Access to Health care
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Access to health care
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Do stateless Palestinians have access to any existing Lebanese public healthcare system/healthcare insurance?
In a UN new brief, Dr Akihiro Seita noted that UNRWA was the only solution for Palestinian refugees needing primary hospital care.
“In Lebanon, where there are around 480,000 refugees registered with UNRWA, its medical director Dr Akihiro Seita, said that the agency was the “only solution” for primary and lifesaving hospital care for these displaced people.”
(Source: UN News, “News in Brief 24 May 2022”, 24 May 2022)
In a paper published in the Global Journal of Health in March 2022, it was noted that Palestinian refugees in Lebanon are ineligible for the State’s healthcare services.
“Lebanon currently also has approximately half a million Palestine refugees who are registered with the UNRWA. Close to half of these reside in camps with complicated health problems emerging from the deteriorating living conditions, low wages, high poverty and deprivation. Palestinian refugees in Lebanon are ineligible for the State’s health care services. They can only access health care through private sectors, which have high fees, or by international organizations such as UNRWA. UNRWA operates 28 primary health care facilities, providing both preventive and curative care. The UNRWA formed an agreement with Palestine Red Crescent Society (PRCS) to provide equity for Palestinian refugees in accessing secondary health care services. The UNRWA also works on decreasing the financial burden borne by the refugees by providing services such as family planning, preconception care, antenatal and postnatal follow-up, infant care, school health, oral health, outpatient consultations, diagnostics, laboratory services, vaccination, among others. In other words, UNRWA is playing the role of the Ministry of Health to provide Palestine refugees with essential health care services.”
(Source: Shadi Saleh, Sarah Ibrahim, Jasmin Lilian Diab, Mona Osman, “Integrating refugees into national health systems amid political and economic constraints in the EMR: Approaches from Lebanon and Jordan”, 12 March 2022, Volume 12, Journal of Global Health)
In its series of country reports for 2021, the US Department of State wrote about Lebanon:
“Palestinian refugees typically could not access public-health and education services [...].”
(Source: US Department of State (USDOS) “2021 Country Reports on Human Rights Practices: Lebanon”, Section 2. Respect for Civil Liberties, March 2022, p. 29)
In a public letter to the UNHCR published by UNRWA in June 2021, the relief agency stated that:
“Palestine refugees have limited access to public services in Lebanon [UNHCR 2016]. As such most Palestine refugees rely entirely on UNRWA for health care unless they can afford private health insurance. For Palestine refugees registered with UNRWA in Lebanon, UNRWA health services comprise primary health care that includes preventive interventions and general medical consultations, in addition to the coverage of 90 per cent of the costs of secondary hospital admissions and 60 per cent for tertiary admissions in selected hospitals. However, due to the significant costs of hospitalization in Lebanon for Palestine refugees without private health insurance, the sum not covered by UNRWA is still considered high, particularly for those with complex and/or chronic needs. Currently, for example, with limited exceptions [50 per cent of the cost for selected medication for cancer cases, 80 per cent for multiple sclerosis, and 95 per cent for thalassemia cases]. UNRWA is also not able to provide medications for chronic conditions. As a consequence, UNRWA is not able to provide comprehensive medical support to persons with disabilities with chronic medical needs. The additional costs will be prohibitive for many Palestine refugee families.”
(Source : UNRWA, “Letter from UNRWA to UNHCR in the case of NB and AB v. SSHD before the Court of Justice of the European Union (Case C-349/20).”, 21 June 2021, p. 5)
Human Rights Watch reported in an article about Lebanon’s vaccination campaign in April 2021 that:
“They [Palestinians] can get health care only through the private sector, which charges prohibitively high fees, or through international organizations like UNRWA.”
(Source: Human Rights Watch, “Lebanon: Refugees, Migrants Left Behind in Vaccine RolloutEnsure Greater Information Access”, 6 April 2021)
UNRWA noted that even those Palestine refugees in Lebanon who work and contribute to the National Social Security Fund are excluded from the sickness fund.
