At the Assembly, a few countries supported the U.S. request for postponement of the implementation of the scheme, but a large number of Western countries strongly argued for the scheme's immediate application. Germany proposed that the U.S. proposal was an important question requiring a two-thirds majority vote, and the committee considering the issue agreed, by a vote of 60 to 18 (U.S.), with 11 abstentions. The proposal to defer application of the incentive payment scheme then was defeated by a vote of 28 (U.S.) to 52, with 8 abstentions. The issue was not considered in the plenary.

Currency Fluctuation. The United States also opposed a proposed increase in the exchange rate facility for 1990-1991. The 1989 Assembly had approved a facility of $31 million, against which WHO could draw in order to implement programs at their authorized level in the event exchange rate changes diminished the availability of funds.

WHO proposed another $31 million facility for the 1992-1993 biennium, which the U.S. Delegation supported (Resolution WHA44.14), but it requested a $12 million increase in the facility for 1990-1991 because of serious exchange rate losses WHO had suffered. The United States argued that the $31 million originally provided for 1990-1991 had been reasonable, and that any exchange rate losses above $31 million would need to be absorbed by WHO. In the end, the committee voted to approve the extra $12 million appropriation, by a vote of 42 to 6 (U.S.), with 13 abstentions. (Resolution WHA44.13.)

Members in Arrears. The Assembly voted to deny the vote, beginning at the 1992 Assembly, to 13 countries that in May 1991 were more than 2 years in arrears in their payments to WHO. This was a reversal of the position of the previous 2 years, when the Assembly had refused to apply the WHO rule on suspension of the vote. Western countries spoke persuasively about the need to apply sanctions. The U.S. Delegation pointed out that the WHO rule, allowing an extra year before suspension of the vote went into effect, was more liberal and flexible than policies applied in the UN General Assembly and many other agencies.

The committee decided to suspend the vote for the 13 countries, by a vote of 42 (U.S.) to 13 opposed, with 10 abstentions. The positive votes surpassed the required two-thirds majority of 37. In plenary, the suspension was approved by a vote of 70 (U.S.) to 24, with 31 abstentions. The required two-thirds majority was 63. (Resolution WHA44.12.)

Planning for 1994–1995. In July the 12-member Program Committee of the Board reviewed guidance prepared by the Director General for the next biennial budget, covering 1994– 1995, and agreed upon a planning ceiling for the budget. Although the 1992-1993 budget adopted only several weeks earlier had contained cost increases of 10.05 percent, Director General Nakajima proposed an increase for 1994-1995 of 12 percent. The Committee agreed. The U.S. member of the Board, Dr. James O. Mason, said the U.S. position was that the ceiling should be placed at 9 percent.

At year's end, prospects for receiving payments of assessments assigned to the former Soviet Union and Yugoslavia were increasingly bleak, and Dr. Nakajima instructed his staff to withhold implementation of about 10 percent of the authorized program activity for 1992-1993 so that WHO did not overspend its budget.

Setting Priorities. Results of a 2-year study on the setting of priorities for WHO programs was presented to the Board at its January meeting. The United States had been instrumental in having the study initiated and played a key role in shaping the Board's resolution (EB87.R25). The key U.S. objective was to ensure meaningful participation by WHO governing bodies in the review and setting of priorities for the regular budget. After extended debate, the Board agreed with criteria set out in the document and urged they be applied at the global, regional and country levels. In July the Program Committee also discussed at length the manner of shifting allocations of resources within the budget to meet changing health needs and increasingly limited

resources.

Political Issues

Iraq Invasion of Kuwait. The WHO Executive Board was in session in January at the outbreak of the offensive to push Iraqi forces out of Kuwait. Iraq's member of the Board requested a new agenda item on the impact on the health of the Iraqi people of the UN Security Council's resolution imposing an embargo on Iraq. The U.S. Delegate, objecting to the proposed agenda item, told the Board there was no action that could be taken by the WHO Executive Board which would contribute to the saving of lives in Iraq. If there was a problem with food or medical supplies, he said, Iraq had it within its power to invite a representative of the UN Secretary General to visit Iraq and determine the extent of the need, but Iraq had not done so. In any event, WHO had no authority to act in a manner inconsistent with the Secu

rity Council decision. The full Board then rejected the Iraq request for an agenda item on the embargo by a vote of 3 to 11 (U.S.), with 8 abstentions.

The Assembly in May adopted by consensus a resolution (WHA44.32) which, inter alia, urged member states “take action to alleviate the heavy burden being carried by countries neighboring Iraq by improving the delivery of health care to refugees and displaced people, including preventive and hygienic measures." In private talks the Iraqi Delegation attempted unsuccessfully to have all references to Iraq removed.

In the course of the year, WHO staff engaged extensively in analyses of the health situations in both Iraq and Kuwait. Director General Nakajima issued a press release in January contending the Iraqi discharge of oil into the Gulf was an environmental disaster of unprecedented proportions, and appealing to all governments concerned to pursue every effort to mitigate the effects on health of the oil spill.

