High rate anaerobic technologies offer cost-effective solutions for "sewage" treatment in the temperate climate of Palestine and Jordan. However, local sewage characteristics demand amendments to the conventional UASB reactor design. A solution is found in a parallel operating digester unit that stabilises incoming solids and enriches the UASB sludge bed with methanogenic activity. The digester operational conditions were assessed by operating eight CSTRs fed with primary sludge. The results showed a high degree of sludge stabilization in the parallel digesters at SRTs>or=10 and 15 days at process temperatures of 35 and 25 degrees C, respectively. The technical feasibility of the UASB-digester combination was demonstrated by continuous flow pilot-scale experiments. A pilot UASB reactor was operated for 81 days at 6 hours HRT and 15 degrees C and was fed with raw domestic sewage. This period was subsequently followed by an 83 day operation period incorporating a parallel digester unit, which was operated at 35 degrees C. The UASB-digester combination achieved removal efficiencies of total, suspended, colloidal and dissolved CODs of respectively 66, 87, 44 and 30%. Preliminary model calculations indicated that a total reactor volume of the UASB-digester system corresponding to 8.6 hours HRT might suffice for sewage treatment in Palestine.