The Changing Faces of UNRWA

From the Global to the Local

in Journal of Humanitarian Affairs

This article explores the UN Relief and Works Agency for Palestine Refugees’ (UNRWA) responses to the US Government’s decision to dramatically cut its financial contributions to the Agency in 2018. Acknowledging the complexities of the fast-moving changes and dilemmas faced by UNRWA and Palestinian refugees, this article focuses specifically on the events that unfolded in the first six months of 2018. Through a multiscalar analysis, I start by situating UNRWA’s key responses as they have played out on the international stage through a high-profile fundraising campaign (#DignityIsPriceless). I then develop a close reading of three regional-level UNRWA circulars disseminated to UNRWA staff pertaining to the provision of maternal and neonatal health services, and to Palestinian UNRWA staff members’ employment and pension rights. Against the backdrop of the impact of UNRWA’s responses across the region, I subsequently examine how these operational changes have been experienced and conceptualised by Palestinians living in refugee camps in Lebanon, noting that those experiences must be analysed within the broader context of protracted displacement, enforced immobility and overlapping displacement.


This article explores the UN Relief and Works Agency for Palestine Refugees’ (UNRWA) responses to the US Government’s decision to dramatically cut its financial contributions to the Agency in 2018. Acknowledging the complexities of the fast-moving changes and dilemmas faced by UNRWA and Palestinian refugees, this article focuses specifically on the events that unfolded in the first six months of 2018. Through a multiscalar analysis, I start by situating UNRWA’s key responses as they have played out on the international stage through a high-profile fundraising campaign (#DignityIsPriceless). I then develop a close reading of three regional-level UNRWA circulars disseminated to UNRWA staff pertaining to the provision of maternal and neonatal health services, and to Palestinian UNRWA staff members’ employment and pension rights. Against the backdrop of the impact of UNRWA’s responses across the region, I subsequently examine how these operational changes have been experienced and conceptualised by Palestinians living in refugee camps in Lebanon, noting that those experiences must be analysed within the broader context of protracted displacement, enforced immobility and overlapping displacement.


With the UN Relief and Works Agency for Palestine Refugees (UNRWA) having run a deficit almost since the start of its operations in 1950, the US’s decision – as UNRWA’s erstwhile primary funder – to cut its financial support for the Agency is having a significant impact both on UNRWA and over five million Palestinian refugees living across UNRWA’s five areas of operation in the Middle East: Lebanon, Jordan, Syria, Gaza and the West Bank. This article explores UNRWA’s responses to this dramatic cut in funding; more specifically, it examines the ways UNRWA’s operational changes since January 2018 have been experienced and conceptualised by Palestinians living in Lebanon. It does so through a multiscalar analysis, tracing and examining processes taking place in the international arena, on regional and national levels in the Middle East and within the Palestinian refugee camps of Lebanon.1

In January 2018, the US Government declared that it would contribute only $60 million to UNRWA (compared to $364 million the previous year)2 unless the Agency undertook specific US-approved ‘reforms’.3 This ‘catastrophic’ decision (AFP, 2018) was widely denounced around the world as a form of collective punishment against the Palestinian people (Bachner, 2018; Dumper, 2018). By the end of August 2018, when the US Government announced its decision to completely defund UNRWA, commentators identified this as part of a strategy to force Palestinian refugees to rescind the Right of Return to Palestine (a right set out in UNGA Resolution 194).4 Many noted that undermining the Agency’s capacity to deliver relief and services would create such abject living conditions (akin to Agamben’s ‘bare life’: Gordon, 2018) that Palestinians would be forced to accept what Trump and his administration have denominated the ‘deal of the century’ (Gordon, 2018; Wong, 2018). Far from being motivated by an ‘ethics of care’ to protect displaced and dispossessed people, or a quest to secure a democratically grounded ‘liberal peace’, this ‘great deal’ can be identified as a quintessentially neoliberal project. Driven neither by ethics nor humanitarian principles, this is an approach underpinned by the depoliticisation of the cause of Palestinians’ displacement and dispossession – the occupation of Palestinian territory by the state of Israel. In essence, the deal is a ‘truly Trumpian solution’: ‘cash for peace instead of land for peace… Peace will therefore be economic, rather than political… Their hopes may be dead but their bank accounts will be in the black’ (Fisk, 2018).

While UNRWA may be perceived as being at particular risk due to the financial precarity resulting from the funding cuts, it is (as I explore below) Palestinians who continue to bear the manifold risks created and perpetuated by diverse actors – including states and UN agencies.

As a means of laying the foundations for the subsequent analysis of UNRWA’s responses to the major financial shortfall arising in January 2018, in the first section of the article I start by providing a brief overview of the history of UNRWA supporting Palestinian refugees in the Middle East since the 1950s. In presenting this historical reflection, I start from the premise that the current processes must be analysed in relation to UNRWA’s long-standing financial insecurity and the extent to which the Agency has repeatedly ‘shrunk’ the group of Palestinian refugees considered to be a priority in addition to the nature of services it has been willing or able to deliver to these selected recipients.

In the second section, I trace the contours of the #DignityIsPriceless campaign launched by UNRWA in January 2018. I focus on this campaign given its hypervisibility in the international public sphere as UNRWA’s official response to the cuts and its acute financial crisis, while acknowledging that other international responses, such as bilateral and multilateral discussions between UNRWA and potential donors and various diplomats, have been ongoing throughout this period. Understandably, given UNRWA’s financial circumstances following the announcement of the cuts, the campaign sought to encourage existing and ‘non-traditional’ state and non-state actors to commit funds to ensure that the rights and needs of Palestinian refugees were met. By examining the representational strategies used in this campaign, I outline how it simultaneously highlights the vulnerability and ‘worthiness’ of certain groups of Palestinian refugees (a well-worn, and equally critiqued, fundraising strategy) while also centralising certain Palestinians’ agency and rights. Considering hypervisibility and invisibility (Fiddian-Qasmiyeh, 2016a), I argue that the international campaign’s celebration of specific groups of Palestinian refugees and its prioritisation of communication with international audiences simultaneously dismisses the roles and rights of diverse groups of Palestinians in the Middle East. Equally, it veils the adverse effects of UNRWA’s own regional and local-level operational processes on a wide range of people, including UNRWA’s Palestinian staff members.