WHO coordinated delivery of basic health emergency kits to Kuwait early in the year, and issued an appeal for health assistance to Kuwait. From the outset of the atmospheric pollution following the Iraqi torching of Kuwaiti oil wells, WHO joined with WMO and UNEP in efforts under a UN Interagency Environmental Action Plan for the Gulf Region. WHO's work focused on health problems related to air pollution, drinking water, waste water management, solid and hazardous wastes and food safety. A Human Exposure Assessment Locations (HEAL) project was initiated, in cooperation with the U.S. Environmental Protection Agency (EPA), to monitor air pollutants.

Occupied Territories. More than 30 countries introduced a resolution on health conditions in the occupied territories that was basically the same as that adopted, over U.S. opposition, in 1990. The text criticized Israeli handling of health issues in the occupied territories. Western countries argued the text was much improved, but U.S. and Israeli Delegates argued it was worsened by insertion of references to UN General Assembly resolutions irrelevant to WHO, and of one reference to "Palestine." The U.S. Surgeon General, Dr. Antonia C. Novello, told the Assembly:

It serves no useful purpose for the World Health Assembly to adopt a resolution that is provocative and antagonistic in political terms at a time when serious efforts are underway meant to achieve a resolution of problems in the occupied territories and in the surrounding area.

In the end, 8 of the 12 European Community countries cosponsored the resolution, and the text was adopted in committee by a vote of 92 to 2 (U.S., Israel), with 8 abstentions. In plenary, it was adopted 102 to 2 (U.S., Israel), with 10 abstentions. (Resolution WHA44.31.) The Israeli Representative told the plenary afterward that because of Israel's disagreement with the resolution, “Israel is taking stock of its relations with WHO and will shortly communicate its feelings to the Director General." There was no further public communication on the point during the year.

PLO Membership. In 1989 and 1990, the Assembly had defeated efforts by the PLO to obtain membership in WHO on behalf of the "state of Palestine." The 1990 Assembly provided for indefinite deferral of action, leaving to the judgment of the Director General the question of whether and when the issue should be resubmitted to the Assembly. Nevertheless, at the outset of the 1991 Assembly, Western countries understood that several Arab states planned to introduce another resolution on the subject, either asking the Director General to continue his studies or calling for a specific report to the 1992 Assembly. U.S. Delegates privately worked to prevent a text from being introduced.

In the end, there was no resolution on this issue. The only mention of the subject came in a letter to the Director General from the chairman of the council of Arab health ministers, which said the council had met and "noted the right of Palestine to become a member of WHO,... took note of the willingness of Palestine to postpone the consideration of this matter to a future session of the World Health Assembly," and asked the Director General to report to the Assembly "at an appropriate time.” There was no public discussion of the letter.

Southern Africa. The Assembly adopted by consensus a resolution (WHA44.39) calling for health assistance to states in southern Africa. After years of contentious dialogue in the Assembly concerning the role of South Africa, the 1991 Assembly provided a dramatic change of tone, including a paragraph in its resolution which noted "positive developments in South Africa, which may lead to a just solution of the social and health problems of the country and the subregion."

Procedural Issues

The Executive Board recommended the Assembly amend the rules of procedure regarding the roll call vote, which tended to consume more than 30 minutes each time it was employed.

Rather than permit this device to be invoked by a single delegate acting alone, as under existing rules, the Board recommended the roll call vote be used only if a majority of the committee or the plenary had agreed. The Western group supported the proposal, largely because it had been extensively abused by Cubans, Soviets and others in the World Health Assembly. By a vote of 55 to 19 (U.S.), with 6 abstentions, the committee decided that the change of the rule was an important question requiring a two-thirds majority vote. The proposed change was then defeated 24 (U.S.) to 54, with 5 abstentions.

The Assembly adopted a new rule allowing the one-and-ahalf day "technical discussions," addressing a selected topic each year, to be held only in alternate years when the budget was not under review. The long technical discussions were seen by the Board as excessively extending the workload of the Assembly. The Assembly agreed, reversing a decision taken 7 years earlier that the technical discussions should continue on an annual basis. (Resolution WHA44.30.)

The Assembly also approved a Board proposal intended to prevent new resolutions being introduced at the Assembly on technical topics not previously reviewed by the Board or thoroughly discussed by the Assembly. This was recommended by the Board in order to limit the practice of many countries of appearing at the Assembly with a resolution on a discrete technical topic not on the agenda and not the subject of a discussion document which fleshed out issues for careful consideration. (Resolution WHA44.30.)

The U.S. Delegation to the Executive Board, expressing concern about the sizeable cost of the annual Assembly, raised the possibility of holding Assemblies every other year instead of annually. The Assembly had rejected a proposal to make such a shift in the early 1980s and it was quickly apparent there was no support for a shift to biennial Assemblies in the 1990s either. The U.K. member of the Board said firmly he hoped the issue would not be reopened, and the French Board member said flatly that the "time is wrong." The issue was not pursued.

The U.S. Delegation to the January Board meeting praised the WHO regional committee for Europe for institutionalizing the idea of a search committee prior to election of the regional director. All other WHO regional groups had rejected the idea, but the U.S. Delegation noted that the concept had been praised in a recent paper about the UN system prepared for the Ford and Hammarskjold foundations. The United States recommended