Health system and community responses to COVID-19 among Palestine refugees in Gaza and Lebanon

This project studies the resilience of UNRWA health systems, and health and social care workers, as well as Palestine refugees living in crowded settlements in Gaza and Lebanon, in the context of COVID-19. Principal Investigator: Dr. Karin Diaconu (Queen Margaret University) Research Snapshot: Trust and resilience during COVID-19 This study involved a specific health system, the United Nations Refugee and Works Agency in the Near East (UNRWA), focusing on Gaza and Lebanon. They aimed to find out if and how UNRWA is resilient in the face of COVID-19 and what factors were at the core of this resilience, including whether the community's trust in UNRWA as a service provider played a role. View snapshot What did the study set out to achieve? The study aimed to understand how health systems can be resilient in their response to the COVID-19 pandemic and disease outbreaks generally, particularly in contexts where systems cater to the needs of refugees living in densely populated areas. Further to this, the study explored how community trust relates to the resilience of systems, including the effectiveness of their routine delivery of services and epidemic response measures. The study sought to inform UNRWA's response to the COVID-19 pandemic in Gaza and Lebanon by making findings on stressors and wellbeing, and resilience of communities, health and social care workers, and wider UNRWA systems, available to decision-makers to inform contextually tailored pandemic responses. Findings on how trust in UNRWA relates to the effectiveness of both routine service delivery and COVID-19 response in the two settings will inform programming of UNRWA and other agencies operating in the region. The project paid particular attention to the needs and outcomes of persons affected by chronic diseases, mothers and children and disabled populations. More widely, findings will contribute to ongoing debates on health system and community resilience, including on how best to nurture resilience capacities in other health systems globally. What were the key findings? UNRWA health systems in Gaza and Lebanon adapted service delivery and introduced new services to meet the needs of populations during COVID-19. Emergency preparedness and planning is a core resilience capacity of UNRWA which has been honed across multiple security related shocks. While COVID-19 was a new type of shock, the agency used similar strategies for preparedness, including collaboration and communication via emergency coordination bodies and shared decision-making with field offices. The ability to rapidly innovate and adapt service delivery strategies, and implement and evaluate strategies in real time, allowed the agency to deploy effective responses. A learning culture was also key. Described as "a pillar" and "a unifying body" by Palestine refugees surveyed, UNRWA is constantly expected to provide more and better services. What does this mean for policymakers and practitioners? While this research was conducted within a specific health system, lessons may be widely useful to other systems dealing with a long-term humanitarian crisis. Humanitarian practitioners and policymakers should consider the diverse underlying capacities that sustain health system resilience and invest in strengthening these collectively rather than focusing on single targets. While emergency preparedness and planning may be critical to meeting challenges like COVID-19, preparedness and planning is only effective where collaborative structures and networks exists which can implement, review and revise plans as necessary. At UNRWA, the collaboration between Health and Education Programmes and the joint decision making with the Gaza Field Office enabled the prompt establishment of medical points at schools, two months after the inception of the pandemic, to serve as triage. A culture of learning, rewarding employee innovation in service delivery and allowing real time adjustment of responses, is critical in sustaining resilience in the face of immediate shocks and longer-term stressors. Demonstrating compassion towards beneficiary populations, providing services consistently and being responsive to community needs create a sense of belonging, a key driver of trust.