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Principal Investigator: Alastair Ager, Queen Margaret University

What did the study set out to achieve?

The study aimed to assess the key vulnerabilities of UNRWA health systems in the face of disruptions associated with the displacement of Palestine refugees registered in Syria. It sought to understand the mechanisms that help systems withstand and adapt to such disruptions, and establish lessons to enhance the resilience of health systems in other contexts of protracted displacement.

Research Snapshot

What makes a health system resilient?


What were the key findings?

  • UNRWA health systems have proven resilient over the course of the Syrian crisis and maintained access to health care services as well as ensured delivery of quality care for Palestine refugees.
  • Resilience is illustrated by the health system’s ability to absorb shocks (e.g. an increased demand for services) and quickly adapt its response.
  • To meet the needs of Palestine refugees and health care staff, the system has at times been transformed. For example, the introduction of mental health and psychosocial wellbeing services.
  • Collaboration with external agencies (e.g. UNHCR) as well as internal UNRWA branches (Relief and Social Services) has been a critical component in providing care in hard to reach areas of Syria and in the new host countries of Lebanon and Jordan.
  • The commitment of UNRWA staff – most of whom are Palestine refugees themselves – and the reflective and responsive leadership of health managers and field office staff in each country constitute the core bases of the organisation’s resilience.

What does this mean for policymakers and practitioners?

Policymakers should view resilience as a property of complex and dynamic systems. A systems modelling approach, where stakeholders are actively engaged in discussing key pathways and elements of complex systems, can engage actors in identifying challenges and points for leverage. Such an approach can help build shared understanding of resilience in a specific context.

For humanitarian actors, ‘Absorption, adaptation and transformation’ is a simple framing method to reflect on alternative strategies to sustain service delivery. The following examples were specifically implemented by UNRWA-Syria:

  • Absorption- anticipating population and resource needs, reflecting on circumstances, mobilising available human, financial and
    organizational resources effectively.
  • Adaptation- coordinating to meet organisational goals, revising practices and distributing control.
  • Transformation- creating a culture of resilience by having dedicated and inclusive leaders and staff capable of creating new services/systems
Play video


Impact Case Study Health Systems & Services, Research Uptake

Impact Case Study: Increasing health system resilience during the Syria crisis

Peer Reviewed Health Systems & Services

Resilience capacities of health systems: Accommodating the needs of Palestinian refugees from Syria

Article Health Systems & Services

In support of UNRWA appeal for health and dignity of Palestinian refugees

Briefing Note Health Systems & Services

UNRWA SYRIA: Delivery of Health Services in the Context of the Syria Crisis

Briefing Note Health Systems & Services

Resilience across UNRWA systems in Syria, Lebanon and Jordan

Peer Reviewed Health Systems & Services

Health system resilience in the face of crisis: analysing the challenges, strategies and capacities for UNRWA in Syria

Latest Updates

Impact Case Study published

Jul 2023

This study was selected by the R2HC for our Research Impact Case Study series. The case study is now available to view online.


UNRWA: withstanding shocks and planning its future

Jan 2019

Over almost 70 years, UNRWA (the United Nations Relief and Works Agency for Palestine Refugees) has provided services to one group: Palestine refugees forced to leave Palestine during the second half of the 1940s following the Arab-Israeli conflict.


How we continued when we had to work 24/7? Commitment, nothing but commitment!

Apr 2017

Immigration is a topic that is rarely out of the headlines these days. There is large discussion around how western European countries are coping with the influx of migrants from…


Uncovering resilience

Mar 2017

As part of an R2HC funded project exploring health system resilience in the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA)* , I had…

UNRWA 2017 Photo by Maysoun Jamal Mustafa. Palestine refugee child from Syria being examined at Beddawi Health Centre, North Lebanon
UNRWA Health Clinic Staff - Elyse Callahan
UNRWA 2017 Photo by Maysoun Jamal Mustafa Palestine refugee from Syria being examined at Beddawi Health Centre
UNRWA 2017 Photo by Maysoun Jamal Mustafa NLA, Beddawi Health Centre,
UNRWA 2016 Photo by Mohammad Magayda The nurse measures Palestine refugee child weight at Irbid health center, Irbid
UNRWA 2016 Photo by Mohammad Magayda. The pharmacists use E-health system to deliver medications at Irbid health center, Irbid
UNRWA 2016 Photo by Mohammad Magayda. The dentist examines Palestine refugee patient at Irbid health center, Irbid
UNRWA 2016, Photo by Mohamamd Magayda, Nuzha Health Centre
UNRWA 2016 Photo by Mohammad Magayda. Doctor Nabeel examines a child at Nuzha Health Center, Amman
UNRWA 2016 Photo by Mohamamd Maga, The clerk schedules appointments for the patients at Nuzha Health Center, Amman
UNRWA 2016 Photo by Mohammad Magayda Palestine refugee adolescent from Syria being examined by the dentist at Zarqa heath center, Zarqa
UNRWA 2016 Photo by Mohammad Magayda. Various Palestine refugees waiting for their appointments at Zarqa Health Centre, Zarqa, Jordan
UNRWA 2016 Photo by Mohammad Magayda. The pharmacist delivers medications to the patients at Zarqa Heath Center, Zarqa

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