Beirut - In a small second-floor apartment in Shatila, a Palestinian refugee camp in Beirut, Alia Abdul Haleem boils coffee on a small, rickety stove. Sitting on a set of cushions nearby, Lamia Saad, a neighbour and friend in her 20s, removes bright magenta seeds from a pomegranate and places them in a bowl. 

Abdul Haleem, 56, and Saad previously lived in the Yarmouk Palestinian refugee camp in Damascus. Both sought refuge in Lebanon more than three years ago as conflict made life in Yarmouk unbearable. Abdul Haleem, a widow who lives with her daughter, pays $200 a month for her apartment: a plain, five-square-metre room that serves simultaneously as a bedroom, a living room and a kitchen.

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Upon arrival to Shatila from Syria, Abdul Haleem received a $100 monthly housing stipend from UNRWA, the UN refugee agency, to subsidise her rent. Last July, the aid was suspended, and in recent weeks, further changes to UNRWA's medical aid policy have raised fresh fears. 

"Now, if I become sick or my daughter is sick, I don't know if I will be able to afford treatment," Abdul Haleem told Al Jazeera.

"Before the war, Damascus was a beautiful city with good infrastructure. Palestinians were allowed to own property and there was no discrimination to stop us [from] working," she added. "Here, it is much worse. People rely on aid from UNRWA. Without it, people will suffer."


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Most of the 42,500 Syrian Palestinians registered with UNRWA in Lebanon live in the country's 12 Palestinian refugee camps, supplementing a pre-existing Palestinian community of 450,000. In Lebanon, in contrast to Syria, Palestinian refugees are prohibited from owning property and working in as many as 20 professional fields.

Living conditions in the camps are notoriously poor. In Shatila, whose population has skyrocketed amid the Syrian refugee influx, electricity supplies are unreliable and access to safe drinking water is limited. Poverty is endemic throughout the camp.

But since the new year, these concerns have been overshadowed by growing fears over access to vital healthcare.

I didn't need assistance from UNRWA in Damascus. There were opportunities for me to work and study provided by the state. Here, there is nothing.

Lamia Saad, resident of Shatila camp

At the start of 2016, UNRWA - established as a temporary refugee agency in 1949 to assist Palestinians displaced by the 1948 Arab-Israeli war - introduced a new hospitalisation system. Palestinian refugees who had been covered fully by UNRWA for secondary medical care - treatments requiring a short period of hospitalisation, such as childbirth, intensive care and medical imaging - must now pay five percent of bills accrued at Palestine Red Crescent hospitals, 15 percent at government hospitals, and 20 percent at private hospitals.

The policy change comes after UNRWA announced last summer that it faced a budget deficit of $101m, leading to the suspension of housing subsidies and education cuts that threatened the start of the school year in UNRWA schools across Lebanon. 

Zizette Darkazally, UNRWA's public information officer for Lebanon, said the changes should not be understood as "cuts".

"The overall budget remains $10m," Darkazally told Al Jazeera. She explained that although funding for secondary healthcare has been reduced, the organisation's budget for tertiary healthcare - for inpatients in facilities for advanced medical treatments including cancer management, neurosurgery and cardiac surgery - has increased.

"We raised coverage of tertiary healthcare from 50 percent to 60 by reducing coverage of secondary healthcare, in order to cover life-threatening conditions that are expensive to treat," Darkazally added. "There were no budget cuts; we just readjusted the services through the budget to provide better coverage for those with very expensive-to-treat conditions, who need operations that could potentially be life-saving."

But many Palestinians in Shatila - originally built in 1949 for 3,000 people, but now home to more than 25,000 - and elsewhere fear the worst.

"There is confusion. People worry they will no longer be able to afford treatment. No one thinks this change is a good thing; people just fear more and more services will disappear," said Khoda Khatab, who was born in Shatila and lost relatives during the 1982 Sabra and Shatila massacre.

On January 12, Mohamed Omar Khedr, a 23-year-old Palestinian man who suffers from a rare blood disorder called thalassemia, set himself on fire outside a UNRWA clinic to protest against changes to the system. Khedr survived with serious injuries.

Some have also blamed UNRWA's new policy for the deaths of two Palestinian women since the start of 2016, accusations that Darkazally refutes. Since then, protests have been held outside numerous UNRWA facilities in Lebanon's various Palestinian camps. The protests have garnered support from Palestinian political groups including Hamas, Fatah and Islamic Jihad.

Speaking at a demonstration outside the Ain el-Hilweh camp in Sidon last Saturday, Maher Shabayta, the secretary of Fatah in Lebanon, told Lebanon's Daily Star newspaper: "People are dying at the doors of hospitals ... Palestinians are standing in one line against the arbitrary decision."


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Darkazally stated that primary healthcare remains completely covered by UNRWA, and that the cost of prescription medicine remains the same. However, many in Shatila appear to be unaware of this. Speaking to Al Jazeera, both Khatab and Monira Qasm, a Syrian Palestinian woman whose brother drowned in the Mediterranean last year attempting to reach Europe, expressed concern that prescription medicines would soon become too expensive to afford.

Darkazally said reliance on UNRWA has created panic in the Palestinian community, which has contributed to the spread of misinformation with tragic consequences. 

Regarding Khedr's case, Darkazally said that the adjustments to the UNRWA system "would not have affected his level of care".

"Unfortunately, he performed a drastic action. It is tragic," she added.

While last summer was the "worst financial crisis" that UNRWA has ever encountered, Darkazally added, "there are more challenges ahead in 2016".

Back in Abdul Haleem's apartment, Saad observed that before the war in Syria, Palestinians were less reliant on UNRWA for assistance than in Lebanon.

"I didn't need assistance from UNRWA in Damascus," said Saad, removing a final, few stubborn seeds from the pomegranate. "There were opportunities for me to work and study provided by the state. Here, there is nothing."

Source: Al Jazeera