I demonstrate this, firstly, by developing a close textual analysis of three regional-level UNRWA circulars disseminated to UNRWA staff in early 2018. Several of my interviewees in Lebanon shared the full text of these circulars with me, showing me the circulars they had received by email from UNRWA on their mobile phones and/or laptops; all quotes from the circulars are taken verbatim from the documents on file with the author. In undertaking this close reading of the documents, I trace the nature and implications of a series of UNRWA’s more ‘private’ responses to the 2018 cuts, with a particular focus on shifts in educational and maternal and neonatal health services on the one hand and employment and pension rights on the other. I thus illustrate the extent to which UNRWA’s operational changes are invisible on the international stage and yet are having significant impacts on Palestinian refugees’ access to services and diverse rights on regional and local levels.

I subsequently examine how these operational changes were experienced by Palestinians living in refugee camps in Lebanon in the first half of 2018, noting that those experiences must be analysed within the broader context of protracted displacement, enforced immobility and experiences of overlapping displacement (Fiddian-Qasmiyeh, 2015, 2016b). In the case of Lebanon, this requires acknowledging the impacts of operational changes both on the ‘established’ 450,000 registered Palestinian refugees who have resided in Lebanon since 1948 (primarily living in twelve official refugee camps and numerous informal gatherings in that country) and on the ‘more recently arrived’ 31,000 Palestinian refugees from Syria who have sought safety in Lebanon since 2011 from the ongoing Syrian conflict. Palestinian refugees from Syria (PRS) in Lebanon are considered by UNRWA to be a particularly vulnerable group – 90 per cent are living under the poverty line and 95 per cent are food-insecure – and are primarily being ‘hosted’ in established Palestinian camps which are themselves characterised by chronic poverty, insecurity, marginalisation and exclusion (UNRWA, 2017b). As noted by UNRWA, even before the arrival of tens of thousands of Palestinians displaced from Syria, ‘Among the five UNRWA fields, Lebanon has the highest percentage of Palestine refugees living in abject poverty’ (UNRWA, n.d.b). Since then, ‘The influx of Palestine refugees from the Syrian Arab Republic has aggravated the dependency situation of the community… In this context, the Agency’s services are seen as a lifeline for the refugees’ (UNGA WG, 2016).5

To examine the implications of UNRWA’s operational shifts in such a context, I build upon my long-standing ethnographic research in and about the Palestinian refugee camps in Lebanon and insights from an ongoing research project examining how the members of nine local communities – including Palestinian refugee communities – in Lebanon, Jordan and Turkey have been responding to the arrival and presence of refugees from Syria.6 As part of this project, between January and June 2018 I conducted semi-structured interviews in Lebanon with ten Palestinians with the aim of exploring the impacts of UNRWA’s responses to the recent cuts on their own lives and those of their communities. In order to protect interviewees’ anonymity, certain personal identifiers have been changed and the precise location of interviews excluded.

On a conceptual level, my analysis is framed around two dichotomies – hypervisibility and invisibility on the one hand and the public and the private on the other – in turn building upon existing literature on humanitarian campaigns and critiques of neoliberal approaches to refugee situations. With regards to the latter, it is important to start by acknowledging that humanitarian agencies around the world are facing cumulative funding reductions and a concomitant drive to diversify their donors. Simultaneously, donors and agencies alike are promoting greater degrees of ‘localisation’ – supporting the roles played by regional, national and local actors in affected regions – and ‘self-reliance’ amongst refugee communities. Indeed, in many ways, the above-mentioned deal echoes this increasing determination to promote, or even acquire, the ‘self-reliance’ of refugees.

As I have discussed elsewhere (Fiddian-Qasmiyeh, 2015), as a programmatic approach and as a key ‘indicator’ of successful outcomes, ‘self-reliance’ has been defined by the UN High Commission for Refugees (UNHCR) as referring ‘to developing and strengthening livelihoods of persons of concern, and reducing their vulnerability and long-term reliance on humanitarian or external assistance’ (UNHCR, 2006b: 1; 2011:15); elsewhere, UNHCR defines ‘self-reliance’ much more narrowly as ‘providing… a professional qualification geared towards future employment’ (UNHCR, 2007: 7, emphasis added). While frequently extolled as a key way of ‘empowering’ refugees and recognising their ‘agency’, self-reliance programmes have been criticised for providing ways for donors and states to evade their responsibilities towards refugees and a justification to perpetuate structural inequalities that create and maintain particular forms of vulnerability and risk in protracted displacement.7 Critiques of ‘self-reliance’ are relevant in many ways when examining both the US’s decision to defund UNRWA, and UNRWA’s operational responses to these cuts.

Firstly, UNRWA has, to an extent, ensured the ‘self-reliance’ of tens of thousands of Palestinians since it is an agency that both provides services and assistance and employs 30,000 Palestinian refugees who work full-time to support other members of their community (UNRWA, 2016). These employees embody the potential for a form of multiscalar ‘mutual self-reliance’ or ‘collective self-sufficiency’ – this is to say that UNRWA employees have not only aimed to achieve a degree of ‘self-reliance’ on an individual and family level (as per UNHCR’s definition above) but have also acted as peer providers of assistance and services for communities across the region (Fiddian-Qasmiyeh, 2011, 2015). At a time when ‘self-reliance’ and job creation are being extensively promoted as the key, apolitical and status-quo-maintaining solutions to refugee situations in settings that include Palestine and the ‘special economic zones’ of Jordan, it may appear ironic that ‘one of the largest employers of Palestine refugees’ (UNRWA, 2016: 48) is being targeted for ‘disruption’ by the US Administration.

However, rather than a total disjuncture between ‘the great deal’ and UNRWA’s employment practices, some (uncomfortable) continuities can be identified between them: UNRWA has provided tens of thousands of jobs to Palestinians across the region, while being unable to secure Palestinians’ political rights, including the collective/national right to self-determination and the Right of Return. Indeed, one of the main criticisms levelled by many Palestinians against UNRWA is that its modus operandi has arguably enabled many Palestinians – employees and non-employees alike – to normalise rather than resist and demand sustainable and effective alternatives.8 Such alternatives, as long argued by proponents of the self-determination of Palestine (the ultimate form of self-sufficiency on a national level), should prioritise securing a political solution to the occupation; in the absence of such a solution the continuation of UNRWA’s mandate and financial security has remained a priority on international, regional and local levels alike (UNGA, 2009).

Noting these and other criticisms of UNRWA, this article pivots around my interviewees’ perceptions and fears regarding the effect of UNRWA’s 2018 operational changes that are undermining individual, familial and collective rights. Although they are invisible on the international stage and in UNRWA’s #DignityIsPriceless campaign, a series of increased risks are thus being borne by Palestinian UNRWA staff whose employment rights are being undermined both by financial cuts and operational changes.

