UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

Udlændinge- og Integrationsudvalget 2022-23 (2. samling)
UUI Alm.del Bilag 36
Offentligt

COUNTRY OF ORIGIN INFORMATION (COI)

FFM REPORT

Udlændinge- og Integrationsudvalget 2022-23 (2. samling)

UUI Alm.del - Bilag 36

Offentligt

February 2023

Lebanon

Access to Health Care Services

for Palestinian Refugees

us.dk

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

This report is not, and does not purport to be, a detailed or comprehensive survey of

all aspects of the issues addressed. It should thus be weighed against other country

of origin information available on the topic.

The report at hand does not include any policy recommendations. The information

does not necessarily reflect the opinion of the Danish Immigration Service.

Furthermore, this report is not conclusive as to the determination or merit of any

particular claim to refugee status or asylum. Terminology used should not be

regarded as indicative of a particular legal position.

The report is a synthesis of information gathered from different sources, and it

brings together condensed information in a relevant manner for the reader’s COI

needs and it organises information together thematically to form a coherent whole

of the topic in question, instead of listing or quoting information source by source.

The Danish Immigration Service

Farimagsvej 51A

4700 Næstved

Denmark

Phone: +45 35 36 66 00

us.dk

February 2023

The publication can be downloaded for free at us.dk/landeoplysninger

The Danish Immigration Service’s publications can be quoted with clear source

reference.

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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Executive summary

The present report describes health care services in Lebanon, as they are available to Palestinian refugees

from Lebanon (PRL) including information about services for persons with drug addiction, persons living with

disabilities and people in need of home-based care or nursing homes. Based on a survey conducted in four

hospitals and three pharmacies in Beirut and Saida in October 2022, the report provides information about

availability and accessibility of medicines and specialised treatment. In addition to the survey data, infor-

mation was collected through in-depth and repeated interviews with ten NGOs, UN agencies and humanitar-

ian organisations.

The health care sector in Lebanon suffers from several years of political instability, economic recession and

hyperinflation (including restrictions in withdrawing cash from banks) compounded by an energy crisis, which

affects access to electricity and fuel, as well as the devastating effects of the Beirut port explosion in August

2020. Furthermore, the high number of Syrian refugees in Lebanon places an additional burden on the exist-

ing health system. These events have had the effect that a high number of medical personnel has left the

country, prices for medicines and specialised treatment have gone up, and the supply of medicines for some

chronic conditions, such as cancer and diabetes, is now subject to interruptions.

PRL have limited civil rights, including restricted access to employment in the formal sector and cannot ben-

efit from the National Social Security Fund (NSSF). PRL may access primary health care services free-of-charge

through the 28 health care facilities, which United Nations Relief and Work Agency for Palestine Refugees

(UNRWA) manages across Lebanon. Palestine Red Crescent Society (PRCS) is a key provider of specialised

health services free-of-charge to PRL on behalf of UNRWA but the funding situation of PRCS is uncertain. PRL

may also access health care services from private hospitals given that the patient or their families are able to

demonstrate their ability to pay in cash up front for medicines and treatment.

Cancer treatment, including chemotherapy, is scarce or unavailable in Lebanon, including for PRL. PRL suf-

fering from cardiac complications and hypertension may find expertise and medicines at hospitals managed

by PRCS. The supply of insulin in hospitals and pharmacies across Lebanon is low. At UNRWA facilities, how-

ever, there was still a stock of diabetes medicines at the time of data collection. Many psychiatrists have left

Lebanon and the care capacity for psychiatric patients has decreased. PRCS does not offer mental health

treatment but there is some treatment available at private or NGO-managed hospitals. Mental health prob-

lems are widespread in PRL communities and stigmatisation is a challenge.

Opioid maintenance therapy is legal in Lebanon for patients with drug addiction. This form of therapy is

available in a few NGO-driven harm reduction centres

ega dless of the patie ts atio alit . The apa it of

these harm reduction centres to take in new patients is limited.

For PRL living with disabilities, access to services is described as insufficient; the waiting list to existing centres

is long and the capacity of these centres to meet the demand for treatment and assistive devices is low.

There is a market for nursing homes in Lebanon managed by private actors but information about the quality

of care as well as of the prices was scarce. Information on the existence of home based care was scarce.

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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Table of contents

Executive summary ................................................................................................................................ 1

Introduction........................................................................................................................................... 5

Purpose of report and methodology ............................................................................................................. 5

Defining scope and terms of reference ......................................................................................................... 5

Collection of information............................................................................................................................... 6

Survey of health facilities ........................................................................................................................... 6

Key informant interviews........................................................................................................................... 7

Quality control ............................................................................................................................................... 8

Limitations ..................................................................................................................................................... 8

Structure of report and presentation of collected data ................................................................................ 9

Abbreviations ...................................................................................................................................... 10

Map of Lebanon ................................................................................................................................... 11

Brief overview of the situation of Palestinian refugees from Lebanon ................................................... 12

Demography ................................................................................................................................................ 12

Palestinian refugees from Lebanon and their access to basic rights ....................................................... 12

Impact of the economic crisis on the Lebanese health sector ................................................................. 13

Ongoing instability in Lebanon ................................................................................................................ 13

Hyperinflation .......................................................................................................................................... 13

Health care sector in Lebanon .............................................................................................................. 14

Organisation of the health sector ................................................................................................................ 14

Human resources for health .................................................................................................................... 15

Health insurance ...................................................................................................................................... 16

Current state of health sector.................................................................................................................. 16

Beirut port explosion ............................................................................................................................... 17

Supply of medicines ................................................................................................................................. 18

Hospitals in Lebanon ................................................................................................................................ 18

UNRWA’s

role in health service provision ............................................................................................. 22

UNRWA s

a date a d espo si ilities i

elatio to health

..................................................................... 22

St u tu e of UNRWA s health se i es

........................................................................................................ 23

Health care services available through UNRWA ...................................................................................... 23

UNRWA s health a e se i es i Le a o

.................................................................................................. 24

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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Primary health care programme in Lebanon ........................................................................................... 24

Hospitalisation programme in Lebanon .................................................................................................. 24

UNRWA s efe al path a

and reimbursement schemes ...................................................................... 25

Current financial and procurement challenges ....................................................................................... 26

Health care services ............................................................................................................................. 27

Cancer .......................................................................................................................................................... 27

Cardiac complications and hypertension .................................................................................................... 29

Diabetes type I and II ................................................................................................................................... 31

Mental health .............................................................................................................................................. 34

Chronic obstructive lung disease ................................................................................................................. 37

Other medicines .......................................................................................................................................... 39

Painkillers / analgesics ............................................................................................................................. 40

Antihistamines, sleeping pills, vitamins ................................................................................................... 40

Services for persons with drug addiction .................................................................................................... 41

Services for persons living with disabilities ................................................................................................. 43

Nursing homes and home-based care ......................................................................................................... 43

Bibliography ........................................................................................................................................ 44

Annexes ............................................................................................................................................... 49

Annex 1: Terms of Reference (ToR) ............................................................................................................. 49

Annex 2: Consulted sources......................................................................................................................... 51

WHO Lebanon .......................................................................................................................................... 52

Anera ........................................................................................................................................................ 56

An international NGO .............................................................................................................................. 60

SIDC .......................................................................................................................................................... 63

UNFPA Lebanon country office ................................................................................................................ 66

UNICEF Lebanon Country Office .............................................................................................................. 68

UNRWA Lebanon Field Office .................................................................................................................. 70

A local humanitarian organisation ........................................................................................................... 73

UNRWA, Department of Health ............................................................................................................... 79

A local NGO .............................................................................................................................................. 81

Annex 3: Treatment and medicines by health facility ................................................................................. 85

American University of Beirut Medical Center (AUBMC) ........................................................................ 85

Governmental Hospital Beirut

–

Karantina .............................................................................................. 91

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Psychiatric Hospital of the Cross.............................................................................................................. 98

Hamshary Hospital ................................................................................................................................. 100

Mazen Pharmacy ................................................................................................................................... 105

Pharmacy Alexandra .............................................................................................................................. 120

Saida DT Pharmacy................................................................................................................................. 138

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Introduction

Purpose of report and methodology

The purpose of this report is to describe how Palestinian refugees from Lebanon (PRL)

may access health

care services in Lebanon. The report contains information about the general health system

in Lebanon but

emphasis is on PRL and their access to medicines and specialised treatment in Beirut as well as in the city of

Saida. The findings presented in the present report are based on data collected via a survey conducted in

selected health facilities, on interviews with key health sector actors, as well as on written material. This

report is written in alignment with the methodology of the European Union Agency for Asylum (EUAA)

–

p e iousl k o

as Eu opea As lu Suppo t Offi e s EASO –

as well as with EUAA-MEDCOI

s sta da ds

for medical country of origin information (COI).

The Country of Origin Information (COI) Division of the Danish Immigration Service (DIS) initiated this report

in collaboration with the Ministry of Immigration and Integration at a moment where little information about

medicines and specialised medical treatment in Lebanon was available. Lebanon is one of the countries in

which EUAA-MedCOI,

the first instance European provider of medical information for the use of processing

asylum cases and cases concerning humanitarian residence permits, does not have reliable local contacts

who can obtain information about medical treatment and medication.

The purpose of the present report is

to address this lack of updated information.

Defining scope and terms of reference

The terms of reference (ToR) of the present report have been developed jointly by DIS and the Ministry of

Immigration and Integration. In the process of preparing the ToR, the Secretariat of the Danish Refugee Ap-

peals Board and the Asylum Division of DIS have been consulted. They identified the following chronic dis-

eases and medical conditions for which information was needed:

1. Cancer(

2. Cardiac complications and hypertension

3. Diabetes (type I and II)

4. Mental health (including alcohol and drug abuse, psychotic disorders, PTSD, dementia and cognitive

disorders)

5. Chronic obstructive lung disease

Follo i g WHO, health s ste is defi ed as all the o ga isatio s, i stitutio s, esou es a d people hose p i a pu pose is to

improve health. WHO,

Monitoring the Building Blocks of Health Systems,

2010,

url,

p. vi

EUAA,

EASO Country of Origin Information Report Methodology,

June 2019,

url;

EUAA MedCOI,

Guidelines for the Research and

Use of Case-Specific MedCOI on Availability,

2017; Project MedCOI - Belgian Desk on Accessibility,

Guidelines for the Research and

Use of Case-Specific MedCOI on Accessibility and General MedCOI,

2018

EUAA MedCOI is a service that collects medical information from countries and regions where asylum applicants come from, for

the use of first instance migration authorities of the EU+ countries, EUAA MedCOI,

About MedCOI,

n.d.,

url

EUAA MedCOI,

AVA 15758,

17 June 2022

United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA)

efe s to PRL as Palesti e

efugees f o Le a o . The use of this la guage a e t a ed a k to its i itial a date see

the chapter

UNRWA s

mandate and responsibilities

i elatio to health p.

. It should e oted, this epo t uses Palesti ia Refugees

f o Le a o

athe tha Palesti e Refugees f o Le a o , the te used UNRWA, a d applies the sa e a o-

used UNRWA, PRL .

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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In addition to questions about availability of medicines and treatments for the above-mentioned diseases,

the ToR also includes questions about the availability of facilities providing maintenance therapy for opioid

addiction. The ToR moreover includes issues concerning persons living with disabilities as well as persons in

need of care at nursing homes.

The geographical scope of data collection is Beirut and Saida, where the largest Palestinian refugee camp,

Ein El Hilweh, is located. Tripoli, the largest city in northern Lebanon, was not included as sufficient infor-

mation could be gathered in Beirut and Saida.

For the specific formulation of the Terms of Reference (ToR), please see Annex 1 of this report.

Collection of information

Three main data sources have been used for the purpose of this report: (1) a survey of preselected pharma-

cies and hospitals in Beirut and Saida; (2) qualitative key informant interviews with United Nations (UN) spe-

cialised agencies, non-governmental organisations (NGOs) and other representatives of relevant institutions

based in Lebanon; and (3) COI-literature, public health reports and academic articles.

Survey of health facilities

Data collection in Lebanon was conducted from 10 to 15 October 2022 from three pharmacies (Mazen Phar-

macy, Pharmacy Alexandre and Saida DT Pharmacy) as well as from four hospitals: a private hospital (Amer-

ican University of Beirut Medical Center

–

AUMBC); a psychiatric hospital (Psychiatric Hospital of the Cross);

a government hospital (Beirut Governmental Hospital

–

Karantina); and a Palestine Red Crescent Society

(PRCS) hospital (Hamshary Hospital).

The survey of specialised treatment was based on a questionnaire that followed EUAA MedCOI

s defi itio

of case-specific availability of specialised medical treatments. The team met with several managers at the

above-mentioned hospitals and went on a guided tour through different wards. Based on information from

the hospital managers, hospital websites, annual activity reports and observations at the wards, an assess-

ment of the available treatments was made. The availability of medicines was only inquired into at the above-

mentioned pharmacies, not at the visited hospitals.

Assessment of the availability of medicines was based on the presence of the inquired medicines in the phar-

macy as advised by the manager of the facility. Most of the medicines were also presented to the team for

visual inspection. The following three MedCOI categories determined the status of the inquired medicine:



Medicine is available: the requested medicine is in principle registered in the country and

available at a health facility in the selected town. At the time of investigation, there are no

supply problems.

Medicine is partly available

u e t suppl p o le s :

though the medicine might be li-

censed in a country and used to be available, it is now confronted with interruptions in sup-

ply. If there is a time horizon for re-supply, the expected delivery time should be noted as

precisely as possible.

Medicine is not available: the medicine is neither registered nor available in any of the sur-

veyed health facilities.



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Availability

refers to whether a given medicine or treatment is objectively obtainable without taking into

consideration the individual circumstances of the patient.

Accessibility,

by contrast, refers to whether a given

medicine or treatment would be accessible in reality. That is, whether financial (price), geographical (in terms

of accessibility via air or road and in relation to day/night security) or social issues (possibly discrimination in

terms of gender based discrimination or discrimination based on marital status or political or religious affili-

ation) would constitute a barrier. Accessibility is always based on the fact that a given medicine or treatment

is available in the country of research.

Purpose sampling techniques were used to select the health facilities included in the survey. First, the team

conducted a mapping of some of the biggest and best-known public and private health facilities and pharma-

cies in Beirut and Saida.

The team asked for input to this mapping exercise from contacts in Lebanon, includ-

ing from the Danish Embassy in Beirut. Based on this list, the team invited managers of the selected health

facilities to participate in the survey, one person was interviewed; if that person did not have all the required

information at hand, they consulted with relevant colleagues at the facility. Each hospital has been inter-

viewed according to its specialisation. For some hospitals, in particular the American University of Beirut

Medical Center (AUBMC), it was not possible to obtain information about prices and availability of all treat-

ments as the hospital stated that such information always depended on an assessment of the individual case

–

in these cases, there have been left blank cells in the matrix. All managers, who accepted to be interviewed,

agreed to have the name of the facility included in the report.

Data regarding availability of medicines and treatments as well as information about prices are reported in

tables in the chapters about the specific diseases: Health care services on cancer, cardiac complications, dia-

betes, mental health, chronic obstructive lung disease and other medicines. The matrixes in Annex 3 contain

details about availability, price, dosage and form of medicine (tablet, liquid, etc.) and are listed by health

facility. It should be noted that during the time of data collection and immediately after, important fluctua-

tions in foreign exchange rates took place. Prices reported in the report are thus unlikely to be the exact

same as they were at the time of data collection (October 2022). The price of the products is regulated after

the current official exchange rate. Pharmaceutical products at all pharmacies in Lebanon are subject to price

regulation in accordance with the prices published in a national database. This database, the Lebanon Na-

tional Drugs Database, contains official information about the pharmaceutical products registered and mar-

keted by the Ministry of Public Health (MoPH) in Lebanon.

In the surveyed pharmacies, this regulation takes

place automatically every two weeks. All prices in this report are reported in Lebanese Pounds (LBP) or in US

dollars (USD) as they were given to the team by the health facility managers. Following the mission to Leba-

non, some communication with the health facility managers took place in order to gather final details on

prices and availability regarding specific medicines.

Key informant interviews

Prior to the mission, DIS and the Ministry of Immigration and Integration conducted semi-structured inter-

views with key informants during September and October 2022. The team identified ten organisations from

the UN and civil society; all are involved in the provision of health care services to PRL. The team conducted

in-depth online interviews with nine of these organisations before the mission to Lebanon, and seven of

Project MedCOI - Belgian Desk on Accessibility,

Guidelines for the Research and Use of Case-Specific MedCOI on Accessibility and

General MedCOI,

2018

See a list of health facilities that have been consulted in Annex 2

Republic of Lebanon, Ministry of Public Health,

Lebanon National Drugs Database,

2022,

url

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these organisations were interviewed again in length during the mission. The team also visited the Ein El

Hilweh Palestinian refugee camp in Saida in order to visit primary health (PH) facilities managed by UNRWA

inside the camp, talk with UNRWA health workers and to see how health care services are organised in the

camp. The sources were informed about the purpose of the interview and the fact that their statements

would be included in a publicly available report. Two organisations preferred to be referred to as anonymous

organisations. One international humanitarian organisation declined an invitation to participate in an online

interview or via email, stating that the information they could provide was already fully covered by other

organisations.

Immediately after each interview, a summary was written. It is not a full transcript of what was said, but

rather a detailed note with a focus on the elements of relevance for the ToR. All interview notes were for-

warded to the sources for their amendments and final approval. This gave the sources an opportunity to

reflect on the information that was shared during the interview as well as an opportunity to offer corrections.

In the report, care has been taken to present the views of the sources as accurately and transparently as

possible. Reference is made to the specific paragraphs of the meeting notes in the footnotes. All sources

approved the interview notes. The notes are included in their full length in Annex 2.

Quality control

Quality control of the reliability and validity of the information in this report has been carried out in several

ways. First, the different team members carried out internal quality control of the interview notes and the

survey data throughout the process. In order to check for accuracy of the information collected at the phar-

macies, the survey data was double-checked by a person external to the team who also compared the prices

to the prices found in the Lebanon National Drugs Database.

Secondly, the Belgium COI-unit peer reviewed

the full report. Belgium was selected because the Belgian COI unit has extensive experience as a founding

member of the original MedCOI-project and because the unit has its own medical doctors capable of checking

the accuracy of the medical information included in this report.

Finally, the report has been peer reviewed in form and content by DIS.

Limitations

Firstly, the financial crisis and the hyperinflation worsened through the time of data collection. Therefore,

the prices listed for the different medicines and treatments should be read as only indicative; the deteriora-

tion of the LBP and a continuously changing exchange rate makes it difficult to give an exact overview of

prices for health care services in Lebanon.

Secondly, in some cases, it proved difficult to obtain precise information about treatment from all of the

relevant organisations during the visit. The team thus contacted these organisations after the visit to gather

additional information.

The Lebanese health sector is well described in academic public health literature. Therefore, the team did

not contact the Lebanese Ministry of Public Health (MoPH) to obtain further information about the organi-

sation of health care in the country.

9 Republic of Lebanon, Ministry of Public Health,

Lebanon National Drugs Database,

2022,

url

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It was not possible to obtain a list of hospitals partnering with UNRWA (including requirements for becoming

a partner); therefore, the report does not contain information that addresses this part of the ToR.

Structure of report and presentation of collected data

The report begins with a brief overview of the specific situation of the Palestinian refugee population in Leb-

anon in order to contextualise the conditions of their access to health care services. This includes a brief

description of the political instability, which has been dominating Lebanon over the past years. Then follows

a description of the organisation of the health sector in Lebanon and the external factors that affect patients

access to services (human resources within health care, health insurance, hyperinflation and the Beirut Port

explosion). After that follows a description of United Nations Relief and Work Agency for Palestine Refugees

(UNRWA) and the key role of this agency in the provision of health care services to PRL. Then the findings

related to availability and accessibility of medicines and specialised treatment are presented in separate

chapters. Finally, the interview notes can be found in Annex 2 and information about the availability of med-

icines and specialised treatment in Annex 3.

The report is a synthesis of the sources' statements, data collected on the ground as well as relevant health

care system reports and academic articles.

The drafting of the report was initiated in August 2022 and was finalised in January 2023. The report is avail-

able on

the website of DIS.

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Abbreviations

AUBMC

COI

DIS

EASO

EUAA

FHT

LBP

LGBT+

MoPH

NSSF

NGO

OAT

OCHA

OST

PHC

PLO

PRL

PRS

PRCS

PRCS/L

SIDC

UNICEF

UNRWA

YMCA

WHO

American University of Beirut Medical Center

Country of Origin Information

Danish Immigration Service

European Asylum Support Office

European Union Agency for Asylum, previously European Asylum Support Office

Family Health Team

Lebanese Pound

Lesbian, Gay, Bisexual, and Transgender

Ministry of Public Health

National Social Security Fund

Non-Governmental Organisation

Opioid Agonist Treatment

Office for the Coordination of Humanitarian Affairs

Opioid Substitution Treatment

Primary Health Care

Palestine Liberation Organization

Palestinian Refugees from Lebanon

Palestinian Refugees from Syria

Palestine Red Crescent Society

Palestine Red Crescent Society in Lebanon

Society for Inclusion and Development in Communities and Care for All

United Nations Children's Fund

United Nations Relief and Works Agency for Palestine Refugees in the Near East

You g Me s Ch istia Asso iatio

World Health Organization

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Map of Lebanon

Lebanon, Copyright UN Geospatial

UN,

Lebanon,

1 January 2010,

url

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Brief overview of the situation of Palestinian refugees from

Lebanon

Demography

Lebanon last conducted a census in 1932.

The actual population figure is thus unknown but is estimated to

reach between 5.2 and 6.7 million people of which presumably 30

–

35 percent comprise of refugees (Pales-

tinians and Syrians) as well as migrant workers.

The last decade has seen a large influx of refugees, partic-

ularly from Syria (up to 1.5 million),

including Palestinians from Syria, which makes Lebanon the host of the

largest number of refugees per capita in the world.

Palestinian refugees from Lebanon and their access to basic rights

According to UNRWA figures, more than 479,000 Palestinian refugees are registered with UNRWA in Leba-

non. However, it is estimated that only around 180,000 are still living in the country; 45 per cent live in one

of the 12 official Palestinian refugee camps. The camps, of which some are guarded by the Lebanese army,

are overcrowded and the housing conditions are poor.

Palestinians refugees in Lebanon (PRL) experience high levels of poverty, unemployment and lack of access

to justice through the legal system. PRL do not have the same basic rights as Lebanese citizens; they are not

granted basic civic rights, and are not allowed to work within 39 different professions.

PRL often work in

seasonal agriculture, constructions jobs and as informal workers.

In November 2022,

UNRWA s Co

issio e Ge e al

expressed grave concern over the current humanitarian

situation of Palestinian refugees from Lebanon, noting that people are unable to afford medicines or co-share

the cost of treatment particularly for chronic diseases and cancer.

In early 2022, the poverty rate of Pales-

tinians in Lebanon was 70 percent and by the end of October 2022, it reached 93 percent.

Registered and unregistered Palestinian refugees

Palestinians in Lebanon registered with UNRWA are entitled to receive UNRWA services, including access to

primary health care services free of charge.

According to two sources, Palestinian refugees living in Lebanon can be divided into the following groups:



PRL registered with UNRWA and DPRA (Directorate General of Palestinian Refugee Affairs);

PRL who fled to Lebanon as a

o se ue e of the 9

a a d ho a e atego ised as o

-IDs

a d

who are neither registered with UNRWA nor DPRA;

Maktabi, R.,

The Lebanese Census of 1932 Revisited. Who Are the Lebanese?

in: British Journal of Middle Eastern Studies, Novem-

ber 1999,

url,

p. 219

WHO,

Annual Report 2020: Leveraging Emergency Health Support for Health System Development,

2022,

url,

p. 1

Migrationsverket,

Libanon

–

en sviktande stat,

2023,

url,

p. 6; UNRWA,

Palestine refugees in Lebanon: struggling to survive,

2022

url,

p. 10

UNRWA,

Protection Brief Palestine Refugees living in Lebanon,

September 2020,

url,

pp. 1-3

UNRWA,

Where we work, Lebanon,

n.d.,

url;

UNRWA,

Protection Brief Palestine Refugees living in Lebanon,

September 2020,

url,

pp. 1-3

UNRWA,

Protection Brief Palestine Refugees living in Lebanon,

September 2020,

url,

pp. 1-3

An international NGO: 2

UNRWA,

Palestine Refugees in Lebanon fall further in to abyss,

24 November 2022,

url

MEMO,

UN: Poverty among Palestine refugees in Lebanon jumps to 93 %,

27 October 2022,

url

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

PRS (Palestinian refugees from Syria).

While the majority of Palestinians in Lebanon are registered with UNRWA, there is a group of 3,000 to 5,000

Palestinians who are not registered with UNRWA, as they are not registered with the Lebanese authorities.

Therefore, this group does not

ha e alid legal status i Le a o a d a e efe ed to as o

-IDs . The illegal

status of non-IDs has a number of implications, including limitations on access to public services from Leba-

nese educational and public health services. UNRWA provides education and primary health care services to

non-IDs in accordance with budget availability.

Impact of the economic crisis on the Lebanese health sector

Ongoing instability in Lebanon

In October 2022, at the time of data collection, Lebanon had neither a president nor a government to deal

with the economic recession and the long-term consequences of the Beirut Port explosion, which occurred

on 4 August 2020. Since 2019, the economic crisis in Lebanon has resulted in dramatic increases in prices of

fuel, food and medicines, a development that was further accelerated by the fact that the subsidy on essen-

tial products was lifted in 2021.

Palestinian refugees are, like the rest of the Lebanese population, at risk of

food insecurity, electricity blackouts and increased health problems because of the shortages of medicine

and health care interventions.

Hyperinflation

In 2020, the average inflation rate in Lebanon had reached 85 percent. This inflation rate has been com-

pounded by a decline in the Lebanese pound (LBP).

