Utilization of treated municipal effluent for irrigating agricultural land in Palestine: The driving factors and existing practices

This article investigates the motivations and practices of using treated wastewater (TWW) to irrigate crop fields in Jenin, Palestine. Around 40 farmers were surveyed for data collection. The results showed that 66% of the farmers grew alfalfa crops while 30% grew fruit trees. The main obstacles the farmers faced before starting to use TWW were disgust (68.2%), worries about the quality of TWW (68.2%), health concerns (63.6%), and concerns about adverse effects on the soil (63.6%). All interviewed farmers considered the establishing and funding of an irrigation project to be the cornerstone for any reuse project. The second most important driving factor was the price of TWW that is 10-25% of the fresh water prices. After reusing TWW for irrigation, 59% of the farmers did not use any fertilizer, but they were not sufficiently aware of the crops' water needs, nor the nutrients in the TWW. All the fodder-growing farmers abstained from selling their crops before drying. The farmers used the TWW for five to nine months annually. After the TWW was reused, the main positive impacts of the TWW reuse were increased crop yields (77.3%), crops quality (50.0%), and crops marketing (47.7%). On the other hand, the main negative impacts were blocking of the irrigation systems (77.3%) and release of odors (54.5%). After practicing TWW use in crops irrigation, the key factors contributed to the "no difference" index were the effects on human health (100%), soil quality (56.8%), and insects spread (54.5%). Therefore, the results of the study support the decision makers to implement TWW reuse policies for crop irrigation in arid regions with scarce water resources. Monitoring TWW reuse and training farmers and helping them overcome obstacles is essential.

Assessment of Bacteriological Quality and Physiochemical Parameters of Domestic Water Sources in Jenin Governorate: A Case Study

Water quality of drinking water is a concern in Palestine due to possible pollution sources. There is a demand for investigating the quality of municipal water supply. This study aimed to assess the quality of domestic water in Jenin Governorate located in the north of the West Bank. The methodology of this research was based on field sampling and laboratory standard testing. The tested parameters included (1) physicochemical parameters of electrical conductivity, turbidity, total hardness, salinity, pH, and total alkalinity, (2) chemical contents including the contents of nitrate, nitrite, sulfate, chloride, sodium, potassium, aluminum, and fluoride, and (3) biological contents including total coliforms and fecal coliforms. The water quality parameters were compared with the acceptable limits set by local and international standards. The findings confirm that most of the values of the investigated parameters are within the acceptable standard limits. No pollution of heavy metals is detectable. On the other hand, there are limited pollution contents in terms of the total dissolved solid (TDS), total hardness, and calcium. Furthermore, the biological parameters indicate that there are low to very high risks in a fraction of the water quality samples in terms of total coliforms and fecal coliforms. This is believed to be due to the presence of septic tanks in the neighborhoods of the sampling locations. For these cases, biological disinfection treatments are recommended before human use with an essential need for the construction of urban sewer systems. Furthermore, water treatment for harness removal may be required.

Evaluating strategies for sustainable recovery and recycling of plastic waste in the West Bank of Palestine: The perspectives of plastic companies

The plastic waste (PW) makes up the second largest portion of the total solid waste generated in Palestine. Hence, it is important to consider proper PW management mainly through recovery and recycling and implement appropriate strategies. This study aims to identify and evaluate the social, legal, technological, environmental, and economic strategies that can positively motivate plastic manufacturing and/or recycling companies to recover and recycle PW. A structured questionnaire was developed to address 30 plastic companies in the West Bank. The results indicate that 80% of the companies supported the social strategies that implement community awareness programs. Almost 92% of the companies agreed with legal strategies which enforce legislations to support PW recovery and recycling practices. As for technological strategies, 76% of the companies endorsed the application of modern technologies for PW management. However, only 68% of the companies accepted the environmental strategies which promote life cycle assessment and environmental awareness programs and adopted the use of recycled plastic materials in manufacturing from the context of the economic and market strategies. Palestinians are invited to implement PW recovery and recycling practices to better utilize available resources, achieve sustainable management of solid waste, and promote environmental health.

Heavy Metals in Harvested Rainwater Used for Domestic Purposes in Rural Areas: Yatta Area, Palestine as a Case Study

Rainwater harvesting is considered one of the most important water resources in the Palestinian countryside. In this research, the study area chosen for the study was Yatta town in Hebron city. 75 water samples were collected from 74 cisterns in a number of neighborhoods in Yatta, and a structured household survey was conducted with the same households where the water samples were collected. Statistical analysis was made using the SPSS software. An analysis for the samples was made using ICP-MS to test the existence of a number of heavy metals, namely Pb, Cr, Mn, Co, Ni, Cu, Zn and Cd. The results were compared with the WHO and Palestinian limits for drinking water quality. Considering the metals Mn, Co, Cu and Cd, neither of the samples exceeded any of the two limits. For the metals, Pb, Cr, and Ni, two samples exceeded both limits. For the metal, Zn, one sample exceeded the WHO limit only. Sources of pollution by heavy metals of the harvested rainwater were identified by means of a questionnaire distributed to the households. The results showed that except for nickel and the water collection surface of the cistern factor, there is no direct relationship between the factors and activities that may contribute to contaminate harvested rainwater with heavy metals and the existence of heavy metals beyond local and international limits. Based on the questionnaire and literature: Possible sources of lead and zinc are the roof, storage tanks, distribution systems and plumbing; possible sources of chromium are road dust, asbestos brakes and anthropogenic activities occurring around the house; possible source of nickel is leaching from metals in contact with harvested rainwater such as pipes and fittings which are used to collect the harvested rainwater. In addition, an assessment of the potential health risks due to contamination of the harvested rainwater by heavy metals was made for all the samples that exceeded either WHO limit or the Palestinian limit or both. The Chronic Daily Intake (CDI) and the Health Risk Index (HRI) were calculated. The assessment was made for both adults and children. The results showed that all the samples are considered safe (HRI < 1), which means that there are no potential health risks for consumers.