“PRL who have the right to work, are required to contribute to the Lebanese National Social Security Fund (NSFF) but are “still excluded from family allowance and the sickness and maternity fund”
(Source: UNRWA: “Protection brief Palestine refugees living in Lebanon Updated in September 2020”, Updated September 2020, p. 1)
The World Food Programme reported in June 2020 about the majority of Palestinian refugees in Lebanon without access to health insurance:
“Impact on healthcare
Public and private health care in Lebanon vary significantly as public health practitioners have always been underpaid compared to those providing private health care. Private hospitals account for 82 percent of Lebanon’s health care capacity [Human Rights Watch 2019], which is unaffordable and inaccessible to many. Since mid-2019, medical equipment importers, for both public and private hospitals in Lebanon, began facing difficulties in bringing medical supplies into the country due to the shortage of US dollars, which was exacerbated further in November due to the unofficial devaluation of the Lebanese pound. This has become more alarming with the emergence of the global pandemic. Around 95 percent of Palestinian refugees do not have health insurance in Lebanon which means they are heavily reliant on the UN Relief and Works Agency for Palestinian refugees (UNRWA) and other sources to cover hospital fees. As a result, most are completely dependent on Palestinian Red Crescent Society (PRCS) hospitals for medical care.”
(Source: WFP “Assessing the Impact of the Economic and COVID-19 Crises in Lebanon”, June 2020, p. 17)
In the internationally recognised book they published in 2020, legal scholars Dr. Francesca Albanese [currently Special Rapporteur on the situation of human rights in the Palestinian Territory] and Professor Lex Takkenberg wrote:
“As foreigners, Palestinian refugees do not have access to Lebanese public health services and rely mainly on UNRWA for health services, in addition to assistance from charities. Through UNRWA, they can access primary health care, although not all medical services and treatments are possible through UNRWA clinics; UNRWA financially assists refugees with partial cost coverage for treatment in secondary and tertiary health care in UNRWA-contracted hospitals. UNRWA’s frequent funding shortages hamper its capacity to meet refugees’ demands.”
(Source: “Francesca P. Albanese and Lex Takkenberg/Oxford University Press, Palestinian Refugees in International Law”, May 2020, Chapter 3.3.3, Legal Status and Treatment, p. 276)
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Is there evidence that stateless Palestinians have difficulties accessing health care? If so, what are the reasons?
Despite UNRWA providing support, stateless Palestinians have difficulty accessing health care:
“Lebanon: Sector specific interventions: […] During the reporting period, 348 refugees (251 PRL, 10 PRS and 87 PRL/ PRS cancer and chronic disease patients) were supported under the MHF [Medical Hardship Fund] to top-up their hospitalisation coverage or to purchase medications for chronic illnesses. Hospitals now require patients to settle their accounts in US dollars, which is not affordable for the majority of refugees and results in a reduction in the number of patients seeking tertiary care. In addition, the absence of cancer medications, usually distributed by the MoPH [Ministry of Public Health] at a subsidised rate, resulted in a decrease in the number of Palestine refugees receiving treatment.”
(Source: UNRWA, “Syria, Lebanon and Jordan, 2022 Emergency Appeal Progress Report for the reporting period 1 January – 30 June 2022”, 3 November 2022, p. 27)
UNRWA struggles to meet the health needs of Palestine refugees:
“During the year, Agency operations were adapted to address the impact of the financial and economic crises that continued to affect Lebanon […] As the crisis deepened, violent incidents against Agency staff increased, particularly in health centres where demand for otherwise unobtainable medicines spiked. From July, fuel shortages also forced many Area staff residing in camps to work from home. This arrangement was challenged under chronic power cuts with many staff having access to only two-hours of electricity per day for much of the summer and autumn.”
[…] In 2021, there were closures of UNRWA installations for at least 53 days in Lebanon, in addition to 24 partial closures. Closures were mostly the result of strikes and protests by beneficiaries and general civil unrest. Palestinian factions closed UNRWA installations on several occasions to demand further support from UNRWA due to the growing vulnerability and socio-economic challenges faced by PRL.”
(Source: UNRWA, “Annual Operational Report 2021” 27 October 2022, pp. 11-12, and p. 16)
UNRWA also published an article in October 2022 outlining the increasingly limited access to healthcare and affordable medical treatment following rising costs:
“The cost of water, fuel, electricity, gas, transport and health care is now three to five times higher. Medicines are increasingly unavailable on the market and families are unable to afford them since government subsidies have been lifted. Too many Palestine refugee families are no longer able to afford secondary health care. Some are skipping lifesaving treatment to avoid accumulating debts.”
