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BEIRUT: The implementation of a revised health care funding policy by UNRWA on June 1 was met with surprise and anger from Palestinian groups who believed negotiations were ongoing, with activists vowing to escalate protests in reaction. Following rounds of talks between UNRWA and Palestinian groups over adjustments to a new health policy, initially announced in December, the U.N. agency implemented the changes at the beginning of the month. However, Palestinian officials expressed surprise at the decision, despite UNRWA saying they had notified the parties in advance of the move.

“We first suspended the policy on March 1 to give space for dialogue ... and UNRWA was clear from the beginning that the suspension couldn’t last forever,” Zizette Darkazally, head of communications for UNRWA in Lebanon, told The Daily Star.

At the beginning of January, UNRWA implemented a new health care policy that requires contributions from Palestinians for secondary hospital care. The U.N. agency explained that the policy was designed to meet the changing nature of health care needs and place a greater emphasis on often expensive, complex tertiary care for specialist, long-term and chronic issues. However, the policy sparked anger among many Palestinian groups and factions who saw the move as a cut in services and proof that UNRWA was slowly winding down assistance for Palestinians. Following the initial announcement, the factions formed a crisis cell to press UNRWA to revise the decision, and they staged a number of protests across Lebanon, closing several UNRWA centers on multiple occasions. The agency suspended the policy revision in March to allow for talks. “[The suspension was] first until April 21, and we didn’t reach a conclusion but we saw the dialogue was going really well and we are going to reach conclusions so we extended it until the end of May. But the director of UNRWA was very clear in his letter sent to the Palestinian ambassador and the factions on May 3 that by end of May there was an expectation that the parties would reach some kind of conclusion about a more refined, adjusted policy,” Darkazally explained. However, Ahmad Abdel-Hadi, a member of the Palestinian crisis cell negotiating with UNRWA, said that there was an understanding that nothing would be implemented until the talks were completed. “Regardless of what [UNRWA’s Country Director Matthias] Schmale said, we had an understanding throughout the talks that the new policy would be suspended until the talks came to a conclusion,” he told The Daily Star. “Regardless of the letter sent this was the agreement.”

Abdel-Hadi and a number of other Palestinian activists and officials expressed surprise at the decision. Hamas member Mohammad Shahabi said: “We were shocked by the decision because we had just sent the list of demands with the understanding that we would be negotiating the terms.”

January’s policy covered referral care for Palestinian refugees up to 95 percent of treatment at a Palestine Red Crescent hospital, 85 percent at a government hospital, and 80 percent at a private hospital. They had previously received free care at all three types of institutions.

June’s refined policy adjusted these figures to 100 percent coverage for Palestine Red Crescent hospitals and 90 percent for government and private hospitals. The increased coverage for tertiary care brought in with January’s regulation has remained, with 60 percent of tertiary care costs being covered with an increased ceiling of $5,000. It had previously been 50 percent coverage, up to $4,200.

But Palestinians expressed concerns this coverage may still leave many unable to afford treatment. “Ideally what we demand is complete coverage for health and education, even if [UNRWA] pays a large percentage the Palestinian people can’t pay the rest,” said a Fatah official who spoke on condition of anonymity. “Where are they supposed to get the money if they can’t even work?”

Darkazally, however, played down concerns that this was the end of talks, stressing that they were always available to discuss the issue further and keep looking for the best outcomes possible.

Meanwhile, the crisis cell are now assessing their next move. “Palestinian political figures are meeting with [General Security head] Maj. Gen. Abbas Ibrahim to talk about the best course of action, but probably it will move toward more demonstrations,” Abdel-Hadi said. Ibrahim has earlier mediated between the crisis cell and UNRWA in the initial talks as he was seen as a neutral and impartial figure. “The crisis phase is still ongoing and will persist until all our demands are met,” explained Shahabi.

But since the start of the Syrian crisis in 2011, UNRWA funding has been stretched to cover existing services and emergency response. Darkazally highlighted that if there was more money, they would be better able to offer improved services for free; however, the budget reality prevents this. “With raising the percentages [for hospitalization] we have really pushed it to our [funding] limit. It will of course take more fundraising efforts from our side.”

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