Access to hospital services for Palestine refugees: the challenge of UNRWA in difficult times

Access to hospital services for Palestine refugees: the challenge of UNRWA in difficult times
The mission of UNRWA is to help Palestine refugees achieve their full potential in human development, regardless of the tenuous conditions and difficult circumstances in which they live. As the General Assembly has expressed, due to the absence of a resolution to the plight of Palestine refugees for almost seven decades, the Agency’s provision of services will remain essential for the well-being, human development, and protection of the refugees across the Agency’s five fields of operation (Jordan, Lebanon, Syria, Gaza and West Bank).[1]
The right to health is a fundamental human right, to which all individuals are entitled. It is also an instrumental element of human development. UNRWA contributes towards the realization of this right for Palestine refugees by providing quality and universally accessible primary health care.
In addition to its primary health-care, UNRWA administers a Hospitalization Support Programme (HSP) to ensure essential health needs are met and Palestine refugees (PRs) have access to hospital services that are comparable to those available to an average citizen in the host country, without incurring a catastrophic health expenditure.
The accessibility of financial aid and a varied array of support under the HSP is contingent on the availability of resources under the Agency’s Programme Budget and through other innovative funding and partnership modalities.
Ensuring the effectiveness and efficiency of providing hospitalization has become essential given the Agency’s constrained finances, in the continually sustained fragile context UNRWA is operating. UNRWA’s hospitalization policy is defined by the users’ eligibility, which depends on their access to alternative services, the medical urgency of their case, and their economic status.
Cost sharing is a key component of the Agency’s HSP and it is determined in each Field based on a strategic approach to the provision of access to secondary and tertiary care that prioritize the support for the most vulnerable and those without other alternatives (ex. poor, non-insured). Moreover, priority is given to the most clinically urgent cases requiring immediate care (lifesaving and urgent).
UNRWA, with the exception of Qalqilya Hospital in the West Bank, a 63-bed secondary care facility which, in 2018, served 5,690 patients that are both UNRWA refugees and non-refugees from the surrounding municipalities, does not offer hospital care. Access to such care is facilitated through the provision of financial assistance to access public or private hospital services operating within the healthcare system of host countries or through local partners (Palestine Red Crescent Hospitals in Lebanon), through different contract modalities.
In 2018, UNRWA supported over 90,000 hospital admissions Agency-wide, with HSP being the second highest health-related expenditure after medical personnel costs.
Utilization of available resources in service of the target population, unit costs, number and type of contracts, staff involved, hospital service targets, and caseload, vary in each field according to the access PRs have to hospital services provided by host government and of the local implementation of the overall hospitalization policy.
There is reasonable health coverage for PRs in Jordan while UNRWA is the only health provider for most PRs in Lebanon. On-going conflict limits access to health care in Syria. Mixed caseloads permit priority to surgeries and deliveries in Gaza and UNRWA as being the alternative of MoH in West Bank.
Containing expenditure in the allocated budget was a challenge in 2018 in particular, considering the precarious financial condition of the Agency. In Lebanon and West Bank, where the financial pressure is highest due to the high level of expenditure, serious cost containment measures have been implemented and closely monitored: e.g. utilization of Palestine Red Crescent Hospitals and strict audit revision of invoices in Lebanon, utilization of bulk payment (lump sum contract) and suspension of non-urgent cases in West Bank. As a result, patients have decreased by 8 per cent in Lebanon and by 6 per cent in West Bank, while expenditure has decreased by 14 per cent in both Fields.
In Jordan, Syria and Gaza patient number and expenditure have been in line with previous years utilization patterns.
To avoid any risk of a strong reaction to that by Palestine Refugees, by hospitals or by MoH of the concerned host country, constant discussion was in place between UNRWA, the community and all local stakeholders.
Hear more about the challenges and key lessons in providing healthcare services to refugees in situations of crisis and responding to their critical needs from Dr Akihiro Seita in his keynote presentation at the IHF World Hospital Congress taking place in Muscat, Oman on 6-9 November 2019. Visit for more details.

[1] Latest UNGA resolution at the time of drafting A/RES/73/94 (7 December 2018).

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