It's a daunting task, but Cathy Gritzner's brief to set up a health service for the people of Palestine is a job in a million. She talked to Mark Gould

Having a chief executive called Yasser Arafat tends to focus the mind. Next month, former Patients Association general manager Cathy Gritzner flies out to Palestine with the daunting job of creating a national health service out of the chaos of a state that was born and has lived in almost constant strife.

In preparation she has consulted the writings of Lawrence of Arabia. 'I have read the Seven Pillars of Wisdom . Its message to me is ''make sure you have an escape route', ' she says.

Ms Gritzner has worked in Palestine for the former Overseas Development Agency and has good contacts with clinicians. She was called 'out of the blue' and asked to take charge of the health strand of an EU regeneration scheme - the Meda project.

The task before her and Mr Arafat's government is colossal. As there is no national health service, there is no tradition of managerial or medical education or training.

'I will be calling in a few favours from NHS managers, ' she predicts. The Gaza Strip is the world's most populous area.

Palestine's million people have suffered from war damage, deprivation, crumbling infrastructure, and an almost nonexistent economy with 90 per cent male unemployment.

There is also a nagging fear that the Oslo peace accord with Israel could break down. Medicine, supplies, drugs and equipment arrive in a haphazard fashion.

'On my last trip we smuggled in a huge box of condoms. I once met a diabetic women of 45 on her 15th child. The gynaecologist sterilised her and told her husband it was to save her life.'

Healthcare, where it is available, comes via four strands: the ministry of health, the United Nations, the private sector and non-governmental bodies.

Widows and orphans of Palestine Liberation Organisation fighters get free healthcare provided by Yasser Arafat's Fatah Party, while the UN's World Refugee Organisation provides care in the refugee camps.

'Every hospital director is a doctor - which is the first problem. As Palestine has no medical schools, doctors have trained all over the world - Russia, Cuba, Spain, Kuwait and Bulgaria. They bring totally different managerial and medical techniques.'

There is a nurse training school, but Ms Gritzner tactfully says it is of a 'basic standard'.

After 18 months of work in Palestine, she is under no illusions about the size of the job. 'If it works it will mean literally millions of ecus for Palestine. It will be of huge benefit.'

Primary care is almost non-existent. 'Every doctor wants to go into hospital medicine. They are very keen on gadgets. They always want to zap a tumour. It's not just GPs that are needed, it's nurses and midwives as well.'

She wants to encourage NHS managers to visit Palestine. 'The Palestinians have a great deal of respect for the NHS and for English managers. They see us as people who can roll up their sleeves and get things done.'

Ms Gritzner is ultimately answerable to Yasser Arafat. So what is he like? She takes a deep breath and thinks hard. 'I have met him. The man is under a great deal of pressure to deliver improvements, as he has a huge mandate. I think he will have huge problems in ensuring the people's expectations are met.'