Ain al-Hilweh refugee camp, Lebanon – Friday prayers had just ended inside Ain al-Hilweh, and about 200 residents congregated near one of the entrances to this Palestinian refugee camp near the southern city of Sidon.
Chants protesting at recent changes introduced by UNRWA, the United Nations agency for Palestinian refugees, to its hospital system rang out from the assembled crowd. In the middle of the protest stood Saleh al-Youssef, a representative of the Palestine Liberation Front (PLF) political faction in southern Lebanon.
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“These changes must be reversed. Life in the camps such as Ain al-Hilweh is already a grave humanitarian issue. Healthcare, like education, is a fundamental right,” Youssef said, as the crowd nodded in agreement.
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In January, UNRWA started requiring Palestinian refugees to pay between five and 20 percent of their hospital bills. Previously, the refugees had secondary healthcare fully covered by the organisation.
Secondary healthcare refers to treatments requiring a short period in hospital, such as childbirth, intensive care and medical imaging.
The cost of healthcare in Lebanon ranks among the highest in the Middle East and North Africa region, and many Palestinians – whose access to formal job markets in Lebanon is limited by state-imposed restrictions – fear they will no longer be able to afford treatment.
Established in 1949 as a temporary refugee agency to assist the hundreds of thousands of Palestinians displaced by Israel’s 1948 establishment, UNRWA recorded a budget deficit of more than $100m last year – the largest in its history.
The deficit pushed the organisation to slash its educational budget and suspend $100 monthly domestic aid subsidies which had previously been offered to each family. Those changes have caused resentment among the approximately 450,000 Palestinians in Lebanon. Residents of Ain al-Hilweh, Lebanon’s largest Palestinian refugee camp, have been hit particularly hard.
Built to accommodate 10,000 Palestinians forced into exile in 1948, mostly from the Galilee region of present-day Israel, Ain al-Hilweh is an impoverished, 1sq km compound of narrow avenues and electrical wires, surrounded by concrete breeze blocks and Lebanese Army checkpoints.
Since 2011, the camp’s population has grown from around 70,000 to more than 90,000 owing to the arrival of mainly Syrian-Palestinians displaced by the war in Syria. The influx has boosted competition for jobs, pushing down wages and raising unemployment, and created an endemic housing crisis.
Protests against the health cuts held outside UNRWA facilities in Lebanon’s 12 Palestinian camps have become common, and some have even blamed the cuts for the deaths of a small number of Palestinians earlier this year.
People have labelled these adjustments an 'intifada against UNRWA', because the health programme is one of our core services.
Zizette Darkazally, UNRWA’s public information officer for Lebanon, told Al Jazeera that the organisation was not responsible for those deaths. She pointed out that UNRWA’s annual hospital budget in Lebanon for 2016 remained the same ($10m) as in 2015, and subsidies for tertiary healthcare actually increased.
“People have labelled these adjustments an ‘intifada against UNRWA’, because the health programme is one of our core services,” Darkazally said.
“Because tertiary is very expensive and people often struggle to afford it, we raised the ceiling on this cover to 60 percent from 50 percent, and the ceiling of the intervention from $4,200 to $5,000. In order to cover the difference, we reduced secondary coverage,” she said. “There were no budget cuts; we just readjusted the services to cover those with very expensive-to-treat, life-threatening conditions.”
Despite such assurances, Youssef and others at the demonstration in Ain al-Hilweh said they were committed to keep demonstrating until the cuts were revoked.
“We will continue protesting in Ain al-Hilweh, but we are also discussing initiatives to hold a sit-in at the headquarters of the European Union, among other things,” he said.
Palestinian factions in Ain al-Hilweh, including the PLF, Fatah, Hamas and the Islamic Jihadist Movement, have all expressed support for the current demonstrations. That unity is uncommon in a camp that is home to many armed Palestinian groups, and where outbreaks of violence between rivals are frequent.
The 1969 Cairo Accord prohibits the Lebanese Army from entering Palestinian refugee camps in Lebanon. Last summer, a spree of political assassinations and gun battles pitted Fatah and its supporters against fighters from the al-Qaeda-affiliated group Jund al-Sham. The clashes left many dead, and buildings throughout the camp remain pockmarked with bullets.
“The situation now is calm. There is coordination between all the factions to maintain the peace,” said Sheikh Jamal Khattab, the head of the Islamic Jihadist Movement, who has played the role of arbitrator during previous clashes.
But many in the camp remain concerned about potential future cuts by UNRWA.
“The health issue is an important issue. But I am also worried that at the start of the new year, [UNRWA] schools will not open,” Abd Abu Saleh, who heads a committee that manages affairs inside the Ain al-Hilweh camp, told Al Jazeera.
“If more UNRWA services are cut, I think it is inevitable that more people will seek alternative solutions, and leave.”
In the second half of 2015, following the UNRWA cuts to domestic assistance and the outbreak of violence in Ain al-Hilweh, many primarily younger residents of the camp joined hundreds of thousands of Syrian refugees leaving Lebanon for Europe.
From a small, second-floor office in a school and social centre run by the NGO Nabaa in Ain al-Hilweh, camp resident Nidal told Al Jazeera: “There is no work; there is no stability. With these cuts, how are we meant to live?”
The 47-year-old widow, who spoke under a pseudonym, said she paid around $100 a month for medication to treat hypertension and rheumatism. She fears that if her condition deteriorates, the cuts will render her unable to afford hospital care.
“Even people not directly affected by the cuts now have no security. They are scared that if they become sick, they will be turned away at the hospital doors,” said Nida.
Last year, one of Nidal’s daughters left Ain al-Hilweh with her husband for Germany.
“It has become common to hear of people leaving,” explained Ibtisam Mosri, 39, whose cousin also travelled from Ain al-Hilweh to Europe last year.
With unemployment high in the camp and UNRWA assistance across sectors being scaled down – and with the threat of a return to violence never far away – both Nidal and Mosri said they understood why leaving Ain al-Hilweh had become an increasingly attractive option for some.
“I support the demonstrations,” Nidal said. “This is about the rights of the Palestinian community. But members of my own family have left. What could I say to stop them? People here are suffering.”