Assessment of water and sanitation systems at Palestinian healthcare facilities: pre- and post-COVID-19

The availability of safe drinking water and the proper management of wastewater in healthcare facilities are important pillars for maintaining safety of workers, patients, and visitors and protecting human health and environment. Water and sanitation services at 495 healthcare facilities in the West Bank of Palestine are assessed using the results of PCBS and MoH (2014) survey study. Services are reassessed after the COVID-10 pandemic using personal interviews with experts from healthcare facilities, regulatory authorities, and service providers. The results show that 92.1% of healthcare facilities were connected to public water networks, 12.9% of them purchased water tanks, and 10.8% of them depended on harvested rainwater which may cause contamination and waterborne diseases. Regardless the source of freshwater, the water quality has to be regularly examined and compared to local guidelines and international standards for health promotion. Almost 63.4% of healthcare facilities were not connected to wastewater networks and used either tight or porous cesspits. Once these cesspits are filled off, wastewater is randomly disposed into nearby valleys causing adverse environmental impacts on air, water, and land resources. Medical wastewater of hazardous substances should be treated before discharged to wastewater networks. Experts assured that although heightened procedures have been made by service providers to curb the spread of the COVID-19 disease, yet, more consistent protocols and stringent procedures are crucial. There have not been any new directives or procedures regarding the management of water supplies and wastewater services in the healthcare facilities. Stakeholder collaboration can help prevent the COVID-19 disease.

Scavengers' contribution in solid waste management sector in Gaza Strip, Palestine

This study deals with the assessment of the role and potential contribution of-valuable and recyclable items-waste pickers (scavengers) in the overall recycling sector of solid waste management in Gaza Strip, Palestine. The analytical descriptive approach was applied in this study to achieve this goal. A special questionnaire was designed to record the views and activities of a statistically representative sample of scavengers, to determine their socio-economic conditions, their job satisfaction level, and their role in waste management. Together with that, the legal issues arising from their activity are investigated and conducted interviews with stakeholders/officials highly contributed to this. The results showed that the scavengers are mostly men, working informally for themselves, and do not belong to any official body or informal local association, yet their contribution was calculated to be 1-7.7% as far as the recyclable diversion rate is considered. According to the processed data, 34.1% of them are collecting from community bins distributed along the streets and from random dumpsites, 15.1% are collecting from random dumps only, and 12.7% are collecting from community bins distributed along the streets in addition to the random dumps and transfer stations. The monetary outcome is less than NIS 500 (New Israeli Shekels-NIS) monthly for approximately 72% of them. Taken into consideration that 91% of them are originating from a bad economic status, the aforementioned income-however low-is considered important for their live-hood. The results also showed that 93% of them are dissatisfied with their job due to mainly the district of residence, the negative attitude receipt by community members, and the low selling price of recyclable materials. The analysis is a stepping stone for scavengers' incorporation to the official waste management sector, providing them orientation and on-the-job training, in addition to the government support through tax incentives to the private sector which is highly recommended in developing countries. Such activities will certainly lead further development of the recycling sector, a wide range of circular economy pattern application locally, and elevation of their financial/life status.

Inventory of main greenhouse gas emissions from energy sector in Palestine

This paper analyzes the building process of the main greenhouse gas (GHG) emissions (CO₂, CH₄ and N₂O) inventory from the energy sector in Palestine. The paper includes determination tools, i.e., emission factors, to estimate the amounts of national GHG emissions from sub-sectors of energy including energy industries, manufacturing industries and construction, transport and other sectors (households, agriculture and commerce and public services). The results show that the total amount of national GHG emissions from the energy sector in 2016 was 4131 thousand metric tons of CO₂-equivalent (TtCO_2e), which represented 0.011% of the total global GHG emissions. The average value of GHG emissions per capita from the energy sector was 0.86 tCO_2e in Palestine, and its gross domestic product was estimated at 3212 $/ton of CO_2e. The estimated amounts of CO₂, CH₄ and N₂O emission from the energy sector were 4022, 49 and 60 TtCO_2e, respectively. The transport and household sub-sectors dominated the national GHG emissions from the entire energy sector by 58 and 32%, respectively. In general, fuels including diesel, gasoline, wood and charcoal and liquefied petroleum gas made most of the total amount of the national GHG emissions from the energy sector at 50, 18, 18 and 12%, respectively. Finally, the mitigation actions included in the first nationally determined contribution of Palestine and recommendations to help lower the national GHG emissions from the Palestinian energy sector are provided.

Medical waste management at three hospitals in Jenin district, Palestine

Medical wastes are considered hazardous because they may possess infectious agents and can cause unsafe effects on the environment and human health. This study is to analyze and evaluate the current status of medical waste management at Jenin's district in light of medical waste control regulations recommended by the World Health Organization. The results demonstrated that the average hazardous healthcare waste generation rate ranges from 0.54 to 1.82 kg/bed/day with a weighted average of 0.78 kg/bed/day. There was no established waste segregation of healthcare waste types in all hospitals, and these wastes were finally disposed of in a centralized municipal sanitary landfill, namely Zahrat Al-Finjan. The results suggest that there is a need for activation and enforcement of medical waste laws. This can be achieved through cooperation among key actors: Ministry of Health, Environmental Quality Authority, Ministry of Local Government, and Non-Governmental Organizations working in related fields. Additional remediation measures proposed to tackle the problematic areas of medical waste management in Jenin's district hospitals are addressed. Some recommendations to minimize potential health and environmental risks of medical waste are also introduced.

Public-private partnership in solid waste management sector in the West Bank of Palestine

Palestine, being a developing country, faces lots of obstacles and deficiencies in the existing solid waste management (SWM) field. In wake of these circumstances, it seems hard for the public sector to run sustainable SWM systems. The overall objective of the research presented in this paper was to study the current status of the SWM field in the West Bank of Palestine under the perspective of potential private sector involvement. For this purpose, twelve Joint Service Councils (JSCs) for solid waste management were investigated. Out of them, only two are currently having a Public-Private Partnership (PPP) contract for the management and operation of the transfer station and the sanitary landfill. On the other hand, two JSCs are currently making arrangements and implementing studies for future PPPs on waste-to-energy, biowaste management and recycling projects. Jenin and Tubas Joint Service Council (JSC) had 3-month-duration PPP contract for the implementation of a recycling project, which is a worst case scenario as it failed to meet its objectives. The parameters that could encourage JSCs or ease the implementation of PPP in local SWM field are analysed. Overall conclusion is that sustainability can be accelerated once the government-represented by the Ministry of Local Government (MoLG)-is involved; providing legal support to local authorities and incentives to potential contractors in order to encourage them to join PPPs. Parameters that are believed to facilitate PPPs include the following: development or updating existing laws and regulations, facilitation of licensing procedures, and activation of the Investment Promotion Law. Feasibility and market analysis study implementation will indicate the appropriate actions required locally to achieve environmental and financial sustainability in all contracted PPPs.

