Systems resilience in UNRWA health provision to Palestine refugees displaced by Syria crisis

Purpose

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.

Outcomes

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.

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.