(Source: UNRWA, “Hitting Rock Bottom - Palestine Refugees in Lebanon Risk Their Lives in Search of Dignity”, 21 October 2022)
In their “Syria, Lebanon and Jordan Emergency Appeal 2022, UNRWA wrote:
“[...] UNRWA also contributes 50 per cent of the total cost of medications not available at UNRWA health centres for around 640 patients (with an annual ceiling of US$ 8,000 per patient) to cover treatments for cancer, thalassemia, multiple sclerosis and sickle cell anaemia. [ft. 34, notes, “The report also notes “Hospitalization costs per patient are higher in Lebanon than in the Agency’s other fields of operation. UNRWA contributes to tertiary care for invoices up to US$ 4,000, mainly for PRL patients registered with the SSNP as well as for PRS. For this purpose, a refined Medical Hardship Fund (MHF) was instituted in 2016 as part of the hospitalization reform which introduced cost co-sharing with patients (tertiary care: 60 per cent UNRWA and 40 per cent patient; secondary care: 90 per cent UNRWA and 10 per cent patient at non-PRCS (Palestine Red Crescent Society) hospitals for secondary care).”
[…] Shortages of medicines in the local market and the massive price increase for vital NCD medications and other medicines and medical supplies necessitates the need to secure funds through this EA to maintain sufficient stocks for PRL and PRS patients.”
(Source: UNRWA, “Syria, Lebanon and Jordan Emergency Appeal 2022”, 18 January 2022, p. 36)
UNRWA in this report titled: Palestine Refugees in Lebanon: Struggling to Survive, wrote:
“ESCWA estimates that the share of households deprived from health care rose to 33 per cent in 2021 from 9 per cent in 2019, which corresponds to around 400,000 households out of a total of 1,210,000. [ESCWA, Multidimensional poverty in Lebanon (2019- 2021), September 2021]. The situation will deteriorate further if the government completely ends subsidies on health care and medicine. Given that some 55 per cent of the population are not covered by any form of health insurance, an end to government subsidies will be detrimental. In mid-November, the government lifted additional subsidies on medicine drugs used for cholesterol, blood pressure and other diseases [As reported in Al-Arabiya on 17 November 2021, “From bad to worse: Lebanon lifts more medicine subsidies”] and there are concerns about devastating consequences if subsidies on drugs needed for chronic diseases are completely removed. […] There are alarming reports on Palestine refugees who are forgoing essential treatments for chronic diseases due to their inaccessibility and lack of health insurance coverage. The Agency’s hospitalization policy covers only a percentage of hospital expenses and an increasing number of Palestine refugees are now unable to cover the remaining cost of care.”
(Source: UNRWA, “Palestine Refugees in Lebanon: Struggling to Survive” 18 January 2022, p. 12)
UN News stated in May 2022 about UNRWA’s difficulties to meet Palestinian refugees’ medical needs:
“The health and wellbeing of many Palestinian refugees is at risk if greater funding is not found soon to offset higher costs caused by the global economic crisis, the UN relief agency for Palestinians, UNRWA, said on Tuesday.
In Lebanon, where there are around 480,000 refugees registered with UNRWA, its medical director Dr Akihiro Seita, said that the agency was the “only solution” for primary and lifesaving hospital care for these displaced people.
But medicines now cost more because of price inflation, and hospital costs for those with mental health problems in Lebanon had risen from $90 per night before the current economic crisis, to $200 per night now, Dr Seita explained.
(Source: UN News, “News in Brief 24 May 2022”, 24 May 2022)
In its annual report for the year 2021, UNRWA’s department of health gave a summary of its primary mission:
“In 2021, the Syrian crisis entered its tenth year. Approximately 40 percent of the 438,000 Palestine refugees in the country have been internally displaced and more than 120,000 Palestine refugees have fled to neighbouring countries, including Jordan and Lebanon. Being doubly displaced, Palestine refugees from Syria (PRS) are often identified as highly vulnerable and more reliant on UNRWA services. During the reporting period, political unrest continued in Lebanon, with the financial crisis in the country deepening, causing fuel scarcity, rampant inflation and shortages of medicines, all of which posed significant challenges for the continuity of UNRWA health services.”
(Source: UNRWA, “UNRWA Department of Health, Annual Report 2021”, 24 May 2022, p. 10)
The UN Office for the Coordination of Humanitarian Affairs stated in April 2022 that:
“Compared to the Lebanese population, more than half of all PRL [Palestinian refugees in Lebanon] households reported that they have at least one member in the household with a health problem who needed to access health care in the three months prior to the assessment [Lebanese Crisis Response Plan 2022, Food Security Section]. The main barriers reported by PRL households in accessing health were the costs related to treatment, consultation, and transportation, same as for Lebanese and migrants [REACH Initiative, Multi-Sectoral Needs Assessment (MSNA), December 2021]. The main coping strategies adopted by households included going to the pharmacy instead of the doctor or clinic, switching to a healthcare facility closer to home, or delaying or cancelling doctors visit or other treatment. More than two-thirds of PRL households (70 percent) across all regions reported that because medication was too expensive, they did not access the needed medication.[REACH Initiative, Multi-Sectoral Needs Assessment (MSNA), December 2021]”
(Source: OCHA, “Increasing Humanitarian Needs in Lebanon, April 2022”, 14 April 2022, p. 27)
In its series of country reports for 2021, the US Department of State wrote about Lebanon:
“Palestinian refugees typically could not access public-health and education services [...].”
