The treatment of high strength sewage was investigated in a one-stage upflow anaerobic sludge blanket (UASB) reactor and a UASB-digester system. The one-stage UASB reactor was operated in Palestine at a hydraulic retention time (HRT) of 10h and at ambient air temperature for a period of more than a year in order to asses the system response to the Mediterranean climatic seasonal temperature fluctuation. Afterwards, the one-stage UASB reactor was modified to a UASB-digester system by incorporating a digester operated at 35 degrees C. The achieved removal efficiencies in the one-stage UASB reactor for total, suspended, colloidal, dissolved and VFA COD were 54, 71, 34, 23%, and -7%, respectively during the first warm six months of the year, and achieved only 32% removal efficiency for COD total over the following cold six months of the year. The modification of the one-stage UASB reactor to a UASB-digester system had remarkably improved the UASB reactor performance as the UASB-digester achieved removal efficiencies for total, suspended, colloidal, dissolved and VFA COD of 72, 74, 74, 62 and 70%. Therefore, the anaerobic treatment of high strength sewage during the hot period in Palestine in a UASB-digester system is very promising.