Furthermore, a second related way that ‘self-reliance’ is pertinent to this analysis emerges through the application of an additional lens: the private–public framework. I use this lens and what I denominate a process of ‘privatisation’ to denote the ways that operational changes are increasingly rendering Palestinians responsible for the provision of their own welfare and services – including education and health care – within the private sphere of their homes and local communities. The withdrawal and deterioration of UNRWA services available in the public sphere is ultimately paralleled by the increasing demand on Palestinian individuals, families and communities to be self-sufficient, in spite of the long-standing (and arguably increasing) precarity of their situations.

UNRWA: A Brief Background

UNRWA was established by UN General Assembly (UNGA) Resolution 302 (IV) in December 1949, as one of two UN agencies (the other being the United Nations Conciliation Commission on Palestine – UNCPP) mandated to fulfill the international community’s obligations towards Palestinian refugees displaced and dispossessed by the partition of Palestine in 1948. The exclusion of Palestinian refugees from the ‘universal’ refugee regime – the 1950 Statute of the United Nations High Commissioner for Refugees (UNHCR) and the 1951 Refugee Convention – and the international community’s failure to secure a political solution to ensure Palestinian refugees’ Right of Return enshrined in UNGA Resolution 194, has meant that Palestinians have remained in a precarious protracted refugee situation since then. They have been unable to access international refugee protection, or the durable solutions that the UNCPP had been mandated to secure for the Palestinian refugee community (Akram, 2014: 228).

In effect, ‘political impasse, lack of support, and de-funding by the UN’ led to the UNCPP ‘shrinking’ to such an extent that it disappeared, in spite of never being legally terminated by the UNGA (ibid.: 229). The intertwined risks of defunding, institutional shrinking and potential disappearance continue to pervade Palestinian refugees’ experiences and perceptions of UNRWA as the remaining UN agency responsible for Palestinians.

UNRWA’s initial three-year mandate as a ‘relief and works’ agency supporting Palestinian refugees residing within its five areas of operation has been renewed for the past seventy years. While continuing to provide ‘works’ and ‘services’ to Palestinian refugees – including in the fields of health, social services, education, microfinance and direct cash emergency programmes – its budget and programming have been precarious since the agency’s inception, as has Palestinian refugees’ access to its services. Funded through fluctuating annual bilateral donations, donor support ‘has generally failed to keep pace with the rapid growth of UNRWA’s clientele… consequently the Agency has faced a worsening financial crisis’ (Brynen, 2003, 157).9 The cumulative effects of this ongoing financial crisis meant that by mid-2016, UNRWA faced ‘a crippling crisis in the form of a $96.5 million funding gap’ (Krähenbühl, 2016). Since then, the UNGA Working Group on the Financing of UNRWA has been actively exploring and adopting measures to strengthen the Agency’s financial situation and ability to provide essential services (see UNGA WG, 2016); by December 2017, the situation had ‘improved’ somewhat when the agency ‘only’ faced an outstanding deficit of $49 million (Krähenbühl, 2017). Ongoing plans set out in the UNGA WG paper of August 2016 included establishing a World Bank Trust Fund for UNRWA, a waqf endowment fund in support of Palestinian refugees managed by the Islamic Development Bank, and (now in place) an endowment fund proposed by the Organisation of Islamic Cooperation.

In the context of the long-standing financial deficit, although UNRWA has continued to provide ‘relief and works’, the actual services provided have been reduced and the groups of Palestinian refugees entitled to receive UNRWA services have constantly shrunk over time.

With a current total registered refugee population of over five million people in the Middle East, ‘UNRWA’s mandate extends to groups or categories of vulnerable Palestinian refugees and displaced persons according to relief or protection criteria’, and – importantly - ‘[i]ts designated categories and individuals can be dropped from the rolls or cease to be provided services based on changed priorities of need and vulnerabilities’ (Akram, 2014: 230, emphasis added). A small selection of such changes in priorities – implicitly or explicitly linked to past and ongoing financial crises – is summarised in Table 1.

Table 1Adapted from Barney’s figure (2003: 183) entitled ‘Examples of Key Strategic and Operations Priorities made by UNRWA’
YearOperational change implementedFurther information on the change
1982Change: food and relief no longer provided to all registered refugees

Beneficiaries: relief only provided to ‘special hardship cases identified by social workers’
Selection criteria:

  • no men aged 19–60

  • female-headed households

  • over-60s

1994Change: stopped mental health programmesReason given: mental health programmes no longer considered beneficial since they are ‘clinical rather than community-based’
1995Change: stopped supplementary feeding programmesTo minimize ‘great hardship’, liaised with other agencies to ensure they will ‘pick up’ cases if necessary
1998Change: stopped free distribution of prosthetics to all beneficiaries

Beneficiaries: prosthetic devices restricted to children and ‘those who need the aids to work’
Impact: no hearing aids/glasses for OAPs
1999Change: reduction in UNRWA salaries and terms and conditionsImpact: ‘difficulty in recruiting and keeping hold of quality staff’

The shifts in UNRWA’s strategic and operational priorities since the announcement of the January 2018 funding crisis explored below – in the areas of maternal and neonatal services, education and employment – must be viewed in relation to this long history of defunding, shrinking services and groups of beneficiaries and the erosion of different groups of Palestinian refugees’ access to rights.

The #DignityIsPriceless Campaign

Until recently, the US was ‘the largest bilateral donor to UNRWA’.10 By the end of 2017, the US had pledged $157,476,322 to UNRWA’s general programme budget and an additional $206,789,263 to its non-programme budget; this included a contribution of $103,300,000 for UNRWA’s Syria Appeal and $95,000,000 to the Occupied Palestinian Territories Emergency Appeal.11 Having provided a total of $364 million in 2017, Trump’s announcement in January 2018 that the US would only contribute $60 million that year left an already struggling UNRWA to face ‘the most critical financial situation in the history of the Agency’ (Krähenbühl, 2018a).

On 22 January 2018, UNRWA’s Commissioner-General, Pierre Krähenbühl, launched an emergency fundraising campaign. The #DignityIsPriceless campaign (Table 2) aims to mobilise donor states and civil society worldwide to secure funds to keep open 700 UNRWA schools that educate 525,000 children across the region and to ensure that UNRWA can continue providing lifesaving emergency food aid, emergency cash assistance and essential medical services to millions of refugees. These include 400,000 Palestinians who remain at great risk within Syria, almost 1 million people who entirely rely on UNRWA in Gaza and over 50,000 Palestinian refugees from Syria now living precariously in Lebanon and Jordan (UNRWA, 2018a).

Table 2#Dignity Is Priceless campaignSource:
For 70 years, we stood #ForPalestineRefugees as they endured injustice and suffering.