[…] “Palestinian refugees who fled Syria for the country since 2011 received limited basic support from UNRWA, including food aid, cash assistance, and winter assistance, such as cash to purchase fuel for heating. Authorities permitted children of PRS to enroll in UNRWA schools and access UNRWA health clinics.”
(Source: US Department of State (USDOS) “2021 Country Reports on Human Rights Practices: Lebanon”, Section 2. Respect for Civil Liberties, March 2022, p. 29)
UNRWA has also noted what they have done to curb the effects of COVID-19:
“Finally, the impact of COVID-19 has been keenly felt among Palestine refugees. By 31 October, 15,443 Palestine refugees had been infected with the virus, with 1,819 requiring hospitalization and 443 losing their lives. Amongst UNRWA staff, there have been 888 positive cases and five deaths. Vaccine hesitancy is high among Palestine refugees, with 45,831 having received one dose and 35,309 two doses of the vaccine, either at a Lebanese hospital or UNRWA facility. In order to address emerging needs across the Palestine refugee population, the 2022 EA focuses on ensuring regular cash assistance for vulnerable groups amongst PRS and PRL. Under this appeal, UNRWA is expanding support towards vulnerable PRL families who have been disproportionately affected by the crises impacting Lebanon. The Agency will provide 162,301 PRL, PRS and other eligible populations21 with emergency cash assistance to support them meet their most basic needs. Other essential services such as health, education and protection will also continue, adjusted to the COVID-19 context to ensure the safety of staff and beneficiaries. Under this appeal, UNRWA will ensure the continuity of learning for 39,129 Palestine refugee students; will continue to provide primary, secondary and tertiary health care to PRS, as well as additional secondary and tertiary care to 6,210 of the most vulnerable PRL affected by the crisis; and will ensure that Palestine refugees with protection concerns are supported, including with referral pathways.”
(Source: UNRWA, “Syria, Jordan and Lebanon Emergency Appeal 2022”, January 2022, p. 16)
In a public letter to the UNHCR published by UNRWA in June 2021, the relief agency stated that:
“Palestine refugees have limited access to public services in Lebanon [UNHCR 2016]. As such most Palestine refugees rely entirely on UNRWA for health care unless they can afford private health insurance. For Palestine refugees registered with UNRWA in Lebanon, UNRWA health services comprise primary health care that includes preventive interventions and general medical consultations, in addition to the coverage of 90 per cent of the costs of secondary hospital admissions and 60 per cent for tertiary admissions in selected hospitals. However, due to the significant costs of hospitalization in Lebanon for Palestine refugees without private health insurance, the sum not covered by UNRWA is still considered high, particularly for those with complex and/or chronic needs. Currently, for example, with limited exceptions [50 per cent of the cost for selected medication for cancer cases, 80 per cent for multiple sclerosis, and 95 per cent for thalassemia cases]. UNRWA is also not able to provide medications for chronic conditions. As a consequence, UNRWA is not able to provide comprehensive medical support to persons with disabilities with chronic medical needs. The additional costs will be prohibitive for many Palestine refugee families.”
(Source : UNRWA, “Letter from UNRWA to UNHCR in the case of NB and AB v. SSHD before the Court of Justice of the European Union (Case C-349/20).”, 21 June 2021, p. 5)
Human Rights Watch reported in an article about Lebanon’s vaccination campaign in April 2021 that:
“Many [Palestinians] have very little trust in the Lebanese government, which has systematically discriminated against them and barred them from getting government social services, including health care. They can get health care only through the private sector, which charges prohibitively high fees, or through international organizations like UNRWA.”
(Source: Human Rights Watch, “Lebanon: Refugees, Migrants Left Behind in Vaccine Rollout Ensure Greater Information Access”, 6 April 2021)
UNRWA noted that even those Palestine refugees in Lebanon who work and contribute to the National Social Security Fund are excluded from the sickness fund.