In October 2022, during the time of data collection for

this report, one USD was worth 36,000 LBP according to the unofficial exchange rate. The bank system has

ee des i ed as o pletel a k upt ,

and in October 2022, the banks decided to close so that deposi-

taries could not withdraw their own money.

It is estimated that because of the devaluation of the LBP

–

combined with repercussions from Covid-19

–

medical doctors across Lebanon have lost about 80 percent of

their income.

Access to cash is a crucial aspect of being able to access medical care in Lebanon according to an international

NGO.

At the time of data collection, October 2022, the devaluation of the local currency and fluctuations

in the official exchange rates were reported to affect payments by credit card

a d to ha e atast ophi o -

se ue es o people s dail life.

Patients needed to show proof that they are able to pay prior to any

medical intervention such as surgery. This aspect was particularly challenging at the time of the interview. In

PRCS,

PRCS/L Hospitals Annual Report 2021,

2022, not available online, p. 14; a local humanitarian organisation: 3

DIS,

Palestinian Refugees, access to registration and UNRWA services, documents and access to Jordan,

June 2020,

url,

pp. 26-29;

UNRWA,

Protection Brief: Palestine Refugees living in Lebanon,

September 2020,

url,

pp. 1-3

Migrationsverket,

Libanon

–

en sviktande stat,

2023,

url,

p. 6; UNRWA,

Palestine refugees in Lebanon: struggling to survive,

2022,

url,

p. 6

UNRWA,

Palestine refugees in Lebanon: struggling to survive,

2022,

url,

p. 6

WHO,

Annual Report 2020: Leveraging Emergency Health Support for Health System Development,

2022,

url,

p. 1

Shallal A. et al.,

Lebanon is losing its front line

in: J Glob Health, 27 March 2021,

url

Reuters,

Lebanese banks close again after holdups by depositors seeking their own money,

7 October 2022,

url

Shallal A. et al.,

Lebanon is losing its front line,

in: J Glob Health, 27 March 2021,

url

An international NGO: 15

DW,

Lebanese exchange rate chaos causes economic hardship,

13 October 2022,

url

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terms of access to own funds, the international NGO explained that the banks were currently closed and even

before the closure, there were strict limitations on how much money each person could withdraw from their

personal bank account. The international NGO referred to an incident of a Lebanese woman who wished to

access her funds in the bank to pay for her sister s cancer treatment and who was denied payout by the bank.

She then threatened the bank to get access to her own funds enabling her to pay fo

he siste s t eat e t.

The international NGO further noted that there had been an increase in robberies and kidnappings for ran-

som as a means for people to obtain cash.

In October 2022, people with money in the bank were allowed

to withdraw 100-200 USD per month of their deposits.

The above mentioned episode with a woman who

threatened to rob a bank to get access to her own funds illustrates the fact that Lebanon has been described

as a ash-st apped ou t

ith a di e t i pa t o people s a ilit to pu hase edi i es a d pa fo hos-

pital bills. As an example, insulin prices have increased significantly: from 180,000 LBP to 730,000 LBP after

the government reduced its subsidies on important medicines in November 2021.

Due to the financial crisis in Lebanon, commodities in general, including medicines, have increased in price

and were estimated to be more than ten times as expensive as before the financial crisis. When applying the

official exchange rate at that point of time, the purchasing power was reduced with up to 90 percent.

Before

the financial crisis, the government used to spend up to 130 million USD in monthly medical subsidies; after

the financial crisis, however, the worth of this amount was reduced to 35 million USD.

One NGO Anera

stated that the Hôtel-Dieu Hospital had a social fund for vulnerable patient groups. Anera also emphasised

that this pathway required detailed knowledge of the health care system and connection to gatekeepers.

Health care sector in Lebanon

Organisation of the health sector

The health sector in Lebanon is regulated by the MoPH, which is supported by the World Health Organization

(WHO) and other health care partners.

The central coordination of the sector has been described as

eak .

The provision of health care services in Lebanon is organised in: i) public (governmental) dispensaries, pri-

mary health care (PHC) centres and hospitals; (ii) private (for profit/non-profit) clinics and hospitals; and iii)

UNRWA-supported primary health clinics and hospitals specifically for the Palestinian refugee population.

Private health care providers dominate the health sector in Lebanon.

The private for-profit sector is geared

towards hospital-based and curative health care services rather than towards prevention and primary health

An international NGO: 15

A local humanitarian organisation: 2

Das, M.,

Lebanon: insulin out of reach after subsidies lifted,

7 February 2022,

url

UNRWA Lebanon Field Office: 11

Das, M.,

Lebanon: insulin out of reach after subsidies lifted,

7 February 2022,

url

Anera: 5

WHO Lebanon: 3; MoPH,

About MOPH,

2022,

url

Tyler, F.,

Characteristics and challenges of the health sector response in Lebanon,

November 2014,

url

WHO Lebanon: 1

UNRWA Department of Health: 1, Tyler, F.,

Characteristics and challenges of the health sector response in Lebanon,

November

2014,

url

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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care.

The private sector absorbs more than 80 percent of the national health budget.

As an example of

the dominance of the private sector compared to government-managed facilities, less than 10 percent of all

dispensaries and PHC centres belonged to the MoPH or to the Ministry of Social Affairs in 2014.

In 2006,

only 12 percent of all hospitals across Lebanon belonged to the public sector.

According to one interviewed

international organisation, PRL with financial means tend to prefer private hospitals, including those con-

tracted with UNRWA, over Palestine Red Crescent Society (PRCS) hospitals, as the quality of services is per-

ceived to be better at private hospitals.

There is currently no regulation of prices at the private hospitals.

Pricing of services is based on the current exchange rate of US dollars in the black market, which is highly

volatile.

All patients in Lebanon with legal residency may access health care services at a private hospital regardless

of their nationality given that the patient or their families are able to pay in cash for the costs of treatments,

medicines and hospitalisation; according to WHO, the payment should be made in USD.

Please see Annex

3 for more information about prices for treatments and medicines at different hospitals as well as about

hospital capacity.

In addition to the private health care sector being an important actor, PRCS in Lebanon (PRCS/L) is an im-

portant health sector actor in Lebanon. PRCS/L operates five hospitals across Lebanon:

1) Safad Hospital in central Beirut area,

2) Haifa Hospital in the southern suburbs of Beirut,

3) Nasraa Hospital in Mar Elias, West Beirut,

4) Hamshary Hospital in Saida, South Lebanon, and

5) Tal Satar Hospital in Rashidyea, South Lebanon.

Human resources for health

WHO has recommended that a minimum of 4.45 medical doctors, nurses and midwives combined should be

available per 1,000 persons as a general rule in order to deliver safe health care.

In comparison, even before

the economic crisis Lebanon had in 2018 under 40 medical staff per 10,000 persons,

hi h is elo WHO s

recommendations.

According to the same source, as many as 400 medical doctors have since then in 2021

alone left the country.

WHO

s offi e i

Lebanon confirmed that Lebanon was still experiencing a severe exodus of medical staff, in

particular of medical doctors and those with the highest levels of specialisation, including a high number of

International Medical Corps,

Disability and Health Situational Analysis Report: Improving Access to Quality Health Care for Per-

sons with Disabilities in Lebanon,

May 2020,

url,

p. 12

Project Hope,

Si Mo ths After E plosio , Le a o ’s Health Care Se tor o Verge of Collapse,

2 February 2021,

url

Tyler, F.,

Characteristics and challenges of the health sector response in Lebanon,

November 2014,

url

Kronol, N. M.,

Rebuilding of the Lebanese health care system: health sector reforms,

url,

p. 460

UNICEF Lebanon Field Office: 5

WHO Lebanon: 10; DW,

Lebanese exchange rate chaos causes economic hardship,

13 October 2022,

url

WHO Lebanon: 2, 8; UNICEF: 6; an international NGO: 14, 16

PRCS,

PRCS/L Hospitals Annual Report 2021,

2022, p. 11, not available online; a local humanitarian organisation: 8

WHO,

Health workforce requirements for universal health coverage and the sustainable development goals,

2016,

url,

p. 6

Shallal, A. et al.,

Lebanon is losing its front line,

url

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psychiatrists; this led to prolonged waiting time for a consultation with a specialist.

UNFPA

(United Na-

tions Population Fund) country office in Lebanon confirmed that a high number of health workers had left

the country; furthermore, UNFPA noted that a number of those who were still in Lebanon were not showing

up at their duty stations because they experienced difficulties in paying for transport. According to UNFPA,

40 percent of medical doctors have left, while the number for nurses and midwives is 20 percent and 8-10

percent respectively.

Additional consulted sources confirmed that a high number of medical staff has left

the country.

Palestinian refugees are prohibited from practicing medicine in Lebanon.

Palestinians with a medical de-

gree are allowed to practice medical professions in the health facilities that UNRWA manages.

Health insurance

Health care in Lebanon is financed through multiple funding sources, including private insurance, households

out-of-pocket payments, NGOs or by various other funds such as

UNRWA s

fund for Palestinian refugees.

Health insurance in Lebanon is a mixture of private health insurance companies and employment-based in-

surance funds such as the National Social Security Fund (NSSF) (covering national protection for sickness and

maternity leave for employees from any sector).

Less than half of the Lebanese population has some form of health insurance.

PRL who have jobs in the

legal labour market are required to contribute to the NSSF; however, they

do ot e efit f o the NSSF s

sickness and maternity coverage.

By contrast, only seven percent of refugees in Lebanon possesses a health

insurance.

Those without insurance may apply for assistance from UNRWA or local NGOs.

One of the interviewed NGOs advised that there was an increase in persons obtaining private insurances and

that anyone who had the financial means to buy an insurance can do so, including Palestinians. This source

elaborated that insurances purchased with so-called

f esh dolla s

offered better coverage than one paid

for in LBP.

Current state of health sector

Lebanon has previously been known as a provider of excellent health care services,

and the country has

even been

des i ed as the hospital of the Middle East

, attracting patients from the whole region for its

WHO Lebanon: 11

UNFPA Lebanon Field Office: 4

Anera: 11; a local NGO: 3

ILO,

Labour Market Challenges of Palestinian Refugees in Lebanon: A qualitative assessment of Employment Service Centres,

Sep-

tember 2018,

url,

p. 5

UNRWA,

Working at UNRWA,

n.d.,

url

Lebanon, Ministry of Public Health and WHO,

III - Health System Financing

in: Health Beyond Politics, 2009,

url,

pp. 63, 75

An international NGO: 2

UNOCHA,

Emergency Response Plan, Lebanon 2021-2022,

6 August 2021,

url,

p. 9

USDOS,

2021 Country Report on Human Rights Practices: Lebanon,

April 2022,

url;

an international NGO: 2

PRCS,

PRCS/L Hospitals Annual Report 2021,

2022, not available online, p. 7

UNRWA, Health Department: 1

F esh Dolla s ea s a a ou t de o i ated i USD i the Le a ese a ki g s ste , hi h is eithe i ash o i i te a-

tio al i e t a sfe s

according to Melki & Associates,

Le a ese Ba ks to u fresh Dollars fro the parallel

arket,

8 September

2021,

url

Anera: 23

UNRWA Lebanon Field Office: 1

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hospitals offering both treatment for somatic and psychiatric diseases.

In 2006, Lebanon had 26 beds per

1,000 population, which was one of the highest hospital beds ratio in the Middle East.

However, the inter-

viewed sources concurred that this status has been lost over the past years; prices for services have increased

dramatically and essential medical workers have left the country.

According to WHO

s Le a o offi e,

the

health a e s ste i Le a o as al ead

o ki g at the li its of its apa it efo e the Bei ut po t e plo-

sion and the explosion only contributed to a further deterioration of the situation.

WHO stated that the

hospital sector in Lebanon was still recovering from the impact of the Covid-19 pandemic: the public sector

hospitals were unprepared for the influx of patients that needed hospitalisation during the spike of the pan-

demic; and the private sector hospitals were reluctant to receive these patients, as many of them did not

have health insurance.

Furthermore, in November 2022, Lebanon experienced its first cholera outbreak in

more than 30 years, and the MoPH needed assistance from WHO to control the outbreak. This has been

described by WHO as a reflection

of the …

ongoing deterioration in the economic situation and poor access

to clean water and proper sanitation services across the country.

The health sector in Lebanon is severely affected by an energy crisis: UNRWA emphasised that there was an

insufficient amount of petroleum, electricity and solar panels. The lack of stable energy supplies had led to

reduced availability of medicines. Although there was some amount of petroleum for generators for basic

operations, there continued to be a lack of electricity, which is crucial to maintain storage facilities, to keep

vaccination programmes running and to continue the computerised work of health care services (health in-

formation systems, eHealth, etc.). The lack of electricity also affected pharmacies and medical warehouses.

In October 2022, it was impossible to forecast when the energy crisis would be solved, as it is closely con-

nected to the financial crisis.

Beirut port explosion

On 4 August 2020, a large amount of ammonium nitrate, which was stored at the port of Beirut, exploded.

Over 6,500 people were injured and the homes of more than 300,000 persons as well as several hospitals

were destroyed in the greater Beirut area.

WHO estimated that more than 200 lives were lost after the

explosion,

others that 504 people had died.

According to one media outlet, over 2,000 medical doctors

have been directly affected by the explosion either through injuries or through the destruction of their place

of work.

Nation (The),

Lebanon hospitals under threat as doctors and nurses emigrate,

14 September 2020,

url

Kronol, N. M.,

Rebuilding of the Lebanese health care system: health sector reforms,

2006, 1,

url,

p. 460

WHO Lebanon: 2, Anera: 7; an international NGO: 1; UNFPA: 4; UNICEF: 1; a local humanitarian organisation: 1; UNRWA Lebanon

Field Office: 1

WHO,

Annual Report 2020: Leveraging Emergency Health Support for Health System Development,

2022,

url,

p. 1,

WHO Lebanon: 12

WHO,

600 000 doses of cholera vaccine arrive in Lebanon amidst evolving outbreak,

17 November 2022,

url

UNRWA Lebanon Field Office: 3, a local NGO: 5

UNRWA Lebanon Field Office: 1; an international NGO: 17; UNICEF Lebanon Office: 3

UN Security Council,

Implementation of Security Council resolution 1559, 2004, Thirty-fifth semi-annual report of the Secretary-

General [S/2022/749],

11 October 2022,

url,

p. 3; WHO,

Annual Report 2020: Leveraging Emergency Health Support for Health Sys-

tem Development,

2022,

url,

p. 20; Shallal, A. et al.,

Lebanon is losing its front line

in: J Glob Health, 27 March 2021,

url

WHO,

Annual Report 2020: Leveraging Emergency Health Support for Health System Development,

2022,

url,

p. 20

Shallal, A. et al.,

Lebanon is losing its front line

in: J Glob Health, 27 March 2021,

url

Nation (The),

Lebanon hospitals under threat as doctors and nurses emigrate,

14 September 2020,

url

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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The Beirut port explosion destroyed the main warehouse of the Ministry of Public Health (MoPH), which

contained medicines and medical supplies. Hence, these goods were relocated to two to three different

locations (with the required cold chain infrastructure) designated by the MoPH. WHO and UNICEF have as-

sisted the government in reconstructing the MoPH

s Ce t al D ug Warehouse

and have been providing sup-

port for its functionality.

The explosion, which occurred in the midst of the Covid-19 epidemic, has had several negative effects on the

functionality of the health sector, according to health system observers. Firstly, there was a spike in Covid-

19 cases in Lebanon following the explosion; secondly, medical doctors left the country to find a better life

else he e; a d fi all , people s t ust i the go e

e t a d the pu li se to de eased.

Among the de-

stroyed health facilities were two psychiatric in-patient units placed within general hospitals, adding to the

poor availability of psychiatric care in the country.

Supply of medicines

WHO Lebanon emphasised that some medicines for chronic diseases were subject to interruptions of supply.

These medicines included, but were not limited to, cancer treatment. Before the financial crisis, the Lebanese

government used to reimburse the costs for 50 percent of the population who had no health insurance. This

amounted to more than 4,000 cases per year supported by the MoPH (around 40 percent of all cancer cases).

These cases were fully subsidised by the government, including brand medication and new forms of immu-

notherapy, which are expensive and needed for an extended period of time. During the current economic

crisis, the government has not been doing that. Instead, the government has tried to replace branded medi-

cine with generic medicines and to establish new treatment protocols.

The NGO You g Me s Ch istia Asso iatio Le a o

YMCA Lebanon) manages the National Chronic medi-

cations programme for the MoPH, according to WHO

Lebanon office.

This programme covers 440 PHCs

and dispensaries providing basic care, including for patients with chronic diseases. YMCA

list of medications

follows the MoPH Essential Drug List (EDL).

The medicines are primarily distributed to vulnerable popula-

tion groups, including refugees; and the eligibility criteria are based on an assessment of vulnerability: house-

hold income, socioeconomic status, being elderly, having a special needs condition. Everybody who resides

in Lebanon, regardless of nationality, is eligible if the patient meets the criteria. The work of YMCA is also

distu ed

the u e t isis a d people s i a ilit to pa fo asi se i es. Patie ts

who wish to benefit

from these services and access to medicines need to open a medical file and produce some ID to open such

a file. This creates a challenge for persons who do not have ID papers such as many Syrian refugees.

Hospitals in Lebanon

Below is a description of the three main hospitals in Lebanon that the team visited: one private for profit

hospital in Beirut (AUMBC); one charity based hospital also in Beirut (Hospital of the Cross); and one PCRS/L

hospital located in Saida. The latter provides services free of charge to PRL on behalf of UNRWA.

UNFPA Lebanon Field Office: 5

Shallal, A. et al.,

Lebanon is losing its front line,

27 March 2021,

url

Arab Reform Initiative,

Mental Health Reforms in Lebanon During the Multifaceted Crisis,

28 September 2021,

url

WHO Lebanon: 5

WHO Lebanon: 9

YMCA Lebanon,

Medical Program, Medications,

n.d.,

url

WHO Lebanon: 9

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American University of Beirut Medical Center

According to an international ranking of hospitals, the American University of Beirut Medical Center (AUBMC)

is the highest ranked of all hospitals in Lebanon.

Established as a hospital in 1902, AUBMC provides health

care services to patients across Lebanon as well as to patients from other countries.

AUBMC is home to

four centres of excellence: the Abu-Haidar Neuroscience Institute (AHNI); the Child

e s Ca e Ce te of

Lebanon (CCCL), which is dedicated to the treatment of pediatric cancer; the Naef K. Basile Cancer Institute

(NKBCI), which is dedicated to the treatment of adult cancer; and the first Multiple Sclerosis (MS) centre in

the region.

AUBMC has a number of departments, including (but not limited to) family medicine, cardiology, endocrinol-

ogy, psychiatry, pulmonary and critical care, and radiation oncology.

Furthermore, it has ambulatory ser-

vices and diagnostic radiology. AUBMC employs 300 physicians, 973 nursing staff as well as a number of other

staff.

The ambulatory services of the AUBMC include an outpatient department (OPD)

and private clinics;

the latter offers approximately 22,000 outpatient consultations per month.

Admission procedures and

charges for services are described on the website. Admission is based on a three-step procedure. Firstly, all

new patients are screened by either the tellers (clerks/financial officers), residents or nurses and are then

given an appointment. Secondly, on the day of the appointment, a new file is opened and the financial clear-

ance is finalised with the teller of the unit. Finally, the patient is charged 100,000 LBP if it is a new patient

and 50,000 LBP

if it is a follow-up admission (note that these fees only cover the initial admission fees).

According to observations during the visit at the hospital, a patient cannot be admitted at the hospital with-

out presenting a guarantee that the patient or their family is able to pay for the services. According to its

website, the hospital accepts payments are by credit card, online money transfer, cash and checks. The hos-

pital also accepts payments by private insurance.

AUBMC is also a teaching hospital for the Faculty of Medicine.

Psychiatric Hospital of the Cross

The team visited the Psychiatric Hospital of the Cross /Hôpital

psychiatrique de la Croix

in October 2022. The

Psychiatric Hospital of the Cross is located in Jal El Dib in the northern parts of Greater Beirut.

It has a

capacity of 905 beds divided into male and female wards in separate buildings.

The hospital receives patients who suffer from mental illnesses such as depression, schizophrenia, maniac

episodes, mental retardation and cerebral paralysis. The hospital admits patients who are in an agitated state

and who may constitute a risk to themselves and to others. The hospital has infrastructure that allows for

CINDOC,

Ranking Web of Hospitals: Lebanon,

January 2015,

url

AUBMC,

I ter atio al Patie ts’ Ser i es,

n.d.,

url

AUBMC,

Department and Services,

n.d.,

url

AUBMC,

Department and Services,

n.d.,

url

AUBMC,

I ter atio al Patie ts’ Ser i es,

n.d.,

url

AUBMC,

Outpatient Department (OPD),

n.d.,

url

AUBMC,

Specialty Clinics,

n.d.,

url

Please note that due to the hyperinflation, all prices are likely to change very often.

AUBMC,

Outpatient Department (OPD),

admission fee as they appeared on the website 23 November 2022,

url

AUBMC,

I ter atio al Patie ts’ Ser i es,

n.d.,

url

AUBMC,

Facts & Figures,

January 2022,

url

Hôpital psychiatrique de la Croix,

Situation géographique

(Geographical location), n.d.,

url

Hôpital psychiatrique de la Croix,

Visite guidée

(Presentation of services), n.d.,

url

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confinement of patients.

The psychiatric treatment follows WHO standards on mental diseases and the

American Drug Association standards.

The hospital offers psychiatric treatment with medicines, electro-

convulsive therapy (ECT), psychotherapy, art therapy and occupational therapy.

In October 2022, the hos-

pital had 12 psychiatrists, four psychologists and a number of nurses and social assistants.

The services of the Psychiatric Hospital of the Cross are available to patients who can afford the costs, includ-

ing PRL.

100

There are patients from many Middle Eastern countries at the hospital, including Palestinians,

Syrians and Lebanese.

101

Patients may be referred to the hospital by the MoPH, the Ministry of Defense,

NSSF, other ministries or by UNRWA.

102

Mental health care services in Lebanon suffer from a number of challenges: the general health budget is

already low; there is no national mental health act; government funding is restricted; and the costs of services

for patients and their families are high.

103

According to WHO

s Le a o offi e,

the services of the Psychiatric

Hospital of the Cross are costly. While the hospital receives partial support from the MoPH, it is currently

experiencing financial strain.

104

The NGO Anera (American Near East Refugee Aid) supports the Psychiatric

Hospital of the Cross/Hôpital

psychiatrique de la Croix,

with medicines and medical supplies (e.g. needles,

syringes and diapers). According to Anera, UNRWA does not have contracts with psychiatric hospitals.

105

UN-

FPA also confirmed that there is a shortage of medicines for patients with psychiatric diseases. Efforts are

being made to solve this problem.

106

PRCS/L Hamshary Hospital

The team visited the PRCS Hospital in Saida in October 2022. PRCS is a non-profit humanitarian organisation

under the principles of the Red Cross and Red Crescent movement. PRCS/L was created in 1969 with the

purpose to provide health care to Palestinian refugees in and outside camps in Lebanon. In Lebanon, PRCS

operates five hospitals (so-

alled PRCS hospitals

and eight health care centres across the country.

107

Hamshary Hospital has a contract with UNRWA.

108

The hospital provides secondary health care services free

of charge to PRL in accordance with UNRWA s hospitalisation policy and reimbursement scheme (see the

section about UNRWA for further details).

The Hamshary Hospital in Saida is located in the neighbourhood right outside the refugee camp Ein El Hilweh,

the largest refugee camp in Lebanon.

109

The Hamshary Hospital is the largest of the five PRCS/L hospitals,

110

Hôpital psychiatrique de la Croix,

Visite guidée,

(Presentation of services), n.d.,

url

Hôpital psychiatrique de la Croix,

Les prestations thérapeutiques

(Available treatments), n.d.,

url

Hôpital Psychiatrique de la Croix,

Les prestations thérapeutiques,

(Available treatments), n.d.,

url

100

Anera: 15

101

WHO Lebanon: 16, Hôpital Psychiatrique de la Croix,

Visite guidée,

n.d.,

url

102

Hôpital psychiatrique de la Croix,

Visite guidée

(Presentation of services), n.d.,

url

103

Arafat, S. M. Y. et al.,

Psychiatry in Lebanon,

2020,

url

104

WHO Lebanon: 16

105

Anera: 15

106

UNFPA Lebanon Field Office: 6

107

PRCS,

PRCS/L Hospitals Annual Report 2021,

2022, not available online, pp. 8, 9

108

UNRWA,

Red Crescent and UNRWA Secure Better Hospital Services in Lebanon,

April 2010,

url

109

Nilsson, M.,

Surviving Seemingly Endless Refugeeship

–

Social Representations and Strategies of Palestinian Refugees in Ein El

Hilweh,

2021,

url,

p. 1; a local humanitarian organisation: 35

110

A local humanitarian organisation: 35

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and it has a capacity of 125 beds.

111

In 2021, it admitted 5,453 patients;

112

73 percent of the admitted patients

were referred to the Hamshary Hospital by UNRWA.

113

The Hamshary Hospital has an emergency room and

a number of specialised clinics as well as a physiotherapy clinic. The specialised services include internal med-

icine, cardiology, general surgery, obstetrics and gynecology, gastroenterology, emergency care, pediatrics,

laboratory services and ambulance services.

114

At the time of the visit, the Hamshary Hospital had a dialysis

centre funded by the NGO Health Care Society. In 2021, the hemodialysis unit in Hamshary Hospital had 120

beneficiaries.

115

At the time of data collection for this report, the funding for the continuation of the hemo-

dialysis programme beyond 2022 was not secured. Furthermore, there is a PRCS-managed physiotherapy

centre at the Hamshary Hospital with limited capacity, which offers services to adults and children.