1.7 million extremely vulnerable refugees rely on regular food and cash assistance.

Average of 9 million patient visits to our 150 clinics annually.

Half a million girls and boys attend our 700 schools.

That’s their rights and dignity. And it’s threatened by drastic funding reductions.

Following UNRWA’s Rome Extraordinary Ministerial Conference in March 2018 and the UNRWA Pledging Conference of June 2018, major financial commitments have been made by UNRWA’s state and non-state supporters (Krähenbühl, 2018b, c). However, a significant funding shortfall both for UNRWA’s standard programming needs and for emergency campaigns remains. And, indeed, it has long been recognised that ‘[w]hile donor support for emergency appeals increases UNRWA’s ability to deliver critical services, the very launching of such appeals also reflects new and acute demands being placed on the Agency by the eruption of violence or other circumstances. In such cases, increases in donor support may indicate a decline—rather than an improvement—in UNRWA’s ability to perform its primary functions’ (Brynen, 2003: 163, emphasis added).

Even with pledges secured, UNRWA’s ability to ‘perform its primary functions’ and meet Palestinians’ needs and rights in 2018 has been acutely threatened, and is in significant decline (ibid.). In such a context, it is unsurprising that many Palestinian refugees have been asking whose and which rights are being prioritised through UNRWA’s campaigning and operational shifts.

Indeed, before turning to the operational shifts implemented since January 2018, it is worth noting that UNRWA’s #DignityIsPriceless campaign has used images and text that consistently centralise the needs and rights of ‘womenandchildren’ (Enloe, 1991). In particular, the campaign has allocated a central role to Palestinian refugees as vulnerable people whose bodily needs must be met; this includes through the figure of the mother(to-be)-and-child, infirm patients and other ‘particularly vulnerable groups’ whose wellbeing and very lives depend on receiving medical and emergency cash assistance. At the same time, Palestinian children and youths have been recognised as actively demanding that their rights be met – especially as students demanding their right to an education qua a right to a future.

Placing the vulnerable ‘womanandchild’ at the forefront of current and ongoing fundraising campaigns is entirely expected, as both women and children – agentic or otherwise – have historically been positioned as ‘ideal victims’: as innocent and apolitical beings who are truly ‘worthy’ recipients of humanitarian aid (Malkki, 1996; Enloe, 1991; Fiddian-Qasmiyeh, 2009). As such, the centralisation of Palestinian children and youths as active agents demanding their rights does not mean that the campaign has offered an effective solution to the long-standing tendency for humanitarian agencies to raise funds through invoking pity and compassion. Instead, recognising Palestinian refugee children as rights-bearers – even when viewed alongside the solidarity-infused rhetoric of official UNRWA statements by non-Palestinian senior staff (see – embodies a continuation of, rather than an alternative to, preexisting strategic frames. Furthermore, by focusing on rights through the figure of the Palestinian child as a bearer of the right to basic education and health, this approach also marginalises the significance of political and legal rights and perpetuates the depoliticisation of the causes of, and solutions to, occupation, dispossession and displacement.

In turn, I argue that the campaign risks drawing attention away from other major threats being borne by different groups of Palestinian refugees, including those that are a result of a series of ‘invisible’ regional and local-level responses developed by UNRWA. Equally, the campaign has effectively erased the figure, and rights of, certain cohorts of Palestinian refugees as active agents and indeed as providers of services in their capacity as UNRWA’s Palestinian employees. In the following pages I thus trace the ways in which locally-circulated and institutionalised operational changes in the fields of health, education and employment risk undermining the rights of both the vulnerable and active figures present in the official UNRWA campaigns, and of those Palestinian refugees who are ultimately invisible in the international arena.

‘Privatising’ Health and Education in the Palestinian Refugee Camps?

In this part of the article I contribute to debates pertaining to the promotion of the ‘localisation of aid’ and ‘self-reliance’ amongst refugees through my notion of the ‘privatisation’ of health and educational services. Here, I distinguish between ‘the public’ and ‘the private’ to highlight the apparent disjuncture between vocal assertions being made on the international stage and the reduction of services on the regional and local level. I also posit that services for Palestinians are increasingly being ‘privatised’ through their redesignation as activities which are to be led by Palestinian refugees themselves within their homes with no externally-provided support, rather than in public health or educational institutions.

For instance, on 29 March 2018 UNRWA’s Beirut office issued an internal circular to UNRWA staff in Lebanon entitled ‘Clarification on the Coverage of Specific Health Services’. The national-level circular announced that UNRWA’s limited financial resources in 2018 mean that the agency ‘finds itself compelled to suspend the coverage of normal deliveries from normal pregnancies starting the end of March 2018’. It also announced the suspension of a copayment system through which UNRWA covered 10 per cent of ‘the Secondary Hospitalization bill at public and private hospitals for Palestine refugees who are registered in the Social Safety Net program and Palestine refugees from Syria who are registered in Lebanon’.

By withdrawing these programmes, hospitals and medical services may continue to run, but the costs to access these will be prohibitive for many. This is especially the case since 65 per cent of Palestinians in Lebanon (PRL) were living under the poverty line by the end of 2017, only 42 per cent of PRL were estimated to be economically active, and Palestinians from Syria living in Lebanon were in acutely precarious conditions (Charles, 2017). The implications of reduced services will undoubtedly include an increase in the number of women giving birth at home if they are unable to cover the approximately $400-$500 USD fee for a normal delivery in a public hospital (Karas, 2017). As early as 2017, UNRWA’s Health Program had noted that ‘maternal mortality rates remain relatively high’, acknowledging that ‘[u]nless additional resources are secured, further reductions will be a challenge’ (UNRWA, 2018b: 10).

Importantly in this circular, UNRWA ‘clarified’ its announcements through asserting that the programmes and services that were being suspended in March 2018 had in fact been funded through external donations as ‘additional’ measures, and that these services in fact do not ‘essentially fall within UNRWA health policy mandate’. In the case of ‘normal deliveries’, this service had been funded through additional support provided from the Qatari Red Crescent and UNICEF from 2011 to March 2018, with the start of this service clearly coinciding with the onset of the mass displacement of refugees from Syria to Lebanon and the acknowledgment of the particular vulnerabilities that all Palestinians in Lebanon would be facing as a result. In turn, the copayment service had been introduced in 2017 as a ‘complementary step to the adjusted hospitalization policy’ for particularly vulnerable Palestinians living in Lebanon, with ‘UNRWA finance[ing] this service outside the Health Program Budget, through contributions of the Medical Hardship Fund donors’.

