We offer preventive and curative health services to sustain and promote the health of Palestine refugees, from conception through pregnancy, childhood, adolescence and adulthood and active ageing. These services include family planning, pre-conception care, antenatal care and postnatal follow-up, infant care (growth monitoring, medical check-ups and immunizations), school health, oral health, outpatient consultations, diagnostic or laboratory services and the management of chronic non-communicable diseases.
UNWA reproductive health services include pre-conception care, antenatal care, intra-natal care, postnatal care and family planning.
Pre-conception care (PCC)
The UNRWA PCC programme, introduced in 2010, consists of six main components: health promotion, counselling, screening, periodic risk assessments, intervention and follow-up and regular folic acid supplementation. Couples receive counselling concerning the risks of 'too many, too often, too early and too late pregnancy' and on how to prepare for a healthy pregnancy. Women are assessed for risk factors, screened for hypertension, diabetes, anaemia, oral health diseases and are provided with medical care where relevant. They are given folic acid supplementation to prevent congenital malformation. Where necessary, couples may be advised to avoid or delay pregnancy using a reliable contraceptive method.
Antenatal care (ANC)
UNRWA encourages pregnant women to receive their first antenatal assessment as early as possible and to have at least four antenatal care visits throughout their pregnancy to promote early detection and management of risk factors and complications. Pregnant women receive a comprehensive initial physical examination and regular follow-up care, including screening for pregnancy-related hypertension, diabetes mellitus, anaemia and oral health problems and other risk factors. Women are classified according to their risk status for individualized management. Iron and folic acid supplementation is provided to all pregnant women. In 2010, UNRWA introduced the Maternal and Child Health (MCH) handbook, which serves as a health education tool and a home-based record from pregnancy until the child reaches the age of 5 years. During 2012, all pregnant women registered in UNRWA antenatal care were provided with the MCH handbook..
Intra-natal (delivery) care (INC)
Delivery in a health facility, where complications can be managed, substantially lowers the risk of complications and death for both mother and baby. UNRWA subsidizes hospital delivery for pregnant women classified as high-risk. In 2002, UNRWA established a registration system (based on the expected date of delivery) to track the outcome of each pregnant woman in each health facility.
Postnatal care (PNC)
UNRWA encourages all women to attend postnatal care as soon as possible after the delivery. Postnatal care services include a thorough medical examination of the mother and the new born, either at UNRWA health centres or at home, counselling on family planning, breastfeeding and caring for the newborn.
Family planning (FP)
Family planning services, including counselling and the provision of modern contraceptives, are available at all times to women accessing UNRWA health centres. Services are also provided as an integral part of maternal and child services through pre-conception, antenatal and postnatal care, along with growth monitoring for children under 5 years of age.
Family planning services will be further strengthened through the FHT approach, by increasing the participation of males.
Infant and Child Care
UNRWA provides care for children across the phases of the life cycle, with specific interventions to meet the health needs of newborns, infants under 1 year of children, children under 5 years of age and school-age children. Both preventive and curative care is provided, with a special emphasis on prevention. Services include newborn assessment, well-baby care, periodic physical examinations, immunization, growth monitoring and nutritional surveillance, micronutrient supplementation, preventive oral health, school health services and care of sick children, including referral for specialist care.
Well-baby clinic and growth monitoring
Each UNRWA health centre maintains a system of registration for children under 5 years of age. This system enables the follow-ups for children who have missed important appointments, for example, for immunization, growth monitoring or screening.
Growth and nutritional status of children under 5 is monitored at regular intervals through UNRWA health services. Breastfeeding is promoted and mothers are counselled on infant and child nutrition, including the appropriate use of complementary feeding and micronutrient supplements. A new electronic growth monitoring system, based on the revised WHO growth monitoring standards, was introduced in pilot health centres during 2011. The system documents the four main growth and nutrition-related problems among children under 5: underweight, wasting, stunting and obesity.