116

In 2021, the Hamshary Hospital had 19 general practitioners, 35 specialised doctors and 87 nurses.

117

The admission procedures were explained as follows: a patient may show up at a PRCS hospital. PRCS will

then contact an UNRWA health clinic staff member who will visit the patient, assess the case and conduct

the administrative work related to the admission. This is most often in cases of emergency admissions. Most

commonly, the patient will be referred by UNRWA health clinic to the nearest PRCS hospital. In some cases,

however, persons will be referred to Hamshary Hospital in Saida, regardless of where the patient live, as this

hospital offers the broadest coverage of medical services.

118

According to findings from a team of independent auditors who analysed the performance of the PRCS/L

hospitals in 2009 and 11, the quality of the services in PRCS/L hospitals were found to be

i ge e al a e age

a d e lo o pa ed to Le a ese hospitals of the sa e atego .

119

Sources reported that the current

financial crisis in Lebanon had led to more demand by poor patients (of all nationalities) on PRCS/L hospi-

tals.

120

Combined with weakening donor commitment, the PRCS/L hospitals are experiencing difficulties in

retaining specialist doctors, which has led to difficulties in maintaining quality requirement, patient safety

and operation of services.

121

The Hamshary Hospital serves registered and unregistered Palestinian refugees as well as poor Lebanese

citizens and patients of foreign nationalities. PRCS/L hospitals serve patients without health insurance for a

i i al fee.

122

In 2021, 55 percent of the patients were Palestinians.

123

A local humanitarian organisation: 35

PRCS,

PRCS/L Hospitals Annual Report 2021,

2022, not available online, p. 7, 20

113

PRCS,

PRCS/L Hospitals Annual Report 2021,

2022, not available online, p. 28

114

A local humanitarian organisation: 37; own observations during visit at the hospital

115

Health Care Society,

Annual Report 2021,

n.d.,

url,

p. 5

116

A local humanitarian organisation: 32

117

PRCS,

PRCS/L Hospitals Annual Report 2021,

2022, not available online, p. 40

118

A local humanitarian organisation: 23

119

PRCS,

PRCS/L Hospitals Annual Report 2021,

2022, not available online, p. 10

120

A local humanitarian organisation: 12; PRCS,

PRCS/L Hospitals Annual Report 2021,

2022, not available online, p. 7

121

A local humanitarian organisation: 13, 17

122

PRCS,

PRCS/L Hospitals Annual Report 2021,

2022, not available online, p. 7

123

PRCS,

PRCS/L Hospitals Annual Report 2021,

2022, not available online, p. 25; a local humanitarian organisation: 36

112

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UNRWA’s role i health service provisio

UNRWA’s

andate and responsibilities in relation to health

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) was estab-

lished in December 1949 under UN resolution 302 (IV),

124

and the agency began operating on 1 May 1950.

UNRWA was created to respond to the urgent humanitarian needs of the then about 750,000 Palestinian

refugees who were displaced as a result of the 1948 Arab-Israeli war.

125

UNRWA operates in Lebanon, Jordan,

Syria, the West Bank and Gaza.

126

For nearly seven decades, the agency has been providing

state-like

ser-

i es

, including health services to Palestinian refugees.

127

According to its mandate, UNRWA continues to operate until there is a political solution to the Palestine-

Israel conflict in line with Resolution 194, which stipulates the right to return of the Palestinian people.

128

such, the UN General Assembly has continuously renewed

UNRWA s a date, ost e e tl e te di g it

until 30 June 2023.

129

Usually, the mandate is extended periodically in the General Assembly resolution enti-

tled

Assistance to Palestine refugees

130

A number of General Assembly resolutions that directly links to the work of UNRWA are renewed periodically;

the two key resolutions are

Operations of the United Nations Relief and Works Agency for Palestine Refugees

in the Near East

a d

Persons displaced as a result of the June 1967 and subsequent hostilities

These res-

olutio s outli e UNRWA s ke espo si ilities to a ds Palesti ia efugees. The o e se i es a e the p o i-

sion of education, health, relief and social services as well as emergency assistance.

131

All issues pertaining

to Palestinians and the work of UNRWA are covered by the so-

alled fou th o

ittee –

the Special Political

and Decolonization Committee within the UN Ge

e al Asse l

132

More detailed priorities

a e add essed i UNRWA s fi e ea Mid Te St ategies MTS . The ost e e t

strategy covers the years of 2016-2021 with a recent extension to include 2022. The current MTS identifies a

…

priority focus on life-threatening illnesses requiring life-saving/ life-supporting medical care and treat-

ment, but who lack the financial assets or insurance coverage to attain these.

133

Comprehensive primary

health care falls under UNRWA s core mandate and it is unlikely that UNRWA will fully stop delivering primary

health care services. Access to secondary and tertiary care through its hospitalisation programme

is UNRWA s

way of assisting Palestinians in need of more advanced health care services. However, in a time of financial

124

125

UNRWA,

General Assembly Resolution 302, A/RES/302 (IV) 8 December 1949,

n.d.,

url

UNRWA,

Who we are,

n.d.,

url

126

UNRWA,

UNRWA Fields of Operations Map 2020,

June 9, 2020,

url

127

CMI,

UNRWA, funding crisis and the way forward,

September 2022,

url,

p. 6

128

UNRWA,

General Assembly Resolution 302, A/RES/302 (IV) 8 December 1949,

n.d.,

url;

Security Council Report,

Resolution 194,

11 December 1948,

url

129

UN,

Assistance to Palestine Refugees, GA Resolution (A/RES/74/83),

26 December 2019,

url;

UN,

GA Resolution (A/RES/72/81),

Persons displaced as a Result of June 1967 and subsequent hostilities,

14 December 2017,

url;

UN,

GA Resolution (A/RES/75/94),

Operations of the United Nations Relief and Works Agency for Palestine Refugees in the Near East,

18 December 2020,

url

130

Bartholomeusz, L.,

The Mandate of UNRWA at Sixty,

10 May 2010,

url

131

UN General Assembly,

Resolution adopted by the General Assembly on 7 December 2017, A/RES/72/81,

7 December 2017,

url;

United Nations General Assembly,

Resolution adopted by the General Assembly on 10 December 2020, A/RES/75/94,

10 December

2020,

url

132

UN, The United Nations and Decolonization,

Fourth Committee,

n.d.,

url

133

UNRWA,

Mid Term Strategy 2016-2021,

2016,

url,

p. 56

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shortfall and an increasing demand for services

–

including primary health care and hospitalisation

–

UNRWA

has predicted that it will not be able to meet all of the existing needs.

134

According to UNRWA, the current

MTS is implemented at a time where the agency faces a number of challenges, including continuous chronic

underfunding, and that has a direct impact on UNRWA services.

135

Structure of UNRWA’s

health services

Health care services available through UNRWA

The o e fo us of UNRWA s Health P og a

e is to deli e o p ehe si e p i a health

care services free

of charge to Palestinian refugees through 140 primary health facilities managed by UNRWA across its five

countries of operation. Primary health care centres are located inside and outside camps.

136

In these centres,

a Family Health Team (FHT) offers services from maternal and child health to family planning, preventive

and curative care, outpatient and diagnostic services, oral care, specialist care

a d efe als.

137

In addition to providing primary health care, UNRWA also administers a hospitalisation programme where

services are provided by public, private or NGO-hospitals that have contracts with UNRWA. Contrary to the

access to primary health care services, the hospitalisation support is different in each of the five countries,

depending on local circumstances.

138

This also means that the percentage of the costs covered by UNRWA

differs and varies over time and place.

139

Each UNRWA country operation manages the reimbursement

scheme within its budgetary limitations.

140

It is only in Lebanon that UNRWA provides free of charge second-

ary health care through PRCS hospitals.

141

A o di g to UNRWA s A ual Repo t,

a little over 73,000 Palestinian refugees benefited from UNRWA-sup-

ported hospitalisation services in 2021, with an average length of in-patient stay of 1.9 days.

142

The financial shortfall of UNRWA has had a negative impact on the quality of services delivered by UNRWA.

Because of chronic underfunding, the ambition of providing access to a full range of quality health services

to everybody within the target group has had to be reconsidered, according to information given to DIS by

UNRWA in 2020.

143

When consulting UNRWA for this current report, UNRWA similarly explained that the

agency is unable to fully cover the existing health care needs and that the reimbursement scheme for sec-

ondary and tertiary treatment at UNRWA-contracted hospitals is at risk of being adjusted or put to a com-

plete halt.

144

134

UNRWA, Health Department, 14-16

UNRWA, Department of Internal Oversight Services Evaluation Division,

evaluation of the UNRWA medium term strategy 2016-

2022,

September 2021,

url,

pp. 11, 34; UNRWA,

Mid Term Strategy 2016-2021,

2016,

url,

p. 36

136

UNRWA,

Health Programme 2021,

n.d.,

url;

UNRWA, Lebanon Field Office: 5

137

UNRWA, Lebanon Field Office: 13; UNRWA,

What we do, Health,

n.d.,

url

138

UNRWA,

Mid Term Strategy 2016-2021,

2016,

url,

p. 35

139

UNRWA,

Department of Health, Annual Health Report 2021,

18 August 2022,

url,

p. 39; UNRWA,

Health Programme 2021,

n.d.,

url;

UNRWA, Health Department: 5; A local humanitarian organisation: 8

140

de Almeida, S. V. et al.,

Co-payments and equity in care: enhancing hospitalization policy for Palestine Refugees in Lebanon,

January 2022,

url

140

UNRWA, Department of Health,

Annual Health Report 2021,

18 August 2022,

url

141

UNRWA,

Health in Lebanon,

n.d.,

url;

UNRWA Lebanon Field Office: 5; UNRWA Department of Health: 5

142

UNRWA, Department of Health,

Annual Health Report 2021,

18 August 2022,

url

143

DIS,

Palestinian Refugees - Access to registration and UNRWA services, documents and entry to Jordan,

June 2020,

url,

p. 25

144

UNRWA Department of Health: 9, 12

135

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UNRWA’s

health care services in Lebanon

The general health care sector in Lebanon largely relies on private providers (as explained in more detail in

the section

O ga isatio of health se to

). Whereas Lebanese citizens may rely on health insurance to cover

their health expenses, there is no health insurance or Lebanese government funding for PRL. The only option

for financial support for Palestinians in need of health care services is from UNRWA or NGOs.

145

Primary health care programme in Lebanon

UNRWA s primary health care services in Lebanon are provided through 28 health care facilities located

across the country inside and outside camps. At these UNRWA health clinics, UNRWA doctors offer consul-

tations, examine patients and prescribe required medicine to Palestinian refugees eligible to receive UNRWA

services.

146

Medicines for basic health problems are provided to patients free of charge. The vast majority of

UNRWA health centres have a pharmacy-storage in the facility, staffed by a pharmacist and/or other relevant

medical personnel. Medication for diabetes is also available in UNRWA health centres

–

even in October

2022, when insulin was very difficult to find in pharmacies across Lebanon.

147

There is a high demand on UNRWA's services, which results in a high number of consultations per day as well

as short consultations. The number of doctors per patient is low and a medical doctor may have consultations

with up to 100 patients per day. An average consultation will therefore last approximately 3-5 minutes.

148

Mental health care needs are not sufficiently covered by UNRWA and there are no specific medication avail-

able through UNRWA.

149

Hospitalisation programme in Lebanon

Palestinians in Lebanon rely heavily on UNRWA due to the organisation of the Lebanese health care system

as described above. Prior to 2016, UNRWA Lebanon fully covered secondary care in private and public hos-

pitals as well as PRCS hospitals. However, because of severe budget constraints in 2016, UNRWA had to

amend its policy. This means that today secondary care is fully covered only at PRCS hospitals, whereas sec-

ondary health care services received at an UNRWA-contracted hospital are 90 percent covered.

150

In total, 54

hospitals have a contract with UNRWA in Lebanon of which five are governmental. The tendering of contracts

is renewed annually; and generally, the same hospitals are contracted, but prices for services are renegoti-

ated. PRCS hospitals are among the contracted hospitals.

151

In addressing access to secondary care, UNRWA noted that overall, the quality of services in PRCS hospitals

has improved over the last 10-15 years.

152

For reasons of financial limitations, PRCS hospitals cannot meet

the same perceived quality standard as private hospitals.

153

This is also reflected in the choice of health care

UNRWA Department of Health: 1; UNRWA,

Health in Lebanon,

n.d.,

url

The ite ia fo egist atio as a Palesti e efugee a e set out i the UNRWA s Co solidated Eligi ilit a d Regist atio I struc-

tio s CERI . Fo o e detailed i fo atio a out eligi ilit , see DIS epo t

Palestinian Refugees - Access to registration and

UNRWA services, documents and entry to Jordan,

url,

pp. 12-16

147

UNRWA Lebanon Field Office: 5, 15

148

An international NGO: 8

149

An international NGO: 9

150

de Almeida, V. et al.,

Co-payments and equity in care: enhancing hospitalization policy for Palestine Refugees in Lebanon,

January 2022,

url

151

UNRWA Lebanon Field Office: 7; UNRWA Health Department: 10

152

UNRWA Lebanon Field Office: 7

153

A local NGO: 17

146

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providers where UNRWA noted that in Saida alone, 45 percent of patients prefer a PRCS hospital, whereas

the remaining 55 percent choose another contracted hospital, despite having to pay for parts of the admis-

sion out of their own pockets. In the remaining areas where PRCS manage four hospitals, 20 percent of PRL

in need of hospitalisation choose PRCS hospitals.

154

An international NGO explained that in cases where PRL require treatment at a private hospital outside of

the UNRWA-contracted hospitals, they are unlikely to have the funds to cover these expenditures. If the

patient does have the funds, it is on the condition that they pay a deposit in advance (which is based on the

estimated cost of in-patient care and surgery costs).

155

UNRWA’s referral pathway

and reimbursement schemes

When PRL are in need of hospitalisation, UNRWA Lebanon follows the rules and financial coverage plans laid

out in the

age

internal hospitalisation policy. In accordance with the current policy, tertiary level admis-

sions have a coverage ceiling up to 5,000 USD for 12 days. If the cost reaches more than this amount, the

case is eligible to the assistance from

UNRWA s Medi al Ha dship Fu d MHF

for coverage of an additional

percentage starting from 10 percent and not exceeding another 5,000 USD. Most often, however, cases in

the MHF are tertiary care. If a PRL chooses a hospital that is not a contracted partner with UNRWA, because

the service is only available at a non-contracted hospital, UNRWA may reimburse 30 percent of the admission

cost.

156

Anera similarly informed that UNRWA conducts an assessment of the individual case and if approved,

60 percent of the expenditure up to a certain amount will be covered for a pre-decided number of days of

hospitalisation. According to Anera, in cases of tertiary care, UNRWA prioritises

spe ial ha dship ases due

to the limitations in funding.

157

An international NGO explained that since UNRWA does not fully cover all

fees for required medicines and treatments (but only a certain percentage of the fees), the patient may seek

financial support from other organisations or relatives.

158

Due to the financial crisis in Lebanon, commodities, including medicines, have increased in price and was in

October 2022 more than ten times as expensive as before the crisis. This increase in price has had implica-

tio s fo UNRWA s a ilit to o e the osts

of medicines and treatments; in October 2022, UNRWA was

covering only 30 percent of the costs, leaving the patient with a larger out of pocket payment than before.

159

At private, contracted hospitals, the most common diseases that UNRWA partially covers include hernia sur-

gery and caesarian section deliveries. For tertiary care at private, contracted hospitals, where UNRWA covers

60 percent, it often involves services such as neuro surgical operations and other advanced operations. In

terms of cancer treatment, UNRWA covers 50 percent of the costs of medicines needed for the patient up to

a maximum of 8,000 USD, then 25 percent up to 12,000 USD. In addition to covering the costs of medicines,

UNRWA covers a number of selected surgical interventions through its hospitalisation policy. This coverage

includes partial funding of chemotherapy sessions where patients have to pay the remaining costs out of

pocket. This is in most cases financially impossible, as these patients have already depleted their limited

154

155

UNRWA Lebanon Field Office: 7

An international NGO: 14

156

UNRWA Lebanon Field Office: 8

157

Anera: 4

158

An international NGO: 7

159

UNRWA Lebanon Field Office: 11-12

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resources.

160

Whilst medicines for cancer treatment and hemodialysis are

p o ided th ough UNRWA s hos-

pitalisation referral, budgetary limitations of the organisation can have an impact on the ability to cover ex-

penditures.

161

One of the biggest challenges for PRL in Lebanon is obtaining cancer treatment, as this is very expensive and

the medicine is frequently unavailable.

162

UNRWA also experiences a generalised and massive lack of cancer

treatment, as there is a shortage of critical medicines resulting in some patients relying on medicines bought

on the black market with all the problems of counterfeit medicines of poor quality, high prices and lack of

control of expiration dates that this may entail. Contracted service providers are also finding it challenging to

procure these sorts of medicines.

163

Current financial and procurement challenges

The current financial crisis has had the direct effect on UNRWA that parts of the payment in its contracts with

hospitals were requested in USD for the first time. While UNRWA continued to provide access to secondary

and tertiary care, a great effort was made in containing the expenditure by closely monitoring implementa-

tion, increasing referrals to PRCS hospitals, trying to reduce average lengths of hospitalisation as well as con-

ducting strict auditing of hospital bills.

164

In November 2022, UNRWA issued an emergency appeal for Lebanon, highlighting amongst other issues the

growing shortages of medicines and the fact that families are often unable to afford medicines, as govern-

ment subsidies have been lifted. Many Palestinian refugees are no longer able to afford the self-payment

cost for secondary health care and consequently, some skip lifesaving treatment to avoid accumulating

debts.

165

UNRWA emphasised that current challenges in Lebanon with insufficient amounts of gas, electricity and solar

panels have led to reduced availability of medicines. Although there is some gas for generators to continue

basic operations, there is a lack of electricity to maintain storage facilities functioning, keep vaccination pro-

grammes running and continue the operation

of UNRWA s health

care centres.

166

The health sector in Leba-

non is challenged in terms of recruitment and retention of qualified medical staff and so is UNRWA.

167

In terms of procurement of medicines, UNRWA explained that it procured its medicine from UNRWA Head-

quarters in Amman. Procurement is challenging for several reasons: transportation, especially of larger quan-

tities of goods is difficult after the Beirut port explosion in 2020 and because of increased costs of shipment

in Beirut related to the financial crisis. Until now, UNRWA had not yet experienced that the agency was not

able to procure needed medicines; it had, however; experienced delays in the deliveries.

168

160

161

UNRWA Lebanon Field Office: 6

UNRWA Health Department: 8

162

UNRWA Lebanon Field Office: 15

163

UNRWA Lebanon Field Office: 10

164

UNRWA, Department of Health,

Annual Health Report 2021,

18 August 2022,

url

165

UNRWA,

Hitting Rock Bottom

–

Palestine Refugees in Lebanon risk their lives in search of Dignity,

21 October 2022,

url

166

UNRWA Lebanon Field Office: 3

167

UNRWA Lebanon Field Office: 2

168

UNRWA Lebanon Field Office: 4

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Health care services

Cancer

Cancer treatment, including chemotherapy, is scarce or unavailable to the general population in Lebanon.

169

The government hospital Karentina offers in- and outpatient services for children with cancer.

170

Anera, an

NGO that mobilises resources for medical aid in Lebanon, has managed to obtain smaller quantities of cancer

medicines; however, it is not sufficient to cover the need, as cancer medicines are one of the medicines,

which pharmaceutical companies do not often donate.

171

The donations that Anera has received are channeled through the governmental hospital Karentina in Beirut,

which is the main public hub for dispersing medicines. Based on a survey within the Palestinian community,

Anera has assessed 533 patients and their needs for cancer medicines. Anera is in the process of lobbying for

funds for these medicines.

172

Cancer treatment is not offered at the PRCS hospitals due to lack of medicines

and of specialised medical doctors.

173

One local NGO had second hand information about Palestinians being

rejected at hospitals for cancer treatment; they were given the explanation that the hospital did not have

the required medicines but that was not correct, according to the NGO at that point of time. Rather, the

explanation could be that these hospitals prefer treating Lebanese patients. The NGO had not witnessed

examples of such differential treatment directly.

174

Prior to the financial crisis, the Lebanese government fully covered the costs of treatment and medicines for

about half of the Lebanese population who did not have health insurance. However, as the government cur-

rently lacks funds, it can no longer subsidise cancer treatment. This situation affects poor patients dispropor-

tionately.

175

The scarcity of lifesaving cancer treatment is reported

to ha e a egati e effe t o patie ts

health, including the postponing of chemotherapy sessions. The risk that the government might fully stop

subsidising medicines and hospital bills

is des i es as a atast ophi

health se to o se e s.

176

The following data was collected in the period from 10 to 14 October 2022.

I the olu

fa ilit

, it is de-

scribed in which facility the service or medication was available at the time of research. If available in all the

mentioned facilities,

the te

all ill appea .

The price of the treatment is given on the same line as the

facility where the medicine is available. All prices are in USD or in LBP. It was not possible to obtain infor-

mation about prices of all medical treatments and diagnostics tests. The main reason for this is that the sur-

veyed hospitals stated that such information depended on an assessment of the individual case. In these

cases there have been left blank cells in the matrix.

169

170

WHO Lebanon: 5; UNFPA Lebanon Country Office: 8; Anera: 12; a local NGO: 28; a local humanitarian organisation: 27

Annex 3, Governmental Hospital Beirut

–

Karantina

171

Anera: 12

172

Anera: 12

173

A local humanitarian organisation: 27

174

A local NGO: 29

175

WHO Lebanon: 5

176

Al-Monitor,

In Lebanon, deterioration of health system endangers cancer patients' lives,

March 2021,

url;

Anera,

Le a o ’s Crisis

Impacts Cancer Patients Amid Medicine Shortages,

2022,

url

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Table 1: Cost of treatment

Cancer

Treatment

Availability

Inpatient treatment by a can- Available

cer specialist (an oncologist)

Price in USD

Facility

AUBMC

Outpatient treatment and fol- Available

low-up by a cancer specialist

(an oncologist)

First visit: 100

Follow-up visit: 70

Governmental

Hospital Beirut

–

Karantina

(available for

children only)

AUBMC

Governmental

Hospital Beirut

–

Karantina

(available for

children only)

Inpatient treatment by a urol- Available

ogist

Outpatient treatment by a

urologist

Radiation therapy

Available

First visit: 100

Follow up visit: 70

AUBMC

Available

AUBMC

Governmental

Hospital Beirut

–

Karantina

(available for

children only)

Chemotherapy

Available

AUBMC

Governmental

Hospital Beirut

–

Karantina

(available for

children only)

Laboratory research / moni- Available

toring of full blood count; e.g.

Hb, WBC & platelets

AUBMC

Governmental

Hospital Beirut

–

Karantina

(available for

children only)

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Laboratory research / tumor

marker: PSA test (Prostate-

Specific Antigen)

Prostate resection (tran-

surethral resection of the

prostate, Laparoscopic pros-

tatectomy)

Diagnostic test: Biopsy

Available

AUBMC

Available

AUBMC

Available

AUBMC

Cardiac complications and hypertension

This section describes the availability and the prices of medicines and treatments for patients suffering from

cardiac complications and hypertension.

At the PRCS hospitals, preventive care is available for patients with cardiac complications and is fully covered

by UNRWA. Medicines for hypertension are

i luded i UNRWA s o e age.

177

Anera has provided large

amounts of medicines for cardio vascular diseases to PRCS hospitals and to UNRWA as a matter of priority.

Anera was not aware of any critical shortages of medicines to prevent cardio-vascular diseases, including

hypertension.

178

The following data about specialised treatment was collected from selected hospitals in the period from 10

O to e

. I the olu

fa ilit

, it is described in which facility the service or medication was

available at the time of research. If available in all the mentioned facilities,

the te

all ill appea . I A e

3 attached to this report, it is possible to see the name of the pharmacy that sells the product for the price

mentioned in the scheme. The price of the treatment is given on the same line as the facility where the

medicine is available. All prices are in USD or in LBP. It was not possible to obtain information about prices of

all medical treatments and diagnostics tests. The main reason for this is that the surveyed hospitals stated

that such information depended on an assessment of the individual case. In these cases there have been left

blank cells in the matrix.

Table 2: Cost of treatment

Cardiac complications and hypertension

Treatment

Availability

Inpatient treatment by an in- Available

ternal specialist (internist)

Price in USD

Facility

AUBMC

Provided free of charge if approved by Hamshary Hos-

UNRWA up to a predefined limit.

pital

Above this limit, there is a fixed per-

centage of self-payment.

Outpatient treatment by an

internal specialist (internist)

Available

First visit: 100

Follow-up visit: 70

AUBMC

177

178

A local humanitarian organisation: 28

Anera: 13

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Provided free of charge if approved by Hamshary Hos-

UNRWA up to a predefined limit.

pital

Above this limit, there is a fixed per-

centage of self-payment.

Inpatient treatment by a heart Available

specialist (a cardiologist)

AUBMC

Outpatient treatment by a

Available

heart specialist (a cardiologist)

Provided free of charge if approved by Hamshary Hos-

UNRWA up to a predefined limit.

pital

Above this limit, there is a fixed per-

centage of self-payment.

First visit: 100

AUBMC

Follow-up visit: 70

Provided free of charge if approved by Hamshary Hos-

UNRWA up to a predefined limit.

pital

Above this limit, there is a fixed per-

centage of self-payment.

Inpatient treatment by a car-

diac surgeon

Available

AUBMC

28.50

AUBMC

Outpatient treatment and fol- Available

low-up by a cardiac surgeon

Available

Diagnostic imaging by means

of ECG (electro cardio gram;

cardiology)

Diagnostic imaging by means Available

of ultrasound of the heart

Maintenance and follow up of Available

pacemaker by a cardiologist

Available

Laboratory test blood: INR

e.g. in case of acenocoumarol

anticlotting

Available

Laboratory test: monitoring

full blood count: e.g. Hb, WBC

& platelets

AUBMC

Table 3: Cost of medicines

The following data about the availability of medicines was collected from three pharmacies in the period

from 10 to 14 October 2022.