By stressing the exceptional and ‘additional’ nature of these services, and by asserting that UNRWA has provided these services ‘outside’ of its normal programmes, UNRWA has effectively interpellated the cuts in services as a ‘return to normal’, rather than acknowledging them ‘as’ services being withdrawn. Simultaneously, it has made an operational decision to de-prioritise the health needs and rights of people – women, children, special hardship cases and Palestinians from Syria – in communities which are becoming ever-more vulnerable. As noted above, this is by virtue of the increasingly protracted nature of the overlapping displacement of Palestinians from Syria living in the under-resourced Palestinian camps in Lebanon which have themselves hosted multiple waves of displaced people over the past seven decades (Fiddian-Qasmiyeh, 2016b).

A poignant reminder of how these multiple arrivals relate to the second set of services explored below – education – is that, well before the US cuts, UNRWA had made a series of operational decisions to enrol PRS children into existing under-resourced and under-staffed UNRWA schools in Lebanon rather than creating new schools or classrooms.12 In North Lebanon, this can be seen through the case of Al-Mazaar School, which in 2018 hosts the largest number of Palestinian children from Syria currently living in Baddawi camp. As one of my interviewees explained:

Al-Mazaar School [alongside Majiddo and Amqa schools] travelled with the people from Nahr el-Bared [in North Lebanon, to Baddawi camp]… It used to be in Nahr el-Bared camp but when the camp was destroyed [in 2007], and the people arrived here, schools were built for the children of Nahr el-Bared and they were given the same names. When the war from Nahr el-Bared ended, Amqa school returned to Nahr el-Bared while Majiddo and Al-Mazaar stayed in Baddawi, both for the children from Nahr el-Bared who remain here, and also for the children from Syria who have more recently arrived.

In essence, Al-Mazaar School is an ‘old’ school reborn in a ‘new’ place, catering for internally displaced Palestinian refugee children from Nahr el-Bared, who now share their under-resourced temporary structure with Palestinian children from Syria living in Baddawi since 2011. The school may be open, but the children have long been forced to ‘make do’ with the bare minimum.

It is notable that education has historically been UNRWA’s top programming and budgetary priority and yet UNRWA has on several occasions – the most recent being summer 2015 – been on the brink of having to postpone or even cancel the start of the UNRWA school year due to funding crises (UNRWA, 2016). In this context, it is understandable that difficult operational decisions have been made for decades in the field of education, and it is largely unsurprising that the US funding cuts and UNRWA’s resulting strategic reorientation are adding further risks to Palestinian children’s learning. Indeed, even though funds were finally secured to open UNRWA schools in September 2018, UNRWA has reportedly announced that Palestinian children will no longer be provided with UNRWA textbooks free of charge (see Blome Jacobsen et al., 2003), but will have to purchase these themselves.

While currently justified through reference to the 2018 funding cuts, however, it is important to note that the imminent withdrawal of free textbooks had already been announced in summer 2015 during that year’s major crisis (also see UNRWA, 2016). This highlights the need to be attentive to the longer history of such threats and announcements and also the extent to which these may not necessarily lead to the actual withdrawal of a service, but may nonetheless be characterised by major insecurities as families try to determine if they can afford to continue sending their children to school. It also raises the question, beyond the scope of this article, of whether the actual changes that are being introduced in 2018 are responding to the US Administration’s funding cut, or part of a broader process of decision making and planning pre-dating Trump.

Costs associated with school books and other materials will invariably be prohibitive for many, especially families with multiple school-aged children, and yet this is only one of many pressures limiting education systems and more concretely children’s experiences of school and learning. For instance, the eight-year-old daughter of one of my interviewees attends a double-shift UNRWA school in North Lebanon, where she is one of more than 50 children in her class.13 As an UNRWA science teacher noted, it is simply not possible for teachers to meaningfully teach children in such large classes: ‘these children learn nothing at school – they can only learn if their parents can help them at home’.14

Learning, as in the case of childbirth, is increasingly being ‘privatised’, not in the sense of private institutions providing education or health care, but in the sense of these processes taking place within the private sphere of the home, and depending on the skills and knowledge of family members.15 In essence, the ‘privatisation’ of health and learning emerges as a prime example of refugees being expected to fill the gaps created both by international funding cuts and operational responses to these. In turn, if relatives do not have these skills, knowledge, or indeed time or energy, the implications are exponential.

Indeed, another series of pressures clearly influence UNRWA’s service provision on the ground, in spite of their ongoing invisibility in international communications and fundraising campaigns: it is, amongst other things, changes in UNRWA’s employment rules that are leading to larger class sizes and an increase in mistrust towards UNRWA in its dual position as a service provider and the employer of tens of thousands of Palestinians who provide these services.

Precarious Workers’ Rights16

In its 2016–2021 Medium Term Strategy report, UNRWA noted that ‘[t]he largest driver of costs – the Agency’s service delivery and the staff required for that – is also the Agency’s biggest asset’ (2016: 57). Circa 95 per cent of all UNRWA employees are Palestinian refugees, with UNRWA being one of the main employers for Palestinians across the Middle East. Indeed, UNRWA is seen as having an obligation to employ Palestinians as part of the effort to uphold their rights; this is particularly important in contexts where Palestinians are excluded from the national labour market, as is the case in Lebanon, where Palestinians are barred from almost all forms of employment outside of their refugee camp-homes. In January 2018, UNRWA’s Commissioner-General implored:

UNRWA’s full-time 30,000 professional and experienced staff – doctors, nurses, school principals and teachers, guards and sanitation laborers, social and psychosocial workers, administrative and support staff: be at your duty stations to serve the community with the same dedication and commitment that you have always shown. This is a moment for internal cohesion and solidarity. Times are very critical but we will do our utmost to protect you.

(Krähenbühl, 2018b)

In addition to these full-time employees, due to the precarious nature of UNRWA’s budget since its inception in the 1950s, UNRWA has long supplemented the employment of Palestinian staff on fixed-term and indefinite contracts with thousands of people employed on daily contracts for years, and often decades, on end. These precariously employed ‘dailies’ are called upon on an ad hoc basis to fill short-term gaps as they arise, including as substitute teachers and doctors to cover sick leave.

In 2016, UNRWA announced that it ‘is committed to being recognized by all stakeholders … as a fair employer’, an objective that would be reached, inter alia, by ‘applying the correct remuneration [and] providing acceptable conditions of service’ (2016: 63, emphasis added). Irrespective of these aims, many UNRWA employees – including the Palestinian teachers, guards and sanitation workers I have been speaking with across Lebanon – do not believe that UNRWA is committed to ‘protecting’ them at a time when their jobs and futures are at risk. Indeed, potential redundancies in Lebanon’s educational vocational centres had already been officially announced in March 2018 (Cordone, cited in AFP, 2018), and my interviewees had informed me that throughout the first three months of 2018 dozens of UNRWA ‘dailies’ have either been made redundant or have not had their contracts renewed.

