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Page 226

180 Building a Successful Palestinian State

Many acute and chronic health problems can be caused or exacerbated by poor
water quality and exposure to untreated wastewater. Water scarcity and high salin-
ity can result in kidney dysfunction or failure, which can be exacerbated by the hot
weather common in this region (Bellisari, 1994). Chemicals, such as nitrates, found in
the water supply cause other water-related illnesses, including diarrhea. The PHG sur-
vey found that more than 10 percent of children less than five years old were reported
to have had diarrhea episodes during the two weeks previous to the survey. In addi-
tion, there are long-term health consequences of ingesting contaminants in the water.
For example, high nitrate concentrations can increase anemia and induce spontaneous
abortion (Bellisari, 1994). Exposure to raw sewage as a result of the lack of sewage
infrastructure also has significant short- and long-term health implications, especially
in such vulnerable populations as children and the elderly. Finally, communicable dis-
eases such as hepatitis are “the most prevalent and most serious of all health problems
associated with the water supply” (Bellisari, 1994).

Immediate water issues must be addressed to protect the health and well-being of the
West Bank and Gaza population. Current water quantity and quality are insufficient
for the population and will not support population or economic growth. New water
supplies and demand management need to be developed in parallel and in concert with
the design of the water supply and waste systems.

Options for addressing future water scarcity and quality issues for the West Bank
and Gaza follow.

Water demand growth can be moderated through sensible policies for managing do-
mestic and agricultural demand and through infrastructure improvements. Improving
domestic efficiency and implementing systems to reuse household wastewater from
sinks and showers (i.e., graywater) are the two primary methods for reducing domestic
demand without compromising water services. Improving irrigation efficiency, provid-
ing incentives to switch irrigation from water-intensive crops (such as fruit trees) to
less-intensive crops (such as vegetables), and limiting irrigation growth are all effective
methods for managing agricultural demand. Finally, reducing water losses from the
supply infrastructure can reduce the required supply for both sectors.

It is impossible to predict precisely how the many factors driv-
ing today’s domestic, industrial, and agricultural water demand will affect future de-
mand. Although industrial and commercial demand today is very small, a future state
will develop a stronger economy, with corresponding increases in demand for water.
Domestic demand, a large component of today’s total demand, is driven by two highly

Page 227

Water 181

uncertain factors—per-capita water consumption and population growth. Per-capita
water consumption is currently constrained in most places by supply; more water would
be consumed if it were made available at affordable prices. Per-capita consumption in
those few municipalities with a reliable centralized water supply is largely determined
by household needs, tempered by the cost of the water. This suggests that per-capita
consumption will rise initially as supplies are increased. The second determinant, pop-
ulation growth, will be affected by both the internal growth rate in the population and
the net inflow of Palestinians (returnees), which is difficult to predict.

The PWA ultimately would like to develop water resources so that supply can
meet demand. For planning purposes, however, per-capita consumption targets must
be set. The current long-term goal of the PWA is to increase water consumption to
150 l/d (CH2M HILL, 2002a). In the shorter term, we use the intermediate goals of
increasing effective consumption to 100 l/d by 2015 and 120 l/d by 2020. As discussed
below, investing in domestic water efficiency and graywater reuse can reduce the actual
water delivery requirement below this level without affecting service to the consumer.

Demand for agricultural water is uncertain and is tempered by agricultural poli-
cies. Consumption depends on how much land is irrigated and the type of irriga-
tion used. It also depends on the types of crops irrigated, and the needs of livestock.
Options for managing agricultural demand include upgrading water delivery systems
(e.g., lining canals) and improving and maintaining irrigation equipment. Limiting
the expansion of irrigated agricultural area and encouraging the shift of irrigation away
from water-intensive crops are other important demand-management policies.

domestic efficiency and water reuse can reduce per-capita domestic consumption
without compromising consumer services or public health. The efficiency of domestic
consumption can be enhanced by installing water-efficient showerheads, toilets, and
faucets. These relatively inexpensive devices can significantly reduce the water con-
sumed by many household activities. A typical household connected to a water system
can reduce water consumption by approximately 25 percent by adopting a complete
suite of domestic efficiency technologies, including faucet aerators, low consumption
showerheads, and low water-use toilets (CH2M HILL, 2002a). The estimated cost for
implementing these measures is about $300 per household, with an annual mainte-
nance cost of $30 (CH2M HILL, 2002a) (see the subsection Domestic Efficiency in
this chapter for more details).