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Cardiac complications and hypertension (including post operation care)

Name of medicine

(generic name)

Simvastatin

Atorvastatin

Clopidrogrel

Acetylsalicylic acid

Losartan

Bisoprolol

Enalapril

Doxazosin

Isosorbide mono-

nitrate

Amiodarone

Number of units in

the container

120

Price per

box in LBP

96,511

343,811

588,513

52,127

619,047

177,349

199,191

275,816

101,306

272,883

Availability

Available

Dosage

10 mg

40 mg

75 mg

81 mg

50 mg

5 mg

10 mg

4 mg

40 mg

200 mg

Form

Tablet

Pharmacy

All

Mazen

Pharmacy

Mazen

Pharmacy

Mazen

Pharmacy

Mazen

Pharmacy

Alexandre

Digoxin

Furosemide

Warfarin

Amlodipine

Spironolactone

Available

N/A

Available

0.25 mg Tablet

40 mg

5 mg

100 mg

Tablet

100

98,155

52,703

339,862

209,193

All

Diabetes type I and II

Insulin is low in supply across Lebanon and in all hospitals and pharmacies.

179

Whereas medicines for the

treatment of diabetes is difficult to access in pharmacies across Lebanon, UNRWA advised that at UNRWA

facilities, there is still a stock of diabetes medicines.

180

The PRCS/L Hamshary Hospital has a hemodialysis unit, which is used by 120 patients.

181

In October 2022,

this unit still had rapid-acting insulin in stock.

182

The programme is externally funded but funding is not se-

cured for the coming year. Hence, the continuation of the dialysis programme is at stake, and they might not

be able to take in new patients.

183

179

180

Anera: 14

UNRWA Lebanon Field Office: 15

181

Health Care Society,

Annual Report 2021,

n.d.,

url,

p. 5

182

A local humanitarian organisation: 26

183

A local NGO: 13-14, 16-17

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According to observations by health analysts, the spike in prices of life-saving insulin may result in acute

metabolic complications for patients; furthermore,

patie ts health is highl o p o ised

184

The following data about specialised treatment was collected in two hospitals in the period from 10 to 14

O to e

. I the olu

fa ilit

, it is described in which facility the service or medication was available

at the time of research. If available in all the mentioned facilities,

the te

all ill appea . I A e

at-

tached to this report, it is possible to see the name of the pharmacy that sells the product for the price

mentioned in the scheme. The price of the treatment is given on the same line as the facility where the

medicine is available. All prices are in USD or in LBP. It was not possible to obtain information about prices of

all medical treatments and diagnostics tests. The main reason for this is that the surveyed hospitals stated

that such information depended on an assessment of the individual case. In these cases there have been left

blank cells in the matrix.

Table 4: Cost of treatment

Diabetes type I and II

Availability Price

Treatment

Outpatient treatment and follow up by a general prac- Available

titioner

Facility

AUBMC

Hamshary Hospi-

tal

Inpatient treatment by a specialist in diabetes (an en-

docrinologist)

Outpatient treatment and follow-up by a specialist in

diabetes (an endocrinologist)

Laboratory test: blood glucose (incl: HbA1C/ glyc.Hb)

Available

AUBMC

Available

AUBMC

Provided free Hamshary Hospi-

of charge if

tal

approved by

UNRWA up to

a predefined

limit. Above

this limit,

there is a

fixed percent-

age of self-

payment.

184

Das, M.,

Lebanon: insulin out of reach after subsidies lifted,

7 February 2022,

url

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Table 5: Cost of medicines

The following data about the availability of medicines was collected from three pharmacies in the period

from 10 to 14 October 2022.

Diabetes type I and II

Name of medicine

Availability

(generic name)

Dosage

Form

Number of

units

in container

Price

per

box in

LBP

Pharmacy

Fast-acting insulin:

N/A

Insulin aspart, Insulin

glulisine, Insulin

lispro, Insulin human

Intermediate-acting

insulin: Insulin iso-

phane

Available,

but supply

problems in

general with

this product.

Novomix 30 Injection

(Insulin as-

part 30 %,

Insulin as-

part prota-

mine 70 %)

100 IU

Insulin

Injection

glargine

100 IU/ml

5 x 3 ml

483,499

Pharmacy

Alexandre

Long-acting insulin:

Insulin detemir, Insu-

lin glargine, Insulin

degludec

Metformin

Gliclazine

Available,

but supply

problems in

general with

these prod-

ucts.

Available

500 mg

Available

80 mg

5 x 3 ml

674,310

Pharmacy

Alexandre

Tablet

177,795

233,063

All

Table 6: Costs of devices

Devices for diabetes type I and Ii

Name of device

Availability

Blood glucose meter for self-use by pa- Available

tient

Blood glucose self-test strips for use by Available

patient

Insulin pump

N/A but can be bought from special

medical supply centres.

Pharmacy

All

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Mental health

This section describes the availability and prices of medicines and treatment for patients suffering from men-

tal health problems, psychotic disorders, PTSD, dementia and cognitive disorders.

According to UNFPA

s Le a o ou t offi e,

there are two major hospitals in Lebanon that offer psychiatric

services (in addition to other health facilities providing mental health care services).

185

Before the Beirut Port

explosion, there were three psychiatric hospitals and five psychiatric units placed in general hospitals. Two

of these units were destroyed in the Beirut Port explosion.

186

Two organisations stated that mental health problems are a challenge in PRL communities, and one of these

organisations emphasised that there is a lack of awareness about mental health in refugee communities.

187

WHO stated that mental health services used to be offered almost fully by private health sector in Lebanon.

Psychiatric services have not been a priority in the Lebanese health care system, which has prioritised somatic

diseases. Lebanon used to have 80 psychiatrists but many of them have left the country (partly in frustration

over the low priority given to psychiatry and mental health and the rapid decrease in income due to the

economic crisis).

188

People living with mental health problems are often victims of stigmatisation due to lack of awareness in

their communities.

189

The level of stigma, which is associated with mental health in Lebanon, has been de-

s i ed as high .

190

Some medical expertise to treat psychiatric diseases is available in Beirut at the AUMBC and at Psychiatric

Hospital of the Cross. PRCS does not offer mental health services; therefore, UNRWA refers mental health

patients to contracted Lebanese private hospitals.

191

The following data about specialised psychiatric treatment was collected in two hospitals in the period from

10 to 14

O to e

. I the olu

fa ilit

, it is described in which facility the service or medication was

available at the time of research. If available in all the mentioned facilities,

the te

all ill

appear. In Annex

3 attached to this report, it is possible to see the name of the pharmacy that sells the product for the price

mentioned in the scheme. The price of the treatment is given on the same line as the facility where the

medicine is available. All prices are in USD or in LBP. It was not possible to obtain information about prices of

all medical treatments and diagnostics tests. The main reason for this is that the surveyed hospitals stated

that such information depended on an assessment of the individual case. In these cases there have been left

blank cells in the matrix.

185

186

UNFPA Lebanon country office: 6

SFH,

Liban: accès à des soins psychiatriques

(Lebanon: Access to psychiatric treatment), 31 March 2022,

url,

p. 4;

Arafat Y., S. M.

et al.,

Psychiatry in Lebanon,

1 November 2020,

url

187

UNICEF Lebanon country office: 9-10; Anera: 15

188

WHO Lebanon: 15

189

UNICEF Lebanon country office: 9

190

Arafat Y., S. M. et al.,

Psychiatry in Lebanon,

1 November 2020,

url

191

A local humanitarian organisation: 30

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Table 7: Cost of treatment

Mental health (including psychotic disorders, PTSD, dementia and cognitive disorders)

Treatment

Outpatient treatment possibilities

by psychiatrist

Availability

Available

Price in USD

Adult: 175 (first con-

sultation)

120 (second consul-

tation)

Child: 220

Facility

AUBMC

Psychiatric Hospital of the

Cross

Inpatient treatment possibilities by Available

psychiatrist

AUBMC

Psychiatric Hospital of the

Cross

Inpatient treatment possibilities by Available

psychologist

AUBMC

Psychiatric Hospital of the

Cross

Outpatient treatment possibilities

by psychologist

Available

AUBMC

Psychiatric Hospital of the

Cross

Special housing (like protected

apartments) for chronic psychotic

patients with outpatient care

Assisted living / care at home by

psychiatric nurse

Inpatient treatment: physical re-

straint in case necessary

N/A

Available

AUBMC

Psychiatric Hospital of the

Cross

Psychiatric long term clinical treat- Available

ment (e.g. for chronic psychotic

patients) by a psychiatrist

AUBMC

Psychiatric Hospital of the

Cross

Psychiatric Hospital of the

Cross

Care for mentally handicapped:

day care

Available

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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Psychiatric treatment in the form

of ECT (Electro Convulsive Ther-

apy)

Care for combined mental and

physical handicapped: long-term

institutional around the clock care

Psychiatry: antipsychotic medica-

tion administration by injection

(depot)

Available

Psychiatric Hospital of the

Cross

Psychiatric Hospital of the

Cross

AUBMC

Psychiatric Hospital of the

Cross

Available

Table 8: Cost of medicines

The following data about the availability of medicines was collected from three pharmacies in the period

from 10 to 14 October 2022.

Mental health (alcohol and drug abuse, psychotic disorders, PTSD)

Name of medicine Availability

(generic name)

Chlordiazepoxide

Disulfiram

Methadone

Available

N/A

Dosage Form

Number of

units in the

container

Price per box in Pharmacy

LBP

53,638

Mazen Phar-

macy

2.5 mg

Tablet

Morphine

Available on 10 mg

request and

with special

prescription

from the

MoPH

N/A

Tablet

423,964

Mazen Phar-

macy

Saida DT Phar-

macy

Buprenorphine

and naloxone

Olanzapine

N/A

Available

10 mg

Tablet

779,150

All

Chlorpromazine

Haloperidol

Risperidone

Available

100 mg Tablet

5 mg

2 mg

Tablet

78,171

100,721

98,030

All

Pharmacy Alex-

andre

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Clozapine

Quetiapine

Available

100 mg Tablet

50 mg

Tablet

901,801

424,549

All

Mazen Phar-

macy

Pharmacy Alex-

andre

Venlafaxine

Sertraline

Available

75 mg

50 mg

Tablet

106,899

147,128

All

Mazen Phar-

macy

Pharmacy Alex-

andre

Citalopram

Mirtazapine

Available

15 mg

30 mg

Tablet

239,348

519,609

All

Mazen Phar-

macy

Pharmacy Alex-

andre

Diazepam

Lorazepam

Available

5 mg

1 mg

Tablet

91,409

78,758

All

Mazen Phar-

macy

Pharmacy Alex-

andre

Oxazepam

N/A

Pregabalin

Available

150 mg Tablet

320,586

All

Chronic obstructive lung disease

Medical expertise for the treatment of chronic obstructive lung disease is available at the AUMBC. It is not

available at PRCS hospitals.

192

Some medicines are available with UNRWA; however, nebulizers are neither

available nor provided at PRCS hospitals.

193

The follo i g data as olle ted i the pe iod f o

O to e

. I the olu

fa ilit

, it is de-

scribed in which facility the service or medication was available at the time of research. If available in all the

mentioned facilities,

the te

all ill appea . I A e

atta hed to this epo t, it is possi le to see the

192

193

A local humanitarian organisation: 29

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

name of the pharmacy that sells the product for the price mentioned in the scheme. The price of the treat-

ment is given on the same line as the facility where the medicine is available. All prices are in USD or in LBP.

It was not possible to obtain information about prices of all medical treatments and diagnostics tests. The

main reason for this is that the surveyed hospitals stated that such information depended on an assessment

of the individual case. In these cases there have been left blank cells in the matrix.

Table 9: Cost of treatment

Chronic obstructive lung disease

Treatment

Outpatient treatment by a lung specialist

(a pulmonologist)

Diagnostic test: lung function tests ( e.g.,

spirometry)

Diagnostic imaging: X-ray radiography

Availability

Available

Price

Facility

AUBMC

Table 10: Cost of medicines

The following data about the availability of medicines was collected from three pharmacies in the period

from 10 to 14 October 2022.

Chronic obstructive lung disease

Name of medicine

(generic name)

Availability

Dosage

Form

Number of units

in the container

Price per Pharmacy

box in LBP

Formoterol

Budesonide and for-

moteol

Available

12 mcg

1 mg / 2

Capsule,

inhalation

Inhalation

suspen-

sion for

nebuliser

20 x 2 ml

497,245

247,118

Mazen

Pharmacy

Mazen

Pharmacy

Fluticasone propio-

nate

Available,

but supply

problems in

general with

this product.

Available

2.5 mg /

2.5 ml

Inhalation

solution

20 x 2,5 ml

148,460

Saida DT

Pharmacy

Salbutamol

Mazen

Pharmacy

Fluticasone furoate,

umeclidinium

bromide, vilanterol

(Trelegy Ellipta)

N/A

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Fluticasone propio-

nate and salmeterol

xinafoate

Available,

but supply

problems in

general with

this product.

Available

18 mcg

Rota-caps

175,452

Saida DT

Pharmacy

Tiotropium bromide

monohydrate

Mazen

Pharmacy

Alexandre

Beclometasone, for-

moterol/glycopyrro-

nium (Trimbow)

Prednisolone

N/A

Available

20 mg

and 15

mg/5 ml

Tablet /

Syrup

20 / 100 ml

47,695 /

122,494

All

Table 11: Cost of devices

Devices for chronic obstructive lung disease

Name of device

Availability

CPAP machine

Not available at pharma-

cies, but can be bought

at special medical supply

centres. The pharmacy

can order it upon re-

quest.

Oxygen therapy

Available

with device and

nasal catheter

Oxygen therapy

with O2 pressure

tank for use at

home

N/A can be bought at

medical supply centres

Price

Pharmacy

Mazen Pharmacy

Dependent on the com-

pany / given upon re-

quest

Mazen Pharmacy

Other medicines

Below is an overview of the availability and price of a number of different medicines. The following data was

collected in the period from 10 to

O to e

. I the olu

fa ilit

, it is described in which facility

the service or medication was available at the time of research. If available in all the mentioned facilities, the

all ill appea . I A e atta hed to this epo t, it is possi le to see the a e of the pha a

that

sells the product for the price mentioned in the scheme. The price of the treatment is given on the same line

as the facility where the medicine is available. All prices are in USD or in LBP. It was not possible to obtain

information about prices of all medical treatments and diagnostics tests. The main reason for this is that the

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

LE B ANON

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

surveyed hospitals stated that such information depended on an assessment of the individual case. In these

cases there have been left blank cells in the matrix.

Painkillers / analgesics

Table 12: Cost of medicines

Analgesics

Name of medicine Availability

(generic name)

Dosage

Form

Number of

units in the

container

Price in LBP

Pharmacy

Paracetamol

Ibuprofen

Oxycodone

Sumatriptan

Available

500 mg

400 mg

5 mg

100 mg

Tablet

Capsule,

hard

Tablet

52,703

125,664

33,535

313,483

All

Mazen Phar-

macy

Mazen Phar-

macy

Antihistamines, sleeping pills, vitamins

Table 13: Cost of medicines

Antihistamines, sleeping pills, vitamins, etc.

Name of medicine

(generic name)

Cholecalciferol (D-vita-

min)

Magnesia

Availability

Dosage

Form

Number of

units in the

container

Price in

LBP

137,454

96,511

Pharmacy

Available

Promethazine

Sildenafil (erectile dys-

function)

Omeprazole

Cetirizine

Available

Vitamin D3

- 10,000 IU

Magne-

sium 100

mg, Pyri-

doxine 10

25 mg

100 mg

20 mg

10 mg

Unknown

Capsule

Tablet

All

Tablet

Capsule

Tablet

Unknown

28,708

682,792

105,955

79,135

211,000

All

Pharmacy

Alexandre

Tresiquens (female hor- Available

mone)

(but no de-

mand for

this medi-

cation, ac-

cording to

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

the pharma-

cist)

Tamsulosin (enlarged

prostate)

Allopurinol

Calcium

Available

0.4 mg

100 mg

Capsule

Tablet

122,953

35,507

93,978

All

Finasteride (enlarged

prostate)

Available

Vitamin D3 Tablet

–

500 IU,

Calcium

hydrogen

phosphate

600 mg

5 mg

Tablet

126,163

All

Services for persons with drug addiction

This section contains information about existing services for persons in need of maintenance therapy for

opioid addiction.

Drug use in Lebanon is criminalised with punishment for personal consumption ranging from three months

to three years of prison along with a fine.

194

People who use drugs are frequently punished and subject to

arbitrary arrest by the authorities.

195

Complaints from persons being arrested, however, are rarely reported

to the authorities as drug users have limited access to legal recourse.

196

The current law on drugs allows a

person who is arrested on the grounds of drug use as a first time offence to be referred to a drug addiction

treatment centre instead of being sentenced to prison. Drug users who are in prison cannot be enrolled in

any form of Opioid Agonist Treatment (OAT) programme with the exception of drug users who already have

a prescription for OAT, and on the condition they have a family member who is willing and able to pick up

the medicines at one of the designated pharmacies and bring it to the person in prison.

197

UNICEF

s Le a o

office stated that drug abuse is considered to constitute a major problem in the refugee camps, and it has

resulted in violence and crime. In the camps, persons involved in drug abuse are often considered criminals

and are likely to face problems at checkpoints when entering/leaving the refugee camps.

198

In 2011, OAT was officially legalised in Lebanon.

199

In Beirut, the team visited one clinic that offers harm

reduction services, including OAT (or Opioid Substitution Treatment (OST)), to persons with drug addiction.

Arab Weekly (The),

NGO seeking to decriminalise drug use in Lebanon,

July 2019,

url

SIDC: 1

196

USDOS,

2021 Country Report on Human Rights Practices: Lebanon,

April 2022,

url

197

SIDC: 1

198

UNICEF Lebanon Country Office: 12

199

Ghaddar, A. et al.,

Challenges in implementing opioid agonist therapy in Lebanon: a qualitative study from a user's perspective,

2018,

url;

SIDC: 1

195

194

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SIDC-Escale is a clinic operated by the non-profit NGO Society for Inclusion and Development in Communities

and Care for All (SIDC).

200

Established in 2010 as a drop-by centre, SIDC-Escale is recognised as a harm reduction centre in Lebanon and

receives persons in need of OAT referred to the centre by a judge for treatment as well as other persons in

need of OAT.

201

The ai ta get g oup of SIDC s se i es a e i je ti g d ug use s, people ith e tal health

problems, LGBT+ persons, HIV-positive persons and transgender persons.

202

The centre has not experienced

harassment by the authorities during its time of operations; by contrast, SIDC has felt the need to move

location three times due to pressure and reactions in the local environment.

203

SIDC-Escale offers the following services: opioid maintenance therapy, harm reduction kits, overdose man-

agement, mental health services through group therapy, prevention for substance abuse, and hepatitis B and

C treatment and management.

204

In Lebanon, methadone is not used as part of OAT; instead, buprenorphine

is prescribed for opioid maintenance therapy.

205

The staff at SIDC-Escale do prescriptions for OAT but the

beneficiaries will have to pick up the medicine at specific dispensaries under the MoPH. Two of these dispen-

saries are placed in the Beirut area, the Rafic Hariri University Hospital and the Governmental Hospital Dahr

el Bachek. The third one is the Elias Hrawi Governmental Hospital in the town of Zahlé.

206

In October 2022, about 200 persons were included as beneficiaries in SIDC-Es

ale s ha

edu tio p o-

gramme. Out of these, 135 were receiving OAT. At the time of data collection, 40 persons were on the waiting

list for admission to this programme.

207

The staff of SIDC-Escale includes a group of 25 persons composed of psychiatrists, psychotherapists, medical

doctors, nurses and social workers.

208

The admission procedures in the OAT programme and fees are as follows: any person can drop by the centre

but will then be requested to show up on a weekly basis for the first three months, preferably but not nec-

essarily with a family member for support, then bi-weekly.

209

The services of SIDC in general are free of charge

but the beneficiaries of the harm reduction programme receiving OAT must pay a small monthly fee in LBP

of the equivalent of two USD. Medicines for other existing mental health issues are paid out of pocket by the

beneficiary.

210

The government has so far covered 75 percent of the costs of medicines used in OAT. How-

ever, SIDC informed that this subsidisation is expected to end within a short period of time (in a maximum of

SIDC,

Harm Reduction Services,

2022,

url

SIDC: 2

202

SIDC: 21

203

SIDC: 3

204

SIDC,

Harm Reduction Services,

2022,

url,

SIDC: 4

205

Ghaddar, A. et al.,

Challenges in implementing opioid agonist therapy in Lebanon: a qualitative study from a user's perspective,

2018, p. 1,

url;

SIDC: 13

206

SIDC: 13, 19

207

SIDC: 12, 15

208

SIDC: 4, 9

209

SIDC: 10, 12

210

SIDC: 16, 18

201

200

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four months). Consequently, patients will have to pay in cash directly when collecting their medicines. SIDC

estimated that the cost of two weeks use of Buprenorphine was approximately 20 USD.

211

The services are open to all vulnerable groups in Lebanon regardless of nationality, including to Palestini-

ans.

212

Services for persons living with disabilities

Disabilities are a neglected issue in Lebanon in general, but certain groups are particularly neglected and

stigmatised. This include persons living with autism spectrum disorder,

213

women living with disabilities and

persons with profound and multiple disabilities.

214

The level of services for PRL living with disabilities

is des i ed as i suffi ie t .

215

There are centres that offer

interventions free of charge for children, such as speech therapy, educational support for children with learn-

ing difficulties, physiotherapy, occupational therapy and psychological support. Currently, the waiting list for

the services offered at these centres is long because of limited capacity and as such, these centres do not

meet the demand.

216

Some prosthetic devices are provided; however, the quantity is not sufficient to meet

the demand.

217

A local humanitarian organisation emphasised that transportation costs are a particular bar-

rier for patients and their families who were struggling with logistic concerns in their access to services.

218

Nursing homes and home-based care

The interviewed NGOs had little or no information about the existence of nursing homes and home-based

care.

219

One NGO emphasised that following social norms in Lebanon, elderly persons are most often cared for at

home by their relatives except for those without a social network.

220

For persons in need of home-based care,

there is a market of private companies that offer assistance at home. The individual or their families must

pay for such services.

221

According to one interviewed NGO, UNRWA used to have referral mechanisms to

specialised homes for elderly people where UNRWA would pay on their behalf; however, the NGO was un-

certain about whether this reimbursement mechanism continued.

222

One source mentioned the existence of private agencies that offer home-based care, but the team could not

verify this information by a further analysis of quality and prices.

223

211

212

SIDC: 17

SIDC: 21

213

UNICEF Lebanon Country Office: 11; Anera: 19

214

Anera: 19

215

An international NGO: 11

216

An international NGO: 11-12

217

An international NGO: 12

218

A local humanitarian organisation: 32

219

A local humanitarian organisation: 33; Anera: 17

220

Anera: 17

221

A local humanitarian organisation: 33

222

Anera: 17

223

A local humanitarian organisation: 33

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Annexes

Annex 1: Terms of Reference (ToR)

Medical Country of Origin information (MedCOI) about access to health care services for Pales-

tinian refugees registered with UNRWA in Lebanon (PRL)

Background

UNRWA s a date

Defi itio of UNRWA s a date i te s of health a e i ludi g the ele a t esolutio s

and midterm strategy

b. List of medication available to PRL in UNRWA and its medical partners

c. List of health care treatment available to PRL registered with UNRWA in Lebanon

d. List of health care institutions that are partnering with UNRWA, including requirements for

becoming a partner

Availability of medicines and treatment

Medication

Availability, including electrified storage facilities, of medicines for patients suffering from:

a. Cancer

b. Cardiac complications and hypertension

c. Diabetes (type I and II)

d. Mental health (including alcohol and drug abuse, psychotic disorders, PTSD, dementia and

cognitive disorders)

e. Chronic obstructive lung disease

3. The availability of these medicines in the governorate of Beirut (and if relevant in the governorates

of Saida and/or Tripoli)

a. The availability of generic medicines, which are either registered as legal in the country or

which are legally available through licensed pharmacies

b. Extent of interruption in supply of the above mentioned medicines

Treatment

4. Availability of relevant treatment for patients suffering from the above-mentioned diseases from

UNRWA, its medical partners or private health facilities, including non-governmental organisations

NGO s

5. Availability of clinics offering treatment against alcohol and/or drug addiction (including harm re-

duction programs)

Accessibility of medicines and treatment

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6. Accessibility of medicines and treatment for the above mentioned conditions in terms of:

a. Price of medicines mentioned in item 2 and the relevant treatments

b. Cost recovery mechanisms from UNRWA for PRL

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Annex 2: Consulted sources

Health system actors

10.

WHO

Anera

An international NGO

SIDC

UNFPA

UNICEF

UNRWA, Lebanon Field Office

A local humanitarian organisation

UNRWA, Department of Health

A local NGO

Health facilities

11.

12.

13.

14.

15.

16.

17.

American University of Beirut Medical Center (AUMBC), Beirut

Psychiatric Hospital of the Cross, Beirut

PRCS Hospital, Saida

Governmental Hospital Beirut

–

Karantina

Mazen Pharmacy, Beirut

Pharmacy Alexandre, Beirut

Pharmacy Z Saida DT Pharmacy, Saida

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WHO Lebanon

Interview with World Health Organization (WHO) Country Office Beirut, Lebanon

29 September 2022 (online)

Background

1. The interview confirmed that the Palestinian refugees have access to health services through pri-

mary health clinics (PHCs) and hospitals supported by UNRWA. Services not available in these

health facilities are accessible to Palestinian refugees, with financial coverage from UNRWA, within

the existing national health system. All other functions of health system such as surveillance, re-

sponse, and training are integrated within the existing national health system. UNRWA receives

support from five hospitals, which are operated by the Palestinian Red Crescent Society (PRCS),

known as PRCS/L hospitals and services.

