In its fourth year, the conflict in Syria has an ever-deepening impact on civilians. The over half a million Palestine refugees in Syria are affected and particularly vulnerable due to the high incidence of poverty in their community, the recurrence of armed conflict and its effects inside refugee camps and communities, and the refugees’ escalating dependence on humanitarian assistance from UNRWA. Their refugee status affords them limited options to seek safety in other countries and further compounds their vulnerability in Syria. UNRWA’s crisis response builds on a broad and well established operational presence in Syria, Lebanon and Jordan, providing education, health, work and other vital services to Palestine refugees for the past 64 years. UNRWA works to preserve refugee resilience through humanitarian relief and by ensuring continued provision of essential services. The results in this report highlight the effects of underfunding on an otherwise efficient and effective response to the crisis.