Exceptional Measures and Major Insecurities

Almost two years before the US cuts were announced, UNRWA had asserted that it was ‘committed to managing its costs in a way that retains the Agency’s capacity to achieve the Strategic Outcomes with maximum impact of its resources and without compromising on essential services’, aiming to ‘produce a greater quality impact without significant increases in its workforce’ (2016: 57). At the same, it declared that it would ‘be able to meet legal obligations to staff and control the growth in staff numbers in such a way that growth in staff costs will not exceed 3 per cent per annum’ (2016: 63). Against this pre-existing commitment to cost-efficiency and maximising the impact of its (human) resources, UNRWA’s operational policies in 2018 have not only led to the stagnation of staff numbers but have also demonstrated that those UNRWA employees who hold work contracts do so with little to no job security. In this regard, UNRWA is implementing policies that have been extensively criticised elsewhere in the context of livelihood programmes and market employers who offer vulnerable people exploitative contracts with few rights (see Jacobsen, 2006).

In effect, on 17 January 2018 UNRWA headquarters in Amman sent employees an internal Area Staff Circular noting that, due to the ‘severity of the funding shortfall’, it was announcing a series of exceptional measures pertaining to employment across all areas of UNRWA operation. The Circular announced that UNRWA would no longer grant any extension of service beyond the official age of retirement of sixty (as had previously been the case). Furthermore, ‘posts that become vacant due to retirement of Area staff members are not to be filled until further notice’. It noted that from 18 January 2018, conversion of fixed-term (X) appointment to indefinite (A) appointment is suspended’. Moreover: ‘area staff members with ten years of continuous service as of January 18, 2018 or later, and eligible for an indefinite appointment, will instead be considered for extension of their fixed-term appointment in line with applicable rules and instructions at the time of the extension’.

The experiences of one of my interviewees17 are particularly pertinent when tracing the impacts of this circular on UNRWA employees. This Palestinian teacher was first employed as a ‘daily’ teacher, and, for the past 8 years, as a fixed-term full-time UNRWA employee. Since 2011, she has been teaching Palestinian children from Syria who arrived in Lebanon seeking sanctuary in her home-camp. She felt acute insecurity for her future because ‘[i]f my contract is not converted to an indefinite one, I will have nothing to support me or my family after I am 60. As a [fixed term] employee, I would only receive my own savings (tawfeer) as a lump sum, with no contribution from UNRWA’.

This is because upon retirement only UNRWA employees who are on indefinite contracts are eligible to receive the full Provident Fund lump sum18 (an UNRWA official term most Palestinian employees are not familiar with), or what Palestinians refer to as ta’weed. Ta’weed is the full compensation that employees receive from UNRWA for their many years’ service, combining the monthly contributions that are deducted directly from their salaries (i.e. their tawfeer) plus an UNRWA contribution. As UNRWA employees receive no monthly pension after retirement, without the combined payment this teacher would effectively only receive her own savings in one lump sum, which would never be sufficient to support herself and her family as she grows older.

A few days later, she was partially relieved to receive a second UNRWA circular by email and in English, which stated that ‘the Conversion of Fixed-Term to Indefinite Appointment is reinstated as per previous terms, effective January 18, 2018’. This seemed to suggest that when she reaches her tenth year anniversary of working on a fixed-term basis for UNRWA, her contract could still be converted to an indefinite one. However, she told me, having received the devastating news once, she still fears that UNRWA’s ongoing funding insecurity will mean that, in the end, she may never be offered an indefinite contract.19

Such fears appear to have some foundation, as the same interviewee informed me in a subsequent interview that she and her colleagues had been dealt another blow:20 UNRWA reportedly informed them in February that, even if they have been employed for ten years or more, UNRWA will be unable to pay its direct contribution to any UNRWA employees due to the funding shortfall. If this is the case, employees will only receive their own savings (tawfeer) when they turn sixty, as she and others will no longer be eligible to receive their full compensation (ta’weed) upon retirement. While no formal announcement has been made at the time of writing, Palestinians’ fears and mistrust must be situated in the context of their knowledge of UNRWA’s past operational changes over the course of the agency’s multiple financial crises, and also in relation to the nature of UNRWA’s uneven communication with its employees (discussed below). In this context, Palestinians’ insecurities are linked simultaneously to actual operational changes, apparent policy reversals which many people believe cannot be trusted and sometimes unconfirmed potential changes that are passed on by word of mouth.

It is certain that all my interviewees and their colleagues face an insecure future, and, indeed, increasingly difficult working conditions since all employees will be required to retire at sixty, and no new recruitments will be made as posts become vacant due to retirement.21 This means that when the above-cited teacher’s colleagues retire, no replacements will be recruited. Already in March 2018 when her colleague was sick, UNRWA did not find a ‘daily-paid’ substitute teacher – instead, her class of thirty-five students had to ‘absorb’ the other teacher’s class, leaving her to teach seventy children in her small classroom.

Such changes also mean that young Palestinians who had hoped to work for UNRWA – including prospective teachers, doctors, clerical and facilities staff – will face restricted employment possibilities, leading to increased levels of unemployment, underemployment and related long-term precarity.

It must also be acknowledged that the cessation of recruitment and the reduction of employee rights in 2018 took place on top of previous reductions in UNRWA employment conditions, since in 1999 ‘UNRWA salaries and terms and conditions’ had already been significantly reduced (Barney 2003:183). In 1999, UNRWA was already facing ‘difficulty in recruiting and keeping hold of quality staff’, and by 2016 UNRWA had noted that ‘[w]ith so many of the Agency’s achievements depending on the direct delivery of services to refugees by individual staff, building a strong culture of trust, consultation and respect at all levels in workforce management and staff relations are of vital importance’ (ibid.; 2017: 60). Difficulties in recruiting and retaining staff and ‘building a strong culture of trust’ will only increase in light of ongoing financial pressures and concomitant organisational reforms.