2. Throughout the interview, it was emphasised that prices for medicines and treatment have in-

creased in all health facilities and at all levels of the health care pyramid in Lebanon. It was also em-

phasised that all patients regardless of nationality have access to all health care services given that

they could pay the required costs in cash US dollars or equivalent in Lebanese pounds (LBP) at the

black market rate, which is unaffordable for most population groups. Those people without access

to considerable amounts of US dollars in cash are not able to afford expensive forms of medical in-

terventions and brand drugs.

Availability of medicines and treatment

3. WHO supports the Lebanese Government in procuring medicines and medical supplies. The pro-

curement of medicines and medical supplies are carried out by WHO on the basis of the essential

medicines list. The EDL is distributed to around 257 PHC centers , and some 250 dispensaries across

the country. This effort is being hampered by the fact that for the past four years the Lebanese gov-

ernment has not contributed with funds to the procurement of medicines. Seeking to compensate

for the lack of national funding, WHO has allocated 25 million US dollars to the procurement of es-

sential medicines over the past year.

4. There are currently fewer brand medicines available in Lebanon. Patients, who may have been used

to one type of brand medicine, now have to resort to another type of generic medicines. These ge-

neric medicines contain the same molecules and cost one tenth of the price for the brand medi-

cine. However, patients may be left confused because they are used to taking a specific brand med-

icine, which is no longer on the Lebanese market.

5. Some medicines for chronic diseases are subject to interruptions of supply. These medicines in-

clude but are not limited to anti-cancer medicines. Regarding cancer medication, before the finan-

cial crisis the Lebanese government used to pay the costs for 50 percent of the population that has

no health insurance, and in need. This amounted to more than 4,000 cases per year supported by

the MoPH (around 40 percent of all cancer cases). These cases were fully subsidised by the govern-

ment, including brand medication, even the new forms of cancer immunotherapy, which are ex-

pensive and needed for five to six years. This is no more possible because the government lacks

funds to carry on with this level of reimbursement. The government now seeks to bring in generic

medicines to replace for the branded medicine, and to establish treatment protocols. Previously,

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there was limited use of protocols, and any MD prescribed medicines based on what they had

learned in their country of training. Regardless of these efforts by the government, there is cur-

rently an insufficient quantity of cancer medicines in Lebanon, and this deficiency affects the poor

parts of the population disproportionally. The richer parts of the population commissions someone

from the family to travel abroad, e.g. to Turkey, to purchase cancer medicines for them. 70 percent

of the population in Lebanon is currently below the poverty line.

6. Other catastrophic illnesses such as hemophilia, multiple sclerosis and Thalassemia (an inherited

blood disorder, which is particularly prevalent among children in the Palestinian community) are

also experiencing surfacing out of medicines after the financial crisis. Then patients and their fami-

lies have to pay for these medicines out the pocket.

Accessibility of medicines and treatment

7. For the Palestinian population group in Lebanon, UNRWA is supposed to pay for their anti-cancer

medicines on a needs basis. The availability of advanced therapy medication is likely to be nega-

tively affected by the current financial crisis.

8. All patients may access medicines and treatment given that they are able to pay in cash with US

dollars for medicines, treatment and other costs of hospitalisation, etc. See below for reduced ca-

pacity of hospitals to offer treatment.

You g Me s Ch istia Asso iatio

YMCA) Lebanon, a non-profit local organisation, which was

founded in 1890, runs the National Chronic medications program for the MOPH, which covers a

number of PHCs and Dispensaries (440) providing basic care, including for patients with chronic dis-

eases. YMCA list of medications is the MoPH Essential Drugs List (EDL) (list

of medicines offered at

YMCA dispensaries).

The distribution of medicines is targeting vulnerable population groups, and

eligibility criteria are based on an assessment of vulnerability: household income, socioeconomic

status, being elderly, have a special needs condition. Everybody who resides in Lebanon, regardless

of nationality, is eligible if the patients meet the criteria. The work of YMCA is also disturbed by the

u e t isis a d people s i a ilit to pa fo asi se i es. Patie ts ho ish to e efit f o

these services and access to medicines need to open a medical file and to produce some ID to open

such a file. This creates a challenge for persons that do not have papers/ID such as many Syrian ref-

ugees in the country.

10. There is currently no regulation of pricing at the private hospitals. Costs of services is based on the

current exchange rate of US dollars in the black market, which is extremely fluctuating. As an exam-

ple, the interlocutor said that the replacement of a valve (an implantable device) is estimated to

cost 19,000 US dollars but that a private hospital in Lebanon is likely to charge the patient 35,000

US dollars for the intervention.

Human resources for health

11. Lebanon is currently experiencing a severe exodus of medical staff, in particular of MDs and those

with the highest level of specialisation, including a high number of psychiatrists. The interlocutor

advised that this is likely to result in delayed appointments with specialist doctors. Before the crisis,

it was possible to see a specialist within 24 hours, now a patient may need to wait a few weeks be-

fore it is possible to be seen by a specialist. There is a particular lack of specialists in neurosurgery

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and only one pediatric interventional cardiologist in Lebanon (a specialist with training to do valve

replacement).

Capacity of the hospitals

12. The hospital sector is still in the process of recovering from the impact of the Covid-19 pandemic.

The public sector hospitals were unprepared for the influx of patients, and the private sector hospi-

tals were reluctant to receive these patients, as many of them were un-insured and the Govern-

ment was unable to cover the costs associated with these patients.

13. Most of Hospitals in Lebanon are now operating at a level of 50 percent of capacity. There is a risk

of hospitals moving towards operating at less than 50 percent of capacity in terms of beds, general

staff, medical doctors and caseload. People have limited possibilities to pay for services and there-

fore the demand is reduced. The government owes the hospitals around 800 million US dollars.

During the financial crisis more people from the middle class who used to prefer to go to private

hospitals have turned towards public hospitals (because of free or cheap services there), and this

influx of a new patient group has added a burden to the already stretched public hospitals.

14. Some private hospitals have closed after the financial crisis, particularly smaller hospitals and com-

munity clinics have suffered the most from the financial crisis.

Mental health

15. Mental health services used to be offered almost fully and only by the private sector. Mental health

has not been a priority in the Lebanese health care system, which has prioritised somatic diseases.

This is still the case and the sector is fully depending on external funding by donors. Lebanon used

to have 80 psychiatrists but many of them have left the country (partly in frustration about the low

level of priority given to psychiatry and mental health, and rapid decrease in income due to the

economic crisis).

16. One hospital, which is managed by catholic nuns (Hôpital

Psychiatrique de la Croix),

is still operat-

ing but this hospital is also receiving many patients from other Middle Eastern countries. The ser-

vices of this hospital, including in-hospital care, are costly. While the hospital receives partial sup-

port from the MOPH, it is currently experiencing financial strain.

17. The lack of priority given to mental health services is a severe problem given the amount of need;

the level of violence in the households is high, and that violence may drive people into depression

and anxiety.

18. WHO has supported the development and testing of

a self-help psychological intervention that can

be delivered through the internet for Lebanese and displaced adults with depression in Lebanon.

The tool has been found to have a positive effect but as it is highly dependent on the

use s a ess

to the internet.

Harm reduction programmes

19. There are still functional harm reduction programmes in Lebanon but they are not fully covering

the need. There is a lack of opioid substitution therapy (OST). There used to be 2.000 persons en-

rolled in harm reduction programmes but for the past two years that has not been the case due to

lack of funding by the government. A new programme depends on whether any actor will bid on

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the financing of a programme, and so far this is unclear whether the government will be willing to

step in.

20. The need for harm reduction programmes is high and growing because of high levels of abuse of

drugs, including of painkillers, which can be bought over the counter everywhere.

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Anera

Online meeting 07 September 2022, visit 13 October 2022

Anera is a non-governmental organisation, which has operated in Lebanon, Jordan, the West Bank and Gaza

since 1968 with the purpose of helping refugees. The organisation mobilises resources for immediate hu-

manitarian relief and for sustainable health, education, and economic development efforts. Within the field

of health, A era fo uses o pro isio of edi i es a d edi al supplies. A era’s edi al do atio progra

is supported by a number of international medical donation partners such as Americares, Catholic Medical

Missions Board and Direct Relief.

224

A era’s ork related to health

care services

O e of A e a s

most important programmes is a medical donation programme through which med-

icines and medical supplies are provided to health facilities and organisations across Lebanon.

Anera offers assistance to all people in need, noting that PRL are a prioritised marginalised target

group in Lebanon. Based on needs assesments, Anera provides health facilities with medicines for

chronic diseases and for acute diseases as well as medical supplies. The distribution of medicines

and medical supplies to health facilities is based on a needs assessment undertaken at the health

facilities.

2. Some of the partners receiving medicines and medical supplies from Anera are PRCS, as well as the

local organisation

Beit atfal al sumud

and other NGOs and dispensaries. Due to the ongoing eco-

nomic and resource crisis, Anera has recently provided some of these health facilities with solar en-

ergy panels to enable consistent access to energy.

Health care services for Palestinian refugees

3. Anera confirmed that UNRWA is the main provider of medical health care services for Palestinian

refugees from Lebanon (PRL), particularly for primary care free of charge. Anera emphasised that

access to tertiary health care services constitutes the biggest challenge for PRL. For patients in need

of specialised medical treatment, the patient has the option of going to a Palestinian Red Crescent

Society (PRCS) hospital, which are free of charge for the patient, or a more specialised hospital,

which is not free of charge for the patient. The patient can either choose to seek treatment from an

UNRWA contracted hospital, where UNRWA reimburses a certain percentage or choose a public or

private hospital with full self-payment. Public hospitals are less costly than private hospitals.

4. Anera explained, that UNRWA conducts an assessment of the specific case and If the assessment of

the individual case leads to a positive conclusion, UNRWA will cover expenditures up to a maximum

of 60 percent for a pre-decided number of days in the case of hospitalisation (depending on availa-

bility of funds), in cases where tertiary care is needed. As UNRWA does not have unlimited

amounts of funds, the agency gives priority to so-

alled spe ial ha dship ases a o di g to A e a.

5. When patients are in need of medical treatment, which exceeds their own means of payments, pa-

tients and their families turn to so-

alled shoppi g fo ethods of pa e ts . A e a e plai ed that

this is a long and tiresome way of running back and forth between different organisations or the

Palestinian embassy, trying to present their case in the best possible way, hoping to piece together

small amount of about 500 USD in order to piece together the full payment. Certain groups within

224

Anera,

Who we are,

n.d.,

url

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the Palestinian community may be in an advantaged situation, e.g. those with an affiliation to the

PLO who may benefit from PLO assurance. Anera underlined that everybody in Lebanon may try to

negotiate a favorable price from the hospital management, except for the American University in

Beirut Medical Center. Anera stated that the Hôtel-Dieu Hospital has a social fund for vulnerable

patient groups. Anera also emphasised that this pathway required detailed knowledge of the health

care system and connection to gatekeepers.

6. Anera mentioned that UNRWA is continuously facing financial shortages. As such, UNRWA has to

prioritise which medicines to invest in with the highest public health benefit for vulnerable popula-

tion groups. UNRWA continues to prioritise coverage of hospitalisation expenditures, to the extent

funds allow.

Medicine supplies

7. Whilst Anera manages to meet some medical needs, the organisation is not able to satisfy all

needs, noting that the absence of government and the inability of duty holders to fulfil their role is

a much bigger challenge and more than what Anera can cover. Anera is experiencing supply prob-

lems an interruption in stock due to lack of donations and difficulties in of getting medicines into

country.

8. Arena has an agreement with the Ministry of Public Health (MoPH), which states that Arena can

use the warehouse of the Government, run at hospital

Rafiq Hariri,

to store the medicines. From

this warehouse, Anera disburses medicines and medical supplies to the different facilities that the

organisation assists.

9. Anera explained that many of the medicines used to be subsidised. The cost of medicines was regu-

lated and subsidised by the government. However, due to the ongoing crisis, this is no longer the

case, as the official currency of the Lebanese pound has been devaluated. Anera stated that what

you pay as a consumer is not the real cost and with a bankrupt government, there is no subsidy.

10. For treatment of thalassemia, Anera has managed to obtain small quantities as well as for other

acute conditions, but again these donations do not cover the actual needs. Anera pointed to the

fact that even if funds are available, not all medicines are available at pharmacies.

11. According to Anera, UNRWA has the required cold-chain infrastructure as well as the registration

system to administer critical medicines.

Cancer treatment and medicines

12. Anera informed that anti-cancer medicines are scarce or unavailable for the general population.

This is one area where the organisation is finding it hard to provide sufficient medicine to all the

needed patients in Lebanon who are estimated to be in the vicinity of 30,000 patients across Leba-

non. PRL and PRS with cancer are estimated to be

patie ts a o di g to UNRWA s Di e to

Health. Anera has managed to obtain smaller quantities of anti-cancer medicines after much lobby-

ing; however, it is not enough for every patient in need. Anti-cancer medicines are one of the medi-

cines, which pharmaceutical companies do not often donate as these medicines are in high demand

and are very expensive. In some cases, donations have been made if the date of expiration of the

medicament is coming to end - and even then the donations were not given in large quantities to

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cover the needs of all cancer patients in Lebanon. The donations that Anera has obtained and chan-

neled through Karentina, which is the main public hub for dispersing medicines and are tracked

through medical software. Within the Palestinian community, Anera has collected the needs of

medicines of the 533 patients with quantities needed and is in the process of lobbying with its do-

nors to get these medicines and administer them through UNRWA.

Cardio-vascular diseases including hypertension

13. Anera has provided large amounts of medicines for cardio vascular diseases to PRCS hospitals and

to UNRWA as a matter of priority. Anera was not aware of any sharp shortages of medicines against

Cardio-vascular diseases including hypertension.

Diabetes

14. Insulin is a critical medicine, which is in low supply in Lebanon in all pharmacies and hospitals.

Anera explained that some patients have been used to buy brand medicine and are reluctant to

begin on new generic, locally available medicines through some donations.

Mental health and psychiatric care

15. Anera supports the

Psychiatric Hospital of the Cross (Jal El Dib)/Hôpital psychiatrique de la Croix

with medicines and medical supplies (e.g. needles, syringes, diapers). Its services are available to

anyone who can afford the costs, including PRL. UNRWA does not contract psychiatric hospitals.

The interlocutor underlined that PRL are particularly prone to experience mental health problems

at some point of their life because of their difficult living situation.

16. Anera confirmed that to a large extent it is possible to buy medicines, which previously required a

prescription, over the counter at certain pharmacies. In the years before the crisis, when there was

less chaos in Lebanon, pharmacies complied with the fact that certain psychiatric medicines re-

quired a prescription from a specialist but in the current environment people may buy prescription

medicines over the counter. As a matter of principles, Anera does not provide donations of psychi-

atric medicines to health facilities without assurance that a psychiatrist will administer this medi-

cine.

Care for the elderly

17. As is often the case in the Middle East, elderly are generally taken care of by relatives with the ex-

ception of cases where a person is too sick or has no relatives. In such cases, UNRWA used to have

referral mechanisms to elderly specialised homes where UNRWA would pay on their behalf; how-

ever, Anera is not sure if this continues to be the case.

Drug addictions clinics

18. There are no drug addiction clinics inside the refugee camps nor any clinic specifically for PRL. How-

ever, such clinics do exist Lebanon but Anera advised that the topic of accessibility should be stud-

ied clinic by clinic as this is where the cost relationship applies.

Persons with disabilities: access to assistance and support

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19. The representative of Anera stated that persons with disabilities are stigmatised in Lebanon; this is

particularly the case for women with disabilities, and children and persons with profound and mul-

tiple disabilities.

20. While people with disabilities are still being met with stigma in society, the main challenge is acces-

sibility on all account (physical, legal, environmental, etc.). In the camps acute disabilities are a ma-

jor problem where the person with acute disability must rely on the mother/the caregiver. This

constitutes a burden on the physical and emotional wellbeing of the mother/the caregiver.

21. UNRWA has developed policies to address the issue of stigmatisation of persons with disabilities

but these policies are not fully translated into action and are not given any earmarked budget to

sustain these policies. UNRWA s disability programme is limited in outreach and resources.

22. PRL with disabilities are mostly provided with assistance and support through non-governmental

organisations (NGOs) or community based organisations (CBOs) inside the refugee camps. Most

services lie on the shoulders of the local actors that try to coordinate within their own network

The

Palestinian disability forum.

ANERA caters its assistance through this network.

The Lebanese insurance scheme

23. Anera explained that there is an increase in persons obtaining private insurances and that anyone

who has the financial means to buy an insurance can do so, including Palestinians. Anera stated

that i su a es pu hased ith f esh dolla s offe ette o e age tha o e paid fo i Le a ese

Pounds.

24. Anera opined that the Lebanese diaspora is the primary reason that the country is still standing, as

this is the primary way for people in Lebanon to obtain larger quantities of cash.

Persons without a network outside of the country face increased financial difficulties.

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An international NGO

2 September 2022 (online), 10 October 2022 (in Beirut) and 18 November 2022 (online)

General situation in Lebanon and the situation for Palestinian refugees

1. The INGO initiated the meeting by presenting an overview of the current dire situation of Lebanon,

including the lack of electricity, fuel and access to internet. Lebanon is presently facing a financial

and economic crisis; the Lebanese lira has lost its value and banks have been unable to return

money to the depositors. Many families have been pushed into poverty. Because of high transpor-

tation costs, some families are unable to bring their children to the health facilities. As a conse-

quence of the financial crisis, hospitals in Lebanon have been facing many challenges and a number

of private hospitals has closed. Moreover, the high number of refugees (including Syrian and Pales-

tinian refugees) inside Lebanon is an added burden. In addition, many health care professionals has

fled the country.

2. Palestinian refugees from Lebanon (PRL) are a particularly vulnerable population group, as they are

deprived of the right to work in many professions; they often work in seasonal agriculture, con-

structions jobs and as informal workers. Those who have formal employment are obliged to pay the

required fees to the national social security fund (NSSF) (covering national protection for sickness,

maternity for employees from any sector) but are unable to benefit from this fund.

3. Even before the current crisis PRL were challenged in obtaining and affording specialised health

care services. With the ongoing crisis, the poverty rate has more than doubled, and PRL are af-

fected harder, already being more vulnerable than the Lebanese population generally.

4. Because of the financial hardship, the INGO explained that transportation costs have become a bar-

rier to reaching health care for many PRL and in some cases the lack of financial resources has pre-

vented patients from accessing needed medical treatment.

5. The INGO also noted that food prices have increased, which is likely to have long-term negative ef-

fects on the overall nutritional state of health.

6. Furthermore, the INGO emphasised that around 210,000 of Palestinian refugees, an estimate ac-

cording to UNRWA, live in overcrowded refugee camps across Lebanon.

Health care services for Palestinian refugees

7. The INGO confirmed that UNRWA is the main provider of health care services to Palestinian refu-

gees from Lebanon. UNRWA provides primary health care services free of charge to Palestinians

refugees inside and outside of refugee camps. Through its contracts with private, governmental,

and Palestine Red Crescent (PRCS) hospitals, UNRWA also facilitates a certain amount of secondary

and tertiary health care services to this group of patients. UNRWA does not fully cover all fees for

required medicines and treatments but will cover a certain percentage of the fees; the patient then

may seek for financial support from other organisations or relatives. The INGO bridges some gaps in

the services of UNRWA.

8. There is a high demand on UNRWA's services, which causes the high number of consultations per

day and the short consultation time. The number of doctors to patients is low and a medical doctor

may have consultations with up to 100 patients per day. An average consultation will therefore last

approximately 3-5 minutes. The patient history is taken in details and entered into an electronic

medical file.

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Mental health and psychosocial support

9. Mental health care needs are not sufficiently covered by UNRWA; there are no specific medicines

available through UNRWA. In order to bridge this gap, this INGO has received funding by UNICEF

and has been implementing a Mental Health and Psychosocial support project in partnership with

other local NGOs to implement related activities across Lebanon

s a ps.

The activities are offered

at a four-level intervention pyramid, ranging from structured play groups for children with staff

trained to detect some sign and symptoms of mental health problems to consultations with psychi-

atrists for a very limited number of children. The activities focus on children, but there are also of-

fered to parents and survivors of gender-based violence; services are accessible for all regardless of

nationality and if living inside or outside of refugee camps. However, the location of the community

centers where the services are offered is inside the camps, which means that the children attending

the centers are mainly the camps residents. The purpose is to improve wellbeing and resilience in

the population.

10. Through local partners, psychosocial support services are available across Lebanon. The services

are provided inside the refugee camps with an emphasis on prevention and resilience building ra-

ther than treatment of individual cases.

Disability

11. There are not sufficient interventions for people with disabilities because of insufficient funding.

The INGO supports three disability partners who have centers (one in South Lebanon, one in Beirut,

and two in northern Lebanon). The interventions target children and the services offered include

speech therapy, special education for children with disabilities (e.g. educational support for chil-

dren with learning difficulties), physiotherapy, occupational therapy, and psychological support.

There is currently a long waiting list for the services offered at these centers. The projects also work

to improve community awareness about disability issues, inclusion of people with disabilities, and

the rights of people of with disabilities.

12. The disability centers have limited capacity and do not meet the demand. Also, finding specialists to

work in the centers is a challenge. Some prosthetic devices are provided; however, the quantity is

not sufficient to meet the demand.

Drug addiction clinics

13.

The INGO includes awareness raising of the dangers of using drugs in its activities but do not refer

to any specialised treatment facilities.

Pri ate hospitals outside of UNRWA’s referral path a

14. For use of private hospitals outside of the UNRWA contracted hospitals, the INGO stated that PRL

currently residing in Lebanon are unlikely to have the funds to cover these expenditures. In cases

where a PRL can afford treatment at a private hospital, it will be at their own expenses. It is possi-

ble for a PRL to seek care at a private hospital on the condition that a deposit is paid in advance

(depending on the estimated cost of in-patient care and surgery costs).

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15. Access to money in cash is a crucial aspect of being able to access medical care in Lebanon accord-

ing to the interviewed INGO. Any patient needs to show proof of ability to pay prior to any inter-

vention such as surgery. This aspect is particularly challenging at the time of the interview. In terms

of access to own funds the INGO explained that the banks are currently closed and even before the

closure, there were strict limitations as to how much money each person could withdraw from

their personal bank account. The INGO referred to an incident of a Lebanese woman, who wished

to access her funds in the bank to pay for her sisters cancer treatment and who was denied payout

by the bank. She then threatened the bank to get access to her own funds enabling her to pay for

he siste s t eat e t.

The INGO further noted that there is an increase in robberies and kidnap-

pings for ransom as a means for people to obtain cash.

16. A person who have sufficient funds to pay in advance will be able to obtain treatment. Hospitals

have become selective and take in patients that are able to afford the interventions. The prices are

extremely high and hospitals will not provide services until funds are available or a deposit has

been provided.

17. The private hospitals are experiencing difficulties in the current financial situation. There is a short-

age in health care staff, including doctors, specialists and nurses, as many leave Lebanon if they

can. The INGO further stated that to their knowledge, essential hospital are struggling with short-

ages in fuel (hence electricity) and water needed for their operations. Some hospitals had to tem-

porarily close some units such as the kidney dialysis unit due to these shortages.

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SIDC

20 September 2022 (online) and 11 October 2022 (in Beirut)

Society for Inclusion and Development in Communities and Care for All (SIDC) is a non-governmental organi-

sation founded in 1987 and has its headquarters in Beirut. SIDC is a nonprofit civil society organisation,

which offers a multitude of services to vulnerable populations

to pro ote their health a d ell ei g per-

taining to HIV, Harm reduction, SRHR, and mental health, to support them in enjoying their human and gen-

der rights, and to work towards an inclusive society free of stigma and discrimination at the national and

regio al le el.

225

SIDC Lebanon is funded by a number of international donors including The Global Fund to

Fight AIDS, Tuberculosis and Malaria, UNICEF, Expertise France, UNFPA, and GIZ among other donors.

Background

1. SIDC confirmed that Opioid Agonist Treatment (OAT) in Lebanon was legalised in 2011. Drug use in

Lebanon is criminalised and according to SIDC the punishment of people who use drugs is frequent.

The current law on drugs allows a person who is arrested on the grounds of drug use as a first time

offence to be referred to a drug addiction treatment center instead of being sentenced to prison.

Drug users who are in prison cannot be enrolled in any form of OAT programme. The only exception

may be drug users who already have a prescription for OAT and a family member who can pick-up

the medicines at one of the designated pharmacies and bring it to the person in prison.

2. SIDC is recognised as a harm reduction center in Lebanon and receives persons who are in need of

OAT referred to the center by a judge for treatment as well as other persons who are in need of OAT.

3. SIDC staff have not experienced any harassment by the authorities in connection with their work

with drug users. However, that treatment center has moved location three times due to pressure

from neighbours and others living in the specific area.

4. In 2010, the organisation established a drop-in center called SIDC-Escale. SIDC-Escale has three

main programmes: a drop-in harm reduction programme, an outreach programme and a legal aid

programme. These programmes focus on a broad spectrum of services including drug addiction,

harm reduction services, overdose management, mental health services, prevention for substance

abuse and Hepatitis B & C. The center has a broad variety of staff; including psychiatrist, medical

doctors, social workers and nurses.

5. According to SIDC, the organisation has the required capacity to respond to the current volume of

users: OAT can be offered free of charge as long as the current level of donor financing is maintained.

6. SIDC added that the health care sector in Lebanon is currently suffering from important shortages of

medicines.

