While the evidence on the health of Palestine refugees must continue to be built, isn’t it also time for different actions?
I recently had the privilege of participating at the 70th World Health Assembly in Geneva in what was the first-ever panel to focus on the health of Palestine refugees. While the world’s attention is concentrated on the most recent refugee crisis resulting from the war in Syria, the oldest refugee problem—Palestinians in the West Bank, Gaza, Lebanon, Syria, and Jordan—festers below the global radar. The nakba or catastrophe, which Palestinians call the events of 1948, continues today as Palestinians for the second, and sometimes third, time flee their homes in Syria. I learned about the Palestine refugees from Syria (PRS) first-hand in October 2016, when I traveled to Jordan to work with the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) for seven weeks.
Why focus on Palestine refugees from Syria living in Jordan?
An estimated 17,000 PRS are registered with UNRWA in Jordan, just a fraction compared with the 650,000 Syrian refugees registered with UNHCR there. However, the PRS in Jordan are the most forgotten and neglected, and most marginalized segment among refugees from Syria. One-third lack legal documents and consequently risk deportation, and the non-admittance policy was applied to the PRS by the Government of Jordan almost 3 ½ years before the borders were sealed to all other refugees fleeing Syria.
For UNRWA, which was established in 1950 to provide primary health care, education, relief and social services, and emergency assistance to Palestinians fleeing the nakba, the PRS are a new cohort of refugees for its field office in Jordan.
The qualitative assessment that I conducted during the seven weeks in Jordan focused on three segments of PRS: women with children under 2 who had delivered in Jordan; women and men who were diagnosed with diabetes mellitus and/or hypertension; and, women and men who were themselves or had a family member hospitalized in Jordan within the past twelve months. Eighteen group discussions were held in four areas of the country where there are concentrations of PRS.
Although discussions focused primarily on maternal health and care of sick children, non-communicable diseases, and treatment of health providers in hospitals and at UNRWA health centers, participants also brought up the cost of daily living in Jordan, discrimination and bullying of their children in schools, lack of jobs, and the frustration of living on hand-outs. (Read the full report, Health and Status of Palestine Refugees from Syria in Jordan: Situational Analysis)
During the group discussions, participants spoke openly and even offered advice to each other.
In one session, a male participant who was under treatment for both diabetes and hypertension recalled arriving at the hospital, a “dead man.” PRS are unable to get work permits and without income, they hold off seeking health services. His son paid the $185 hospital bill. When I asked if he was taking care of his health as a result of this experience, he shrugged it off. At that point the other participants reprimanded him, telling him that he needs to take better care, if not for himself at least for his wife and son!
It struck me during our discussions that this may have been the first time that participants had anyone ask—and listen to them—about their experiences. Participants shared openly and willingly and seemed eager to tell their stories. In one instance a woman brought her sick baby to the meeting and, despite my protestations, was willing to delay seeking care (she eventually had her baby seen at the UNRWA health center and then returned to the group). And in every male group, at least one man cried.
Through this process, I was reminded of the power of listening to people’s stories and the humanity that unites us all.
Prior to conducting these group discussions, I held meetings with UNRWA health center staff, all of whom were eager to learn more about the PRS and their experiences. The staff, themselves descendants of refugees from generations ago, said that the PRS are treated the same as all their other patients and were not discriminated in any way by UNRWA’s staff. To me, this was precisely the point: the health center staff should treat PRS differently. Find ways to spend more time, listen to their stories, and provide the PRS with special care. In short, focus on equity over equality.
At the World Health Assembly panel on May 24, which was co-sponsored by UNRWA, The Lancet, and the International Federation of Medical Students’ Associations, I highlighted some of the results from this assessment. The other panelists reviewed the challenges to addressing the health of Palestinians under occupation, and the provision of health care and health education in conflict situations.
In general, the discussion was robust and I was particularly glad to see so many young students of medicine, pharmacy, and veterinary sciences in the audience—their interest in learning about the issues and desire to engage in advocacy should give us all hope.
Ultimately, however, I walked away somewhat disheartened and with a sense of déjà vu. How can we make real change happen? The Lancet is trying; in 2009 it established the Lancet Palestinian Health Alliance, a collaboration among Palestinian, regional, and international researchers to focus on health in Palestine and inform evidence-based policy and practices.
More and more evidence is being produced to show that the lived experience of Palestine refugees is not monolithic, but rather quite varied based on when they became refugees, and where they landed as refugees. More evidence is still needed, no one would argue otherwise, but isn’t it also time for more action as well? We need to translate new and existing evidence to strategically hold governments and the global community accountable for ensuring equitable evidence-based policy and practices for all Palestine refugees. The million dollar question is, “How?”