In addition, minor plumbing modifications can allow much of the graywater in
a household to be reused. Possible graywater systems would filter water from sinks and
showers and divert it for use in toilets; for washing clothes, windows, and vehicles; and
for domestic irrigation. A household retrofitted with a domestic graywater reuse system
(where shower and sink wastewater is filtered and reused for toilet flushing, clothes
washing, and domestic irrigation) can reduce water use by 40 percent (Libhaber, 2003;
Faruqui, 2002; Pottinger, 2003). Graywater reuse is often hindered by fears of negative

Page 452

406 Building a Successful Palestinian State

United States
in administration of justice in

Palestine, 46–54
counterterrorism assistance,

health system infrastructure,

intelligence cooperation,

legal system integration and,

military assistance, 58–59

United States Agency for
International Development
(USAID), 273, 284

United States Bureau of the
Census (USBC), 74, 84–87

Universal health coverage,

closing of, 322
enrollment, 95
infrastructure, 96
investment in human capital,

options, 326–327
teachers, 331

U.S. Agency for International
Development, 186

U.S. Health People 2010
targets, 248

U.S. Justice Department,

U.S. State Department, 58
Utilization review, 251
Utilization review, health care,


Vaccines, 282
Varicella vaccine, 233, 282

children exposed to, 283–284,

economic triggers, 42
female education and, 318
infrastructure damage,

internecine, 41–42

legitimacy and, 17
by militants, 57
schools free of, 314

Vital statistics records, 275
Vitamin A deficiency, 233,

Vitamin supplements, 233,

Vocational training programs,

96, 316
access to, 353
health-related, 246
options, 326–327
relevance of, 345–346
standards for, 355

Tertiary education

Waste treatment costs, 195

aquifer infiltration by, 177
current disposal, 169
infrastructure, 187–189
reclamation, 184–186,

reuse, 194, 215–216
reuse costs, 194
treatment, 199, 217–218

Water, 163–221
base case, 196–197, 202
costs of, 202, 386
declining levels, 176–178
declining quality, 176–178
demand management, 180–

demand projections, 202–206
desalination, 186–187,

distribution costs, 195
domestic efficiency, 194,

future options, 193–208
graywater reuse, 181–182
health implications, 179–180
historical context, 172–174
increasing efficiency, 181–182
infrastructure, 170–171,

178–179, 187–189, 192
limiting irrigation, 183

modeling demand for, 189–

modeling supply of, 192
multilateral management

plan, 173
networks, 216–217, 217
per-capita domestic

consumption, 213
policies, 208–211
project costs, 192–193
quality of, 170, 384
quantity of, 384
scarcity, 165–167
sources, 174–175
success of Palestine and, 381
transportation of, 188–189,

unaccounted for (UFW), 179

Water allocation model, 164
Water consumption, per-capita,

93, 163, 213
Water stress index, 166
Water supplies

baseline, 197–201, 198
costs, 202
hydropower and, 123
inadequacy of, 175–176
infrastructure, 93–94
infrastructure damage, 164
infrastructure investment, 143
integrated management,

Israeli use of, 113
new, 198–201
Oslo Accords and, 114
projections, 200, 205
scenarios, 202–208, 213–218
shared rights to, 165
sources, 163

Weizman Institute of Science,

Well-being, 380
West Bank

baseline water supply, 198
governance indicators, 21
groundwater quality, 170
irrigation water scenarios, 183
Israeli annexation of, 15

Page 453

Index 407

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