Drop-in harm reduction programme

7. The beneficiaries at SIDC-Escale are people who use drugs (particularly injecting drug users), people

in OAT, and people who are suffering from mental health disorders. Finally, the partners and/or

relatives of the beneficiary are also included in the approach, to the extend possible. It is thus not a

requirement but rather a strong added value to have a family member involved

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SIDC,

Who is SIDC Lebanon,

2022,

url

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8. The center offers 12 sessions of psychiatric counseling per person, and critical cases are referred to

other centers. The sessions can be conducted online or in person.

9. A multidisciplinary approach is adapted for the different interventions, and the beneficiaries are

met by a cross-disciplinary team, including psychiatrists, psychologists, a doctor specialised in infec-

tious diseases, social workers, psychotherapists and counsellors as well as a registered nurse. The

center has a total of 25 staff.

10. The multidisciplinary harm reduction approach is adjusted to the need of the beneficiary. The ap-

proach can be a combination of individual- and/or group therapy with the different professionals

from the team (psychiatrists, psychologist, social worker, etc.). The frequency of the consultations

is based on the need of the beneficiary. At SIDC-Escale, the staff strongly recommended to involve

family and relatives, if possible, for support. However

–

beneficiaries are also welcome without sup-

porting family members/relatives. It is also possible to receive treatment for other mental health

comorbidities at SIDC-Escale.

11. The program is 3-months but is often extended, and the beneficiaries can be enrolled in the pro-

gram as long as desired. The staff informs that there are beneficiaries enrolled in the program for

years.

12. Currently 200 persons are benefitting from all the drop-in harm reduction programme including the

OAT and harm reduction kits and services. A person entering the programme will be requested to

come to the SIDC-Escale center on a weekly basis for the first three months. Hereafter visits to the

center take place biweekly.

13. Prescription for OAT

is taking place at SIDC-Escale but the center does not have the medication in

house. Instead, the beneficiaries will have to go to specific dispensaries under the Ministry of Public

Health in Lebanon. According to the interlocutors, these dispensaries are the only ones that hand

out the medication used in OAT (Opiates Agonist Treatment opioids-alike medicines). Generally,

methadone is not used as a part of OAT in Lebanon. At SIDC-Escale, Buprenorphine is mainly used.

However, according to the staff at Escale, it is a general problem that the supply of medicines used

for OAT is unstable. Consequently, patients are frequently converted from one opioid-alike medi-

cine to another and noted that this was problematic for patients, as each medication impacts the

patients differently and each patient has to readjust dosage and effect of the medicine when new

medication is introduced, due to unavailability.

14. Based on the responsible party for dispensing OAT in Lebanon, SIDC predicts that Buprenorphine

will be available at the dispensaries for another four to five months.

15. Currently, 135 patients are enrolled in the drop-in harm reduction program receiving OAT at SIDC

(40 additional are on the waiting list for their admission).

Price of treatment and medicines and availability

16. Beneficiaries who are enrolled in the harm reduction program are required to pay a small monthly

participation fee in LBP (approximately 2 USD).

17. The government has so far covered 75 % of the cost of medicines used in OAT. However, SIDC in-

formed that the subsidisation will end within a short period of time in a maximum of four months.

Consequently, patients will have to pay cash directly when they are collecting their medicines. SIDC

estimates that the cost of two weeks use of Buprenorphine is approximately 20 USD. As for the

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SIDC Escale center, SIDC requests that the patients pay one time a month for all the services of-

fered at the center.

18. Medicines for other existing mental health issues are paid out of pocket by the beneficiary. SIDC

emphasised that it is a general challenge that prices go up and down for medicine (as is also the

case for other commodities in Lebanon at the moment). SIDC is witnessing shortages in mental

health medicines in Lebanon and in case they exist, they are expensive for the beneficiaries. There-

fore, the patients are at risk of abusing other medications.

19. Prescriptions are renewed on a bi-weekly basis for persons in treatment at the center and the med-

icine is only available from three specific government health centers/hospitals. Two of them are

placed in the Beirut area (Rafic Hariri University Hospital) and Mont Lebanon (Governmental Hospi-

tal Dahr el Bachek) and the third one in the Beqaa valley in the town of Zahlé Elias Hrawi Govern-

mental Hospital.

Access to SIDC-Escale and inclusion criteria

20. Beneficiaries can show up and ask for assistance without prior appointment. They will be met by a

social worker, and possibly also by a health professional. A plan for the treatment will be made, and

if relevant, prescription for medicine is taking place. The patient will be enrolled under discretion

–

if desired

–

and referred to as a number (and not full name).

21. SIDC targets vulnerable population groups (drug users, LGBT+ persons, HIV-positive persons,

transgender individuals and transgender couples) regardless of nationality. Palestinian refugees

from Lebanon can use the services. The peer educators in the field also reached out to people who

use drugs. They distribute harm reduction kits and encourage them to test for HIV/HCV/ HBV and

to take other tests in the mobile unit and also to come visit the harm reduction center (Escale) The

interlocutors state that it is not allowed to use drugs inside the center and no dealing of drugs near

the center.

Mental health services

22. SIDC also offers mental health services for other vulnerable groups (as mentioned above) who do

not use drugs. SIDC has begun a special activity targeting parents and caregivers of drug users to

help them cope.

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SIDC,

Mental health support,

2022,

url

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UNFPA Lebanon country office

9 September 2022 (online)

Background

1. UNFPA is carrying out a vast programme in Lebanon in which the agency supports the Government

in (i) enhancing access to sexual and reproductive health (SRH) services

227

and (ii) in addressing

Gender-Based Violence (GBV) needs.

228

2. The SRH services, which UNFPA supports include a reproductive health (RH) service package at the

primary care level, family planning counselling, development of SRH service delivery guidelines, ca-

pacity development on SRH to health workers and provision of commodities (contraceptives, PEP

kits, RH drugs, etc.) and interventions at the policy /advocacy levels. UNFPA is involved in the pro-

curement of contraceptives that are distributed to more than 300 health facilities in Lebanon in-

cluding to dispensaries located in remote difficult to access areas. UNFPA has funded the recruit-

ment of a number of midwives to strengthen SRH services including maternal care in primary

health care clinics across the country. UNFPA is also supporting the clinical management of rape

(CMR) in Lebanon including for the development of the national strategy on CMR, capcity develop-

ment of care providers on CMR, provision of post exposure prophylactic kits to the CMR facilities,

etc. In addition UNFPA is adopting an integrated SRH/GBV approach in its programs to ensure ad-

dressing health and protection needs of women and girls including their physical and psychosocial

wellbeing.

Health care situation in general in Lebanon

3. UNFPA is involved in the humanitarian response to the on-going financial and economic crisis in

Lebanon; according to UNFPA 3.2 million people are estimated to be in need of humanitarian assis-

tance (as of 2021). This crisis has led to increased level of GBV with an increased need for psychoso-

cial, medical and legal support to women and girls including for health care services, psychosocial

support, provision of cash voucher assistance to promote access to care, case management for sur-

vivors of gender based violence etc.

229

One effect of the crisis in Lebanon is food insecurity, which

negatively affects the health of pregnant women and lactating mothers. UNFPA in collaboration

with MOPH is supporting development of national guidelines on nutrition for Pregnant lactating

women to be followed by capacity development for targeted heath care providers.

4. With regards to the health workforce, migration of health care providers from different disciplines

have been noted for several reasons including insecurity, financial crisis/ drop in wages, etc; fur-

thermore a number of health care providers are not attending to their duty stations because of

difficulties in paying for transport to get to their work. Latest figures on the number of health

workers who have left their work in Lebanon are



40 % of medical doctors



20 % of nurses



8-10 % of midwives

227

228

UNFPA Lebanon, Sexual and Reproductive Health, 2022,

url

UNFPA Lebanon, Gender Equality and Gender-Based Violence, 2022,

url

229

UNFPA Lebanon, Humanitarian Response, 2022,

url

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Procurement of medicines and medical supplies

5. The main MoPH warehouse has been destroyed by the Beirut port explosion hence medicines and

medical supplies were relocated to two or three different locations designated by MOPH with at-

tention to cold chain management. WHO and UNICEF have helped reconstruction of the MOPH

main warehouse and are providing support for its functionality

Mental health services

6. There are two major hospitals in Lebanon, which offer psychiatric services in addition to other

health facilities providing mental health care services. As per the health sector/ National mental

health program, at the time of the interview there were shortage of medicines for patient with psy-

chiatric diseases. Efforts are being conducted to solve this problem.

Harm reduction services

7. There are not many clinics in Lebanon, which offer treatment against drug addiction; there is a few

clinics offering treatment against drug addiction and harm reduction services in Beirut.

Cancer

8. Cancer patients are particularly exposed to shortage of cancer medicines. There is very limited

availability of anti-cancer medicines, including chemotherapy (at the time of the interview). Efforts

are being conducted by the MOPH to solve this problem.

Main challenges

9. The health care sector in Lebanon is facing the below main challenges:



Reduced access to and availability of health care services due to the economic crisis. There is a

shortage of medicines and medical supplies; and patients and their families are increasingly un-

able to pay the costs for those medicines that may be available.



Increased transportation barriers: The lack of fuel and the economic and financial crisis have

made it difficult for patients, their families as well as for health worker to pay for transport to

health facilities.

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UNICEF Lebanon Country Office

19 September 2022 (online)

The health care system in Lebanon

1. The international organisation emphasised that overall the health care system in Lebanon is in a

state of collapse. Due to the economic situations in Lebanon followed by COVID-19, a lot of health

care services shut down in the country and many health staff left the country looking for better

working opportunities. One effect of the crisis is the fact that primary health care and child vaccina-

tion programmes are suffering; noting that one out of 10 children is missing out on their vaccina-

tion schedule. The interviewees stated that the current situation in the health care sector was not

yet alarming (at the time of the interview) but with the current hyperinflation they found that it

could deteriorate rapidly. At the time of writing, it was still possible to provide basics/primary

health care. There is a risk of widespread child malnutrition in Lebanon. In addition, the financial

situation is a great challenge now for everybody in Lebanon.

2. WHO procures medication for Lebanon based on the Essential Medicines List. These medicines are

delivered to primary health care facilities across the country; the international organisation men-

tioned that there are approximately 150 primary health care clinics in Lebanon. UNICEF procures

vaccines and supports public and UNRWA health facilities.

3. The health care system suffers from insufficient access to electricity. The consequence is that cor-

rect storage of medicines is difficult. Even though there is an increasing focus on installing solar

panels at primary health care facilities, hospitals and dispensaries, this is a long and costly process.

Health care services for Palestinian refugees

4. The international organisation emphasised that the health care situation is particularly difficult for

the Palestinian population in Lebanon (both PRS and PRL). There are five Palestinian Red Crescent

Society (PRCS) hospitals serving the Palestinian population in affordable cost and these hospitals

have a limited capacity in spite of their efforts to expand. There is not enough capacity to meet the

demands at the PRCS hospitals, and some specialised services are not provided. The PRCS hospitals

are contracted by UNRWA and thus UNRWA covers the majority of the costs for the patients.

5. According to the interviewed international organisation, PRL and PRS tend to prefer private hospi-

tals over PRCS hospitals due to a perceived better quality of services at private hospitals. UNRWA

also has contracts with a number of public and private hospitals but the costs are likely to be high

and the patient still needs to pay a part of the costs.

6. All persons with legal stay in Lebanon can access medication and treatment regardless of national-

ity, if they are able to pay the costs themselves at private hospitals.

UNRWA’s role a d ser i es

7. The interview confirmed that UNRWA is the main provider of health care services to PRL and PRS.

However, a group of Palestinians (Non-IDs) have limited access to hospitalisation due to lack of le-

gal status. Other organisations strive to fill the gaps where UNRWA is unable to meet the needs.

8. The international organisation

fou d that u e tl UNRWA s a ilit to offe esse tial health a e

services is compromised by the fact that the agency has to finance these services using project

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funds

athe tha fi a i g these a ti ities f o UNRWA s Ge e al Fu d.

The critical financial situa-

tion of UNRWA is particularly challenging with regards to the provision of secondary and tertiary

care, as UNRWA does not provide these services and the referral system through the contacted

hospitals lacks financial coverage, particularly for complicated cases such as cancer.

Mental health

9. The international organisation confirmed that mental health is a challenge in the PRL and PRS com-

munities. There is a lack of awareness about mental health issues within the refugee communities

and people suffering from mental health problems or with mental disabilities are often victims of

stigmatisation or may be viewed as crazy.

10. There is a generalised lack of psychiatric care available in the refugee camps in spite of the fact that

the mental health situation is alarming. Médicins Sans Frontièrs (MSF) has had some programs but

there is a considerable gap between the availability of services and the need. Some of UNICEF part-

ners including MAP and ARCPA provide mental health services through their sub-partners

Disability

11. Disabilities are neglected in general and autism in particular.

Drug addiction and harm reduction programmes

12. Drug abuse is a major problem in the refugee camps, and it has created violence and crime. In the

camps, persons involved in drug abuse are often considered criminals and are likely to face prob-

lems at checkpoints entering/leaving the camps.

13. Treatment for drug abuse is available to persons who have the required funds to fully cover the

costs of participating in these programmes themselves. UNICEF NGO partners are working at pre-

vention level- access to rehabilitation centres and specialised services is not covered by UNICEF at

this stage. It will be inculded in the 2023 budget (pending avialability of funding).

14. The international organisation referred to the existence of platform of NGOs in Saida offering treat-

ment against drug addiction for only those who have the freedom to leave the camps.

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UNRWA Lebanon Field Office

12 September 2022 (online) and in Saida 12 October 2022

Background

1. In the past Lebanon was known as a leading provider of medical services in the Middle East; how-

ever, the various crisis have resulted in a swift deterioration of this status and in a loss of a high

number of specialised health workers, in particular medical doctors, who have left the country.

2. UNRWA is also affected by the general crisis and thus challenged in recruiting and keeping qualified

medical staff of whom all are Palestinian refugees from Lebanon (PRL).

3. UNRWA emphasised the fact that current problems with insufficient amount of petroleum, electric-

ity and solar panels have led to reduced availability of medicines. Albeit that there is some petro-

leum for generators for basic operations, there is an important lack of electricity to maintain stor-

age facilities function, for keeping vaccination program running and to continue the computerised

work of health care services (health information systems, eHealth, etc.). As of now, it is impossible

to forecast when the energy crisis will be solved, as it is closely connected to the financial crisis.

Procurement

4. Medicines are not produced in Lebanon at large scale, and UNRWA procures its medicine from its

HQ in Amman where the medicine is distributed to its five different fields of operations including

Lebanon. Transportation, especially of large quantities of goods, can be challenging particularly in

light of the recent crisis in the port of Beirut as well as the cost of shipment in Beirut due to the fi-

nancial crisis. Whilst there can be delays in deliveries of medicine, UNRWA has not yet encountered

inability to procure needed medicines.

UNRWA’s referral path a

and coverage of secondary and tertiary care

5. UNRWA primarily offers basic and life-saving Primary Health Care (PHC) services to PRL through its

network of primary health care facilities in the country. From the primary health clinics located in

and outside of camps (27 of which two teams serve on a rotational schedule for small clinics in the

gatherings as mobile health centers/health points), UNRWA refers patients in need of secondary

and tertiary care to a contracted hospital to provide the needed services. In emergencies, patients

can approach contracted hospital directly. At a PRCS hospital, costs are fully covered for the pa-

tient. At private hospitals, the patient has to pay a certain percentage of the costs out-of-pocket.

6. At private contracted hospitals, UNRWA covers 90 % of the cost for secondary medical treatment,

which include the most common diseases such as operations like hernia, caesarian section delivery,

etc. For tertiary care at a private contracted hospitals, UNRWA covers 60 %. This covers treatments

such as neuro surgical operations and other complicated operations. For cancer treatment, UNRWA

covers 50 % of the cost of medicines needed for the patient up to a ceiling of 8,000 USD then 25 %

up to 12,000 USD, in addition to any surgical intervention needed under the hospitalisation policy

and partially to the chemotherapy sessions where the patients need to balance the gap of costs

out- of-pocket. This is in most cases financially impossible as and here these patients have already

depleted their limited resources.

7. In total, 54 hospitals are contracted with UNRWA of which five are governmental. The tendering of

contracts is renewed annually. However, generally, the same hospitals are contracted but prices for

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services are renegotiated. PRCS hospitals are among the contracted hospitals. UNRWA worked with

PRCS on a quality improving program since 2010. The quality of service at PRCS has improved in 3

out of its five hospitals. The two hospitals in Rashidieh and Burj Barajneh have the limitation of geo-

graphical location preventing quality improvements in structure in addition to availing funds ac-

cordingly. In addition, PRCS are mainly secondary level; therefore, some specialised services are not

available there. UNRWA noted that in Saida area alone, 45 % of patients in need for hospitalisation

prefer a PRCS hospital, whereas the remaining 55 % choose another contracted hospital, despite

having to pay for parts of the admission out of their own pockets. In the remaining areas, where

PRCS manage four hospitals, 20 % of PRL in need of hospitalisation choose PRCS hospitals.

8. In addressing a hospitalisation case of a PRL, UNRWA follows the rules laid out in its internal hospi-

talisation policy. The policy also lays out the financial coverage plans. Tertiary level admissions

have a coverage ceiling up to 5,000 USD for 12 days if the bill crosses the ceiling then the case is

eligible to the assistance of the Medical hardship program in an additional percentage starting from

10 % and not exceeding another 5000 USD. If a PRL chooses a hospital outside of an UNRWA con-

tracted hospital because the service is only available at a non-contracted hospital, UNRWA may re-

imburse 30 % of the admission cost.

9. UNRWA informed that PRL can appl

fo o e age f o UNRWA s Medical

Hardship Fund. These

cases are mostly tertiary care and have the same ceiling of 5,000 USD.

Availability and cost of medicine

10. UNRWA experiences a generalised and massive lack of anti-cancer medicines. There is a shortage of

critical medicines and some patients and their families may rely on medicines bought at the black

market with all the problems of counterfeit medicines of poor quality, high prices and lack of con-

trol of expiration dates that may entail. Contracted service providers are also finding it challenging

to procure these medicines.

11. Due to the financial crisis in Lebanon, commodities, including medicines, have increased in price

and is now more than ten times as expensive. This increase

has i pli atio s fo UNRWA s a ilit to

cover the cost of medicines and reimbursements, which has led to UNRWA covering only 30 %,

leaving the patient with a larger out of pocket payment.

12. Persons unable to cover their share of medical costs can apply for financial help from UNRWA

(maximum of 4,000 USD). However, some operations are so costly that the price exceeds the sup-

port that UNRWA can cover. In such instances, a person can seek financial assistance from NGOs

but without any guarantee of obtaining it.

13. As part of its reform efforts of PHC, UNRWA has introduced the Family Health Team (FHT) model of

service provision. The FHT approach is centered on the individual patient but also on the family. A

team is made up of core team of one doctor, one nurse and support members of a pharmacist, CHC

(community health center) nurse midwife, cleaner and a clerk. Each team manages approximately

the same number of 1500

–

2000 family cases. This approach has improved patient flow in the clinic

and equalised the workload among staff.

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14. The Family Health Team (FHT) teams offer services from maternal and child health to family plan-

ning, preventive and curative care, outpatient and diagnostic services, oral care, specialists, phar-

macies and referrals.

230

15. At UNRWA health clinics, UNRWA doctors offer consultations and they examine and prescribe re-

quired medicines to their patients. Medicines for basic health problems are available at the health

center

s o pha a

and given to patients free of charge. The vast majority of UNRWA health

centers have a pharmacy-storage in the facility staffed by a pharmacist and/or other relevant medi-

cal personnel. Medication for diabetes is also available in UNRWA health centers

–

also in the cur-

rent environment where insulin is very difficult to find in pharmacies across Lebanon. Furthermore,

UNRWA provides medicines for hypertension, which is also given to patients at UNRWA health cen-

ters. One of the biggest challenge for PRL in Lebanon is obtaining cancer treatment as this is very

expensive and even the medicine is frequently unavailable.

230

UNRWA,

What we do,

url

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A local humanitarian organisation

5 September (online) 11 October (in Beirut), 12 October (in Saida)

Overall financial situation in Lebanon

1. The local humanitarian organisation explained that the political and financial situation in Lebanon

has been particularly difficult over the last three to four years and in particularly since October

2022 where banks have been closed down, thus hindering people in accessing their cash. People

who had money in the bank, started withdrawing their deposits about three years ago. For this rea-

son, there is still a decent cash flow in the country and people with financial surplus can sustain a

living. In addition, relatives living outside of Lebanon send money to their relatives in Lebanon. This

is still possible through exchange agencies, but not through banks. As such, the most vulnerable

group are people without preexisting funds or without a social network outside the country. A ma-

jority of Palestinians are considered as part of this vulnerable group.

People who had money in the banks before the bank crisis can only access an amount of 100-200

USD a month. When withdrawn the official exchange rate applies limiting the purchasing power by

up to 90 %. Many people have lost their lifesavings and pensions due to the banking crisis.

General situation for Palestinian refugees from Lebanon

3. The local humanitarian organisation explained that Palestinian refugees from Lebanon (PRL) can be

divided into different groups, namely:



PRL registered with UNRWA and DPRA (Directorate General of Palestinian Refugee Affairs)



PRL who fled to Lebanon as consequence of the 1967 war and who are categorised

as o

-ID

and who are neither registered with UNRWA or DPRA



PRS (Palestinians from Syria)

4. Approximately half of the PRL population in Lebanon live in one of the 12 official camps or in gath-

erings of which there are eight in total. The local humanitarian organisation stated that generally,

PRL are deprived of their humanitarian and civil rights due to the lack of inclusion policies within

the Lebanese Government. For example, PRL do not have the right to own property and they are

prevented from employment in at least 39 professions (such as medicine, law, engineering, etc.).

5. The level of poverty among Palestinian refugees from Lebanon is approximately 90 % and unem-

ployment rates are 80 %.

Health services for PRL

6. Health care services are offered at three levels:



Primary health care provided by UNRWA at UNRWA clinics located in and outside of camps.

UNRWA clinics can refer patients to a hospital for other treatments if their needs cannot be

met at this level;



Secondary health care services at UNRWA contracted hospitals. These include private hos-

pitals and PRCS hospitals;



Tertiary health care provided partly by PRCS (e.g. kidney dialysis and some orthopedic ser-

vices) but mainly by private hospitals.

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7. The local humanitarian organisation informed that PRCS has been contracted with UNRWA since

1999 and is currently operating five hospitals across the country. These hospitals are located in and

around Palestinian camps and gatherings. Services at PRCS hospitals are free of charge.

8. In 2015, UNRWA decided to let patients choose whether they preferred to seek treatment at a

PRCS hospital or at a private hospital contracted with UNRWA where there is a percentage of self-

payment. UNRWA covers 90 % for secondary care and 60 % for tertiary care with a ceiling that dif-

fers depending on the treatment.

According to the local humanitarian organisation the five PRCS hospitals are:

1) Safad Hospital in central Beirut Area

2) Haifa hospital in southern suburb of Beirut

3) Nasraa Hospital in Mar Elias, Wetern Beirut

4) Hamshary Hospital in Saida, South Lebanon

5) Tal Satar Hospital in Rashidyea, South Lebanon

9. In addition to providing secondary and some tertiary services, PRCS offers some services to victims

of domestic violence and car accidents, which UNRWA does not cover.

10. The current number of staff at PRCS hospitals are 650 medical doctors, nurses, midwives, etc. com-

bined. The Palestinian Authority covers the salaries of 555 staff while PRCS funds the remaining sal-

aries.

11.

The local humanitarian organisation stated that PRCS

has experienced a significant brain drain and

it is increasingly difficult to get qualified staff for the hospitals. In Lebanon in general 40 % of nurses

and 30 % of doctors have left the country over the last couple of years

12. Asked about whether the currently capacity at PRCS hospitals meets the need, the local humanitar-

ian organisation informed that while

the hospitals are generally able to deal the patient flow the

increased number of people seeking treatment, the potential decrease in funding from partners

and the turnover of staff makes the situation precarious. Incidents like the current cholera out-

break, a resurgence of Covid-19 or any other incidents leading to increased need for hospital treat-

ment could quickly overwhelm already stretched PRCS hospitals. While PRCS has commitments

from donors to support hospital operations in 2023 these remain soft pledges which do not always

materialise.

13. The local humanitarian organisation stated that due to funding insecurities, it is currently unclear if

all five hospitals will continue to deliver services and there is a risk that in the near future, two hos-

pitals will not be able to operate due to financial shortages.

14. Due to the financial situation in Lebanon, where the official US dollar is pegged to the Lebanese

pound (LBP), UNRWA covers 30 % of the invoice by so-called fresh dollars , meaning that the

amount is transferred without a local/Lebanese intermediary bank first or that the amount is paid

in cash. The remaining 70 % are covered in Lebanese pounds at government rate. This results in a

gap between the UNRWA payment and the official billing cost. PRCS is left to cover this gap. For

example, prior to the crisis a c-section would cost 600,000 LBP, equaling around 400 USD at the

time. Now, UNRWA pays 30 % of this cost in USD and the remaining 70 % in LBP at the old official

rate of 1,500 LBP, resulting in a huge gap.

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15.

The local humanitarian organisation explained that there is a

deficit caused by the way UNRWA re-

imburses PRCS, which is causing a precarious situation for PRCS as there is a constant need for

fundraising from other sources to cover the gap - which is not easy to fundraise for. The limited

funds for social cases including Non-IDs mean that a significant number of people are not able to

get the treatment they need. The category in Palestinian refugees who are non-ID (Palestinian ref-

ugees who fled from West Bank and Gaza after war of 1967) those have not registration card of

UNRWA, those are benefit from only primary health services at UNRWA clinic but they cannot ben-

efit from inpatient hospitalisation.

16.

According to the local humanitarian organisation UNRWA payments to PRCS hospital Hamshary in

Saida is approximately 32,000 USD, which is the average patient admission cost. The local humani-

tarian organisation informed that fuel alone costs 37,000 USD, thus running costs alone are not

covered.

17.