“PRL who have the right to work, are required to contribute to the Lebanese National Social Security Fund (NSFF) but are “still excluded from family allowance and the sickness and maternity fund”
(Source: UNRWA: “Protection brief Palestine refugees living in Lebanon Updated in September 2020”, p. 1)
The same source also discussed the bigger picture:
“[...] In the last quarter of 2021, Lebanon was fluctuating between the third and fourth COVID-19 community transmission phase, according to WHO daily briefs. By October 2021, 76,000 Palestine refugees had received both doses of the COVID-19 vaccination. UNRWA will continue to support national vaccination efforts, through raising awareness of the importance of vaccination across the Agency’s staff and Palestine refugees. Through this EA the Agency will also continue to cover the cost of PCR tests for 10,000 PRL and PRS, in addition to providing medications and hospitalization costs for approximately 1,000 refugees requiring COVID-19 treatment. UNRWA will maintain COVID-19 prevention and control through multiple interventions aimed at vulnerable refugees and Agency staff, including: (i) awareness raising on good hygiene practices; (ii) the use of appropriate disinfectants; and (iii) the provision of PPE to all health staff. Based on the situation in 2021, there will be a need to hire 112 additional health staff in 2022 to cover the work of staff who are absent due to contracting COVID-19 or who need to self-isolate or quarantine.”
(Source: UNRWA, “Syria, Jordan and Lebanon Emergency Appeal 2022”, January 2022, p. 36)
The World Food Programme reported in June 2020 about the majority of Palestinian refugees in Lebanon without access to health insurance:
“Impact on healthcare
Public and private health care in Lebanon vary significantly as public health practitioners have always been underpaid compared to those providing private health care. Private hospitals account for 82 percent of Lebanon’s health care capacity [Human Rights Watch 2019], which is unaffordable and inaccessible to many. Since mid-2019, medical equipment importers, for both public and private hospitals in Lebanon, began facing difficulties in bringing medical supplies into the country due to the shortage of US dollars, which was exacerbated further in November due to the unofficial devaluation of the Lebanese pound. This has become more alarming with the emergence of the global pandemic. Around 95 percent of Palestinian refugees do not have health insurance in Lebanon which means they are heavily reliant on the UN Relief and Works Agency for Palestinian refugees (UNRWA) and other sources to cover hospital fees. As a result, most are completely dependent on Palestinian Red Crescent Society (PRCS) hospitals for medical care.”
(Source: WFP “Assessing the Impact of the Economic and COVID-19 Crises in Lebanon”, June 2020, p. 17)
In the internationally recognised book they published in 2020, legal scholars Dr. Francesca Albanese [currently Special Rapporteur on the situation of human rights in the Palestinian Territory] and Professor Lex Takkenberg wrote:
“As foreigners, Palestinian refugees do not have access to Lebanese public health services and rely mainly on UNRWA for health services, in addition to assistance from charities. Through UNRWA, they can access primary health care, although not all medical services and treatments are possible through UNRWA clinics; UNRWA financially assists refugees with partial cost coverage for treatment in secondary and tertiary health care in UNRWA-contracted hospitals. UNRWA’s frequent funding shortages hamper its capacity to meet refugees’ demands.”
(Source: “Francesca P. Albanese and Lex Takkenberg/Oxford University Press, Palestinian Refugees in International Law”, May 2020, Chapter 3.3.3, Legal Status and Treatment, p. 276)
A survey from UNRWA revealed the high dependency of RPS on UNRWA health services:
All PRS are entitled to primary health care in UNRWA health centres and referrals to contracted hospitals for secondary and (subsidized) tertiary care and ambulatory services. […] Since UNRWA does not run any hospitals in Lebanon, its hospitalization services consist mainly of referral services towards contracted Lebanese hospitals. Over three quarters of PRS seeking hospitalization (79.3 percent) had access to such UNRWA services. This relatively high figure can be explained by the fact that virtually no PRS (99 percent) have health insurance cover other than through UNRWA.
(Source: UNRWA, “Socio-economic Survey on Palestine Refugees from Syria Living in Lebanon”, 28 April 2021, pp. 36 & 37)
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How has Covid 19 impacted access to healthcare?
