Hospitalisation coverage by UNRWA in Jordan, Lebanon, Syria, Gaza, and the West Bank: a comparative snapshot analysis

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) supports the hospitalisation of Palestine refugees with country-specific policies in five fields of operation; Jordan, Lebanon, Syria, Gaza, and the West Bank. The objective of this study was to compare caseloads and percentage vulnerability generated by the different policies. A comparative snapshot analysis was conducted on diagnoses for hospitalized patients (13 818 patients in total) for selected months in 2016 and 2017, categorized according to UNRWA-defined criteria (lifesaving, urgent, or non-urgent surgeries, and vaginal delivery or caesarian section). The vulnerability criterion was the Social Safety Net Program (SSNP) status of Palestine refugees (enrolment in the UNRWA SSNP). Data were processed in Excel. Ethical approval was granted from the UNRWA Department of Health. In Jordan, 85% of support (1905 of 2242 cases) was provided for deliveries (vaginal delivery or caesarian section). In Lebanon, 66% (2662 of 4064) were lifesaving and urgent interventions, 26% (1051) non-urgent surgeries, and 7% (284) deliveries. In Syria, 40% (637 of 1594) were urgent, 38% (605) non-urgent surgeries, and 19% (303) deliveries. In Gaza, 26% (675 of 2657) were urgent, 35% (924) non-urgent surgeries, and 40% (1058) deliveries. In the West Bank, 43% (1412 of 3261) were urgent, 10% (333) non-urgent surgeries, and 42% (1367) deliveries. The percentage of vulnerable cases reflects the safety net role of UNRWA: 16% (351) in Jordan, 20% (817) in Lebanon, 46% (738) in Syria, and 19% (506) in Gaza. In the West Bank, only 3% (106) of patients were vulnerable. The profile of patients that used the UNRWA hospitalisation support programme is consistent with hospitalisation policies in UNRWA's fields of operation and the different access that Palestine refugees have to local health services. There is reasonable health-care provision for Palestine refugees in Jordan, whereas UNRWA is the only health-care provider for most Palestine refugees in Lebanon. Ongoing conflict limits access to health care in Syria. Mixed caseloads reflect that priority is given to surgeries and deliveries in Gaza and that UNRWA is the alternative to Ministry of Health services in the West Bank, as the mixed UNRWA caseloads in the West Bank match those of government-supported hospitalisation services, suggesting that people use either one or another. In the case of Gaza, UNRWA-supported hospitals focus on those serv