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)