Mahmoud Wohush, a doctor, is especially proud of one thing: child mortality among Palestinian refugees has dropped dramatically during the last 30 years. While 100 children per 1000 births died in the 1980s, the number today is 18. “We do everything we can to save lives in the refugee camps”, says Wohush. He is deputy director of the health programme at the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), which receives substantial funding from Germany. Germany’s humanitarian contribution to UNRWA comes from the Federal Foreign Office’s Directorate-General for Crisis Prevention, Stabilisation, Post-Conflict Peacebuilding and Humanitarian Assistance.
In the refugee camps, UNRWA operates health centres which provide primary healthcare for the people living there. Pregnant women are examined, babies vaccinated, and diabetes patients as
well as the chronically ill also receive care. “There would be much suffering here if there were no UNRWA health centres”, says Wohush. Although the camps no longer consist of tents but have evolved into densely populated quarters on the fringes of urban centres, the poverty remains. Most people would barely be able to afford the most simple treatment.
Doctors such as Salim Anati therefore have to provide a wide range of treatment and to be tough. He works in the UNRWA health centre in Shuafat refugee camp in East Jerusalem. Some 70,000 people live in his catchment area. He treats 70 patients on a quiet day but sees up to 200 on others. He says that he has just referred a patient with a diabetic foot to hospital. “I fear she’ll lose her foot and I’m very sorry about that.” He says that without UNRWA the healthcare situation for refugees would be disastrous. “They depend on us.”
Anchor of stability for the region
UNRWA was originally set up for a transitional period. The first Israeli-Arab war broke out after the UN partition plan of 1947, which was rejected by the Arab side. Hundreds of thousands of Palestinians fled to what is Jordan, Syria, Lebanon today, as well as into the Gaza Strip and the West Bank. In line with Resolution 302, UNRWA has a mandate to support and protect Palestinian refugees, which have grown from the original 720,000 to around five million people, until a political solution has been found to the Middle East conflict. There are now fourth-generation refugees, but there is no peaceful resolution of the conflict in sight. Although UN Resolution 194 guarantees their right to return, politically this is a point of particular contention between the parties to the conflict and is one of the final status issues.
“UNRWA is a key anchor of stability for the entire region”, says Thomas Zahneisen, Director for Humanitarian Assistance at the Federal Foreign Office. “For the Palestinian refugees, UNRWA means much more than social care.” “For them, it’s a confirmation that they exist and gives hope to young people in particular.” Without UNRWA, there would be no schools for the 500,000 children with refugee status, no primary healthcare and no humanitarian assistance for this especially vulnerable community.
Despite its clear mandate from the international community to care for Palestinian refugees, UNRWA faces considerable financial difficulties, as most of its budget is made up of voluntary contributions from donor countries. Germany’s contribution of around 80 million euros in 2017 – making it the third largest donor behind the United States and the EU – is more important than ever because the United States reduced its share of funding in 2018 from 360 million dollars to 60 million dollars. Without UNRWA, not only would an anchor of stability be missing in the region. The underfunding of UNRWA could also immensely weaken or even bring down the Palestinian Authority, which would be unable to cope with the greater burden. That could result in extreme deprivation, instability and political unrest. All of this would be very damaging for the prospects for peace between Israel and the Palestinians.
Accepting assistance in dignity
UNRWA not only provides healthcare but also operates schools. In acute crisis situations, it ensures that people have a roof over their heads and food if they are unable to provide for themselves. To ensure that families in need can accept assistance in dignity and feel like productive members of the community, UNRWA also runs humanitarian cash-for-work programmes. Any individual can earn 1260 dollars in three months in this way. “I’ve used my earnings to buy food and clothes for my wife and six children”, says 47-year-old Iyad Mahmoud Taha from Jalazone camp. “I’ve also been able to pay back some of my debts in the small supermarket where we normally buy food.”
Dima Abu al-Saud, who heads UNRWA’s cash-for-work programme says that there is enough food in the West Bank and Gaza Strip. “But many people don’t have enough income to buy it.” The unemployment rate among refugees is more than 20 per cent; one quarter of these families suffers from chronic food insecurity –they live in permanent fear that they will not be able to afford even basic foodstuffs. “That’s why we have long waiting lists for the cash-for-work-programme.”
Refugees on a permanent basis
The UNRWA programmes in the Palestinian camps highlight the situation very often confronting humanitarian assistance today: in many places people are living as refugees on a permanent basis. The assistance therefore also has to provide long-term solutions. Relief organisations, for which the Federal Foreign Office is also one of the most important donors beyond UNRWA, have therefore devised ways of helping families in need in such a way that they can decide for themselves what to do with this assistance. For in many respects the situation in the West Bank is typical of the situation in conflict regions around the world: aid for people who have fled their countries or regions not only has to be provided in tent camps but just as frequently in urban settings or on the fringes of urban centres. Refugees have to deal with a temporary and provisional set-up which is often their home for many years or decades.
What is humanitarian aid? How does the Federal Foreign Office provide assistance? On which principles is German aid based?