Social determinants and mental health needs of Palestine refugees and UNRWA responses in Gaza during the COVID-19 pandemic: a qualitative assessment

Refugees are especially susceptible to the negative effects of the pandemic, though its impact on this group remains unclear. This study aimed to determine the mental health effects of COVID-19 on Palestine refugees in Gaza by identifying the role of social determinants, and to assess the efficacy and acceptability of the pandemic response measures enacted by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA).

This qualitative study took place between August and November 2020. Twenty-nine key-informant interviews were conducted remotely with UNRWA Headquarters, field and clinical staff in Gaza, and with community members aged 18 years and over, residing in Rafah and Jabalia camps. Data were coded based on the framework for social determinants of mental health.

Interview results indicated that the relationship between COVID-19 and living conditions was often bidirectional: COVID-19 degraded living conditions, while poor living conditions worsened COVID-19 transmission. Women, children, and daily-paid employees experienced significantly more violence and anxiety than other groups. UNRWA adapted its service delivery to continue providing essential services, and its strategies were considered beneficial overall, though insufficient to meet Gazans' needs.

The pandemic highlights the need to go beyond disease treatment and prevention to address social determinants and reduce refugees' susceptibility to future shocks. UNRWA's rapid rollout of telemedicine and mental telehealth services makes it important to assess the efficacy of these novel approaches, with a hybrid strategy combining online and in-person therapy as a possible long-term option.

This publication relates to R2HC funded study; Health system and community responses to COVID-19 among Palestine refugees in Gaza and Lebanon