Socioeconomic, agricultural, and individual factors influencing farmers' perceptions and willingness of compost production and use: an evidence from Wadi al-Far'a Watershed-Palestine

In Palestine, open dumping and/or burning the waste, including agricultural waste, are prevalent practices resulting in emitting leachate and acidifying greenhouse gases. Composting the agricultural waste can reduce emissions and provide 'compost' as an organic fertilizer and soil amendment; yet, it has not been implemented at the national level. To develop a local marketing strategy for compost, this study views a need to identify farmers' perceptions and willingness of compost production and use in agriculture and examine various socioeconomic, agricultural, and individual factors shaping them. The case of Wadi al-Far'a watershed (WFW) is investigated, where farmers practice inappropriate waste disposal and overuse of agrochemicals. A semi-structured questionnaire is administered to 409 farmers through face-to-face interviews. Descriptive statistics, bivariate analyses, Chi-square test, and binary logistic regression are used for data analysis. High acceptance level (84%) is disclosed among farmers in WFW for the hypothetical idea of producing and using compost. Farmers also have high, yet lower, willingness level (63.6%) of the more salient option of producing compost themselves and using it in agriculture. Tenure systems, large cultivated areas, rainfed irrigation, and lack of access to training sessions inhibit farmers' acceptance of the idea of compost production (overall p value = 0.000). Large cultivated areas and rainfed irrigation is also associated with farmers' unwillingness to produce compost, besides high household monthly income, animal or mixed animal-plant farming, experience in compost production, and use of pesticides (overall p value = 0.000).

Assessment of compost quality and usage for agricultural use: a case study of Hebron, Palestine

Complying with the technical specifications of compost production is of high importance not only for environmental protection but also for increasing the productivity and promotion of compost use by farmers in agriculture. This study focuses on the compost quality of the Palestinian market and farmers' attitudes toward agricultural use of compost. The quality is assessed through selection of 20 compost samples of different suppliers and producers and lab testing for quality parameters, while the farmers' attitudes to compost use for agriculture are evaluated through survey questionnaire of 321 farmers in the Hebron area. The results showed that the compost in the Palestinian markets is of medium quality due to partial or non-compliance with the quality standards and guidelines. The Palestinian farmers showed a positive attitude since 91.2% of them have the desire to use compost in agriculture. The results also showed that knowledge of difference between compost and chemical fertilizers, perception of compost benefits, and previously experiencing problems in compost use are significant factors affecting the farmers' attitude toward the use of compost as an organic fertilizer.

Management of rainwater harvesting and its impact on the health of people in the Middle East: case study from Yatta town, Palestine

Water-related diseases are a primary problem in Palestine where many residents revert to harvested rainwater as their primary water source due to water shortages within the area. From an environmental engineering perspective, it is already well known that certain situations (e.g., cross contamination) reduce drinking water quality and ultimately cause diseases in a population. In this study, we investigated the social practices and situations that may lead to lower disease occurrence. Towards this goal, we surveyed 382 residents in Yatta to collect data on the water-related diseases that they experienced and the specific situations that might affect the disease occurrences such as the residents' practices (i) for maintaining a high quality of cistern water, (ii) for maintaining the environment around the cistern, and (iii) for managing the wastewater. In addition, we measured the physicochemical and microbiological parameters in cisterns to support the qualitative survey data. The measured parameters, including turbidity, salinity, free available chlorine, total Coliforms, and fecal Coliforms, were above Palestinian Standard Institution (PSI) and World Health Organization (WHO) guideline levels, suggesting a potential infectious hazard. The poor quality of the water was also observed by residents based on change in taste and by visually noting floating impurities, turbidity, and green coloration. Survey results showed that observations of the poor quality in cisterns and surrounding environment had statistically significant correlation with most of the water-related diseases. Additionally, frequently emptying the septic tank contributes to improving the observed water qualities. Therefore, residents should be encouraged to continue to observe the water quality in the cistern, improve the surrounding environment of cistern, and empty their septic tank frequently, to keep the water diseases away from their households.

Radon in harvested rainwater at the household level, Palestine

The main objective of this study was to assess Radon concentration in the harvested rainwater (HRW) at the household level in Yatta area, Palestine. HRW is mainly used for drinking as it is the major source of water for domestic uses due to water scarcity. Ninety HRW samples from the household cisterns were collected from six localities (a town and five villages) and Radon concentrations were measured. The samples were randomly collected from different households to represent the Yatta area. Fifteen samples were collected from each locality at the same day. RAD7 device was used for analysis and each sample was measured in duplicate. Radon concentrations ranged from 0.037 to 0.26 Bq/L with a mean ± standard deviation of 0.14 ± 0.06 Bq/L. The estimated annual effective radiation doses for babies, children and adults were all far below the maximum limit of 5 mSvy^-1 set by the National Council on Radiation Protection and Measurements.

Factors affecting the sustainability of solid waste management system-the case of Palestine

Understanding the predictors of sustainability in solid waste management (SWM) systems can significantly contribute to eliminate many waste management problems. In this paper, the sustainability elements of SWM systems of interest are (1) attitudes toward separation at the source, (2) behaviour regarding reuse and/or recycling and (3) willingness to pay for an improved service of SWM. The predictors affecting these three elements were studied in two Palestinian cities: Ramallah and Jericho. The data were collected via structured questionnaires and direct interviews with the respondents, and the analysis utilized a logistic regression model. The results showed that the place of residence and dwelling premises are the significant factors influencing attitudes toward separation at the source; the place of residence and age are the significant factors explaining behaviour regarding reuse and/or recycling; while the dwelling premises, gender, level of education and being received education on waste management are the significant factors affecting willingness to pay for an improved service of SWM.

