JMCC / Public Opinion Polls

Annex III: Copy of the Questionnaire in English

JMCC Public Opinion Polling Unit
POB 25047, East Jerusalem
Tel. 02-5819777

The shaded area to be filled by the interviewer
                                        (For office Use)
Interviewer code        Area Code        Questionnaire Number
.........................        .................           ...............................
R1.......
R3.......

Date:
Day Month Year

The following information to beilled by the interviewer
Name of interviewer:...............................................
Gender:
1. Male 2. Female
R4.......

City/village/camp:.............................
Selected Street:.............................

Time of the interview:
Hour Minute

For office use only:
Field supervisor...........................
Coder...........................
Code reviwer...........................

Signature of interviewer:....................

Hello, I am from the Jerusalem Media & Communication Center in Jerusalem. We are conducting a study about the views of the Palestinian public on issues pertaining to the Palestinian situation and the Palestinian needs during the Intifada. You were randomly selected. Your answers will be included with those of others. Thus you will not be identified in any way. We would like to assure you again that the information in this questionnaire would be dealt with in strict confidence.

How many people 18 years or older living in this household?

------------------

How many of those are women?

------------------

Number of adults in household

One adult Two adults Three adults Four +

None Adult
1 Oldest
3 Middle aged
6 2^nd Oldest male
10

Number of
Women One woman Adult
2 Male / Female
4 Youngest male
7 Middle aged male
11

Two women Youngest female
5 Oldest Female
8 Oldest/youngest male
12

Three women Middle aged female
9 Middle aged female
13

Four women 2^nd youngest female
14

R5.....................

	Question	Value	Code
1.	Are you a refugee or descendant of a refugee family?	1. Yes 2. No (Go to Q.5) 3. D'K 9. No answer	C1
2.	If yes, are you...	1. first generation refugee 2. Second generation refugee 3. Third generation refugee 4.Other 5. D'K 8. Not applicable 9. No answer	C2
3a.	When did you become a refugee?	1. 1948 2. 1967 3. 1948 and in 1967 4. Other 5. D'K 8. Not applicable 9. No answer	C3a
3b.	When did your immediate family become refugees?	1. 1948 2. 1967 3. 1948 and in 1967 4. Other 5. D'K 8. Not applicable 9. No answer	C3b
4.	Do you have an UNRWA card?	1. Yes 2. No 8. Not applicable 9. No answer	C4
5.	From which village or town do you or your nuclear family originally come from?		C5
6.	In which village or town are you a resident? (Interviewer: !!! Place of residence is not place of living!)		C6
7.	In which village or town does your family live?		C7
8.	Are you currently employed or not?	1. I am employed full-time 2. I am employed part-time 3. I am not employed 4. I am a house wife (Go to Q.14) 5. I am a student (Go to Q.14) 6. I am retired	C8
9.	Occupation	1. Professional 2. Skilled worker 3. Unskilled worker 4. Technician 5. Employee 6. Other 88. Not applicable 99. No answer	C9
10.	In which village or town do you work ?		C10
11.	Place of work	1. Settlement 2. Israel proper 3. West Bank 4. Gaza Strip 5. Jerusalem 6. Other 7. Do not work 8. Not applicalbe 9. No answer	C11
12.	Did your employment situation change during the past three months?	1. No, it remained the same (Go to Q.14) 2. I had to search for a different employement 3. I lost my job 8. Not applicable (Go to q.14) 9. No answer (Go to Q.14)	C12
13.	Was this change a consequence of the current situation?	1. Yes 2. No 8. Not applicable 9. No answer	C13
14.	How many people live in this household, including childre (below 18)?	99. No answer	C14
15.	How many of those are employed?	99. No answer	C15
16.	How many of the employed are women?	99. No answer	C16
17.	How many of your household members have lost their jobs in the past three months?		C17
18.	How many of your household members have lost their jobs in the past three months because of the current situation?	0. None (if None, Go to Q.19) 99. No answer (Go to Q.19)	C18
18a.	Where did those who lost there jobs because of the current situation work? (Number of persons)	West Bank ------ 88. Not applicable Gaza -------- 88. Not applicable Jerusalem --------- 88. Not applicable Settlements ---------- 88. Not applicable Israel -------- 88. Not applicable	C18a C18b C18c C18d C18c
19.	To what extent would you say that restrictions on your mobility were a problem for you and your family in the past three months?	1. A lot 2. A little 3. Not at all 8. D'K 9. No answer	C19
20.	Have you noticed anything on the children's behavior since the begining of the Intifada?	1. Yes (Go to Q. 21) 2. No (Go to Q.22) 9. No answer	C20
21.	What kind of change did you notice?	1. Frequent nightmares 2. Sleeping disturbances 3. Bed wetting 4. Concentration difficulties 5. Other (specify)____________ 88. Not applicable 99. No answer	C21
22.	Please answer yes or no if you or your family has incurred any of the following injuries?
22-1	Has any of your family or the relatives of your family martyred in the past four months?	1. Yes 2. No 9. No answer	C22a
22-2	Has any of your relatives been injured in the past four months?	1. Yes 2. No 9. No answer	C22b
22-3	Has any of your property or your family's property been damaged in the past four months?	1. Yes 2. No 9. No answer	C22c
22-4	Where any trees been uprooted for you or for your family in the past four months?	1. Yes 2. No 9. No answer	C22d
22-5	Did your business or that of your family suffer in the past four months?	1. Yes 2. No 9. No answer	C22e
23.	Have you or your family received any assistance from any party since the Intifada al Aqsa started in late September?	1. Yes 2. No I did not receive any assistance, financial or non financial (Go to Q.26) 3. I am not sure 8. I do not know (Go to Q.26) 9. No answer (Go to Q.26)	C23

