Actual situation of tuberculosis in Palestine (especially in Lebanon) Akihiro Seita UNRWA Health Director WHO Special Representative 1 /20

True congratulations and admiration to LATA (especially Mtaneous) Akihiro Seita UNRWA Health Director WHO Special Representative 2 /20

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What we did with Mtaneous (from 1995 to 2010) Defined as problem “TB Global Emergency” Defined the strategy DOTS Scaled up the strategy DOTS All Over Mobilized countries Joint visits to Syria, Pakistan, Afghanistan, etc. etc. 4 million people cared! 4 /20

With this, I went to UNRWA in 2010 United Nations Relief and Works Agency for Palestine Refugees In the Near East 5 /20

Palestine refugees in the Near East 5+ million in 5 Fields (map  ) Palestine (2 million) Jordan (2 million) Lebanon (0.5 million) Syria (0.5 million) 1/3 live in 58 refugee camps 6 Gaza (1,200K) West Bank (740K) Jordan (2,100K) Syria (520K) Lebanon (470K) UNRWA 5 fields of operation (registered Palestine refugee) /20

What is UNRWA? Established in 1949 Education, Health, Relief & social services 33,000 staff Budget: USD 650M/y Health services 138 PHC health centers(  ) 4,000 health staff $ 120M a year 7 Gaza (22) West Bank (42) Jordan (24) Syria (23) Lebanon (27) UNRWA 5 fields of operation (Number of Health Centers) /20

In UNRWA, I realized…! 8 Akihiro Seita Anthony D Harries /20

What we did with Mtaneous (from 1995 to 2010) Defined as problem “TB Global Emergency” Defined the strategy DOTS Scaled up the strategy DOTS All Over Mobilized countries Joint visits to Syria, Pakistan, Afghanistan, etc. etc. 4 million people cared! 9 Source: WHO Global TB Report 2015 /20

What we did from TB lessons (from 2010 to 2016) Defined as problem DM. HTN.  NCD! Defined the strategy DOTS Scaled up the strategy DOTS All Over Mobilized countries Joint visits to Syria, Pakistan, Afghanistan, etc. etc. 10 /20

What we did from TB lessons (from 2010 to 2016) Defined as problem DM. HTN.  NCD! Defined the strategy Family Health Team Scaled up the strategy DOTS All Over Mobilized countries Joint visits to Syria, Pakistan, Afghanistan, etc. etc. 11 /20

` ` Pharmacy Clerk room Laboratory Pre & Post natal care General clinic (Dr’s office) Growth monitoring & Immunization NCD clinic Pre-Reform: When Fatima, Mohamed & their children go to the health center Oral health (dental) ` ` ` Family planning Dressing 12 /20

` ` Pharmacy Clerk room Laboratory Post Reform: When Fatima, Mohamed & their children go to the health center Oral health (dental) ` ` ` Family planning Family Health Team “Comprehensive, Continuity of care” ` ` ` 13 /20

What we did from TB lessons (from 2010 to 2016) Defined as problem DM. HTN.  NCD! Defined the strategy Family Health Team Scaled up the strategy FHT All Over Mobilized countries Joint visits to Syria, Pakistan, Afghanistan, etc. etc. 14 /20

What we did from TB lessons (from 2010 to 2016) Defined as problem DM. HTN.  NCD! Defined the strategy Family Health Team Scaled up the strategy FHT All Over Mobilized countries Evidences & Stories 15 /20

Actual situation of tuberculosis in Palestine (especially in Lebanon) Akihiro Seita UNRWA Health Director WHO Special Representative 16 /20

Tuberculosis notifications among Palestine refugees in UNRWA 17 /20

TB notification rate (/100,000) national rate vs. PR rate 18 Source: WHO Global TB Report 2015 UNRWA data /20

TB among Palestine Refugees in Lebanon PRL (Lebanon) & PRS (from Syria) 19 /20

What we want to do with Mtaneous (from now on) Academic focus on TB Annual scientific event Social determinants Poverty. Insecurity Support to patients People live with TB Eternal friendship! 20 Source: O.Oxlade. et.al. PLOS One Nov 2012 /20