In October 2021, the UK-based NGO Medical Aid for Palestinians (MAP) submitted a letter to the UN Special Rapporteur on Extreme Poverty and Human Rights, ahead of his visit to Lebanon in November 2021. In a blog article about the submission, MAP quoted a May 2021 interview with “Inas*, a resident of the Ein el Helweh refugee camp:“When we go to a hospital for any problem, they won’t receive us without a negative PCR [COVID-19] test, which costs 75,000 to 180,000 Lebanese Pounds [£35 to £85 GBP]. We don’t have this money, so we decided not to go to the hospital even for essential matters”. MAP further stated that:
”In the submission, MAP highlights how these issues have disproportionately affected people with disabilities; pregnant women, nursing mothers and infants; and young Palestinian refugees. MAP has invited the Special Rapporteur to visit affected Palestinian refugee communities on his visit.
(Source: MAP, “MAP highlights plight of Palestinian refugees in Lebanon to UN Special Rapporteur on Extreme Poverty”, 12 October 2021)
In its annual report for the year 2021, UNRWA’s department of health stated that:
“Palestine refugees in all fields have been affected by COVID-19. By the end of 2021, the accumulated number of cases from Jordan, Lebanon, Palestine and Syria since the beginning of the pandemic totalled 2,315,550, resulting in 29,626 deaths, of which, 147,651 cases and 1,559 deaths were reported among Palestine refugees. The number of confirmed cases increased dramatically in all fields during 2021. As anticipated, the deterioration of the epidemiological situation continued with new variants emerging. In 2021 alone, the confirmed cases reached 1,672,027 and 21,674 deaths, of which, 120,519 cases and 2,063 deaths were reported among Palestine refugees. Many more Palestine refugees continue to suffer from the consequences of lockdown and health measures that were put in place to control infection. The pandemic has exacerbated the existing poverty and vulnerability of Palestine refugees.”
(Source: UNRWA, “UNRWA Department of Health, Annual Report 2021”, 24 May 2022, p. 11)
The same source further reported that:
“As shown in the graph below, Jordan reported 8,819 cases and 928 deaths. Lebanon reported 13,246 cases and 348 deaths, Syria reported 689 cases and three deaths and West Bank reported 23,723 cases and 95 deaths. In Gaza, the largest number of cases among Palestine refugees were recorded, with 74,042 cases and 689 deaths. These numbers include UNRWA staff who are also a part of the refugee community.”
(Source: UNRWA, “UNRWA Department of Health, Annual Report 2021”, 24 May 2022, p. 12)
Table 3: Number of COVID-19 cases reported among Palestinians refugees in 2021
UNRWA fields of operations
Number of cases
Number of deaths
Jordan
8,819
928
Lebanon
13,246
348
Syria
689
3
Gaza
74,042
689
WB (including East Jerusalem)
23,723
95
Total
120,519
2,063
UNRWA, in a separate report, also noted that:
“With the ongoing social and economic crisis, Palestine refugees are facing difficulties in covering their most basic health care needs, which were already inaccessible even before the crisis. There are alarming reports on Palestine refugees who are forgoing essential treatments for chronic diseases due to their inaccessibility and lack of health insurance coverage. The Agency’s hospitalization policy covers only a percentage of hospital expenses and an increasing number of Palestine refugees are now unable to cover the remaining cost of care. The reported numbers of COVID-19 related deaths show that the mortality rate for Palestine refugees is three times higher than the rates for Lebanese citizens [...] as a result of the living conditions and cramped camps where social distancing is almost impossible. As of 31 December 2021, 489 Palestine refugees have died as a result of COVID-19.”
(Source: UNRWA, “Palestinian Refugees in Lebanon: Struggling to Survive”, January 2022, p. 12)
The news and information services company Thomson Reuters wrote in February 2021 that:
“Palestinian refugees in Lebanon are three times more likely to die with COVID-19 than the population as a whole, according to U.N. figures that highlight the pandemic’s outsized impact on the community.
[…] Most Palestinians who died after contracting the disease in Lebanon had health conditions such as cardiac or pulmonary issues, which are aggravated by poverty and conditions in the camps, said UNRWA spokeswoman Hoda Samra.
Cramped living conditions and the need to go out to work meant Palestinian refugees were more likely to be exposed to the virus, she added.
«Vulnerable communities tend to have poorer baseline health conditions, hence more co-morbidities and chronic health conditions,» said Joelle Abi Rached, an associate researcher at Sciences Po University in Paris.”
(Source: Thomson Reuters Foundation News “Palestinian refugees in Lebanon three times more likely to die with COVID-19”, 16 February 2021)
The World Food Programme reported in June 2020 about Palestinian refugees’ access to medicine in Lebanon:
“Out of respondents who had to buy medicine in the last month, 56 percent of Lebanese respondents reported facing challenges in accessing medicine, while 71 percent of Palestinians and 73 percent of Syrians reported encountering challenges. With vast majorities not being able to afford medicine.”