A system dynamics approach for hospital waste management in a city in a developing country: the case of Nablus, Palestine

Hospitals and health centers provide a variety of healthcare services and normally generate hazardous waste as well as general waste. General waste has a similar nature to that of municipal solid waste and therefore could be disposed of in municipal landfills. However, hazardous waste poses risks to public health, unless it is properly managed. The hospital waste management system encompasses many factors, i.e., number of beds, number of employees, level of service, population, birth rate, fertility rate, and not in my back yard (NIMBY) syndrome. Therefore, this management system requires a comprehensive analysis to determine the role of each factor and its influence on the whole system. In this research, a hospital waste management simulation model is presented based on the system dynamics technique to determine the interaction among these factors in the system using a software package, ithink. This model is used to estimate waste segregation as this is important in the hospital waste management system to minimize risk to public health. Real data has been obtained from a case study of the city of Nablus, Palestine to validate the model. The model exhibits wastes generated from three types of hospitals (private, charitable, and government) by considering the number of both inpatients and outpatients depending on the population of the city under study. The model also offers the facility to compare the total waste generated among these different types of hospitals and anticipate and predict the future generated waste both infectious and non-infectious and the treatment cost incurred.

Occupational Safety Precautions among Nurses at Four Hospitals, Nablus District, Palestine

Occupational hazards, exposure to blood and body fluids (BBF) accidents and safety precautions constitute an important public health issue. We assessed the prevalence and determinants of exposure to occupational hazards among nurses, and their knowledge of occupational safety precautions. In a cross-sectional study, we surveyed 332 nurses working in 4 hospitals, Nablus, West Bank, Palestine, by a questionnaire. Bivariate analysis tested the associations between ever exposure and the high likelihood of BBF exposure and the independent socio-demographic and occupational variables. Binary logistic regression analysis was used to assess the associations between the same two exposures and selected independent variables (those significant in the bivariate analysis). Prevalence of ever exposure to BBF was 51.7%, and was associated with working in private and charitable hospitals (OR 2.62, 2.68, respectively), having 4–6 family members (OR 0.52) and "nursing" being as one's top career choice at university (OR 0.48). The prevalence of high likelihood of BBF exposure was 62.2%, and was associated with working in charitable and private hospitals (OR 7.81, 2.43, respectively) and "nursing" being as one's top career choice (OR 0.57). Regarding knowledge, most respondents believed it is necessary to enact laws and regulations regarding occupational safety precautions, reported the use of sharps containers, immediate disinfection after an accident, reporting an accident, and using personal protective equipment. Nurses had adequate knowledge of the risks of their hospital work. Nevertheless, they exhibited high prevalence of exposure to BBF accidents. Future studies are needed to re-evaluate existing occupational safety guidelines in hospitals, establish monitoring and evaluation protocols for health care workers' adherence to the guidelines, and institute well-defined policies for reporting occupational injury incidents so these can be handled appropriately.

Implementation of a multi-variable regression analysis in the assessment of the generation rate and composition of hospital solid waste for the design of a sustainable management system in developing countries

Forecasting of hospital solid waste generation is a critical challenge for future planning. The composition and generation rate of hospital solid waste in hospital units was the field where the proposed methodology of the present article was applied in order to validate the results and secure the outcomes of the management plan in national hospitals. A set of three multiple-variable regression models has been derived for estimating the daily total hospital waste, general hospital waste, and total hazardous waste as a function of number of inpatients, number of total patients, and number of beds. The application of several key indicators and validation procedures indicates the high significance and reliability of the developed models in predicting the hospital solid waste of any hospital. Methodology data were drawn from existent scientific literature. Also, useful raw data were retrieved from international organisations and the investigated hospitals' personnel. The primal generation outcomes are compared with other local hospitals and also with hospitals from other countries. The main outcome, which is the developed model results, are presented and analysed thoroughly. The goal is this model to act as leverage in the discussions among governmental authorities on the implementation of a national plan for safe hospital waste management in Palestine.

Public concerns about and perceptions of solid waste dump sites and selection of sanitary landfill sites in the West Bank, Palestinian territory

Palestinian inhabitants have disposed of their solid wastes at open dumpsites over the past 40 years without an adequate solid waste management (SWM) plans. Recently, the Palestinian Authority initiated SWM planning to establish controlled sanitary landfills, based on a participatory approach. The purpose of this study was to assess public concerns about existing solid waste dumpsites and public perceptions of sanitary landfill site selection. The study will also take into consideration the effect of diverse social, economic, and environmental related factors of the inhabitants on sitting suitable landfill sites in three Palestinian districts in the West Bank, namely, "Nablus," "Salfit," and "Ramallah and Al-Bireh." The results of this study showed that 64.9% of the sample population are aware of the problems and potential impacts associated with random dumpsites, and 41.6% think that they are suffering from the dumps. Among the environmental, socioeconomic, and political factors, the environmental factors, air pollution in particular, are thought be the most important consideration in selecting a landfill site. The "fairness in selecting a landfill site" was chosen to be one of the most important socioeconomic factors, possibly as a reaction to the Israeli occupation and subsequent land use restrictions in the West Bank, Palestinian territory.

Public perception of hazardousness caused by current trends of municipal solid waste management

Municipal solid waste (MSW) piling up is becoming a serious problem in all developing countries (DC) as a result of inequitable waste collection and treatment. Citizens' collaboration is partly based on understanding their views and their active involvement in MSW planning; on the other hand the assessment of the perception of hazardousness related with MSW is considered rather important as well since the identification of the weak points of the applied MWM strategy is eased and the level of required training is determined. Researchers implemented a case study in the West Bank (WB) and Gaza Strip (GS) regions of Palestine, taking into consideration previous researches in other developing countries. They reached to safe and useful conclusions regarding the parameters which mean the greatest in the waste management field as far as DC are concerned. Lack of skilled manpower, irregular collection services, inadequate equipment used for waste collection, inadequate legal provisions, and resource constraints are additional factors that are confirmed to be challenging the waste management scenarios in all DCs today. The research takes those factors under consideration but focuses on the educational gap and the results revealed interesting trends a significant relationship between respondent's educational attainment and their awareness of hazardous waste (hazard perception); the results will indicate the measure taking required to avoid accidents occurred in those regions (burns from toxics, cuts from sharps, etc). National policy and legislation development based on the research outcomes will ensure equitable and accessible services are in place in order to move towards a healthier environment. Specialized health education and training programs on national scale are also needed to enhance awareness on hazardous waste.