24. If yes, what kind of assistance did you or your family receive since the Intifada al-Aqsa started and from whom and how satisfied where you?

Type of assistance	Value	Source	Satisfication
1st Type: ____________ 88. Not applicable 99. No answer	________NIS [0] No value [1] No material value [8] Not applicable [9] No answer	______: ________ 88. Not applicable 99 No answer	[1]Very satisfied [2] Satisfied [3] Dissatisfied [4] Very dissatisfied [5] DK [6] Not applicable [9] No answer
C24a1	C24b1	C24c1	C24d1
2nd Type: ____________ 88. Not applicable 99. No answer	________NIS [0] No value [1] No material value [8] Not applicable [9] No answer	______: ________ 88. Not applicable 99 No answer	[1]Very satisfied [2] Satisfied [3] Dissatisfied [4] Very dissatisfied [5] DK [6] Not applicable [9] No answer
C24a2	C24b2	C24c2	C24d2
3rd Type: ____________ 88. Not applicable 99. No answer	________NIS [0] No value [1] No material value [8] Not applicable [9] No answer	______: ________ 88. Not applicable 99 No answer	[1]Very satisfied [2] Satisfied [3] Dissatisfied [4] Very dissatisfied [5] DK [6] Not applicable [9] No answer
C24a3	C24b3	C24c3	C24d3
4th Type: ____________ 88. Not applicable 99. No answer	________NIS [0] No value [1] No material value [8] Not applicable [9] No answer	______: ________ 88. Not applicable 99 No answer	[1]Very satisfied [2] Satisfied [3] Dissatisfied [4] Very dissatisfied [5] DK [6] Not applicable [9] No answer
C24a4	C24b4	C24c4	C24d4