UNRWA health services provide immunization against ten diseases: tetanus, diphtheria, pertussis, tuberculosis, measles, rubella, mumps, polio, haemophilus influenza type B (Hib) and hepatitis. In addition, the pneumococcal vaccine is provided in the West Bank and Gaza, and for the first year of the child’s life in Jordan. Immunization coverage is assessed annually through a review of a sample of records. Immunization coverage has been close to 100% for more than a decade.
Screening and medical checkups
The health programme implements a number of specific interventions related to disability care. UNRWA health centres record data on children under the age of 5 who have permanent physical or mental impairments, in order to facilitate medical follow-ups, such as screening new-borns for hypothyroidism and phenylketonuria. In addition, medical screening activities, targeting fourth and seventh grade students in all Fields, involve assessment for vision and hearing impairment, thyroid enlargement and oral health problems. Other screening activities are mentioned under school health.
During the 2011/2012 academic year, around 490,000 pupils were enrolled in UNRWA schools. Collaboration between the UNRWA Health and Education departments continued through meetings of school health committees, training of health tutors and provision of screening materials and first-aid supplies. Recently, the School Health Strategy was jointly launched by both departments.
The UNRWA School Health programme includes medical and oral health prevention interventions and screening, assistance to children with special health needs, immunization, vitamin A supplementation and a de-worming programme. Particular attention is given to diseases and disabilities that can negatively impact learning capacity, such as hearing and vision impairment.
New school entrants receive a complete medical examination, immunization and follow-up or referral as required.
Oral health screenings are conducted for students in the first, seventh and ninth grades in all fields, and for fourth-grade students in the West Bank. Screening is coupled with other dental caries prevention activities, such as pit and fissure sealant for first- or second-grade students with a first erupted molar, fluoride mouth rinsing, tooth-brushing campaigns and periodic testing of fluoride levels in drinking water
Children with special health needs receive special medical attention from teaching staff and the school health team. Their school records are maintained separately to facilitate follow-up.
In accordance with WHO recommendations, UNRWA maintains a deworming programme for children enrolled in UNRWA schools, applying a single dose of a broad-spectrum anti-helminthic medication for three successive years.
In all UNRWA schools, students in the first through sixth grades receive two 200,000 International Unit (IU) doses of vitamin A supplementation, offered six months apart.
Non-communicable Diseases (NCDs)
Non-communicable diseases (NCDs) continued to account for the vast majority of deaths occurring in UNRWA’s host-country populations. NCDs also represent an increasing health challenge among Palestine refugees, with a steady increase in the number of diabetes and or hypertension patients treated at UNRWA health centres.
A risk-assessment tool adopted by UNRWA from WHO risk-scoring system is used to assess the risk status of NCDs patients. In addition, guidelines for case management including treatment are used in all fields.
In order to evaluate the care provided to diabetes patients registered in UNRWA clinics, the Health department, in collaboration with the World Diabetes Foundation (WDF) conducted a clinical audit in 2012, using tools prepared by WDF and adapted by UNRWA. Measurement of blood glucose using the HbA1c testing was included in the audit.
UNRWA health systems follow up on the late complications of NCDs and on defaulters (patients who fail to attend the NCD clinic for a calendar year, either for follow-up or for collection of medicines) through different means, in addition to the deaths of NCD patients.
The burden of NCDs and their complications is increasing. UNRWA is strengthening its approach to primary prevention through health education and by improving the quality of foods served in school canteens. The Agency is intensifying its screening programmes and conducting outreach campaigns. In some health centres, we introduced a cohort-monitoring system, aiming to improve the quality of NCD care. Furthermore, UNRWA will continue to explore all possible options to introduce lipid-lowering agents into the UNRWA essential drugs list. Prohibitive costs have so far prevented UNRWA from introducing these lifesaving medications.
UNRWA currently provides comprehensive primary health care through a network of 139 health centres, of which 70 are located inside Palestine refugee camps. In addition, UNRWA operates five mobile clinics in the West Bank to facilitate access to health services in areas affected by closures, checkpoints and the Barrier. Utilization of outpatient services Agency-wide reached a total of approximately 9,652,066 medical consultations during 2012. Of these consultations, 211,832 were specialist consultations.