In particular, as I have argued elsewhere (Fiddian-Qasmiyeh, 2016a), now that both UN refugee agencies are physically present in and operating in Palestinian refugee camps – UNHCR is providing assistance and protection to all refugees from Syria apart from Palestinians – camp residents have transformed ‘UNHCR’ into a verb: the camps have been ‘UNHCR-ised’. Through this process, since 2011 many Palestinians who had originally worked for UNRWA have shifted, when possible, to UNHCR positions, which are both more highly paid than UNRWA roles and are perceived as being more ‘stable’ in light of UNRWA’s repeated financial crises. With the 2018 cuts, the likelihood of UNRWA employees seeking alternative forms of employment continues to increase and retention rates will decrease. In turn, Palestinian refugees who have until now provided services to other Palestinians in the camp through UNRWA are increasingly likely to seek employment opportunities to support Syrian refugees through UNHCR. In a context of increasing funding cuts writ large, both institutions are struggling to provide meaningful support to the expanding population in the Palestinian camps in Lebanon, and all refugees – ‘established’ and ‘new’ alike – are suffering in the process.

Miscommunication and Ongoing Fears

As noted above, Palestinians’ experiences of precarity must be situated in the context of their knowledge of UNRWA’s past operational changes and also in relation to the nature of UNRWA’s communication with its employees. UNRWA itself has previously acknowledged that the organisation would have to explicitly ‘strengthen its commitment to transparency, open communication and dialogue’ as part of the process of attempting to ‘foster higher levels of trust and respect’ (2016: 60). Alongside my interviewees’ experiences of precarious employment and pension rights, they also expressed concerns regarding the lack of transparent and open communication throughout this period.

One of my interviewees, a diligent UNRWA sanitation worker who commutes for three hours a day to keep UNRWA hospital rooms and operating theatres clean and functioning, explained that he has no email address, and therefore never receives UNRWA’s circulars.22 As such, he waited longer than the above-cited teacher for the ‘revised’ message pertaining to employment and pension changes to reach him:

Those of us who are employed in the lower grades don’t receive e-mails, we need UNRWA staff who are higher up to tell us the news about our jobs and futures. Not everyone knows what is going on. And, remember, not everyone working for UNRWA, can read, including other people who work with me as cleaners and guards at the hospital. We need to wait for other colleagues to explain what is going on.

Even employees who are ‘higher up’ find it difficult to follow UNRWA’s notifications. The head-teacher of an UNRWA school23 stressed that,

These notifications are always issued in English first. Sometimes they are translated into Arabic, but not always. Even when they are translated into Arabic they always arrive several days after the English version. Why don’t they arrive at the same time? Why does the Arabic version sometimes not arrive at all?

With important messages arriving in complex English sentences, several of my interviewees noted that they have never really understood the exact meaning or the implications of the statements issued by UNRWA. Furthermore, the head-teacher asked: ‘Why does UNRWA headquarters always issue several circulars within two or three days of one another, saying they are going to do one thing and then changing part of their decision in the next message? Are they camouflaging their decisions, or trying to pretend that they are being kind to us by only withdrawing some of our rights rather than all of them?’ By issuing two decisions almost simultaneously, the head-teacher told me, UNRWA employees often dwell on the first message and overlook the other, especially if they are depending on other people to keep them up-to-date. My interviewees, including those whose concerns are outlined above, expressed their suspicion that sending many messages in complex writing might be a purposeful UNRWA strategy: by seeming to reinstate a particular ‘right’ that it had just withdrawn, they perceived that the Agency might be aiming to ensure that other, more significant changes, would pass peacefully and without resistance.24

Indeed, a key theme explored throughout this article pertains to representation, both in terms of who and what has been represented or absented in UNRWA’s campaigns, but also in terms of the disjuncture between UNRWA’s international and local-level communications. Ultimately, the #DignityIsPriceless has veiled its Palestinian staff members’ precarious employment and pension rights from international audiences via its public communication strategy, and has in turn poorly translated (literally and operationally) its strategy to Palestinians on the local level. In this context, significant risks are being borne both by those Palestinians who rely on UNRWA-provided services and by UNRWA’s Palestinian employees. Nonetheless, these impacts continue to be erased from view by a contract and risk-management culture that maintains the primacy of international (read: non-Palestinian) actors and ideological priorities. In the context of UNRWA’s institutional adaptation to long-standing financial crises, a push for cost-efficiency and the desire to maximise ‘value for money’ (and shift responsibility for refugees to ‘local’ actors), have all been characterised by the perpetuation of highly unequal partnerships; throughout, the continued dominance of English has played a key role as a mechanism of exclusion. Such a process is not limited to UNRWA and Palestinians, but can, instead, be identified as one of the main challenges faced by ‘local’ partners throughout the broader process of ‘localisation’ (in the context of Syria, see Howe et al., 2015; Field, 2016).

An Uncertain Future

Throughout 2018, Palestinians including mothers(to-be)-and-infants, ‘particularly vulnerable’ social groups, schoolchildren and UNRWA employees and their families have faced increasing insecurities. This is not just because the US Administration’s funding cuts mean that they may be unable to access key UNRWA educational and medical services, but also because these services themselves are ‘shrinking’ and, in many ways, being ‘privatised’. As illustrated in the internal UNRWA circulars and recent operational changes analysed above, this can be seen through the reconfiguration of health-care provision (including changes in maternity care) and educational systems (resulting in significantly larger classes). In turn, the reduction of employment and pension rights is resulting in an unsustainable strain on service providers and the potential ‘migration’ of employees, current and future, away from UNRWA.

Nonetheless, while justified through reference to the ‘severity of the funding shortfall’, the reduction of services must be viewed as part of a broader historical trend in defunding and shrinking UNRWA, and in conjunction with the incremental restriction of Palestinians’ employment and pension rights. In spite of the partial financial ‘successes’ of the #DignityIsPriceless campaign and UNRWA’s pledging conferences, the US Administration’s total withdrawal of support at the end of August 2018 means that UNRWA is invariably navigating its course towards major structural reforms. There can be no doubt that these will have significantly negative impacts on services and employment rights alike, further undermining the wellbeing and futures both of ‘vulnerable’ refugees who are hypervisible on the international stage, and ‘agentic’ refugees who remain on the margins. In this context, UNRWA’s Palestinian employees – in many ways the epitome of the figure of the self-reliant refugee – have been rendered invisible from international campaigns while being implored to work and continue serving the members of their refugee community with little to no job security.

