The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) has been providing basic services, including education and health, to Palestine refugees1 in Syria, Jordan, Lebanon, the West Bank and Gaza for over 64 years. The Agency has also responded to the urgent humanitarian needs of Palestine refugees in times of conflict and extreme hardship. The current regional crisis, triggered by the conflict in Syria, continues to be one of the greatest challenges UNRWA has faced since it was created to assist Palestine refugees after their original dispossession and dispersion throughout the region in 1948. Without faltering in its core work of providing assistance to further the human development of a population of some 5 million Palestine refugees across the region, and with donor support, UNRWA has responded to the critical needs of Palestine refugees affected by the conflict in Syria. This includes the Palestine refugee population inside Syria, as well as those who have fled to Lebanon and Jordan, and the small number who have reached Gaza. During the reporting period, UNRWA has particularly focused on seeking access to the besieged Yarmouk area, which was achieved after a break of more than one year on 18 January 2014. In 2014, distributions in the area have been intermittent and constrained - as such, UNRWA continues to advocate for rapid, safe and unhindered access, as described in Security Council Resolution 2139. Many Palestine refugees from Syria have sought safety in Egypt, Turkey and further afield. While these countries are beyond UNRWA’s areas of operation, the Agency is actively advocating for them to receive the support they need. The UNRWA Syria Crisis Response Plan for January-December 2013 appealed for critical humanitarian assistance in the form of food, cash, household/winter items and health services in Syria, Lebanon and Jordan for a total of US$ 215,399,454. Many donors responded generously, funding 72.3 per cent2 of the appeal, and the considerable results achieved against this are detailed by strategic objective in this report. Results include the delivery of assistance from UNRWA to some 500,000 Palestine refugees in Syria, Lebanon, Jordan and Gaza. Interventions were specifically positioned to prevent the further deterioration of their living conditions.