Oral health services during 2012 were provided through 108 fixed and 9 mobile dental clinics. The total number of curative oral health consultations reaching a total 620,497 in 2012. During 2012, UNRWA continued to reinforce the preventive component of oral health. Oral health education was introduced as part of routine mother and child health care, with dental screening for women at the first pre-conception care visit and for all pregnant women, Agency-wide. Comprehensive oral health assessment is conducted for all children at the age of 2 years, as well as application of sealant. Regular dental screening for new school entrants, as well as seventh- and ninth-grade students, along with oral hygiene education, continued in all fields except Gaza, where first-graders were targeted for comprehensive dental care.
Outpatient consultations specialist include gynaecology and obstetrics, cardiology, ophthalmology and others. In 2012, the total number of specialist consultations was 211,832 Agency-wide.
Rehabilitation and Physiotherapy
Physiotherapy services are provided through 18 physiotherapy units (11 in Gaza, 6 in the West Bank and 1 in Jordan). Patients receive treatment and home visits by staff under this service. In the West Bank, there are 21 staff members (11 regular employees and 10 recruited under emergency programme), and in Gaza there are 34 staff members.
Physiotherapy outreach activities included: conducting home visits; strengthening the cooperation between physiotherapists and school supervisors; creating partnerships between UNRWA physiotherapy units and non-governmental organizations; launching a preventive physiotherapy programme for feet examination; screening first-grade school children for postural deformities; distributing or loaning assistive devices (wheelchairs, crutches and walkers) to persons with disability; and cooperating with the local committees for people with disability.
At present, 124 of the 139 UNRWA health facilities provide comprehensive laboratory services. The remaining 15 facilities provide basic laboratory support (blood glucose, blood haemoglobin and urine tests by dipstick) through competent nursing staff using basic laboratory equipment. A total of 4,560,889 laboratory tests were performed Agenncy-wide in 2012. The overall cost of laboratory services provided by UNRWA was US$ 6.9 million, out of which US$ 4.7 million were secured through the General Fund and US$ 1.6 million through emergency funds, project funds or donations. The cost of laboratory services continued to be far below the host-coutnry rates for equivalent services.
UNRWA operates 21 radiology units (9 in the West Bank, 6 in Gaza, 4 in Lebanon and 2 in Jordan). These units provide plain x-ray services to patients attending the health centres. Other plain X-rays and specific types of diagnostic radiology services (such as mammography, urography, ultrasounds etc.) are provided through different contractual agreements with hospitals and private radiology clinics to patients and to newly recruited UNRWA staff during periodic medical examinations and as part of medical board examinations. In 2012, we conducted 99,811 X-rays for our patients, of which 82,364 were conducted at UNRWA facilities and 17,447 were contracted to other facilities..
UNRWA helps Palestine refugees obtain hospital care by contracting beds or by partially reimbursing costs incurred for inpatient care at public, non-governmental and private health care facilities. In addition, the Agency directly provides hospital care in one hospital, a 63-bed secondary-care facility, in Qalqiliya, in the West Bank.
During 2012, a total of 80,426 Palestine refugees benefited from assistance for hospital services, representing an increase. The average length of stay was 2.0 days across UNRWA’s five areas of operations. The average daily bed occupancy in Qalqilia Hospital was 57.4 per cent in 2012.
Community mental health
Palestine refugees have for decades suffered the trauma of displacement, as well as repeated episodes of conflict and violence. In response to the situation of ongoing and often severe psychological stress, particularly in the Gaza Strip and the West Bank, UNRWA launched a Community Mental Health programme. The programme offers counselling and support and ensures the long-term strategic incorporation of psychosocial wellbeing of Palestine refugees into the Agency's healthcare package.
UNRWA’S Environmental Health programme controls the quality of drinking water, provides sanitation and carries out vector and rodent control in refugee camps. Environmental health services are managed by different UNRWA departments in different fields, including the Administration Department in Lebanon, the Procurement Department in Jordan, the Department of Infrastructure and Camp Improvement in Syria, and the Special Programmes Department in Gaza Field. In the West Bank, these services remain the responsibility of the UNRWA Health Department during 2012.