Take a second to picture the United Nations Relief and Works Agency (UNRWA). Is it a positive picture? A negative one? Is it even something you know at all? For most Americans, UNRWA either flies totally under the radar or it falls under the nebulous category of the Israel-Palestine issue.
UNRWA is the United Nations organization responsible for providing assistance, protection, and advocacy for Palestine refugees who lost their homes or their livelihood as a result of the 1948 conflict and the descendants of those original refugees. The number of refugees now totals over 5 million refugees. For many of them, UNRWA provides their sole access to health care, education, and financial relief services.
The organization recently made headlines when U.S. Senator Mark Kirk (R-IL) publicly challenged the organization last May. Senator Kirk introduced a bill that called for redefining Palestinian refugees. This new definition could lead to excluding descendents of the original Palestine refugees, as the senator sees that refugee status cannot be passed on. This would drastically reduce the number of refugees down to the original 750,000 that were originally displaced back in 1948. Not only does this directly challenge the Palestinian narrative of the "right of return," but it would also likely affect funding of the organization. The bill passed the Senate Appropriations Committee and was approved to be voted on in the House and Senate in May 2012.
Like Senator Kirk, we believe that it is incredibly important that American tax dollars continue to go to effective and efficient programs. We also agree that it is equally important to continue to work towards a solution to the Palestine refugee issue. However, unlike the senator, our work and personal experience with UNRWA has also made us realize that the organization should actually enter the public discourse for a much more positive reason. UNRWA has been tremendously successful in promoting the economic development of Palestine refugees by following through with the Millennium Development Goals (MDGs). Their work on improving maternal and child health has been exceptionally notable.
UNRWA and the MDGs
In 1950, when UNRWA was first created, the infant mortality rate (IMR) for Palestine refugees stood at a staggering 160 deaths per thousand live births. In 2005-06 that rate dropped to 21.8 deaths. In today's standards, that puts UNRWA around 89/90th in the rankings of IMR (where Afghanistan is No. 1 with 121.63 deaths and Monaco is No. 223 with 1.80 deaths). An article published in 2004 by the Center for Research on Population and Health in Lebanon actually found that Palestine refugees have a "clear advantage" in comparison to their non-refugee counterparts when it comes to mortality rates. UNRWA must be doing something right.
The organization manages to run a unique primary health care system that provides free, continuous care to refugees. The high-quality, long-term health care it provides surpasses what is available in most developing nations. Even with its limited resources and the ever-growing patient population, UNRWA provides continuous prenatal care for over 100,000 pregnant women every year. Their checkups for expectant mothers begin in the first trimester. These early screenings allow clinicians to identify complications early on and also provide mothers with the prenatal vitamins and dietary counseling necessary for a healthy pregnancy. By the end of their pregnancy, refugee women have received on average 7.4 prenatal visits. To put this in perspective, the MDG baseline is four visits.
UNRWA has also succeeded at providing a comfortable environment for couples to discuss family planning options with a medical provider. More than 137,000 couples are enrolled in the clinics for these services and studies have shown that the use of modern contraceptives is actually on the rise. This could have a significant impact on regions like the Gaza Strip where fertility rates are especially high (women living in Gaza on average have about five children). UNRWA provides these women with family planning counseling when they come in for their child's first vaccination appointment.
In 2009, UNRWA provided healthcare services for over 300,000 children under the age of 36 months. Their vaccination program covers close to 100 percent of its population. Their program eradicated the presence of malaria in the Jordan Valley and, as a whole, contributed to a tremendous decline in mortality rates from preventable diseases in the camps. This is an incredible accomplishment especially in places like the Gaza Strip where vaccination shortages can last anywhere from days to months. Political problems between opposing Palestinian parties frequently hold up vaccines at the borders, but UNRWA still manages to successfully immunize the population in Gaza.
How UNRWA lines up with global economic development
Professor Jeffery Sachs, who directs the Millennium Project, argues that the world can eliminate extreme poverty through "carefully planned" development aid. Sachs argues that Western countries have pushed developing countries to privatize their systems and charge user fees to cover costs even though Western health systems "guarantee" universal access.
For people already living in extreme poverty, tacking on additional healthcare expenses is inconceivable. Adding on user fees to essential services like preventative care and vaccinations forces families to prioritize other basic necessities like food and housing over health care. UNRWA's health program enables refugees to tackle their medical issues before they become too expensive or too difficult to manage.
Considering that universal preventive primary care has always been an option for Palestine refugees, could UNRWA be playing in a different ball game? Could UNRWA essentially be following Sachs' model of a health system that promotes economic development? Investments in their primary healthcare system may pay off in higher work productivity because of a healthier adult population and an increased likelihood that illness will not keep Palestinian youth out of school. Moreover, according to UNRWA, focusing on preventive services has cut down costs and increased the number of refugees they can serve.
UNRWA has experienced tremendous success in improving maternal health and reducing child mortality. They have enabled mothers to take ownership of their health and when they have children. Their children also have access to regular medical care. But, this doesn't mean that the story ends here.
UNRWA has provided us with a great foundation that we can learn from when it comes to community development. Instead of threatening to withdraw funding, we can build upon UNRWA's model and introduce even more effective programs and technologies. We should effectively monitor and evaluate these programs in order to track their successes and push those successes in reaching all of the Millenium Development Goals even further.