It is, of course, essential to acknowledge the highly challenging context in which UNRWA headquarters is attempting to balance the lack of financial resources with the need to provide ‘relief and works’ for Palestinian refugees, while also recognising the extent to which UNRWA has, since its inception, always already been in the midst of a financial crisis. In effect, in the absence of a fair and just political resolution to the occupation of the Palestinian territories and the implementation of existing legal frameworks to uphold Palestinian refugees’ rights, UNRWA has few options available. Two such options have been outlined above: firstly, seeking to diversify its funding sources, as embodied in the #DignityIsPriceless campaign and, secondly, to continue reducing services and employment rights. Following the US’s decision to defund UNRWA, two further options are being considered and promoted in the international arena: securing funding for health and hardship cases but expecting Middle Eastern host countries to provide basic education, or taking steps to redefine Palestinians’ refugee status. The latter, which is currently being advocated by the US Administration, would significantly reduce the number of people entitled to UNRWA services and has been seen as a dangerous precursor to further denying Palestinians’ access to core political and legal rights, including the Right of Return and the right to collective self-determination. While these last two options would never be accepted by Middle Eastern states due to the economic and political implications, and while Palestinians’ refugee status cannot – in fact – be stripped by either the US or UNRWA since it is defined and protected in international law and UN Resolutions (Akram, 2018), it is equally the case that throughout 2018 the first two options created grave insecurities on the local level.

As noted by my interviewees, UNRWA’s employees are both vocally and silently questioning the Agency’s ability, or desire, to uphold its obligations towards Palestinian refugees. The decline in UNRWA services thus echoes the decline of UNRWA’s image in the mind of many refugees themselves, as the position of UNRWA as ‘the provider’ of services and assistance has been undermined through UNRWA’s selective prioritisation and programmatic reconfigurations in times of crisis.

A set of particularly urgent questions arise in the context of the US’s financial cuts – and more recent defunding – and UNRWA’s responses to its precarious financial situation in 2018. These include, firstly, examining the implications of internationally declaring an institutional commitment to keeping services active, while undermining the quality and reach of these services on the local level. And, secondly, identifying the risks of promoting a public semblance of funding drives enabling UNRWA to continue ‘work as usual’ while, on the local level, Palestinian refugees’ rights are being increasingly eroded and undermined, both as service beneficiaries and as providers. In turn, as we consider the short- and long-term implications of Palestinians’ experiences of the events unfolding in 2018, further analyses must consider how the localisation of aid agenda can uphold, rather than undermine, the rights of refugees and local citizens working to support refugees. Indeed, as the international community increasingly promotes localisation and self-reliance, it remains to be seen how (and by whom) fair remuneration schemes can be monitored on the local level and precisely whose responsibility it should be to ensure that salaries are paid and rights – including pension rights – are protected in the short-, medium- and long-terms. While political solutions are pending, it is essential that appropriate steps are taken to ensure that people affected by displacement are not rendered responsible for risks created by international systems or forced to carry insecurities throughout their and their families’ lives – lives which are likely to be characterised by ongoing processes of overlapping displacement.


This article draws on research generously funded by UK’s AHRC and ESRC (Grant Ref. AH/P005438/1 – see Thanks are due to Yousif M. Qasmiyeh, Estella Carpi, Juliano Fiori and the article’s two anonymous reviewers for their helpful feedback on earlier iterations.

The cuts and demands for reform were welcomed by some, including selected Israeli politicians and media, who echoed Kuschner’s claims of corruption and of UNRWA’s very existence perpetuating the conflict (cited in Lynch and Gramer, 2018). However, many other Israeli and non-Israeli commentators have remained highly critical of the human and security implications of the cuts for Palestinians and the Middle East (Bachner, 2018; Levy, 2018).

The US Administration has declared its plans to ‘strip [millions of] Palestinians of their refugee status’ (Lynch and Gramer, 2018). See Akram (2018) for a refutation of the assumption that reducing the number of UNRWA beneficiaries would erase Palestinians’ Right of Return (also Roy, 2018).

While UNRWA has established numerous Emergency Appeals to support Palestinians affected by diverse conflicts within the region over the past decade, it could be argued that it is the ongoing conflict in Syria, and its effects on Palestinians within and displaced from that country, that has led to the dramatic deterioration of UNRWA’s capacity to provide assistance and protection to Palestinians (Y.M. Qasmiyeh, personal communication, 15 September 2018).


For critical engagements with the concept, policy and practice of ‘self-reliance’, see Fiddian-Qasmiyeh (2015), Fiori and Rigon (2017) and Easton-Calabria and Omata (2018).

Palestinians have often been highly critical and wary of the UNRWA’s role, intentions and implications, including rejecting it as a Eurocentric institution which censors Palestinian history, politics and priorities under the guise of ‘neutrality’ (personal observations, Lebanon, 2007–18 passim; E. Carpi, personal communication, 16 August 2018).

For an evaluation of donor trends and their implications on UNRWA services through to the early 2000s, see Brynen (2003).

Such decisions, as noted by one of this article’s anonymous reviewers, are not merely underpinned by a desire to save costs but also by a dominant ideology within the humanitarian sector, which prioritises cost-efficiency, value for money and steps to reduce refugees’ dependency on aid (and, of course, international actors’ responsibilities towards refugees).

Anonymous interview, 4 April 2018.

Anonymous interview, 6 April 2018.

It is notable that Palestinian refugees used to rely on the expertise of midwives, usually older or elderly women whose knowledge of childbirth enabled them to support other women throughout pregnancy and delivery (typically homebirths). In the 1980s, UNRWA provided professionally trained medical staff to join midwives in deliveries, supplementing traditional knowledge with formal training (Y.M. Qasmiyeh, personal communication, 5 June 2018). The increasing medicalisation of childbirth, including through UNRWA hospitals, led both to the dilution of midwives’ practice, and the expectation of UNRWA support for childbirth. UNRWA’s provision and subsequent withdrawal of ‘delivery services’ mean that local responses may no longer be as viable as they were in the 1980s and yet may require a major resurgence as refugees step in to fill a gap created by the international community.

Earlier versions of two sections of this article appeared in Fiddian-Qasmiyeh (2018a and b).

Anonymous interview, 20 January 2018.

On the Provident Fund, see UNRWA (2017a).

Anonymous interview, 28 January 2018.

Anonymous interview, 2 February 2018.

At the end of September 2018, two interviewees informed me that Palestinian employees over the age of forty were being ‘invited’ by UNRWA to request voluntary early retirement; their positions would not be filled through new appointments.

Anonymous interview, 14 February 2018. As noted by one of the article’s anonymous reviewers, technology can reinforce privilege and forms of exclusion, rather than facilitating participation and equality of access to services and modes of communication; while beyond the scope of this paper, such processes are of course highly gendered (see Madianou et al., 2015).

Anonymous interview, 15 February 2018.

This process can in turn be fruitfully be considered alongside UNRWA’s interpellation of actual service cuts in the fields of maternal and neonatal health, as not really being cuts but rather a ‘return to normal’.





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