(Source: WFP “Assessing the Impact of the Economic and COVID-19 Crises in Lebanon”, June 2020, pp. 17-18)
The New Humanitarian (formerly IRIN News) reported in April 2020 about the impacts of COVID-19 on the refugee population in Lebanon:
“Assaf, a Syrian refugee, underwent treatment for breast cancer last year and is still prescribed medication for that diagnosis, as well as for chronic heart problems and diabetes.
Until recently, a local NGO brought her the medication she needs to stay healthy. But on 15 March Lebanon instituted a nationwide night-time curfew, and various municipalities put in place their own restrictions on the movements of the country’s estimated 1.5 million refugees. Some have also limited the ability of aid workers to enter camps like the one Assaf lives in, even though these informal settlements have so far had no documented cases of COVID-19. As of 20 April, Lebanon had 677 confirmed cases of the virus, and 21 deaths.
Aid groups say they are having a harder time getting non-coronavirus medical care to refugees, and clinics that serve Syrians say they have seen a drop-off in visitors.
[...]Differing regulations
While MSF and Amel are still reaching patients in more remote parts of Lebanon, some – mostly smaller – NGOs that previously provided mobile medical services told TNH they had been being blocked from entering the camps.
This appears to be partly due to new restrictions on refugee movement, like extra curfews, rolled out, according to a recent Human Rights Watch count, by at least 21 municipalities. There are no hard and fast rules for when NGOs can enter the camps or when people can leave them, enforcement varies, and access often seems to depend on location and pre-existing relationships with local authorities.”
(Source: The New Humanitarian, “How COVID-19 is limiting healthcare access for refugees in Lebanon”, 21 April 2020)42
(Lack of) access to anti-Covid19 vaccination
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Was vaccination made available for stateless Palestinians in Lebanon?
UNRWA stated in its 2021 Annual Operational Report that:
“During the second half of 2021, COVID-19 infection rates continued to decline; however, cases started to increase again at the beginning of December. To mitigate the spread of the virus, the government introduced new preventive measures and imposed country-wide movement restrictions in the evenings for anyone who had not been vaccinated. To increase coverage, the MoPH secured vaccines for a nationwide “vaccination marathon” over several weekends, targeting all eligible persons aged 12 and over. By the end of the year, 38.9 percent of Lebanon’s
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Publication date is outside of this reports reference period, however this excerpt was as it contained relevant information on curfew.
residents had received two doses of the vaccine. Only 118,684 vaccines were administered to Palestine refugees with only 25.2 percent receiving one dose, 19 percent receiving a second dose, and 1.6 percent receiving a booster shot by 31 December.”
(Source: UNRWA, “Annual Operational Report 2021” 27 October 2022, p. 117)
In their “Syria, Lebanon and Jordan Emergency Appeal 2022, UNRWA wrote:
“The impact of COVID-19 has been keenly felt among Palestine refugees. By 31 October, 15,443 Palestine refugees had been infected with the virus, with 1,819 requiring hospitalization and 443 losing their lives. Amongst UNRWA staff, there have been 888 positive cases and five deaths. Vaccine hesitancy is high among Palestine refugees, with 45,831 having received one dose and 35,309 two doses of the vaccine, either at a Lebanese hospital or UNRWA facility.”
(Source: UNRWA, “Syria, Lebanon and Jordan Emergency Appeal 2022”, 18 January 2022, p. 16)
The UNHCR reported in June 2021 about the Lebanese national vaccination strategy: “Good practices
A number of national vaccination strategies do not differentiate between residents based on legal status or nationality:
[…] In Lebanon, stateless persons are included in national vaccination plans and can register for vaccines. Following advocacy efforts, a stateless-ness option was added to the required nationality field in the online registration platform, enabling stateless persons to register.”
(Source : UNHCR, “The impact of covid-19 on stateless populations”, June 2021, p. 5)
Human Rights Watch denounced Lebanon’s vaccination campaign in an article published in April 2021:
“The Lebanese government’s Covid-19 vaccination program risks leaving behind marginalized communities, including refugees and migrant workers, Human Rights Watch said today. Despite the government’s promises of an equitable program, the effort has been tainted by political interference and a lack of information.
United Nations data shows that Syrian and Palestinian refugees have died from Covid-19 at a rate more than four and three times the national average, respectively. Yet, according to the government’s online Covid-19 vaccine registration and tracking platform, only 2.86 percent of those vaccinated and 5.36 percent of those registered to receive vaccinations are non-Lebanese, even though they constitute at least 30 percent of the population.