Hand washing among Palestinians in the West Bank and Gaza Strip: attitudes and practices

Regular and proper hand washing is a low-cost and effective intervention to prevent the spread of infectious diseases. The authors' study aimed to assess the socioeconomic and demographic characteristics associated with attitudes and practices of hand washing before eating in the West Bank and Gaza Strip. It also assessed parents' participation in the personal hygiene of their children. Results revealed that almost all participants believed that it is always necessary to wash one's hands before eating. Females had higher rates than males for washing hands before eating as well as for helping with child hygiene. Not surprisingly, a positive relationship existed between educational level and attitudes and practice of washing hands before eating. The authors recommend that governments, ministries, and different nongovernmental organizations have an active role in developing and implementing programs in order to improve the health of their communities. Such programs should be conducted in all localities and at all levels including homes, schools, and public domains.

Smoking, awareness of smoking-associated health risks, and knowledge of national tobacco legislation in Gaza, Palestine

AIMS

To assess university students' extent of smoking, knowledge of smoking health risks, and awareness of existing national anti-smoking laws.

METHODS

Self-administered questionnaire was employed across 7 universities (1,104 students, equal proportions of males and females) located in Gaza Strip, Palestine.

RESULTS

About 55% of participants reported ever smoking, 31% were current cigarette smokers, and 36% were 'strictly' (only) narghile (water pipe) smokers. Mean age of smoking initiation was 17 +/- 3.15 years. Smokers had less knowledge of smoking associated health risks than nonsmokers. Students' knowledge of existing anti-smoking laws was generally low (11.3-25.5%), and significantly more smokers had knowledge about existing laws (ban of advertisement of smoking, ban of smoking in public places, and ban of selling cigarettes to minors) than non-smokers. About 81% of current smokers tried to quit smoking at least once during their life, 53% felt ready to quit smoking if cessation assistance was provided, 17% were not ready to quit, and 30% were reluctant/felt unsure if they were ready to quit. Most students (94.3%) reported that there were no smoking cessation centres in Palestine, or did not know if such centres existed. Males were associated with almost all categories of smoking (e.g. smoking both cigarettes and narghile, or smoking narghile only).

CONCLUSIONS

There is a lack of knowledge about the existing national anti-smoking legislation among university students in Gaza, Palestine. Smoking cessation centres also seem non-existent in Gaza. Multi-level interventions and actions are required by policy makers, educators and non-governmental agencies to prevent smoking among university students in Gaza, and to educate them on tobacco cessation counselling, on the dangers of tobacco use, and about effective stress management strategies to help them to cope with stressors. Smoking cessation interventions are required to address both cigarette and narghile use. Efforts need to be invested in ensuring compliance with legislation and for follow-up activities to enforce the anti-smoking laws through coordinated actions across ministries and departments.

Residents' concerns and attitudes toward solid waste management facilities in Palestine: a case study of Hebron district

Because of many limitations, the siting, construction and operation of a new solid waste management (SWM) facility is a significant challenge in Palestine. A SWM facility should operate in a sustainable in all aspects, including social acceptance, environmental protection, financial equity, and, in this particular case study, the political acceptance of all regional parts is extremely important. This article presents the outcomes of an extended study that aimed to investigate the concerns and attitudes of the residents of Hebron governorate related to the entire lifecycle of SWM facilities. A structured questionnaire was developed based on literature reviews and was distributed to residents in three different communities in the same governorate with various lifestyle backgrounds. The overall investigation focused on the collection of raw data regarding citizens' levels of concern regarding the environmental impacts of SWM facilities, the general waste management aspects, the benefits gained by the operation of various types of SWM facilities and the attitudes during the construction period of each facility. The results show that concerns about water pollution are significant; the benefits gained as a result of the operation of SWM facilities, particularly the heat supply from incinerators, are welcomed; and 'not in my backyard' syndrome is highlighted. The outcomes of this research are input data for the development of a roadmap that may include educational programs, incentive schemes and active public involvement during all phases of the implementation of SWM facilities (planning, siting, operation), in order to also ensure public acceptance, participation and regional sustainable development.

Incidence and causes of home accidents in the West Bank and Gaza Strip, Palestine

This study aimed to investigate the incidence and causes of home accidents in the West Bank and Gaza Strip of Palestine. Quantitative data were collected through a field survey of a random sample of 1882 people from the West Bank and Gaza Strip, and qualitative data through 15 focus groups discussions with men and women from diverse sectors of Palestinian society, which contributed to the interpretation of some of the results more deeply. The most important result from the study was that more women's were exposed to home accidents (40.0%) than men (25.1%). The most common type of accident for both women and men was from a blunt or sharp object casing blunt trauma or puncture wound. Economic situation of the family, family size, presence of children and place of residence were significantly associated with exposure to domestic accidents. There is a need to educate the people of Palestine on the causes of home accidents and methods of prevention, to reduce it incidence.

Problems of management of medical solid waste at primary health care centres in the Palestinian Territory and their remedial measures

This study was conducted to investigate the management aspects of medical solid waste (MSW) at primary health care centres in Nablus and Salfit governorates in the West Bank, Palestine. We interviewed 190 health care staff from primary health care centres in this area. The most frequent type of waste produced was sharps waste: only 5.3% of respondents said this was never produced. Infectious waste was the second most frequent type produced. Only 40.4% of the respondents stated that hazardous MSW was always treated. Over 80% said that non-sharps MSW was separated into its different components, but almost 20% said that sharps were not placed in special containers. We recorded a mean of 34 g of hazardous solid waste and 55 g of non-hazardous solid waste generated per outpatient per day. Staff awareness and training, separation of MSW, establishment of simple treatment facilities are the major measures suggested for improvement of the waste management practices.

System dynamics model for hospital waste characterization and generation in developing countries

Waste management policy makers always face the problem of how to predict the future amount and composition of medical solid waste, which, in turn, helps to determine the most appropriate treatment, recycling and disposal strategy. An accurate prediction can assist in both the planning and design of medical solid waste management systems. Insufficient budget and unavailable management capacity are the main reasons for the scarcity of medical solid waste quantities and components historical records, which are so important in long-term system planning and short-term expansion programs. This article presents a new technique, using System Dynamics modeling, to predict generated medical solid waste in a developing urban area, based on a set of limited samples from Jenin District hospitals, Palestine. The findings of the model present the trend of medical solid waste generation together with its different components and indicate that a new forecasting approach may cover a variety of possible causative models and track inevitable uncertainties when traditional statistical least-squared regression methods are unable to handle such issues.