The local humanitarian organisation underlined that without financial support and in kind dona-

tions in form of medicines and equipment from its partners (mainly Red Cross Societies), it would

not be possible for PRCS to function.

18. The local humanitarian organisation noted that PRCS are currently able to operate all five of its hos-

pitals, but that there is some uncertainty around the long term prospects of keeping them all run-

ning, due to potential financial shortfall.

19.

In certain cases where the patient cannot afford the outstanding cost, this can be covered through

funds provided by other humanitarian organisations if the case falls under so-called social cases

(e.g. PRS or non-IDs). Thus, this does not apply to all PRL.

20. Medicine costs while hospitalised are covered by PRCS but after discharge, the patient has to pay.

PRL who work for the Palestinian Liberation Organization (PLO) (in a civil or military capacity) will

have their costs covered by the national Palestinian Health Security Fund.

21. The local humanitarian organisation explained that the government used to subsidies medicine, but

that this was recently put to an end. It was also noted that for the last two years, the government

has not reimbursed suppliers and hospitals the subsidies they were entitled to.

22. While medicines are paid for during admission many people are unable to pay for the medicines

after being discharged resulting in negative coping mechanisms. This is especially true following the

governments removal of subsidies for medicines, which have seen prices increase up to 1000 % for

some medicines. As a coping mechanism some try to extend the periods they are admitted to hos-

pital, to limit the costs of medicines sometimes resulting in violence and treats towards PRCS medi-

cal staff.

The step-by-step procedure for admission to PRCS hospitals

23. The local humanitarian organisation explained that there are two pathways to admission at a PRCS

hospital:

- A patient can go directly to a PRCS hospital, and PRCS will contact an UNRWA Health Clinic (HC)

that will visit the patient, assess the case and conduct the administrative work around the admis-

sion. This is most often in cases of emergency admissions.

- Most commonly, the patient will be referred by UNRWA HC to the PRCS hospital closest to the pa-

tie t s ho e. Ho e e , i so e ases, pe sons

will be referred to Hamshary hospital in Saida, as

this hospital offers the broadest coverage of medical services.

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For admission, the person has to present their UNRWA registration card as well as a national ID card.

24. The local humanitarian organisation was asked about information relating to the following five top-

ics.

Diabetes

25. As part of its non-communicable diseases component of primary health care services, UNRWA pro-

vides diabetes medicines at UNRWA clinics.

26. In case of more advanced treatment or hospitalisation, the local humanitarian organisation stated

that PRCS hospitals usually have rapid-acting insulin available, though it is one of the medicines

that is low in availability on the market.

Cancer

27.

According to the local humanitarian organisation, PRCS does not offer cancer treatment at its hos-

pitals and informed that anti-cancer treatment is the biggest challenge in terms of access to medi-

cine and specialised treatment. The treatment is very costly and despite UNRWA covering around

40-50 % of the costs, the part, which the patient must pay, is high due to the expensive medicines.

UNRWA covers 40 % of chemotherapy, which costs between 300-1000 USD per treatment. UNRWA

operates with a ceiling system that limits the coverage though patients can apply for support

th ough UNRWA s Medi al Ha dship Fu d.

It should be noted that the requirements to qualify for

the UNRWA hardship fund are generally difficult to fulfill.

Cardiac diseases and hypertension

28. UNRWA only provides preventive care. Treatment is provided by PRCS hospitals, which is fully cov-

ered by UNRWA. Medi

i e fo h pe te sio is i luded i UNRWA s o e age. B a d edi i es a e

not covered. For most patients these medicines are expensive and unaffordable.

Chronic obstructive lung disease

29. The medical equipment for such treatment is not available at PRCS hospitals. Some medicines are

available with UNRWA, however, nebulizers are neither available nor provided.

Mental health care

30. PRCS does not offer mental health care services; the existing mental health care services are con-

sidered to be of poor quality. Therefore, UNRWA refers mental health patients to contracted Leba-

nese private hospitals. PRCS elaborated that mental health issues are considered a taboo, which

often prevents people from seeking treatment.

31. PRCS is offering limited services to victims of domestic violence. Without UNRWA support, PRCS is

only able to reach a fraction of the people needing these services. Supporting victims of domestic

violence is complicated intervention and without significant support from donors PRCS is not able

to support, just as very few other options are available for this group.

Disabilities

32. PRCS manages two physiotherapy centers: one in the North and one in Hamshary hospital in Saida.

Both centers offer services for children and adults. The centers have some wheelchairs for persons

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with mobility problems. The centers can cover the current need of patients; however, the main

challenge for the patients remains to cover transportation costs, particularly in light of the current

financial crisis

as ell as the e te s a ilit to full eet de a ds fo e uip e t i te s of sup-

portive devices.

Community based outreach activities and nursing care

33. There are community based health centers that provide first aid and psychosocial support. Nursing

care in the homes of people who need assistance but who are not hospitalised exist but must be

paid for individually by the patient and their families.

Existence of drug addictions clinics

34. PRCS does not provide treatment against drug addiction at its hospitals. Drug addiction is an im-

portant problem in Palestinian refugee camps. The drugs used include harder drugs as well as med-

icines bought over the counter such as cough syrup.

PRCS Hamshary Hospital in Saida

35. The local humanitarian organisation informed that Hamshary hospital is the central hospital for

PRCS in Lebanon. The hospital thus receives referrals from other PRCS hospitals for specialised

treatment that is not available other PRCS hospitals. The hospital is located in the city of Saida in

the south of Lebanon. It is in close proximity to the Ein el Helweh refugee camp, which hosts the

largest PRL population of the 12 camps in the country.

36. The hospital has 125 beds and the capacity meets the current needs. PRCS however, noted that

there is an influx in patients choosing PRCS services, due the cost increase at other hospitals be-

cause of the financial situation in the country. PRCS explained, that while the services is free of

charge for the patient (with the possibility of minor charges in some admissions), UNRWA covers

approximately 75

% of the ad issio osts fo patie ts that fulfil UNRWA s ite ia as ell as

of medicine. The daily admission cost is 1,400,000 LBP, which used to be 90 USD. However, due to

the financial situation, this price now equates to only five USD. Due to this, UNRWA now has

agreed to pay 30 % of the price in fresh USD (cash), though still leaving a bigger gap for PRCS to

cover. The price for ICU per night is 200,000 LBP and deliveries are 250,000 LBP.

Medical Services

37. According to the local humanitarian organisation The PRCS hospital in Saida offers the following

specialties: cardiology, orthopedic surgery, eye surgery, obstetrics & gynecology, emergency medi-

cine, internal medicine, gastroenterology, pediatrics. The hospital does not offer psychiatric treat-

ment, cardio vascular surgery, hematology and chest surgery.

Hemodialysis

38. Hemodialysis is neither provided nor covered by UNRWA and PRCS is the main provider of this ser-

vice to PRL free of charge. PRCS informed that more than 100 patients suffering from chronic kid-

ney failure are receiving treatment at the hospital. The hospital provides more than 1,200 sessions

a month and patients need 2-3 sessions a week. The service is fully reliant on an external donor.

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Medicine and equipment availability at the central PRCS warehouse

39. The local humanitarian organisation informed that the Hamshary hospital currently does not have

shortage in medicine stocks, however, the other four PRCS hospitals do not have the same amount

of stock available as they used to and now only have stock available for one month at a time. This is

both due to the increase in prices as well as less availability on the market. As an example, in 2019

a box of Ventolin would cost 20,000 LBP, which now costs 520,000 LBP. The local humanitarian or-

ganisation noted that currently many injectables and antibiotics are not available.

40. The local humanitarian organisation explained that the Ministry of Public Health (MoPH) has estab-

lished rules and regulations regarding storage of medicines and medical supplies, and that the ad-

herence to these rules are monitored through unannounced visits by the Ministry. All medicines

received at the warehouse is registered electronically and registers are kept of distribution of medi-

cines and only released upon request by authorised personnel. The MoPH conducts unannounced

monitoring visits. For certain prescription medicines, these

ill e egiste ed i a offi ial g

een

ooklet , a d i spe tio s a e do e the health autho ities ithout p io a ou e e t, he e

the booklet will be checked against the available stock. Morphine was only used in very rare cases

and in such cases to staff have to sign off on this and the packaging has to be kept and showed to

the MoH during their inspection.

41. The local humanitarian organisation explained that some newer types of medications are not listed

in the WHO generic medicines list. PRCS procures these medicines on the basis of the MoPH ge-

neric medicines list. Around 20 % of medicines are produced locally, and the use of locally pro-

duced medicines has increased slightly, though many patients still prefer the brand medication.

With regards to medical supplies, there is no shortages. These are available at the market. PRCS

does the tendering for medical supplies for all five hospitals from Hamshary hospital. PRCS stated

that some suppliers demand cash payment in USD.

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UNRWA, Department of Health

10 August 2022 (online)

Access to health care services for Palestine refugees in Lebanon

1. UNRWA stated that the general health care sector in Lebanon largely relies on private providers.

Lebanese citizens may recur to health insurance to cover their health expenses; however, there is

no health insurance or Lebanese government funding for Palestine refugees in Lebanon (PRL). The

only option is health care provision or financial support through UNRWA or through

NGO s.

2. Because of the current economic crisis in Lebanon, there is an increasing shortage of medical doc-

tors particularly impacting the hospital sector, including specialised medical doctors as many spe-

cialists have left the country. These shortages have resulted in difficulties in seeking medical consul-

tations and the quality of the consultations might be affected. There is also an increasing shortage

of medicines in Lebanon due to the economic crisis.

UNRWA’s a ti ities a d assista e

3. UNRWA

Health Programme (HP) in Lebanon provides primary health care (PHC) through its 25

health clinics, and assists Palestine refugees to access secondary and tertiary health care services

(hospital health care) through UNRWA contracted public and private hospitals in Beirut, Saida in

the south and Tripoli in the north. UNRWA runs its own primary health centers while secondary and

tertiary services that are not available in the PHCs are provided by partners contracted by

UNRWA.

231

4. The primary health care provided through UNRWA clinics is offered free of charge. Such PHC in-

cludes care for mothers and children, for diabetes and hypertension, and for other common condi-

tions. As said above, UNRWA runs 25 clinics.

5. When patients need secondary or tertiary care (or hospitalised care), UNRWA

suppo t patie ts a -

cess to hospitals by covering health care services expenditures for PRL through contracted health

hospitals at a differential percentage: 90 percent of fees at secondary health care services and 60 %

percent of tertiary health care services.

6. About the medicines at UNRWA clinics, UNRWA purchases and prescribes them based on the WHO

List of Esse tial Medi i e

(EML). In general, there is a good and regular supply in medicines. How-

ever, there were some difficulties through Covid-19 (due to increasing prices).

7. About the medicines at contracted hospitals, UNRWA recognises that there are increasing shortage

of medicines at private hospitals or private pharmacies due to economic crisis. There are medicine

stock-outs and lack of supplies at the market in Lebanon. This shortage sometimes affects

UNRWA s PHC e ause so e

are treated at the private hospitals with more advanced medicines

than

those that a e i luded i UNRWA s

stock (and on the EML), and because of economic crisis

and shortage of medicines, such patients

ofte o e to UNRWA s li i to seek o ti uit of thei

treatment. In those cases, UNRWA recommends replacing the medication with a similar medicine

that has the same active ingredients from EML to make sure that the patient can obtain the needed

treatment. This is, however, not always possible.

231

UNRWA Department of Health, 2022,

Annual Report 2021,

url

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8. Complicated care such as medicines for cancer treatment and hemodialysis is also provided

through UNRWA referral, however, only as much as the budget allows.

UNWRA’s apa it

9. Asked about which effects the financial shortages have had on medical services, UNRWA answered

that so far, UNRWA has not cut in basic health care service delivery. However, one effect of the fi-

nancial instability is that UNRWA is unable to fully cover the health care needs of the targeted pop-

ulation. Provision of medicines on the EML remains a priority.

10. Currently, UNRWA has contract with more than 30 hospitals. UNRWA are contracting the same fa-

cilities, but the price for services goes up these years. Every year there is a discussion on prices tak-

ing place.

11. With the increasing demand in hospitalisation caseloads across all five fields of UNRWA operations

–

in terms of severity, frequency and numbers

–

it is anticipated that hospitalization demand will

continue to outstrip supply capacities. UNRWA will engage in complementary activities with part-

ners as a tool to enhance response and maximise opportunities to increase resource mobilization

through association.

232

12. If UNRWA funding does not suffice, there is a risk secondary and tertiary health care services will

need adjustment in terms of outreach or that it cannot be provided at all.

13. In November 2022, UNRWA issued an Emergency Appeal for Lebanon Highlighting amongst other

issues the growing shortage of medication and the fact that families are often unable to afford

them since government subsidies on pricing were lifted. Too many Palestine refugee families are no

longer able to afford secondary health care. Some are skipping lifesaving treatment to avoid accu-

mulating debts. The appeal also addresses the increasing poverty among Palestine refugees in Leb-

anon.

233

UNRWA mandate

14. UNRWA has an overall mandate to support and protect Palestine Refugees, and engage in human

development and to act in specific activities include (but is not limited to) health, education, relief

and social services.

15.

As p ese ted o UNRWA s e site a d i the Mediu Te St ateg fo

-2022 for decades

the UNRWA Health programme has been delivering comprehensive primary health care (PHC) ser-

vices, both preventive and curative, to Palestine refugees, and helping them access secondary and

tertiary health care services.

234

16. As such, comprehensive primary health care falls under UNRWA s core mandate, whereas UNRWA

will help its beneficiaries obtain access to secondary and tertiary care through its hospitalisation

programme with a focus on those with life-threatening illnesses requiring life-saving/ life-support-

ing medical care and treatment, but who lack the financial assets or insurance coverage to attain

these.

235

232

233

UNRWA,

Medium Term Strategy 2016-2021,

url

UNRWA, Hitting Rock Bottom- Palestine Refugees in Lebanon risk their lives in search of dignity,

url

234

UNRWA, What we do,

url

235

UNRWA,

Medium Term Strategy 2013-2021,

url

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A local NGO

14 October 2022 in Beirut

Overall health care situation in Lebanon

1. According to the local NGO, the situation in Lebanon is changing rapidly in negative terms for the

country as a whole but particularly for refugees. This is also reflected in terms of health care. To

give an idea of the dire situation of the country, the local NGO noted that the Lebanese Govern-

ment has just declared a cholera outbreak. The cost of a proper response to this outbreak alone is

estimated at 50 million USD.

2. The hyperinflation is the root cause of all the current challenges, including brain drain of doctors,

unavailability of and access to medicines, etc.

3. The local NGO explained that physicians are not being reimbursed for consultations and interven-

tions they have performed, as insurance companies have reduced their reimbursements and also

the hospitals are charging the patients paying out-of-pocket less (in US dollars). If you see a doctor

at AUB or at private clinic, the initial cost would have been 100 USD, which is now the equivalent of

40 USD. This is causing doctors to either leave or to stop their medical practice.

4. In addition, the fact that medications are no longer subsidised by the government has made the

price of medicine even more unaffordable for patients. Medicine suppliers are also not getting re-

imbursed and thus do not want to sell at the set prices, as this is not financially feasible. Suppliers

are demanding to be reimbursed in US dollars or not sell medicine at all.

5. The issue of electricity shortages also impacts the health care system, including pharmacies and

warehouses storing medicines. The country as a whole more or less runs solely on generators

–that

run on fuel, which is not only very expensive but also hard to obtain at times.

6. Palestinians often have to seek cash from relatives, other local organisations or the Palestinian em-

bassy to obtain sufficient cash to pay for health care services and medicines.

7. Generally, if a person has the money s/he will get the needed treatment.

Service provisions

8. The local NGO underlined, that its funding situation is currently very unsecure and that at the time

of the interview it is uncertain if most interventions will continue in the new year (2023).

9. The local NGO provides health security to Palestinian refugees from Lebanon by covering parts of

the cost of secondary and tertiary health services. Both local and international humanitarian agen-

cies offer primary health care services to refugees in Lebanon free of charge, however, large gaps in

the coverage of secondary and tertiary care services remain.

10. Initially the local NGO focused its work around access to dialysis for Palestinians with kidney failure.

This treatment was and is still not covered by UNRWA though the disease is chronic and the treat-

ment is lifesaving. The Lebanese government also does not cover this service for PRL.

11. Over the years, the local NGO has expanded its focus to include financial coverage for other tertiary

health care services (not preventive) such as surgeries and hospitalisation. Since PRL do not have

access to the National Social Security Fund (NSSF) and there are a wide range of advanced medical

care that UNRWA cannot cover fully, the local NGO bridges the financial gap up to a certain ceiling.

Treatment of kidney failure

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12. The local NGO started funding the dialysis center in Saida, Hamshary hospital 25 years ago. It

opened a second dialysis center in the North of the country, inside Bedawi camp in another PRCS

hospital in 2016.

13. Due to the uncertain funding situation, the dialysis programme may not be able to take in new pa-

tients and the continuity of the programme is also uncertain.

14. PRCS is the implementing partner of the dialysis programme. The local NGO provides funding for

the consumables; all the materials that is needed to run the dialysis sessions as well as partial funds

for staffing.

15. Currently, 145 patients are enrolled in the dialysis programme.

16. The local NGO informed that it is running out of funding, after having run the dialysis programme

for 25 years. The programme is therefore currently at stake as funding is not secured for the com-

ing year. The programme costs 45,000 USD monthly.

17. According to the local NGO PRCS is overall providing proper care for patients but with the limited

funding, services obviously do not meet the standard of some private hospitals.

Inherited blood disorders

18. Another disease that the local NGO provides coverage for that is not covered by UNRWA, is inher-

ited blood disorders (such as thalassemia and sickle cell disease). These diseases require a high

level of follow up and medications that are difficult to find at the market, more so at the time be-

ing. In addition, the medication has always been very expensive.

19. In practice, the local NGO refers these cases to AUB Medical Center (AUBMC). The local NGO covers

the payment for doctor visits, blood tests, vaccines and other related medical treatment. The local

NGO has a close cooperation with the hematologist at AUBMC.

20. The local NGO informed, that any Palestinian can apply to become part of this programme, as long

as they can proof that they are either PRL or PRS and have legal stay in the country. A person who

does not have legal stay in Lebanon will be able to obtain treatment but will not be able to pur-

chase medicines. As for the referral, the local NGO sends a request to AUBMC on the patient and

their medical needs.

21. 120 Palestinians from across the country are currently in treatment for thalassemia and sickle cell

disease.

22. As for transportation costs, the local NGO is currently looking in to coordinating with another local

NGO to ensure transportation of patients outside of Beirut, particularly from the south. As when

looking at the data, it is clear that half of the patients living in the south have not gone to see the

doctor for the entire year and it turned out this is due to cost of transportation.

23. It is currently uncertain whether the local NGO will be able to uphold funding for the blood disease

programme

–

particularly for the adults in treatment, as the key donor may shift focus. Currently

the budget runs until the end of April 2023. Hereafter it is unclear how and if funding will be se-

cured to continue running the programme for adults. For children, PRCF is funding the treatment.

Coverage of other health care services

24. The local NGO has a programme for hospitalisation and surgery that Palestinians can apply for if

they do not have funds to cover medical bills, not only to PRCS or UNRWA contracted hospitals but

to any hospital that the Palestinian may have received medical treatment from. The challenge is

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however, that a lot of the hospitals are now demanding cash in USD, which the local NGO does not

provide. They rely on writing cheques and this has become problematic as it limits the places that

the local NGO can cover. The local NGO noted that when someone approach a private hospital, the

hospital will request a certain amount of cash up front before they even take the patient in. This is

also the case at AUBMC.

25. As such, the local NGO has a reimbursement programme in place but has had to limit the hospitals

they work with currently, due to the inability of providing cash payments. The list of hospitals that

they are now able to work with constantly changes but currently they include Labib Hospital, Ham-

moud Hospital, Jabal Amel and Rasoul Azam Hospital.

Diabetes

26. The local NGO does not provide support for diabetes treatment (other than dialysis). UNRWA co-

vers preventive care.

Cancer

27. The local NGO informed that a cancer patient in need of hospitalisation or an acute illness can ap-

ply for coverage for surgery and hospitalisation. For example, if a patient needs a tumor removed

or if in chemotherapy, and this causes an infection leading to the need of hospitalisation this can be

covered. Cancer medicines are not covered.

28. The local NGO informed that cancer medication is difficult to find currently at the market, however,

the local NGO does not have knowledge of the cost or availability.

29. The local NGO confirms having heard of Palestinians being rejected at hospitals for cancer treat-

ment, where the hospitals state that they do not have the needed medicines, which is not the case.

Basically, the hospitals prefer treating Lebanese patients. However, this is second hand knowledge

and not something, the local NGO has witnessed directly.

Cardiac complications

30. For cardiac complications, the local NGO covers 20 % up to 2,500 USD. This is considered a tertiary

treatment and thus is only covered 60 % by UNRWA if the surgery was conducted in a contracted

hospital. On average, and depending on the hospital, the cost of cardiac surgery is between 5-

15,000 USD depending on the specific procedure.

Chronic obstructive lung disease

31. The local NGO does not cover for treatment of chronic obstructive lung disease

Mental Health

32. The local NGO does not provide financial support for persons needing mental health services.

33. The local NGO explained that they are currently designing a study on mental health needs focusing

on dialysis patients. The study will be done in cooperation with AUB and the purpose is to identify

what needs there may be and then develop a capacity building programme addressing these once

data has been collected. This, however, is still all on the drawing board and a donor also needs to

be identified. A second phase of this programme would focus on thalassemia and sickle disease pa-

tients and mental health issues for this group.

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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Persons with disabilities

34. The local NGO no longer provides assistive devices. PRCF provides for children, however, the local

NGO is not aware of their capacity.

35. According to their knowledge, the availability of assistive devices as well as medical devices such as

pace makers generally in Lebanon is challenging in terms of both procurement and cost.

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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Annex 3: Treatment and medicines by health facility

The following data was collected in the period from 10 to 14 October 2022. All prices are in USD or in LBP. It

was not possible to obtain information about prices of all medical treatments and diagnostics tests. The main

reason for this is that the surveyed hospitals stated that such information depended on an assessment of the

individual case. In these cases there have been left blank cells in the matrix.

American University of Beirut Medical Center (AUBMC)

Cancer

Inpatient treatment by a cancer

specialist (an oncologist)

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Treatment price (incl. lab test)

Included in price

Outpatient treatment and fol-

Availability ("Available", "N/A" if not available, Available

low up by a cancer specialist (an "Partly available". If "Partly available, specify

oncologist)

time horizon for when it will be available)

Treatment price (incl. lab test)

First visit: 100 USD

Follow up visit: 70 USD

Only consultation

Included in price

Inpatient treatment by an urol-

ogist

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Treatment price (incl. lab test)

Included in price

Outpatient treatment by an

urologist

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Treatment price (incl. lab test)

Included in price

First visit: 100 USD

Follow up visit: 70 USD

Only consultation

Radiation therapy

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Treatment price (incl. lab test)

Included in price

Chemotherapy

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Treatment price (incl. lab test)

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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Included in price

Laboratory research / monitor-

ing of full blood count; e.g. Hb,

WBC & platelets

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Treatment price (incl. lab test)

Included in price

Laboratory research / tumor

marker: PSA test (Prostate-Spe-

cific Antigen)

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Treatment price (incl. lab test)

Included in price

Prostate resection (tran-

surethral resection of the pros-

tate, Laparoscopic prostatec-

tomy).

