Funding crisis threatens Palestinian refugee agency

Sharmila Devi

UN Relief and Works Agency for Palestine Refugees in the Near East says that a $300 million shortfall is threatening health services.

The UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) says it is facing its “worst financial crisis” with a funding gap of US$300 million this year, which could lead to the suspension of health and education services and failure to pay key workers’ salaries amid rising cases of COVID-19, particularly in the Gaza Strip.

The shortfall as of mid-November, 2020, was $115 million to cover purchases and the cost of running services. To pay salaries for 28 000 staff, it needs $30 million in November and $40 million in December.

Akihiro Seita, UNRWA’s director of health, told The Lancet that the agency’s budget crisis would affect its provision of lifesaving medical care—a last resort for many Palestinian refugees. “COVID-19 has made vulnerable Palestine refugees more vulnerable.

UNRWA alone cares for 280 000 people with diabetes and hypertension.”Donors have been trying to cover the gap left in 2018 when US President Donald Trump terminated annual US contributions of $300 million. But COVID-19 pandemic, increased needs, and donor fatigue have diminished funds.

The agency is hoping President-elect Joe Biden will restore assistance to Palestinians, but he does not take office until January.The agency has made cost cuts, saving $500 million over the past few years, but it remained under-funded, Tamara Alrifai, UNRWA spokesperson, told The Lancet.

“The first step is that UNRWA might only partially pay staff in November, and defer the remaining part of their salaries to a time when it has the necessary funds”, she said. “The effect of such a decision is dramatic on entire households that depend on one income…If no more funds come in over the coming few weeks, further adjustments may touch upon the delivery of services.”

Founded in 1949, UNRWA provides health services, education, and other humanitarian aid to 5·7 million Palestinian refugees and their dependants in the Gaza strip, the West Bank, East Jerusalem, Jordan, Syria, and Lebanon.

The situation is particularly difficult in Gaza, an enclave of 2 million people, where UNRWA is the biggest employer, employing around 13 000 people, amid unemployment of more than 50%. The Gaza strip accounted for 39% of active COVID-19 cases in the occupied Palestinian territory (oPt), where active cases rose to 9748 during Nov 3–7, according to the Palestinian Ministry of Health.

In total, there have been almost 80 000 confirmed cases and 676 deaths.Human rights organisations continue to call on Israel to issue more permits to allow patients to leave the Gaza strip. Patients need permission to reach health services available only in different parts of the oPt, with the majority needing access to East Jerusalem.

Ghada Majadli of Physicians for Human Rights Israel, which has coordinated between the Palestinian Authority and Israel on patient referrals, told The Lancet that the number of these permits has dropped dramatically since before COVID-19.

WHO data from 2020 show that 260 patients were given permission by Israel to leave in September, compared with a monthly average of 1777 in January and February.

“There are always shortages in Gaza and the situation is deteriorating, especially as a result of closure of borders by Israel and Egypt”, said Majadli.Almost a third of applications for permits are for patients with cancer, while others are for those needing specialised surgeries, diagnostic imaging, cardiology, or other services otherwise unavailable. These patients are very sick, with their probability of survival at 6 months from first permit application less than 90%, according to WHO.

Since Sept 6, WHO has been operating a temporary coordination mechanism to support Palestinian patients and companions from the Gaza strip to apply for Israeli exit permits. This temporary measure was adopted after the Palestinian Authority in May suspended coordination with Israel after a now-frozen Israeli plan to annex parts of the West Bank.

The Palestinian Authority announced on Nov 17 it would resume cooperation.Israel said it came under attack earlier in November when WHO’s virtual World Health Assembly (WHA) voted 78–14 to ask WHO to continue providing support in the oPt and to report on progress regarding access to and provision of health care. Norway delivered a statement on behalf of Iceland (they were two of 32 countries that abstained in the vote) saying that a Nov 11 WHO report on health conditions in the territories was “balanced and factual” but that there was “no place for politics” at the WHA.

Published in The Lancet: 28 November 2020