[…] Although the 200,000 Palestinian refugees do not face the same fears over arrest and deportation, many have very little trust in the Lebanese government, which has systematically discriminated against them and barred them from getting government social services, including health care.
Mistrust of the Lebanese government runs so deep that Palestinian refugees told Human Rights Watch they fear that even if they were to register, they would not actually receive the vaccine and would have to pay a fee they could not afford.
[…] Lack of Information Among Refugees, Migrants
[…] The Palestinian refugees that Human Rights Watch spoke with also lacked awareness about the government’s vaccination plan and their eligibility and expressed fear that they would be discriminated against in the rollout, given the Lebanese government’s history of discriminating against them in access to virtually all social services.”
(Source: Human Rights Watch, “Lebanon: Refugees, Migrants Left Behind in Vaccine Rollout Ensure Greater Information Access”, 6 April 2021)
The news and information services company Thomson Reuters wrote in March 2021 that:
“Lebanon has also committed to providing COVID-19 vaccines to about 1.2 million Syrian and Palestinian refugees living within its borders in a process being overseen by U.N. agencies. So far, only a small number of them have been vaccinated.
The vaccine roll-out has been overshadowed by favouritism towards the well-connected, inspiring little confidence that marginalized groups will end up getting the jab, said Farah Baba of local human rights NGO the Anti-Racism Movement.”
(Source: Thomson Reuters Foundation News “No papers, no jab: Lebanon’s migrants face barriers to COVID-19 vaccination”, 1 March 2021)
Communicable diseases other than Covid-19
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Are other communicable diseases affecting stateless Palestinians in Lebanon?
Walaa Kayyal, a researcher who lives herself as a Palestinian in Lebanon who was interviewed for this report also confirmed the recent spread of Hepatitis but indicated that it did not concern Palestinians or Syrians specifically:
“Hepatitis A is a communicable disease spread through water. The more polluted the environment you reside in, higher the risk you will get hepatitis A. For Lebanese, they live in bigger houses with better infrastructures but are still getting hepatitis A because their water comes from the same source. Let me give you an example. Last month we went to my mother, who is Lebanese and lives in a village. My brother got hepatitis A from there. My uncle, who is rich and lives in a mini villa, also got hepatitis A, because the water is polluted. But from a public health perspective, when you are more vulnerable, it means you are living in a harsher situation, in a harsher environment where access to services is minimal. When the services are available, they are of a bad quality. So a person who is living in a luxurious place getting hepatitis A and a person who is living in a camp or an informal settlement can both get hepatitis A but the risk of the second and the third are higher than for the first.”
(Source: Walaa Kayyal, interview record, 31 October 2022)
Walaa Kayyal, a researcher who lives herself as a Palestinian in Lebanon who was interviewed for this report also mentioned cases of Cholera:
“We have cholera now in Lebanon. However the Lebanese government is not openly saying how many cases there are and where they are concentrated. As usual, they are blaming the Syrians for transmitting cholera to the country. They say that all the cholera cases are concentrated among Syrians. So you will never know unless you contract it. When COVID-19 hit the country, the Lebanese government also said that it was among Syrians, that they brought it to the country, etc. Then the number of COVID-19 infections started rising and rising and they started to collect data on the nationality, place of residence and age of those infected. So now we have cholera, but I cannot tell you how bad the epidemic is. Until now I heard of 300-something cholera cases and maybe up to 13 deaths from cholera. But I cannot tell you where this is actually concentrated because the Lebanese government does not communicate.”
(Source: Walaa Kayyal, interview record, 31 October 2022)
The Jordanian political economist and long-time commentator on the Israeli-Palestinian dialogue Riad Al Khouri who was interviewed for this report in October 2022 shared his concerns about the spread of a cholera outbreak from Syria to Lebanon:
“There is now a major problem with an outbreak of cholera in Syria. This happened over the last few weeks. The reason for this outbreak is due to polluted water. The water is not clean. This is partly because of the fighting in Syria and the situation of violence and militias and foreign armies and so forth, partly because of the gradual breakdown of public services that has been going on now for decades... [...]”
(Source: Riad Al Khouri, interview record, 7 October 2022)
In its annual report for the year 2021, UNRWA’s department of health wrote about an increase of hepatitis A among the population of Palestinian refugees in the countries where the organisation works:
“Other Communicable Diseases Viral Hepatitis
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