The UNRWA health program has delivered comprehensive primary health care services (PHC) to Palestine refugees for over 60 years, achieving some remarkable health gains particularly in relation to maternal and child health. For example, the infant mortality rate among UNRWA's served beneficiaries has declined from 160 per 1000 live births during the 1950s, to less than 25 in the first decade of the 21st century. However, the context in which the health program operates is evolving, bringing with it new challenges and opportunities that require new ways of providing health services. Maintenance of the status quo in current health services will not be able to address the changing environment. Thus, without introducing new approaches, UNRWA health services will become less relevant and unable to respond to the growing health needs of the Palestine refugees.