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Abstract Health system resilience reflects the ability to continue service delivery in the face of extraordinary shocks. We examined the case of the United Nations Relief and Works Agency (UNRWA) and its delivery of services to Palestine refugees in Syria during the ongoing crisis to identify factors enabling system resilience. The study is a retrospective qualitative case study utilizing diverse methods. We conducted 35 semi-structured interviews with UNRWA clinical and administrative professionals engaged in health service delivery over the period of the Syria conflict. Through a group model building session with a sub-group of eight of these participants, we then elicited a causal loop diagram of health system functioning over the course of the war, identifying pathways of threat and mitigating resilience strategies. We triangulated analysis with data from UNRWA annual reports and routine health management information. The UNRWA health system generally sustained service provision despite individual, community and system challenges that arose during the conflict. We distinguish absorptive, adaptive and transformative capacities of the system facilitating this resilience. Absorptive capacities enabled immediate crisis response, drawing on available human and organizational resources. Adaptive capacities sustained service delivery through revised logistical arrangements, enhanced collaborative mechanisms and organizational flexibility. Transformative capacity was evidenced by the creation of new services in response to changing community needs. Analysis suggests factors such as staff commitment, organizational flexibility and availability of collaboration mechanisms were important assets in maintaining service continuity and quality. This evidence regarding alternative strategies adopted to sustain service delivery in Syria is of clear relevance to other actors seeking organizational resilience in crisis contexts.

The passage of over seven decades, coupled by consistent practice of States, has triggered the emergence of a distinct international legal regime for Palestinian refugees. Unlike the majority of contemporary refugees, Palestinians ‘refugeehood’ would not end pursuant to the acquisition of other citizenship(s) or by gaining protection akin to citizens in host States. Given their distinctive situation, individuals in this group, whose refugee status is intertwined to that of a prolonged denial of the right to self-determination, continue to be entitled to the right of return in their homeland in pre-1948 Palestine, namely either the State of Israel or the new State of Palestine within the 1967-occupied territory, depending on the original place of habitual residence of each individual or his/her ascendants before flight. In short, international law has generated a lex specialis regime for Palestinian refugees, which provides either equal, or heightened, protection and is in no means inferior, to other refugees.

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.

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.

In April 2017, the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) released the electronic the application. One of the first mobile health (m-Health) interventions in a refugee setting, the application gives pregnant women and mothers access to educational information and health records on smartphones. This study investigated factors associated with the dissemination and implementation of m-Health in the refugee setting. A cross-sectional study was conducted in 9 of 25 UNRWA health centres for Palestine refugees in Jordan. Self-administered questionnaires were distributed for 1 week to pregnant women and mothers with children aged 0-5 years. The outcomes were whether participants knew about, downloaded or used the application. Multiple regression analyses were conducted to determine factors associated with application download and usage. 1042 participants were included in the analysis. 979 (95.5%) had a mobile phone and 862 (86.9%) had a smartphone. 499 (51.3%) knew about, 235 (23.8%) downloaded and 172 (17.4%) used the application. Having other mobile applications (OR 6.17, p<0.01), staff knowledge of the application (OR 11.82, p<0.01), using the internet as a source of medical information (OR 1.63, p=0.01) and having internet access at home (OR 1.46, p=0.05) were associated with application download. The age of the husband was associated with application usage (OR 1.04, p=0.11). Though m-Health may be a promising means of promoting health in refugees, multiple barriers may exist to its dissemination and implementation. Those who regularly use mobile applications and get medical information from the internet are potential targets of m-Health dissemination. For successful implementation of a m-Health intervention, health staff should have thorough knowledge of the application and users should have access to the internet. Husband-related factors may also play a role.

PurposeThis study aims to investigate how e-health system characteristics (information quality, system quality, perceived ease of use, perceived usefulness) contribute to the enhancement of medical staff performance, patient care, and doctor–patient relationships at UNRWA-Gaza healthcare centers. It aims at testing an integrative single model comprising Technology Acceptance Model (TAM), D&M model and e-health system utilization.Design/methodology/approachThis study followed the quantitative methodology and the deductive research approach. Data were collected from 241 medical staff who use the system employed in 19 different healthcare centers across the Gaza Strip. Partial least square/structural equation modeling technique was used to analyze the collected data and to test study hypotheses.FindingsStudy concluded that information quality of the adopted Health Information System (HIS) has both direct and indirect positive impact on staff performance, only direct positive impact on patient care and only positive indirect impact on doctor–patient relationship. System quality, on the other hand, was found to have negative direct impact and positive indirect impact on staff performance and has both direct and indirect positive impact on both doctor-patient relationship and patient care.Research limitations/implicationsNoteworthy that HIS has availability, speed and error detection and error prevention issues. It is recommended that these shortfalls be addressed together with improving user perception towards ease of use and usefulness of the system.Practical implicationsManagement should also work to raise confidence in its medical staff to improve the effect of HIS on medical performance and patient care. It is also recommended that UNRWA should implement crowed management techniques such as queuing systems and on-phone booking to minimize patient waiting time.Originality/valueThe importance of the study stems from its context being conducted in a developing region (Gaza Strip-Palestine) which has a fragile economic, political and social environment with many other complexities. It is also conducted at United Nations Relief and Work Agency (UNRWA) healthcare centers, which provide medical services to Palestinian refugees. In addition, this study is among the few studies that address the impact of individual e-health success factors on both doctor-patient relationship and patient care constructs. Most previous studies concentrated on the impact of health system adoption as a whole on these two subject variables and one can hardly ever stop at studies that address effect of individual success factors on them. It also integrated both D&M system success model and TAM model with some additional amendments creating and tested a new model.

