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The programme delivered comprehensive primary health care, including maternal and child health, non-communicable disease care, and mental health support. The situation worsened on 13 October 2023, when an evacuation order forced civilians to move from northern Gaza to southern Gaza, intensifying pressure on already strained health services amidst widespread displacement and collapsing infrastructure (2). Impact of the war on UNRWA health services and health programme response To address the healthcare crisis due to the war, UNRWA prioritized restoring access to healthcare, re-establishing vaccination programmes, enhancing disease surveillance, and replenishing medical supplies. UNRWA has established medical points at all designated shelters to provide essential health care services for IDPs and set up additional medical points in the Mawasi area.

Background Due to pre-existing difficulties, refugees are especially susceptible to the negative effects of the pandemic; nonetheless, the pandemic’s effect on this group is still unclear. The purpose of this study was to determine the effects of the COVID-19 pandemic on the mental health of Palestine refugees in Gaza by identifying the role of social determinants. During the pandemic, the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) enacted a number of policies and measures. The purpose of this research was to assess their efficacy and acceptability. Methods This qualitative study took place between August and November 2020. Twenty-nine key-informant interviews were conducted remotely with UNRWA Headquarters, field and clinical staff in Gaza and with community members, aged ≥18 years and residing in Rafah and Jabalia camps. We sought informed consent verbally or via email. Data was coded based on the framework for social determinants of mental health. Results Interview results indicated that the relationship might be unidirectional, with COVID-19 causing the degradation of living conditions and vice versa, with living conditions exacerbating the COVID-19 situation by facilitating virus transmission. In other instances, the association between mental health determinants and COVID-19 might be bidirectional. In terms of experiencing violence and anxieties, women, children, and daily-paid employees were significantly more disadvantaged than other groups in the community. UNRWA modified its service delivery techniques in order to continue providing essential services. In general, UNRWA’s strategies throughout the pandemic were deemed beneficial, but insufficient to meet the needs of Gazans. Conclusion The pandemic highlights the need to go beyond disease treatment and prevention to address social determinants to improve refugees’ health and reduce their susceptibility to future shocks. UNRWA has rapidly implemented telemedicine and mental telehealth services, making it imperative to assess the efficacy of these novel approaches to provide care at a distance. A long-term option may be to employ a hybrid strategy, which combines online and in-person therapy.

In 2024, the reach of UNRWA's medical work extended to the entire population of Gaza regardless of refugee status. Since Oct 7, 2023, nearly 300 UNRWA staff have been killed and others have been repeatedly displaced. 2 In 2024, UNRWA health-care workers treated on average 75 patients per shift, a 48% increase compared with 2023, exceeding Sphere standard limits of 50 patients per shift. 6 Internally displaced people remained extremely vulnerable to infectious diseases due to limited access to clean water, poor hygiene, and overcrowded living spaces since the water and sanitation infrastructure has been destroyed. [...]with the scale of the crisis exceeding all predictions, in February, 2025, the average ratio was 1:360 for people to toilet and 1:2416 for people to showers, far exceeding the maximum of 20 people per toilet and shower in Sphere guidelines. 7 Internally displaced people have resorted to open defecation and consumption of contaminated water, further exacerbating disease spread. 112 suspected meningitis cases were reported in 2024, but these cases were not microbiologically confirmed due to the scarcity of functioning laboratories. Since July 16, 2024, the Global Polio Laboratory Network notified the detection of six circulating variant poliovirus type 2 isolates in environmental samples from Deir al-Balah and Khan Younis in Gaza. 8 UNRWA confirmed one polio case presenting with acute flaccid paralysis in its health-care centre. The provision of mental health and psychosocial support services has presented a huge challenge. Since the start of the conflict, 730 000 individuals, including 520 000 children, accessed mental health and psychosocial support services.