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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.


JERUSALEM — 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.

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