Workers' safety in the construction industry in the southern West Bank of Palestine

There are few data about safety in the construction industry in Palestine. The main aim of the study was to assess worker's experiences and perceptions of safety at construction sites in Hebron and Bethlehem governorates of the West Bank. A structured questionnaire was completed through direct interviews with 349 construction workers. Of the respondents, 34.6% had experienced work-related accidents, 13.0% and 65.6% indicated that their workplace did not have a first-aid kit or trained first-aid specialist respectively, 35.8% reported that their work sites did not have safety tools and 83.7% had not received safety training. Workers perceived that awareness and training were the most frequent factor affecting workers' safety, with the foreman position having the greatest impact on the workers' safety. Greater enforcement of the current Palestinian safety laws is needed.

A study on the attitudes and behavioural influence of construction waste management in occupied Palestinian territory

As a step towards comprehending what drives the management of construction waste in the occupied Palestinian territory, this paper quantifies construction waste generation and examines how the local contractors' waste management attitudes and behaviour are influenced. Collection of data was based on a survey, carried out in the southern part of the West Bank between April and May 2010. The survey targeted contractors who specialized in the construction of buildings. A logistic regression model was used to investigate the relationship between various attributes and the attitudes and behaviour that the local contractors demonstrate towards waste management. The results showed that during the construction of buildings, 17 to 81 kg of construction waste are generated per square metre of building floor. Although the area of a building is the key factor determining 74.8% of the variation of construction waste generation, the employment of labour-intensive techniques in the study area means that human factors such as the contractor's attitude and behaviour towards waste management, exert a key influence on waste generation. Attitudes towards the 3Rs of waste minimization and behaviour towards waste disposal are generally positive with smaller contractors exhibiting more positive attitudes and more satisfactory behaviour towards waste management. Overall, while contractors' behaviour towards waste sorting and disposal tends to be more satisfactory among contractors who are more conscious about the potential environmental impacts of construction waste, it was generally observed that in the absence of a regulatory framework, the voluntary attitudes and behaviour among the local contractors are mostly driven by direct economic considerations.

[Of the environmental health knowledge, attitudes and practices in Ramallah and Al-Bireh District Palestine]

We assessed the knowledge, attitudes and practices of some aspects of environmental health among residents of Ramallah and Al-Bireh district, Palestine. We found that few residents had attended sessions of awareness in environmental health but 83.6% were willing to participate in such events to raise public awareness. Most residents (91.2%) were aware of the relationship between water and human health, but only 39.7% reported that they or their families cleaned their water tanks more than once a year. Only 76.3% of the respondents reported that they always washed their hands before eating and only 67.0% reported that they checked the safety of food before eating. Only 33.7% felt reassured when they ate in restaurants. This was due to lack of cleanliness of the restaurants, staff and utensils, and the uncertainty regarding the source of the food.

A review of residential solid waste management in the occupied Palestinian Territory: a window for improvement?

Solid waste is considered an urgent environmental health issue in the Palestinian Territory. The aim of this paper was to analyse the current status of residential solid waste (RSW) management in the Palestinian Territory, with the objective of identifying windows for improvement. The study is based on a national household sample survey in the Palestinian Territory, which was conducted by the Palestinian Central Bureau of Statistics (PCBS). The results of this study revealed various interesting trends. For example, while about 90% of households in the Palestinian Territory receive solid waste collection service, about 50% of the households receive this service three times per week or less, leaving a chance for waste pile-up and litter generation. Organic waste (including food waste) was found to account for more than 90% of RSW, providing an opportunity for waste utilization through composting or biogas generation. Additional efforts are required, and some were suggested in this paper, in order to improve the current situation of Palestinian residential solid waste management.

Dental solid and hazardous waste management and safety practices in developing countries: Nablus district, Palestine

This study investigated the dental waste management practices and safety measures implemented by dentists in the Nablus district, Palestine. A comprehensive survey was conducted for 97 of the 134 dental clinics to assess the current situation. Focus was placed on hazardous waste produced by clinics and the handling, storage, treatment and disposal measures taken. Mercury, found in dental amalgam, is one of the most problematic hazardous waste. The findings revealed that there is no proper separation of dental waste by classification as demanded by the World Health Organization. Furthermore, medical waste is often mixed with general waste during production, collection and disposal. The final disposal of waste ends up in open dumping sites sometimes close to communities where the waste is burned. Correct management and safety procedures that could be effectively implemented in developing countries were examined. It was concluded that cooperation between dental associations, government-related ministries and authorities needs to be established, to enhance dental waste management and provide training and capacity building programs for all professionals in the medical waste management field.

Solid waste characterization, quantification and management practices in developing countries. a case study: Nablus district - Palestine

Solid waste management (SWM) is one of the most challenging issues faced by developing countries that suffer from serious pollution problems caused by the generation of large waste quantities. This paper presents the case study of SWM in the Nablus district - Palestine. Surveys for household residents' and SWM program operators, field investigations, on-site waste measurements and characterizations were conducted. Per capita waste generation rates varied between different localities although trends were similar. Overall, the majority of waste was organic (65.1% by weight), suggesting a strong resource recovery potential in terms of animal feed or compost. Recyclable waste (plastic, paper and card) made up 16.7% by weight the waste composition suggesting an incentive to introduce source separation. Household attitudes complemented the waste characterization study, revealing the main problems faced. SWM operators quoted on the current status, highlighting problems with disposing in unsanitary landfills, ineffective solid waste fees system, increasing solid waste quantities and lacking equipment and experienced personnel. To enhance sustainable SWM, public awareness, funding, expertise, equipment and facilities and other provisions currently lacking or inappropriate must be provided.

Solid health care waste management status at health care centers in the West Bank--Palestinian Territory

Health care waste is considered a major public health hazard. The objective of this study was to assess health care waste management (HCWM) practices currently employed at health care centers (HCCs) in the West Bank--Palestinian Territory. Survey data on solid health care waste (SHCW) were analyzed for generated quantities, collection, separation, treatment, transportation, and final disposal. Estimated 4720.7 m(3) (288.1 tons) of SHCW are generated monthly by the HCCs in the West Bank. This study concluded that: (i) current HCWM practices do not meet HCWM standards recommended by the World Health Organization (WHO) or adapted by developed countries, and (ii) immediate attention should be directed towards improvement of HCWM facilities and development of effective legislation. To improve the HCWM in the West Bank, a national policy should be implemented, comprising a comprehensive plan of action and providing environmentally sound and reliable technological measures.