Due to their stressful lives, Palestinian refugees are prone to use cognitive enhancers (CE) and psychostimulant substances (PS). Recognising health problems associated with CE/PS use can indicate how preventive programs should be directed towards adolescents. Unfortunately, research has not thoroughly investigated the health problems related to tobacco and caffeine products, the most socially acceptable CE/PS among Palestinian refugee adolescents. In 2021, schoolchildren from five Palestinian refugee camps (N=271) aged 12-<16 years agreed to give blood samples and to be interviewed to address the association between metabolic syndrome (MetS) and tobacco smoking, coffee, energy drinks (ED), black tea, and chocolate consumption. MetS was diagnosed based on International Diabetic Federation Criteria. To address the association, we used binary logistic regression models adjusted to age, gender, BMI, and central obesity. The prevalence of MetS was [17 (6.3%)]; (7.4%) in males, (5.1%) in females. The prevalence of substance use was as follows: ED [163 (48.9%)], coffee [255 (76.6%)], black tea [295 (89.1%)], cigarette [35 (10.5%)], waterpipe [59 (17.7%)], and chocolate [309 (93.6%)], with male predominance. Cigarette smokers have increased central obesity (p-value=0.024), and decreased HDL-cholesterol (p-value=0.015) than non-smokers. Similar results were observed for waterpipe smokers besides the increased levels of triglycerides (p-value=0.01). ED consumers have increased central obesity (p-value=0.03) and fast blood sugar (p-value=0.003) than non-consumers. Chocolate consumers have decreased central obesity (p-value=0.008) and increased HDL levels (p-value=0.04) than non-consumers. ED consumers were significantly at higher risk of MetS (OR=9.97, p-value=0.019) than non-consumers and chocolate consumers were at lower risk of MetS (OR=0.14, p-value=0.046) than non-consumers. Waterpipe smokers were at a higher risk of having increased plasma triglycerides than non-consumers (OR=3.4, p-value=0.03). The high prevalence of ED consumption and waterpipe smoking in Palestinian refugee adolescents is problematic. Their use was associated with higher odds of MetS, dyslipidemia, and central obesity, which justifies greater attention.

This study examines the impact of using a play-based instructional program to improve sixth-grade male students’ morphological awareness at UNRWA schools in south Amman area, Jordan. While a dearth of studies has employed play-based activities on acquiring new vocabularies, this article sheds light on the efficacy of play-based learning on enhancing morphological awareness skills, an area that has not been thoroughly explored. Sixty students were selected randomly in two intact sections: thirty students in the experimental group and thirty in the control one. Beside Action Pack 6 as an official textbook chosen by the Ministry of Education in Jordan, we adopted play-based activities along with pre-and post-tests to gauge such the impact of such activities on improving sixth graders’ morphological awareness. The implementation of the instructional program lasted for eight weeks. The results revealed statistically significant differences at ( ≤ 0.05) in students’ mean scores on morphological awareness skills post-test, underscoring the importance of play-based instructional programs. One alternative for improving students’ morphological awareness, we recommend, is using play-based activities as supplementary materials. Further research is also needed on the viability of play-based activities on morphological skills for other graders in different contexts.

This article analyses the health, economic and social impact of COVID-19 on the Palestinian refugee population located in the different areas in which the UNRWA (the United Nations agency for Palestinian refugees) works, focusing on refugee camps and how the pandemic has exacerbated their inhabitants’ isolation, exclusion and lack of protection. In doing this, the study aims to sketch out lines of comparative analysis on certain key issues related to the effects of COVID-19 on long-term refugee populations: the impact on permanent camps and suburbanised spaces, the overlapping of prolonged emergency situations and the accumulated deficiencies in the protection and reception systems in settings of armed conflict and exclusion.

The occupied Palestinian territories (oPt) consist of the non-contiguous West Bank including East Jerusalem and the Gaza Strip. It is densely populated within these confines and has a unique socio-economic context characterized by political and economic tensions. Around 2.2 million Palestinians are displaced and living in the ten UNRWA refugee camps in Jordan. Palestinian communities are exposed to a double burden of disease caused by the severe economic, social and health consequences of Israeli occupation and resultant displacement. Exposure to political violence, economic hardship, fragmentation of Palestinian families, unemployment, trauma and community stress underpin a reported rise in drug abuse. Method: A qualitative study using focus groups ( n  = 3) with a convenience sample of health care and educational professionals was conducted in two UNRWA camps ( Al-Zarka , Al-Wehdat ) in Jordan. Guided discussions explored the experiences of these professionals in working with Palestinian families and children affected by substance/drug use and drug use disorder in the home. Data were analysed using thematic analysis (TA). Five themes emerged from the TA. These were as follows: (1) access to drugs was perceived to be relatively easy in the camps; (2) Attitudes towards drugs appear to have desensitized, yet stigma persists; (3) families of drug users are affected by fear, social and economic poverty, with significant physical and psychological cost to children; (4) causes of substance/drug use in Palestinian communities living in Jordanian UNRWA camps is multifactorial; (5) solutions are multi-faceted and indicative of the need for prevention and support for those at risk, and affected. Threats to UNRWA from the current political climate and the reducing investment in services may exacerbate this public health and security issue. For an evidence-based approach to have credibility in the camp communities, there is a need for accurate, factual information, along with robust epidemiological data, relating to the extent, characteristics and harms associated with drug use.