Seham al-Laham is expecting her first child.
But what should be a happy occasion has been overshadowed by an anxious wait for the United Nations agency for Palestinian refugees (UNRWA) to cover her expenses to give birth at a government-run hospital in Amman, Jordan.
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The 20-year-old Palestinian refugee has been diligent about making it to all her appointments at the medical service centres in Jabal el-Hussein Camp, where she lives, but “the UNRWA-run clinics have been facing shortages in medicine, and lab equipment”, al-Laham said.
“We have been hearing of the financial problems facing UNRWA, and it has left me worried about my delivery and the medical services provided to me and my newborn,” she told Al Jazeera.
UNRWA provides life-saving services, including essential primary healthcare, through 25 health clinics across refugee camps in Jordan.
But an unprecedented financial crisis has put UNRWA’s critical healthcare services in jeopardy – and even United States President Joe Biden’s recent promise to restore aid to Palestinians will not solve the problem in the long term, experts say.
The US has long been the single largest donor to the agency, contributing about 30 percent (nearly $365m) of UNRWA’s annual budget, making it particularly vulnerable to the political whims of different US administrations.
In 2018, the Trump administration ceased funding for UNRWA, plunging the organisation into financial instability. Washington attributed the cut to a need for unspecified reforms as it pushed Palestinians to renew peace talks with Israel.
“The biggest challenge the institution faces is that it is financially unstable unless there’s an international mandate that provides for long-term funding,” said Tareq Baconi, the International Crisis Group’s senior analyst on Palestine and Israel.
“The Trump administration has shown that this is not only something that can be used punitively in a political way, but also that the organisation has become overly dependent on the US.”
UNRWA needs more than $1bn annually to manage its regular, emergency and life-saving services to approximately 5.7 million Palestinian refugees in the occupied Palestinian territories, Jordan, Syria and Lebanon.
While there have been some positive signs that Biden’s administration may resume the funding Washington stopped in 2018, this will not be sufficient to cover the agency’s $200m budget deficit for 2021.
On February 2, US State Department spokesman Ned Price said the Trump administration’s decision to cut assistance to Palestinians was counterintuitive, adding that the new leadership would restore financial aid.
“The suspension of aid to the Palestinian people has neither produced political progress, nor secured concessions from the Palestinian leadership. It has only harmed innocent Palestinians,” Price said during a news briefing.
“The US will reinvigorate our humanitarian leadership and work to galvanise the international community to meet its humanitarian obligations, including to the Palestinian people. This is something we’re working on very quickly to restore,” he added.
UNRWA spokeswoman Tamara al-Rifai said she welcomed the announcement, but the agency’s financial situation nevertheless will be “very difficult” this year. “We expect the occurrence of a funding crisis as of March this year, and on a larger scale, the expected deficit for this year may lead to the financial collapse of the agency,” she said.
“We are taking into account the prospect of re-engaging the new US administration, so we expect a slightly better income than it was in 2020, but this slight increase in income will not be able to cover the huge liabilities of the agency.”
Founded in 1949 after the Nakba – or catastrophe – that led to the exodus of approximately 700,000 Palestinians, UNRWA today provides Palestinian refugees with education, health, and social services.
Palestinian officials believe the US decision to cut funding to UNRWA was an effort to pre-empt any future final status negotiations on the right of return for Palestinian refugees. This is one of the negotiations’ main sticking points, along with Jerusalem and borders of a future state.
The very idea of Palestinians being refugees was what spurred the diplomatic onslaught from the White House, former Brookings Institution expert Hady Amr wrote in 2018; specifically, the ability of stateless people to pass on their refugee status to future generations under international law.
Israeli Prime Minister Benjamin Netanyahu has long pushed for UNRWA to be abolished and advocated for its responsibilities to be handed over to the UN’s refugee agency (UNHCR).
“There is a chronic challenge that the organisation is facing in terms of viability, and the more the political reality for the Palestinian question gets marginalised and challenged, the harder it is for UNRWA to do its job,” Baconi said.
While the organisation is badly wounded from years of budget cuts, it has stayed intact – despite the best efforts of key Trump administration officials, such as former UN Ambassador Nikki Haley and Jared Kushner, Trump’s son-in-law and senior adviser.
In 2018, Haley claimed UNRWA exaggerated the number of Palestinian refugees and said the agency needed to carry out reforms. “You’re looking at the fact that, yes, there’s an endless number of refugees that continue to get assistance, but more importantly, the Palestinians continue to bash America,” she said at the time.
Kushner’s family foundation has made donations to Israeli settlements and has a longstanding relationship with Netanyahu. Foreign Policy reported in 2018 that in an effort to sabotage UNRWA’s work, Kushner tried to pressure Jordan to strip two million Palestinians living there of their refugee status.
The United Arab Emirates, which last year signed a US-brokered normalisation deal with Israel, drastically reduced its funding for UNRWA – from $51.8m in 2019 to $1m in 2020. Israel’s Channel 12 reported that Bahrain also slashed aid to the agency, but it did not provide exact figures.
An Emirati government official told the Reuters news agency this week that the UAE does not intend to restore funding until steps are taken to manage it more effectively. “We are in dialogue with UNRWA’s leadership on how to enhance effectiveness of aid,” said Minister of State for International Cooperation Reem al-Hashimy.
“The question is whether the Gulf will try to dismantle UNRWA, and whether the US will go along [with it],” said Zaha Hassan, a human rights lawyer and senior legal adviser to the Palestinian negotiating team during Palestine’s bid for UN membership in 2010-12.
Whether Washington will in fact resume aid to Palestinians also remains to be seen, Hassan told Al Jazeera.
“The Biden administration has not resumed aid to UNRWA and did not mention the agency by name. The money may go to other international NGOs or UNHCR.”