Food sanitation practices in restaurants of Ramallah and Al-Bireh district of Palestine

Safe handling of food in restaurants is a basic element in the reduction of foodborne illness. We investigated knowledge and practices about food safety by food-handlers in restaurants in Ramallah and Al-Bireh district of Palestine. A high proportion of workers in the restaurants had no previous experience in other restaurants and 63.4% had received no training on food sanitation and safety. Most of the restaurants in the refugee camps, villages and towns had only 1 worker. Restaurants lacked basic conditions for food sanitation and safety, such as hot water in most and cleaning materials in some. Many workers had poor personal hygiene practices. Training is needed for restaurant owners and staff to improve food handling practices and standards.

Management of healthcare waste in circumstances of limited resources: a case study in the hospitals of Nablus city, Palestine

The objectives of this study were the assessment of healthcare waste management and the characterization of healthcare waste material generated in the hospitals in Nablus city, Palestine, and furthermore, to estimate the prevalence of hepatitis B among the cleaning personnel working in these hospitals. The medical waste generation rate in kg per bed per day was between 0.59 and 0.93 kg bed(-1) day(-1). The waste generation rate in the healthcare facilities of Nablus city hospitals was similar to some other developing countries; however, the percentage of medical wastes in the total waste stream was comparatively high. The density of medical waste at the four hospitals studied ranged between 144.9 and 188.4 kg m(-3) with a mean value of 166.7 kg m(-3). The waste segregation and handling practices were very poor. Other alternatives for waste treatment rather than incineration such as a locally made autoclave integrated with a shredder should be evaluated and implemented. The system of healthcare waste management in Nablus city is in need of immediate improvement and attention. Formulating rules and guidelines for medical waste and developing strategies for overcoming the obstacles related to waste management should be considered as an urgent matter.

Microbiological quality and sample collection policy for dairy products in Ramallah and Al-Bireh district, Palestine

We aimed to identify bacterial pathogens/contaminants in dairy product samples collected by environmental health inspectors of the Palestinian Ministry of Health from 2001-04. A total of 722 samples of dairy products were randomly collected from different sources in Ramallah and Al-Bireh district. The percentages of unacceptable samples for the combined years were: 23.0% for total aerobic count, 21.0% for total coliforms, 15.2% for faecal coliforms, 1.0% for Staphylococcus aureus, 10.3% for moulds, 2.3% for yeasts and 14.3% for Escherichia coli. All the examined samples tested negative for Salmonella spp. Total aerobic counts rose continuously between 2001 and 2004.

Children's perceptions and behavior with respect to glass littering in developing countries: a case study in Palestine's Nablus district

The aims of this study were to assess the current situation regarding glass litter on the streets and children's attitudes, and behavior concerning glass litter. Out of 240 interviewed children, 41.7% admitted glass littering. This was reflected in the high incidence of injuries caused by street glass among children; 140 (58.3%) of the children interviewed had been injured by broken glass at least once while walking outdoors and 95 of the children had received professional medical care for the lacerations. As reported by the children who admitted to glass littering, the most effective elements (29.6%) in preventing them from littering the streets with glass were moral and religious convictions, and the next most effective practice (20.4%) was improved street cleanliness. Preventive measures such as encouraging moral and religious convictions among children, more effective street cleaning by local authorities, improved footwear, education, and glass recycling incentives, as well as engaging the community in street cleaning campaigns, are all needed to address this public health hazard. More recreational facilities should be provided. Public awareness initiatives led by environmentalists, social workers, primary health care providers or home healthcare providers may also help educate children to wear shoes, prevent glass injuries and increase glass litter awareness.

Enhanced solid waste management by understanding the effects of gender, income, marital status, and religious convictions on attitudes and practices related to street littering in Nablus - Palestinian territory

Litter is recognized as a form of street pollution and a key issue for solid waste managers. Nablus district (West Bank, Palestinian Territory), which has an established network of urban and rural roads, suffers from a wide-spread litter problem that is associated with these roads and is growing steadily with a well-felt negative impact on public health and the environment. The purpose of this research was to study the effects of four socio-economic characteristics (gender, income, marital status, and religious convictions) of district residents on their attitudes, practices, and behavior regarding street litter generation and to suggest possible remedial actions. All four characteristics were found to have strong correlations, not only with littering behavior and practices, but also with potential litter prevention strategies. In particular, the impact of religious convictions of the respondents on their littering habits and attitudes was very clear and interesting to observe.

[Management of solid medical waste in the private medical sector in the occupied Palestinian territory: problems and remedial measures]

Management of solid medical waste in healthcare centres within the private sector in Palestine was studied. This included segregation, transport, treatment and final disposal. The study found that 30% of the centres completely segregated all kinds of healthcare waste, 35.9% segregated the sharps and 27.7% segregated infectious waste. Healthcare waste was manually transported in 99% of the centres that segregate waste. Nearly 87% of the centres disposed of the waste in open dumps randomly distributed in the area. It is concluded that all stages of healthcare waste management in healthcare centres in the private sector pose a hazard to personnel working in them and also to the general public in Palestine.

Influence of socio-economic factors on street litter generation in the middle east: effects of education level, age, and type of residence

Street littering is considered an important environmental health issue in the Middle East. This problem is growing steadily and is attracting great concerns within the communities. The purpose of this paper, which focuses on Nablus district (Palestinian Territory), is to measure the perception and opinion of residents toward littering, in addition to studying prevailing attitudes and practices on littering. This was achieved using an interview survey approach. The influence of three socio-economic factors; level of education, age, and type of residence, on the littering behaviour of individuals was studied. As a result, possible remedial actions have been suggested. The data presented in this work can be considered as one piece of information, which can be compiled with other future data to design an effective litter control programrhe for Middle Eastern countries.

[Medical waste management in healthcare centres in the occupied Palestinian territory]

Medical waste management in primary and secondary healthcare centres in the occupied Palestinian territory was assessed. The overall monthly quantity of solid healthcare waste was estimated to be 512.6 tons. Only 10.8% of the centres completely segregated the different kinds of healthcare waste and only 15.7% treated their medical waste. In the centres that treated waste, open burning was the main method of treatment. The results indicate that Palestinians are exposed to health and environmental risks because of improper disposal of medical waste and steps are needed to improve the situation through the establishment and enforcement of laws, provision of the necessary infrastructure for proper waste management and training of healthcare workers and cleaners.

