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Principal Investigator: Alastair Ager, Queen Margaret University


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?



The study documented the impact of the displacement of Palestine refugees registered in Syria on the operation of UNRWA health systems through case studies in the contexts of Lebanon, Jordan and Syria. Interviews were undertaken with key informants across UNRWA fields in Lebanon, Jordan and Syria to document the health systems challenges precipitated by the Syria crisis and strategies adopted to address them. The study team modelled the systemic linkage of factors which influence health service functioning in circumstances of adversity. Scenario-based models were developed which explored three topics: utilisation of UNRWA clinics, reproductive health and service delivery for patients with diabetes. These allowed the identification of situations/strategies where interventions by UNRWA policy makers and field managers could yield greatest positive results. Finally, the models were validated against prospective data.

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 organization’s resilience.
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Key Outputs

  • One peer reviewed article and one commentary have been published
  • Four further peer reviewed articles and one book chapter are planned
  • Presentation of findings at World Health Assembly (May 2018)
  • Two briefing notes summarising the key findings.
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


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

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