For nearly 70 years, The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) has delivered lifesaving assistance to more than five million Palestinian refugees in Lebanon, Syria, Jordan and the occupied territories. The agency allocates 17% of its budget in order to safeguard the health of the refugees and reduce the burden of disease. With 143 primary health facilities, more than three million refugees accessing the UNRWA health services and nearly nine million annual patient visits, the agency is critical to the wellbeing of countless Palestinians – the recent decision of the United States (US) to cut UNRWA funding could put millions of lives at risk.

According to a recent World Bank report, such a devastating setback to UNRWA will have a “severe impact on its ability to provide education, health services and food parcels to more than one million Gazans”. Back in January 2018, the Trump administration had withheld about $305 million in funding and only delivered $60 million to UNRWA. Consequently, the agency spent eight months struggling to find financial assistance and was only able to continue operating after large donations, including $150 million raised by Qatar, the United Arab Emirates and Saudi Arabia.

Nearly all of the population in the Gaza Strip receives support from the agency. UNRWA is said to function partially as a de facto government in that area, overseeing the bulk of schools, healthcare facilities and other public services. In the healthcare sector, UNRWA offers both preventive and curative health services ranging from reproductive health, infant and child care and school health to non-communicable diseases (NCDs), mental health and rehabilitation and physiotherapy, along with many more.

According to UNRWA’s 2017 annual Health Report, by the end of 2017, 98.6% of newly registered pregnant women were protected against tetanus, and post-natal coverage reached up to 95% of pregnant women. The analysis for the agency’s drug expenditure revealed that more than half of the budget was spent on medicine for the treatment of NCDs. The report also indicates that due to the high rate of immunization coverage for all age groups, no cases of vaccine-preventable disease outbreaks were recorded all through 2017.

The complete discontinuation of US funds will force programs developed with, and entirely funded by, the US Agency for International Development (USAID) to wind down. As a consequence, it will no longer be possible to bring doctors to Gaza to perform various complex surgeries, including intricate eye surgeries. This will also halt the training of local surgeons to operate on eyelids, a training which is normally unavailable in Gaza. UNRWA will also be prevented from subsidizing the surgeries. For the 1,050 type 1 diabetes patients registered with UNRWA, the earlier budget cuts meant that blood sugar test strips were no longer provided, forcing the patients to manage their condition without knowing the details of their current status. Typically, Al-Rimal Clinic, supported by UNRWA, provides insulin and syringes to patients suffering from type 1 diabetes, so budget cuts could cause a shortage of needed medication. Moreover, cuts in funding will lead to a halt in providing food vouchers to Palestinian refugees.

The UNRWA Central Support Services Division (CSSD) is responsible for the procurement, distribution and provision of the services required to support the Palestinians in all of the agency’s areas of operation. UNRWA regularly procures maintenance services, pharmaceuticals and drugs along with equipment (including medical and lab, ICT and transport). UNRWA also collaborates with other UN agencies to procure fuel for generators and heaters. Recently, the UN has issued warnings that both hospitals and sanitation services could face complete shutdowns in Gaza if generator fuel is not financed through international support. If the fuel shortages continue, Gaza’s health sector will once again experience severe setbacks, such as postponing elective surgeries and reducing 80% of cleaning, catering and sterilization services.

Following the US decision to cut its funding, UNRWA announced that the contracts of 1,000 of its employees in the Gaza Strip will not be renewed. This includes the termination of the mental health program, which employs 430 people. The healthcare sector alone employs well over 3,000 personnel, and the contracts of some employees working in the UNRWA health department responsible for helping children with speech and hearing disabilities were terminated. According to Amal al-Batsh, the deputy chairman of the UNRWA’s staff union, the “unjust decisions” will have a negative impact on all services provided to refugees and those employed by UNRWA, along with their families, in terms of their psychological state, adding to the deteriorating living conditions in Gaza.

The budget cuts exacerbate existing obstacles faced by Palestinians seeking healthcare. Gaza’s ongoing electricity crisis and power shortages undermine the healthcare system and make it exceedingly difficult for patients to receive proper healthcare. Moreover, a problematic permit system has constrained the ability of Gazan cancer patients to receive specialized medical assistance such as chemotherapy medication.

Defenders for Medical Impartiality (DMI) recognizes that the US decision to discontinue funds to UNRWA is in violation of the United Nations General Assembly, resolution 302 (IV) of 1949, which guarantees assistance to Palestine refugees, and may amount to a breach of international law. DMI calls upon the international community to support UNRWA in the midst of these funding shortages by providing the necessary medication to all those suffering from chronic diseases and supplying medical facilities with the fuel needed to function.