Trends and problems of solid waste management in developing countries: a case study in seven Palestinian districts

There is a great interest in solving problems related to municipal solid waste (MSW) management in the Palestinian territory. However, few studies have been done to assess the extent of these problems and suggest the best alternative solutions. This study aims at assessing MSW conditions in the seven major districts in northern West Bank, Palestinian territory. The study focuses on comparing several MSW management elements (such as collection, budget, and disposal) in municipalities, village councils, and refugee camps in the studied districts and the problems faced by these institutions in handling the waste. It also provides information on MSW collection service availability and waste disposal practices in the districts studied. It was found that, although MSW collection service was available for 98% of the residents in the areas surveyed, no proper treatment or landfill procedure was followed for the collected waste in most of these areas. Instead, waste burning in open dumpsites was the most common practice. Moreover, due to inefficient collection of waste disposal fees from the residents, municipalities were forced to sometimes cut the collection service and reduce its labor force, especially in villages. The budget for MSW management was between 2% and 8% of the total budget of the municipalities studied, indicating a low priority for this issue.

[Occupational safety of cleaning personnel in Palestinian district hospitals]

This study examined occupational safety among cleaning workers in Palestinian hospitals and its relation with the medical waste management in these hospitals. The level of occupational safety was below standard requirements, as protective equipment and clothes are not available for most workers. Over 40% of workers had been pricked with needles while handling medical waste. There was no clear policy for vaccination of workers against infectious diseases and no medical examination for workers before or during employment. Only 37.2% were trained in handling medical waste and 23.2% were working 15 hours per day or more; 55.8% had spent 1 year or less in their work.

Effects of prevailing conditions during second Palestinian uprising on solid waste management system in Nablus city in Palestine

Since the start of the second Palestinian uprising (Al-Aqsa Intifada), and due to the Israeli activities, curfews, closures, and military checkpoints imposed since 2000, the quality of social services rendered by Nablus city has been gradually deteriorating. Solid waste management in Nablus city was badly affected by these conditions, and this situation is negatively affecting health and damaging the environment. Most of these cases were due to reasons beyond the capability of the municipality with its limited resources. This study revealed that some of the important municipal solid waste (MSW) equipment had been damaged during the uprising. The workforce in the MSW system was reduced and certain MSW-related development projects and activities have been frozen due to the current conditions. The city's medical waste incinerator had been phased out and the number of special medical containers had been reduced from 16 to 10. Some MSW compressing trucks had been out of use with no substitute. Another important figure is the number of waste collection workers which decreased from 420 to 301, although the city is growing in premises as well as population. The created unsanitary solid waste transfer station is now a pollution source on its own, causing an ugly scene at the eastern entrance of Nablus city. There should be a comprehensive and urgent solution for this problem and the needed resources should be invested.

[Assessment of medical waste management in a Palestinian hospital]

We studied medical waste management in a Palestinian hospital in the West Bank and the role of municipality in this management. In general, "good management practices" were inadequate; there was insufficient separation between hazardous and non-hazardous wastes, an absence of necessary rules and regulations for the collection of wastes from the hospital wards and the on-site transport to a temporary storage location inside and outside the hospital and inadequate waste treatment and disposal of hospital wastes along with municipal garbage. Moreover, training of personnel was lacking and protective equipment and measures for staff were not available. No special landfills for hazardous wastes were found within the municipality.

Housing conditions and health in Jalazone Refugee Camp in Palestine

We investigated some of the housing conditions at Jalazone Refugee Camp and their impact on refugees' health inside the camp, especially those with respiratory symptoms and diseases. A randomized sample of 200 housing units, representing one fifth of the camp's population, was selected. Approximately half of the people in our sample were under 15 years. Overcrowding and high population density were significant. There was a statistically significant relationship between some respiratory conditions (common cold, cough, tonsillitis and ear infection) and poor housing conditions (including damp and mould), overcrowding and high population density. A radical solution for the housing problem is needed to avert further negative health impacts.

Evaluation of dental waste management in two cities in Palestine

Disposal of dental waste was investigated at 37 randomly selected clinics in Ramallah and AI-Bireh cities: 31 private practices and 6 public/NGO clinics. Dentists were interviewed regarding their disposal of different forms of dental waste. Disinfectants and X-ray processing solution were thrown down the drain. For sharps, 13.5% of dentists used puncture-resistant containers (only in the public/ NGO clinics), 45.9% discarded needles directly in the garbage after being recapped and 40.5% placed the used needles and blades in closed plastic bottles before throwing in the general garbage. Blood-soaked dressings and amalgam waste were also thrown in the garbage. While 10.75% of dentists were vaccinated against hepatitis B, 47% of the staff at private clinics were not.

Dentists' perceptions of occupational hazards and preventive measures in East Jerusalem

Dentists, like other health professionals, are exposed to various occupational health problems, with specific ones of their own. A randomly distributed sample of 40 (42.2%) dentists working in East Jerusalem was interviewed. A questionnaire was used to detect their perception of occupational hazards. Most respondents were aware of biological hazards: 38% specifically mentioned hepatitis B virus and 13% human immunodeficiency virus. Perceived sources of stress included factors that coincided with international data, such as relationships with patients, physical strain and economic pressure, but also some specific to the Palestinian culture such as relationships with other dentists and Israeli occupation tax policy when dealing with the Arab dentists in East Jerusalem. Chemical dependency was not mentioned as a potential hazard.

Housing environment and women's health in a Palestinian refugee camp

This study was carried out during January and February 2002 in Al-Ein Refugee Camp in Nablus city in Palestine. Interviews were held with 150 women of different age groups and different marital status. The results show a positive relationship between women's physical and mental health and housing conditions. There is a statistically significant relationship between the family size represented by the number of children in the household, the number of children that sleep in one room, and the number of children that sleep in one bed, the house size, and number of rooms and women's feeling of privacy (mental health and well-being). Most of the houses in the camp are unhealthy and overcrowded. The family income is very low and there is a general poor health status of women in the camp. Most of the women do not know the conditions of a healthy house. The study shows the importance of housing reforms on the health of the family in general and women's health in particular, mainly in refugee camps.