This interview took place in 2017 when UNRWA was still funded by the US. It is no longer, as my previous blog explains. UNRWA is 100 per cent funded by donations (the largest donor was the US) followed by the EU, some other European countries, Japan, and to some extent Australia and some smaller countries. Lucia Dore writes.
A case study of UNRWA working with Palestinian refugees
The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) working with Palestine refugees has introduced a "family-medicine" approach in its treatment of Palestine refugees. This is because of the high incidence of non-communicable diseases (NCDs) - which includes diabetes, high blood pressure, hypertension, cardiovascular diseases, cancer and smoke-related chronic lung diseases. Director of UNRWA's health programme for Palestine refugees, Akihiro Seita says the new programme was introduced four years ago and is working well. NCDs account for 70 per cent to 80 per cent of deaths of Palestinian refugees, he notes.
He then explains how "family-medicine" works. "This means that any refugees coming to our clinic always see the same doctor and the same nurse; it's like a family doctor. For example, if there are three doctors at the health centre, we divided the refugee population by three so each doctor had about the same number of people." This is around 10,000 or 20,000 people. He says: "It's a big population to cover, but it's the reality with the number of doctors we have."
UNRWA has 143 clinics with 3,700 staff including 500 doctors, providing primary health care for 5.2 million Palestine refugees. Before the family-medicine approach was introduced, UNRWA had three delivery points at the health centres: childcare, NCDs and more general issues such as back pain, Akihiro explains. The family-medicine approach has streamlined this. This approach ensures each individual gets personal care, which is very important, he says, since an NCD "is a life-long condition". It's also necessary for the entire family to be involved in treating NCDs, especially those who do the cooking, he adds. It is taking time for the programme to "bed down" in rural Syria, however, because of the conditions there.
In addition to adopting a family-medicine approach, UNRWA introduced an electronic health record system (or e-health) in clinics. Some clinics have become paperless, and, consequently, more efficient. This will allow UNRWA to monitor people with NCDs over a long period of time, for example.
Unsurprisingly, UNRWA has difficulty adopting this approach in Syria because of connectivity problems, although one or two clinics have become paperless, Akihiro says.
Another issue with which UNRWA has had to grabble with is the training of doctors in family medicine. UNRWA has neither the time nor the money to provide specialist training, Akihiro explains. Therefore, to overcome this hurdle, UNRWA went to a UK institution, called RILA Institute of Health Sciences, to conduct one-year on-the -job training with the help of partners who provided financial support.
Fifteen doctors were trained in Gaza last year and another 40 from Gaza, West Bank and Jordan will complete the one-year diploma in Family Medicine by mid-2018. The course is webinar-based, with online training. Local family doctors are also facilitators and mentors for the trainees. The course covers about 60 subjects.
UNRWA also introduced mental health training in July and August 2017. "What we are trying to do is to train all the staff in the health centres according to the needs [of the patients] ", says Akihiro. Mental health and psychosocial issues are at the forefront of his concerns. The aim is to roll out the programme in three to five years to all the clinics, he says.
UNRWA is also trying to buy medicines in a much more efficient way. " Many good medicines are now produced in India and its neighbours, which are good quality and they are cheap," Akihiro says. This programme was started in 2016.
In this region alone, UNRWA spends almost USD 20 million each year on medicines, half of which are for NCDs.
The other strategy UNRWA is adopting is to support the hospitalisation of refugees because many do not have insurance. "This is a major challenge because it [hospitalisation] continues to be costly all over the world," he says.
Apart from medical care, UNRWRA provides education up to Year 9. UNRWA has 700 schools, which includes 100 in Jordan and 200 in Gaza. There are 22,000 teachers, and 0.5 million kids.
Employment
UNRWA employs about 32,000 staff including 3,700 health care staff, almost all of whom are Palestine refugees, says Akihiro. "They grew up here, studied here and then they are trained by us and become doctors," he says, adding: "Refugees are caring for refugees." Akihiro also notes: "Finding a job is very important to refugees", but circumstances can make this very difficult. He notes how tough it is to find a job in Syria; in Lebanon, refugees are marginalised from ordinary Lebanese; and in Gaza the economy has collapsed because there has been the 10-year blockade there. Unemployment stands at about 40%, but at 70% among the young people," he adds.
In total, there are about 5.2 million Palestinian refugees registered with the UN, who are based in Jordan, Lebanon and Syria, Akihiro says. (Akihiro is based in Amman, Jordan). "The Palestinians have the most prolonged refugee status in the 21sttcentury", he adds, explaining that Palestinians were first granted refugee status in 1948 and have had the same status for nearly 70 years.
"The situation is not improving; it is getting worse," he says. "The world should always remember and should never forget that there are Palestinian refugees and it is the single largest refugee population in the world."
Funding
UNRWA spends USD 120 million on health for Palestinian refugees. The running costs for all programs including health, education and others, are almost USD 800 million. When the project on shelters, housing, and emergency humanitarian support is included, the total annual expenditure amounts to USD 1.8 billion each year. USD 300 million to USD 400 million is spent on the running costs of the schools with 90 per cent to 95 per cent of expenditure being for teachers.
UNRWA is 100 per cent funded by donations, the largest donor being the US, followed by the EU, some other European countries, Japan, and to some extent Australia and some smaller countries.