Back to Contents 6.2. Is there evidence that stateless Palestinians have difficulties accessing health care? If so, what are the ​​ reasons? Despite UNRWA providing support, stateless Palestinians have difficulty accessing health care: “Lebanon: Sector specific interventions: […] During the reporting period, 348 refugees (251 PRL, 10 PRS and 87 PRL/ PRS cancer and chronic disease patients) were supported under the MHF [Medical Hardship Fund] to top-up their hospitalisation coverage or to purchase medications for chronic illnesses. Hospitals now require patients to settle their accounts in US dollars, which is not affordable for the majority of refugees and results in a reduction in the number of patients seeking tertiary care. In addition, the absence of cancer medications, usually distributed by the MoPH [Ministry of Public Health] at a subsidised rate, resulted in a decrease in the number of Palestine refugees receiving treatment.” (Source: UNRWA, “Syria, Lebanon and Jordan, 2022 Emergency Appeal Progress Report for the reporting period 1 January – 30 June 2022”, 3 November 2022, p. 27) UNRWA struggles to meet the health needs of Palestine refugees: “During the year, Agency operations were adapted to address the impact of the financial and economic crises that continued to affect Lebanon […] As the crisis deepened, violent incidents against Agency staff increased, particularly in health centres where demand for otherwise unobtainable medicines spiked. From July, fuel shortages also forced many Area staff residing in camps to work from home. This arrangement was challenged under chronic power cuts with many staff having access to only two-hours of electricity per day for much of the summer and autumn.” […] In 2021, there were closures of UNRWA installations for at least 53 days in Lebanon, in addition to 24 partial closures. Closures were mostly the result of strikes and protests by beneficiaries and general civil unrest. Palestinian factions closed UNRWA installations on several occasions to demand further support from UNRWA due to the growing vulnerability and socio-economic challenges faced by PRL.” (Source: UNRWA, “Annual Operational Report 2021” 27 October 2022, pp. 11 -12, and p. 16) UNRWA also published an article in October 2022 outlining the increasingly limited access to healthcare and affordable medical treatment following rising costs: “The cost of water, fuel, electricity, gas, transport and health care is now three to five times higher. Medicines are increasingly unavailable on the market and families are unable to afford them since government subsidies have been lifted. Too many Palestine refugee families are no longer able to afford secondary health care. Some are skipping lifesaving treatment to avoid accumulating debts.” (Source: UNRWA, “Hitting Rock Bottom - Palestine Refugees in Lebanon Risk Their Lives in Search of Dignity”, 21 October 2022) In their “Syria, Lebanon and Jordan Emergency Appeal 2022, UNRWA wrote: “[...] UNRWA also contributes 50 per cent of the total cost of medications not available at UNRWA health centres for around 640 patients (with an annual ceiling of US$ 8,000 per patient) to cover treatments for cancer, thalassemia, multiple sclerosis and sickle cell anaemia. [ft. 34, notes, “The report also notes “Hospitalization costs per patient are higher in Lebanon than in the Agency’s other fields of operation. UNRWA contributes to tertiary care for invoices up to US$ 4,000, mainly for PRL patients registered with the SSNP as well as for PRS. For this purpose, a refined Medical Hardship Fund (MHF) was instituted in 2016 as part of the hospitalization reform which introduced cost co-sharing with patients (tertiary care: 60 per cent UNRWA and 40 per cent patient; secondary care: 90 per cent UNRWA and 10 per cent patient at non-PRCS (Palestine Red Crescent Society) hospitals for secondary care).” […] Shortages of medicines in the local market and the massive price increase for vital NCD medications and other medicines and medical supplies necessitates the need to secure funds through this EA to maintain sufficient stocks for PRL and PRS patients.” (Source: UNRWA, “Syria, Lebanon and Jordan Emergency Appeal 2022”, 18 January 2022, p. 36) 6. Access to health care 59