UNRWA’s efforts in tobacco control


9-seitaDr. Akihiro Seita
9-flag Jordan
25 Nov 2014


Dr. Akihiro Seita is the Director of the Health Programme (HP) and the World Health Organization Special Representative at United Nations Relief and Works Agency (UNRWA), Jordan. Dr. Seita is responsible for UNRWA’s extensive primary health care system, serving more than 5 million Palestine refugees in Palestine, Jordan, Syria and Lebanon. UNRWA’s HP runs 139 health centers with more than 3,000 staff and a budget of US$100 million. UNRWA is amid of health reform, aiming at improving its primary health care with a special focus on non-communicable diseases, particularly diabetes, and their risk factors such as tobacco use, unhealthy diet and physical inactivity.

Dr. Seita worked for more than 15 years at the WHO/ Eastern Mediterranean Regional Office (EMRO) in Egypt, which covers 22 countries in North Africa and Middle East, focusing on  tuberculosis, AIDS and malaria. He graduated from Kochi Medical School in Japan, and was the Takemi International Health Fellow at the Harvard School of Public Health from 2003 to 2004. He received the Karl Styblo Public Health Award from the International Union Against TB and Lung Disease in 2001.

What is UNRWA?

UNRWA is a United Nations agency established by the General Assembly in 1949 and is mandated to provide assistance and protection to a population of some 5 million registered Palestine refugees. Its mission is to help Palestine refugees in Jordan, Lebanon, Syria, West Bank and the Gaza Strip to achieve their full potential in human development, pending a just solution to their plight. UNRWA’s services encompass education, health care, relief and social services, camp infrastructure and improvement, and microfinance.

Financial support to UNRWA has not kept pace with an increased demand for services caused by growing numbers of registered refugees, expanding need, and deepening poverty. As a result, the Agency’s General Fund (GF), supporting UNRWA’s core activities and 97 percent reliant on voluntary contributions, has begun each year with a large projected deficit. Currently the deficit stands at US$ 56 million.

Our mission is to promote a life of dignity and human development for Palestine refugees by informing the American public about UNRWA’s work and generating support for its programs through fundraising, education, and advocacy.

What drove the UNRWA office in Jordan to focus on the field of tobacco control?

Smoking is a major risk factor for the health of Palestine refugees and UNRWA staff. The prevalence of smoking is high and is increasing. Among education staff at UNRWA schools, 16 to 27% of them are currently smoking. Among the health center staff in Jordan, 20% of males and 6% of females are smokers. The situation is more concerning among doctors, 41% of them smoke, and among UNRWA school children aged 13 to 15 years, 6 to 22% are current smokers.

In the world, tobacco kills nearly 6 million people each year, of which more than 600,000 are non-smokers dying from breathing second-hand smoke.

Please tell us about areas of collaboration and partnerships concerning tobacco control: 

The UNRWA Health Department at HQ (Amman) and the Health Program at the Jordan Field Office (JFO) explored areas for cooperation on fighting tobacco use among beneficiaries. UNRWA started cooperation with King Hussein Cancer Center (KHCC) last year, as representatives from the Health Department at HQ (Amman) were invited to participate in various activities conducted by KHCC. In addition, senior staff from KHCC have visited UNRWA HQ (Amman) and JFO for meetings and to conduct relevant activities. We have also established partnerships with WHO/ EMRO, the Centers for Disease Control (CDC), and with the American University of Beirut (AUB) to conduct studies and research.

What are the goals of these partnerships?

In fact, the HD at HQ (Amman) and the Health Program in JFO have started collaboration with KHCC to launch the first-ever smoke free health center at the Talbieh Health Center as a pilot for implementing a 100% smoke free health center initiative. In addition, we plan to facilitate the access of HQ (Amman) who are current smokers and willing to quit to the services provided by Tobacco Dependence Treatment Clinic at KHCC. We hope also that we would benefit from this partnership in making HQ (Amman) offices 100% smoke-free.

Our partnership with WHO/ EMRO and CDC enabled us to conduct two rounds of the Global Youth Tobacco Survey (GYTS) at UNRWA schools. This study offered us valuable data to help us in making our school anti-tobacco programs stronger and more evidence-based. For the AUB, we currently have a strong and growing partnership to conduct research on tobacco use by our Palestine refugee beneficiaries. This research will enable us to build a basis for tobacco control programs to protect them against its bad effects on their health.

Describe some of the main activities UNRWA has done within the tobacco control field: 

  • Staff from UNRWA (Amman) attended several workshops regarding tobacco control and were part of the working groups on Tobacco Dependence Treatment (TDT) jointly with other stakeholders.
  • Conducted important training for UNRWA health and education staff from Jordan, Lebanon, West bank and Gaza, and presented on tobacco dependence treatment and prevention of tobacco use among adolescents and young adults (Nov. 2013)
  • Conducted a workshop for health educators on Preventing Tobacco Use among Youth and Young Adults (April 2014)
  • UNRWA staff at HQ (Amman) organized a commemoration activity by Health Department (HD), Education Department (ED), and The Area Staff Union (ASU) at HQ (Amman) to observe the World No Tobacco Day (WNTD) 2014. The slogan adopted was “If you care, say NO to Tobacco” and the theme was “Support 100% smoke-free UNRWA”. (June 2014)

What are some interventions UNRWA HD intends to implement to control tobacco use among UNRWA staff and Palestine refugees? 

  • Declare UNRWA health centers as “100 smoke free” places by the end of 2014 (and later schools, HQ/Field offices, etc.)
  • Incorporate cessation into primary health care
  • Offer training for health care workers on counseling for TDT
  • Development of informational materials for tobacco users (health education)
  • Monitor tobacco use by target population through different surveys
  • Conduct anti-smoking (anti-tobacco use) campaigns for the Palestine refugees’ communities stressing smoke-free houses, in addition to public places