in the meantime, it’s going to be very, very painful.”

Bargouthi said the Palestinian leadership has a tailor-made solution to the problem already in place: There are 830 Palestinian non-governmental organizations in fields ranging from health care to education and rehabilitation that have been functioning for years in the territories.

Then he explained why Arafat has not simply plugged those organizations into a new governmental structure. “It is because you have many people from outside who want to come in and take these posts,” he said of exiled leaders such as Arafat, who will assume key positions of power in lands they haven’t seen in years.

“The biggest problem is, the needs are tremendous. The expectations are very high. And the resources are limited. People will see their lives deteriorating at a time when their expectations have never been higher, and they will turn to (the militant fundamentalist group) Hamas and the other radical organizations who are opposed to this peace process.”