25.	In general, how do you evaluate the assistance provided to you and to your family during the last three months by various governmental, non-governmental, and international organizations?	1. Very satisfied 2. Satisfied 3. Dissatisfied 4. Very dissatisfied 5. DK 8. Not applicable 9. No answer	C25
26.	If neither you nor your family received any assistance, would you say that you need assistance?	1. Yes 2. No 3. Not sure 4. We did not receive assistance	C26
27.	Regardless of whether you receive or do not receive assistance, what is the most important need would you say you require?	Most important need: _________________	C27
28.	How much money would you say your household needs every month to be able to meet the basic life necessities?	_________ Shekel. [99] No answer	C28
29.	To what extent would you say your household income is close to this number nowdays?	1. Much higher than this 2. Little higher than this 3. About the same 4. Little less than this 5. Much less than this 8. DK 9. No answer	C29
30.	Do you know of any projects that were carried out in your community since the Intifada al Aqsa started?	1. Yes I do 2. No I do not (Go to Q. 32) 9. No answer (Go to Q.32)	C30
31.	If yes, what are they?	[99 Not applicable [99] No answer	C31
32.	Do you or your family regularly benefit from any assistance, such as education and health, from UNRWA?	1. Yes 2. No (Go to Q.34) 8. I do not know (Go to Q.34) 9. No answer (Go to Q.34)	C32
33.	In general, how satisfied are you with the services provided by UNRWA?	1. Very satisfied 2. Satisfied 3. Dissatisfied 4. Very dissatisfied 8. I do not know 9. No answer	C33
34.	What kind of relief do you think is needed for the community you live in? (only the most important ONE)	______________ [55] I do not know [99] No answer	C34
35.	For each of the following services, please rate its importance in the current crisis?
35-1	The importance of education in the current situation?	[1] Very high [2] High [3] Medium [4] Low [5] Very low [6] Do not know [9] No answer	C35a
35-2	The importance of health in the current situation?	[1] Very high [2] High [3] Medium [4] Low [5] Very low [6] Do not know [9] No answer	C35b
35-3	The importance of food distribution in the current situation?	[1] Very high [2] High [3] Medium [4] Low [5] Very low [6] Do not know [9] No answer	C35c
35-4	The importance of finding employment in the current situation?	[1] Very high [2] High [3] Medium [4] Low [5] Very low [6] Do not know [9] No answer	C35d
35-5	The importance of infrastructure (such as building roads, sewage, etc.) in the current situation?	[1] Very high [2] High [3] Medium [4] Low [5] Very low [6] Do not know [9] No answer	C35e
36.	For each of the following, services, please rate its effectiveness in the current situation?
36-1	The effectiveness of education in the current situation?	[1] Very effective [2] Effective [3] Not effective enough [4] Not effective at all [5] Do not know [9] No answer	C36a
36-2	The effectiveness of Health in the current situation?	[1] Very effective [2] Effective [3] Not effective enough [4] Not effective at all [5] Do not know [9] No answer	C36b
36-3.	The effectiveness of food distribution in the current situation?	[1] Very effective [2] Effective [3] Not effective enough [4] Not effective at all [5] Do not know [9] No answer	C36d
36-4	The effectiveness of finding employment in the current situation?	[1] Very effective [2] Effective [3] Not effective enough [4] Not effective at all [5] Do not know [9] No answer	C36e
36-5	The effectiveness of infrastructure (such as building roads, sewage, etc.) in the current situation?	[1] Very effective [2] Effective [3] Not effective enough [4] Not effective at all [5] Do not know [9] No answer
37	Which Palestinian political or religious faction do you trust most?	No one (Do not read) Refuse to answer	C37
38.	Your age	-------- Years	C38
39.	Educational level	[1] Illiterate [2] Until element. [3] Until Prep. [4] Until second [5] Some college [6] College & above [9] No answer	C39
40.	If the average income of a family is around 3,000 shekels per month, how much is your family income?	[1] Much higher than average [2] Little higher than average [3] Close to average [4] Little less than average [5] Much less than average [9] DK/NA	C40
41.	Married Status	[1] Single [2] Married [3] Divorced [4] Widower [9] No answer	C41
42.	Area	[1] West Bank [2] Jerusalem [3] Gaza Strip	C42
43.	Residence	[1] City [2] Camp [3] Village	C43
44.	Gender	[1] Male [2] Female	C44