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Treatment price (incl. lab test)

Included in price

Diagnostic test: Biopsy

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Treatment price (incl. lab test)

Included in price

Cardiac complications and hypertension

Inpatient treatment by an inter- Availability ("Available", "N/A" if not available, Available

nal specialist (internist)

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Treatment price (incl. lab test)

Included in price

Outpatient treatment by an in-

ternal specialist (internist)

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Treatment price (incl. lab test)

Included in price

Inpatient treatment by a heart

specialist (a cardiologist)

First visit: 100 USD

Follow up visit: 70 USD

Only consultation

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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Treatment price (incl. lab test)

Included in price

Outpatient treatment by a heart Availability ("Available", "N/A" if not available, Available

specialist (a cardiologist)

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Treatment price (incl. lab test)

Included in price

First visit: 100 USD

Follow up visit: 70 USD

Only consultation

Inpatient treatment by a cardiac Availability ("Available", "N/A" if not available, Available

surgeon

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Treatment price (incl. lab test)

Included in price

Outpatient treatment and fol-

low up by a cardiac surgeon

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Treatment price (incl. lab test)

Included in price

Diagnostic imaging by means of Availability ("Available", "N/A" if not available, Available

ECG (electro cardio gram; cardi- "Partly available". If "Partly available, specify

ology)

time horizon for when it will be available)

Price

Included in price

Diagnostic imaging by means of

ultrasound of the heart

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Price

Included in price

Maintenance and follow up of

pacemaker by a cardiologist

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Price

Included in price

28.5 USD

Laboratory test blood: INR e.g.,

in case of acenocoumarol anti-

clotting

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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Laboratory test: monitoring full

blood count: e.g., Hb, WBC &

platelets

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Price

Included in price

Diabetes type I and II

Outpatient treatment and fol-

Availability ("Available", "N/A" if not available, Available

low up by a general practitioner "Partly available". If "Partly available, specify

time horizon for when it will be available)

Treatment price (incl. lab test)

Included in price

Inpatient treatment by a spe-

cialist in diabetes (an endocri-

nologist)

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Treatment price (incl. lab test)

Included in price

Outpatient treatment and fol-

low up by a specialist in diabe-

tes (an endocrinologist)

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Treatment price (incl. lab test)

Reimbursement scheme

Included in price

Laboratory test: blood glucose

(incl: HbA1C/ glyc.Hb)

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Price

Included in price

Mental health (including alcohol and drug abuse, psychotic disorders, PTSD, dementia and

cognitive disorders)

Outpatient treatment possibili-

ties by psychiatrist

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Treatment price (incl. lab test)

Adult: 175 USD (first

consultation)

120 USD (second con-

sultation)

Child: 220 USD

Included in price

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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Inpatient treatment possibilities Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

by psychiatrist

time horizon for when it will be available)

Treatment price (incl. lab test)

Included in price

Inpatient treatment possibilities Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

by psychologist

time horizon for when it will be available)

Treatment price (incl. lab test)

Outpatient treatment possibili-

ties by psychologist

Included in price

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Treatment price (incl. lab test)

Included in price

Special housing (like protected

apartments) for chronic psy-

chotic patients with outpatient

care

Availability ("Available", "N/A" if not available, N/A

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Treatment price (incl. lab test)

Included in price

Assisted living / care at home by Availability ("Available", "N/A" if not available,

"Partly available". If "Partly available, specify

psychiatric nurse

time horizon for when it will be available)

Treatment price (incl. lab test)

Included in price

Psychiatric long term clinical

Availability ("Available", "N/A" if not available, N/A

treatment (e.g. for chronic psy- "Partly available". If "Partly available, specify

chotic patients) by a psychiatrist time horizon for when it will be available)

Treatment price (incl. lab test)

Included in price

Care for mentally handicapped:

day care

Availability ("Available", "N/A" if not available, N/A

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Treatment price (incl. lab test)

Reimbursement scheme

Included in price

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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Care for combined mental and

Availability ("Available", "N/A" if not available, N/A

physical handicapped: long term "Partly available". If "Partly available, specify

time horizon for when it will be available)

institutional around the clock

care

Treatment price (incl. lab test)

Included in price

Chronic obstructive lung disease

Inpatient treatment by a lung

specialist (a pulmonologist)

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Treatment price (incl. lab test)

Included in price

Outpatient treatment by a lung

specialist (a pulmonologist)

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Treatment price (incl. lab test)

Included in price

Diagnostic test: lung function

tests (e.g., spirometry)

First visit: 100 USD

Follow up visit: 70 USD

Only consultation

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Price

Included in price

Diagnostic imaging: X-ray radi-

ography

Availability ("Available", "N/A" if not available, Available

"Partly available". If "Partly available, specify

time horizon for when it will be available)

Price

Included in price

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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Governmental Hospital Beirut

–

Karantina

Cancer

Inpatient treatment by a cancer specialist (an oncolo-

gist)

Availability ("Available", "N/A" if not availa- Available (for

ble, "Partly available". If "Partly available,

children only)

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Included in price

Availability ("Available", "N/A" if not availa- Available (for

ble, "Partly available". If "Partly available,

children only)

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Inpatient treatment by an urologist

Included in price

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Included in price

Radiation therapy

Availability ("Available", "N/A" if not availa- Available (for

ble, "Partly available". If "Partly available,

children only)

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Included in price

Chemotherapy

Availability ("Available", "N/A" if not availa- Available (for

ble, "Partly available". If "Partly available,

children only)

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Included in price

Laboratory research / monitoring of full blood count;

e.g. Hb, WBC & platelets

Availability ("Available", "N/A" if not availa- Available (for

ble, "Partly available". If "Partly available,

children only)

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Included in price

Laboratory research / tumor marker: PSA test (Pros-

tate-Specific Antigen)

Availability ("Available", "N/A" if not availa-

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Outpatient treatment and follow up by a cancer spe-

cialist (an oncologist)

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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Treatment price (incl. lab test)

Included in price

Prostate resection (transurethral resection of the

prostate, Laparoscopic prostatectomy).

Availability ("Available", "N/A" if not availa-

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Included in price

Diagnostic test: Biopsy

Availability ("Available", "N/A" if not availa-

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Included in price

Cardiac complications and hypertension

Inpatient treatment by an internal specialist (intern-

ist)

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Included in price

Outpatient treatment by an internal specialist (intern- Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

ist)

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Included in price

Inpatient treatment by a heart specialist (a cardiolo-

gist)

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Included in price

Outpatient treatment by a heart specialist (a cardiolo- Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

gist)

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Reimbursement scheme

Included in price

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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Inpatient treatment by a cardiac surgeon

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Included in price

Outpatient treatment and follow up by a cardiac sur-

geon

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Included in price

Diagnostic imaging by means of ECG (electro cardio

gram; cardiology)

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Price

Included in price

Diagnostic imaging by means of ultrasound of the

heart

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Price

Included in price

Maintenance and follow up of pacemaker by a cardi-

ologist

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Price

Included in price

Laboratory test blood: INR e.g., in case of acenocou-

marol anticlotting

Laboratory test: monitoring full blood count: e.g., Hb, Availability ("Available", "N/A" if not availa- Available (for

WBC & platelets

ble, "Partly available". If "Partly available,

children only)

specify time horizon for when it will be

available)

Price

Included in price

Diabetes type I and II

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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Outpatient treatment and follow up by a general

practitioner

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)'

Treatment price (incl. lab test)

Included in price

Inpatient treatment by a specialist in diabetes (an en- Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

docrinologist)

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Included in price

Outpatient treatment and follow up by a specialist in

diabetes (an endocrinologist)

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Reimbursement scheme

Included in price

Laboratory test: blood glucose (incl: HbA1C/ glyc.Hb)

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Price

Included in price

Mental health (including alcohol and drug abuse, psychotic disorders, PTSD, dementia and cognitive

disorders)

Outpatient treatment possibilities by psychiatrist

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Included in price

Inpatient treatment possibilities by psychiatrist

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Included in price

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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Inpatient treatment possibilities by psychologist

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Included in price

Outpatient treatment possibilities by psychologist

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Included in price

Special housing (like protected apartments) for

chronic psychotic patients with outpatient care

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Reimbursement scheme

Included in price

Assisted living / care at home by psychiatric nurse

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Included in price

Psychiatric long term clinical treatment (e.g. for

chronic psychotic patients) by a psychiatrist

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Included in price

Care for mentally handicapped: day care

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Reimbursement scheme

Included in price

Care for combined mental and physical handicapped:

long term institutional around the clock care

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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Treatment price (incl. lab test)

Included in price

Chronic obstructive lung disease

Inpatient treatment by a lung specialist (a pul-

monologist)

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Included in price

Outpatient treatment by a lung specialist (a pul-

monologist)

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Treatment price (incl. lab test)

Included in price

Treatment price (incl. lab test)

Included in price

Diagnostic test: lung function tests ( e.g., spirometry)

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Price

Included in price

Diagnostic imaging: X-ray radiography

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Price

Included in price

Devices for chronic obstructive lung disease

CPAP machine

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Price

Oxygen therapy with device and nasal catheter

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Price

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Oxygen therapy with O2 pressure tank for use at

home

Availability ("Available", "N/A" if not availa- N/A

ble, "Partly available". If "Partly available,

specify time horizon for when it will be

available)

Price

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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Psychiatric Hospital of the Cross

Outpatient treatment possibilities by psychia- Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

trist

available, specify time horizon for when

it will be available)

Treatment price (incl. lab test)

Included in price

Inpatient treatment possibilities by psychia-

trist

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Available

Treatment price (incl. lab test)

Included in price

Inpatient treatment possibilities by psycholo- Availability ("Available", "N/A" if not

gist

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Available

Treatment price (incl. lab test)

Included in price

Outpatient treatment possibilities by psy-

chologist

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Available

Treatment price (incl. lab test)

Included in price

Special housing (like protected apartments)

Availability ("Available", "N/A" if not

for chronic psychotic patients with outpatient available, "Partly available". If "Partly

available, specify time horizon for when

care

it will be available)

N/A

Treatment price (incl. lab test)

Included in price

Assisted living / care at home by psychiatric

nurse

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

N/A

Treatment price (incl. lab test)

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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Included in price

Psychiatric long term clinical treatment (e.g.

for chronic psychotic patients) by a psychia-

trist

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Available

Treatment price (incl. lab test)

Included in price

Care for mentally handicapped: day care

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Available

Treatment price (incl. lab test)

Included in price

Care for combined mental and physical hand- Availability ("Available", "N/A" if not

icapped: long term institutional around the

available, "Partly available". If "Partly

clock care

available, specify time horizon for when

it will be available)

Available

Treatment price (incl. lab test)

Included in price

Psychiatry: antipsychotic medication admin-

istration by injection (depot)

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Available

Treatment price (incl. lab test)

Included in price

UUI, Alm.del - 2022-23 (2. samling) - Bilag 36: Orientering om Udlændingestyrelsens rapport om sundhedsbehandling i Libanon for statsløse palæstinensere

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Hamshary Hospital

Cancer

Inpatient treatment by a cancer specialist Availability ("Available", "N/A" if not

N/A

(an oncologist)

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Treatment price (incl. lab test)

Included in price

Outpatient treatment and follow up by a

cancer specialist (an oncologist)

Availability ("Available", "N/A" if not

N/A

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Treatment price (incl. lab test)

Included in price

Treatment price (incl. lab test)

Included in price

Cardiac complications and hypertension

Inpatient treatment by an internal spe-

cialist (internist)

Availability ("Available", "N/A" if not

Available

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Treatment price (incl. lab test)

Provided free of charge if ap-

proved by UNRWA up to a pre-

defined ceiling. Hereafter

there is a set percentage of

self-payment.

Included in price

Outpatient treatment by an internal spe-

cialist (internist)

Availability ("Available", "N/A" if not

Available

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Treatment price (incl. lab test)

Provided free of charge if ap-

proved by UNRWA up to a pre-

defined ceiling. Hereafter

there is a set percentage of

self-payment.

Included in price

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Inpatient treatment by a heart specialist

(a cardiologist)

Availability ("Available", "N/A" if not

Available

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Treatment price (incl. lab test)

Provided free of charge if ap-

proved by UNRWA up to a pre-

defined ceiling. Hereafter

there is a set percentage of

self-payment.

Included in price

Outpatient treatment by a heart special-

ist (a cardiologist)

Availability ("Available", "N/A" if not

Available

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Treatment price (incl. lab test)

Reimbursement scheme

Included in price

Inpatient treatment by a cardiac surgeon

Availability ("Available", "N/A" if not

N/A

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Treatment price (incl. lab test)

Included in price

Outpatient treatment and follow up by a

cardiac surgeon

Availability ("Available", "N/A" if not

N/A

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Treatment price (incl. lab test)

Included in price

Diabetes type I and II

101

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Outpatient treatment and follow up by a

general practitioner

Availability ("Available", "N/A" if not

Available

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Treatment price (incl. lab test)

Included in price

Inpatient treatment by a specialist in dia-

betes (an endocrinologist)

Availability ("Available", "N/A" if not

N/A

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Treatment price (incl. lab test)

Included in price

Outpatient treatment and follow up by a Availability ("Available", "N/A" if not

N/A

specialist in diabetes (an endocrinologist) available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Treatment price (incl. lab test)

Reimbursement scheme

Included in price

Laboratory test: blood glucose (incl:

HbA1C/ glyc.Hb)

Availability ("Available", "N/A" if not

Available

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Price

Provided free of charge if ap-

proved by UNRWA up to a pre-

defined ceiling. Hereafter

there is a set percentage of

self-payment

Included in price

Mental health (including alcohol and drug abuse, psychotic disorders, PTSD, dementia and cognitive

disorders

102

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Outpatient treatment possibilities by psy- Availability ("Available", "N/A" if not

N/A

chiatrist

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Treatment price (incl. lab test)

Included in price

Inpatient treatment possibilities by psy-

chiatrist

Availability ("Available", "N/A" if not

N/A

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Treatment price (incl. lab test)

Included in price

Inpatient treatment possibilities by psy-

chologist

Availability ("Available", "N/A" if not

N/A

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Treatment price (incl. lab test)

Included in price

Outpatient treatment possibilities by psy- Availability ("Available", "N/A" if not

N/A

chologist

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Treatment price (incl. lab test)

Included in price

Chronic obstructive lung disease

Inpatient treatment by a lung specialist (a Availability ("Available", "N/A" if not

N/A

pulmonologist)

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

103

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Treatment price (incl. lab test)

Included in price

Outpatient treatment by a lung specialist

(a pulmonologist)

Availability ("Available", "N/A" if not

N/A

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Treatment price (incl. lab test)

Included in price

Outpatient treatment by a lung specialist

(a pulmonologist)

Availability ("Available", "N/A" if not

N/A

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Treatment price (incl. lab test)

Included in price

Devices for chronic obstructive lung disease

CPAP machine

Availability ("Available", "N/A" if not

N/A

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Price

Oxygen therapy with device and nasal

catheter

Availability ("Available", "N/A" if not

N/A

available, "Partly available". If "Partly

available, specify time horizon for when

it will be available)

Price

104

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Mazen Pharmacy

prices according to exchange rate on 1/11/22

Cardiac complications and hypertension (including post operation care)

Simvastatin

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Atorvastatin

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Clopidogrel

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Acetylsalicylic acid

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Available

Vascor

10 mg

Tablet

96,511

Available

Apo-Atorvastatin

40 mg

Tablet

343,811

Available

Plavix

75 mg

Tablet

588,513

Available

Aspicot

81 mg

Tablet

120

52,127

105

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Losartan

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Available

Cozaar

50 mg

Tablet

619,047

Available

Bisoprolol

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Biscordex

5 mg

Tablet

177,349

Available

Enalapril

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Enalapril maleate

10 mg

Tablet

199,991

Available

Doxazosin

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Cardular

4 mg

Tablet

275,816

Available

Isosorbide monotritate

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Monocinque

106

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Dosage

Form

# of units in container

Price per box

Amiodarone

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Digoxin

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Furosemide

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Warfarin

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

40 mg

Tablet

101,306

Available

Cordarone

200 mg

Tablet

272,883

Available

Lanoxin

0,25 mg

Tablet

100

98,155

Available

Lasix

40 mg

Tablet

52,703

N/A

107

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Amlodipine

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Available

Amlo tad

5 mg

Tablet

339,862

Available

Spironolactone

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Aldactone

100 mg

Tablet

209,193

N/A

Diabetes type I and II

Fast acting insulin: Insulin as-

part, Insulin glulisine, Insulin

lispro, Insulin human

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Intermediate-acting insulin: In-

sulin isophane

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Long-acting insulin: Insulin de-

temir, Insulin glargine, Insulin

degludec

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

N/A

108

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Brand name

Dosage

Form

# of units in container

Price per box

Metformin

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Available

Brand name

Dosage

Form

# of units in container

Price per box

Gliclazide

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Glucophage XR

500 mg

Tablet

177,795

Available

Glyzide

80 mg

Tablet

233,063

Available

Devices for diabetes type I and II

Blood glucose meter for self use

by patient

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Price

Blood glucose self test strips for

use by patient

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Price

Insulin pump

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Price

Not known (can be given upon request)

Available

Not known (can be given upon request)

Can be bought from special medical

supply centers

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Continuous glucose monitoring

(CGM) implanted device

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Can be bought from special medical

supply centers

Price

Mental health (alcohol and drug abuse, psychotic disorders, PTSD)

Chlordiazepoxide

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Disulfiram

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Methadone

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Morphine

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

Available

N/A

Available

Bipax

2,5 mg

Tablet

53,638

N/A

MST Continus

10 mg

Tablet

110

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# of units in container

Price per box

Buprenorphine

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Buprenorphine and naloxone

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Olanzapine

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Chlorpromazine

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

423,964

N/A

Available

Olizax

10 mg

Tablet (mouth dissolving)

779150

Available

Brand name

Dosage

Form

# of units in container

Price per box

Chlorpromazine

100 mg

Tablet

78,191

111

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Haloperidol

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Available

Haldol

5 mg

Tablet

100,721

Partly available (shortages of this medi-

cation)

Risperidone

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Risperdal

1 mg

Tablet

133,513

Available

Clozapine

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Leponex

100 mg

Tablet

901,801

Available

Quetiapine

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Rezal XR

50 mg

Tablet

424,549

Available

Venlafaxine

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Defaxine

112

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Dosage

Form

# of units in container

Price per box

Sertraline

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Citalopram

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Mirtazapine

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

75 mg

Tablet

106,899

Available

Sertine

50 mg

Tablet

147,128

Available

Cipralex

15 mg

Tablet

239,348

Available

Brand name

Dosage

Form

# of units in container

Price per box

Diazepam

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Mirta tad

30 mg

Tablet

519,609

Available

Valium

5 mg

Tablet

91,409

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Lorazepam

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Available

Lorazepam

1 mg

Tablet

78,758

N/A

Oxazepam

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Pregabalin

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Available

Brand name

Dosage

Form

# of units in container

Price per box

Lyrica

150 mg

Tablet

320,586

Available

Chronic obstructive lung disease

Formoterol

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Budesonide and formoteol (sym- Availability ("Available", "N/A" if not

bicort)

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Foradil

12 mcg

Capsule, inhalation

497,245

Available

Budesonide Arrow

114

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Dosage

Form

# of units in container

Price per box

Fluticasone propionate

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Salbutamol

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Fluticasone furoate, umec-

lidinium bromide, vilanterol

(Trelegy Ellipta)

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Fluticasone propionate and sal-

meterol xinafoate

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Tiotropium bromide monohy-

drate

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

1mg/2ml

Inhalation suspension for nebuliser

20 x 2 ml

247,118

N/A

Available

Asthalin

2,5mg/2,5 ml

Inhalation solution

20 x 2,5 ml

148460

N/A

Available

115

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Brand name

Dosage

Form

# of units in container

Price per box

Beclometasone, formoterol/gly-

copyrronium (Trimbow)

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Prednisolone

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Tiova-t

18 mcg

Rotacaps

175,452

N/A

Available

Prednisone

20 mg

Tablet

47,695

Can be bought from special medical

supply centers - the pharmacy can or-

der it upon request

Devices for chronic obstructive lung disease

CPAP machine

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Price

Oxygen therapy with device and

nasal catheter

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Price

Oxygen therapy with O2 pres-

sure tank for use at home

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Can be given upon request

Can be bought from special medical

supply centers - the pharmacy can or-

der it upon request

Can be given upon request

Can be bought from special medical

supply centers

Price

Analgetics

116

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Paracetamol

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Available

Doliprane

500 mg

Tablet

52,703

Available

Ibuprofen

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Brufen

400 mg

Tablet

125,664

Available

Oxycodone

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Oxynorm

5 mg

Capsule, hard

33,535

Available

Sumatriptan

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Imigran

100 mg

Tablet

313,483

Available

Other (antihistamines, sleeping pills, vitamins, etc.)

Cholecalciferol (d-vitamin)

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Maxi D 10,000

Vitamin D3 - 10,000IU

Capsule

137,454

117

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Magnesia

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Available

Mavit

Magnesium 100 mg, Pyridoxine 10mg

Tablet

96,511

Available

Promethazine

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Prometal

25 mg

Tablet

28,708

Available

Sildefanil

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Sildenafil arrow lab

100 mg

Tablet

682,792

Available

Omeprazole

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Axipron

20 mg

Capsule

105,955

Available

Cetirizine

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Cetimed

10 mg

Tablet

79,135

118

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Tresiquens

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

N/A

Tamsulosin

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Available

Prostafine

0,4 mg

Capsule

122,953

Available

Allopurinol

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Aluric

100 mg

Tablet

35,507

Available

Calcium

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

OSTRONG

Vitamin D3 - 500IU, Calcium hydrogen

phosphate 600 mg

Tablet

91,978

Available

Finasteride

Availability ("Available", "N/A" if not

available, "Partly available". If "Partly

available, specify time horizon for

when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Sterifine 5

5 mg

Tablet

126,163

119

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Pharmacy Alexandra

Pharmacy Alexandre

prices according to exchange rate on 13/10/22

Cardiac complications and hypertension (including post operation care)

Simvastatin

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Atorvastatin

Availability ("Available", "N/A" if

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Vascor

10 mg / 20 mg / 30

Tablet

89,935 / 117,742 /

122,00

Available

Brand name

Dosage

Form

# of units in container

Price per box

Clopidogrel

Tarden

10 mg / 20 mg / 40

Tablet

157,694 / 197,038

/ 236,412

Available

Availability ("Available", "N/A" if

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Apo-clopidogrel

Dosage

Form

# of units in container

Price per box

75 mg

Tablet

526,000

Acetylsalicylic acid

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

Aspicot

100 mg

Tablet

120

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

# of units in container

Price per box

Losartan

20,416

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Bisoprolol

Losanet

50 mg

Tablet

136,574

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Enalapril

Bisocor

5 mg

Tablet

99,000

Availability ("Available", "N/A" if

N/A

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Doxazosin

Availability ("Available", "N/A" if

N/A

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

121

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Isosorbide monotritate

Availability ("Available", "N/A" if

N/A

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Amiodarone

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Digoxin

Cordarone

200 mg

Tablet

262,000

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Furosemide

Lanoxin

0.25 mg

Tablet

100

90,605

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Lasix

40 mg

Tablet

48,649

122

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Acenocoumarol

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Amlodipine

Sintrom

4 mg

Tablet

67,407

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Spironolactone

Amlo Tad

5 mg

Tablet

83,423

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Aldactone

25 mg

Tablet

105,000

Diabetes type I and II

Fast acting insulin: Insulin aspart, Insulin glulisine, Insulin

lispro, Insulin human

Availability ("Available", "N/A" if

N/A

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

123

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Intermediate-acting insulin: Insulin isophane

Availability ("Available", "N/A" if

Available, but gen-

not available, "Partly available". If

eral experiencing

"Partly available, specify time hori-

supply problems

zon for when it will be available)

Generic name

Brand name

Dosage

Form

# of units in container

Price per box

Insulin aspart 30

%, Insulin aspart

protamine 70 %

Novomix 30

100IU/ml

Injectable suspen-

sion

5 x 3 ml

483,499

Long-acting insulin: Insulin detemir, Insulin glargine, Insu- Availability ("Available", "N/A" if

Available, but gen-

lin degludec

not available, "Partly available". If

eral experiencing

"Partly available, specify time hori-

supply problems

zon for when it will be available)

Generic name

Brand name

Dosage

Form

# of units in container

Price per box

Metformin

Insulin glargine

Lantus solostar

100IU/ml

Injectable solution

5 x 3 ml

674,310

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Gliclazide

Glucophage

750 mg

Tablet

253,000

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Diamicron

60 mg

124

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Form

# of units in container

Price per box

Tablet

30 mg

154,054

Devices for diabetes type I and II

Blood glucose meter for self use by patient

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Price

Blood glucose self test strips for use by patient

1,000,000

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Price

Insulin pump

600,000

Availability ("Available", "N/A" if

N/A

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Price

Continous glucose monitoring (CGM) implanted device

Availability ("Available", "N/A" if

N/A

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Price

Mental health (alcohol and drug abuse, psychotic disorders, PTSD)

Chlordiazepoxide

Availability ("Available", "N/A" if

N/A

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

125

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Disulfiram

Availability ("Available", "N/A" if

N/A

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Methadone

Availability ("Available", "N/A" if

N/A (requires spe-

not available, "Partly available". If cial approval)

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Morphine

Availability ("Available", "N/A" if

N/A (requires spe-

not available, "Partly available". If

cial approval)

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Buprenorphine

Availability ("Available", "N/A" if

N/A (requires spe-

not available, "Partly available". If

cial approval)

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

126

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Buprenorphine and naloxone

Availability ("Available", "N/A" if

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Olanzapine

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Chlorpromazine

Zolapine

5 mg

Tablet, orodis-

persible

306,390

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Haloperidol

Chlorpromazine

100 mg

Tablet

72,863

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Haloperidol

2 mg

Tablet

36,000

127

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Risperidone

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Clozapine

Depia

2 mg

Tablet

98,030

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Quetiapine

Lanolept

100 mg

Tablet

596,216

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Venlafaxine

Seropine

25 mg

Tablet

260,483

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Venlax XR 75

75 mg

Tablet

151,000

128

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Sertraline

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Escitapram

Sertine

50 mg

Tablet

137,102

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Mirtazapine

Citoles

10 mg

Tablet

168,841

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Diazepam

Mirta Tad

30 mg

Form

500,000

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Valium

5 mg

Tablet

84,376

129

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Lorazepam

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Oxazepam

Lorazepam

2 mg

Tablet

110,174

Availability ("Available", "N/A" if

N/A

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Pregabalin

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Gabrika 75

75 mg

Tablet

164,000

Chronic obstructive lung disease

Formoterol

Availability ("Available", "N/A" if

N/A

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

130

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Budesonide and formoteol (symbicort)

Availability ("Available", "N/A" if

N/A

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Fluticasone propionate

Availability ("Available", "N/A" if

N/A

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Fluticasone furoate, umeclidinium

bromide, vilanterol (Trelegy Ellipta)

Availability ("Available", "N/A" if

N/A

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Fluticasone propionate and salmeterol xinafoate

Availability ("Available", "N/A" if

N/A

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

131

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Tiotropium bromide monohydrate

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Beclometasone, formoterol/glycopyrronium (Trimbow)

Tiova-T

18 mcg

Rotacaps

169,000

Availability ("Available", "N/A" if

N/A

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Ventoline

Availability ("Available", "N/A" if

Available, but gen-

not available, "Partly available". If eral experiencing

"Partly available, specify time hori- supply problems

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Prednisolone

Ventolin

5 mg/ml

Solution

20 ml

169,884

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Prednisone

20 mg

Tablet

47,695

Devices for chronic obstructive lung disease

132

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

CPAP machine

Availability ("Available", "N/A" if

N/A (can be

not available, "Partly available". If bought at medical

"Partly available, specify time hori- supply center)

zon for when it will be available)

Price

Oxygen therapy with device and nasal catheter

Availability ("Available", "N/A" if

N/A (can be

not available, "Partly available". If bought at medical

"Partly available, specify time hori- supply center)

zon for when it will be available)

Price

Oxygen therapy with O2 pressure tank for use at home

Availability ("Available", "N/A" if

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

N/A (can be

bought or rented

from medical sup-

ply center)

Price

Analgetics

Paracetamol

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Ibuprofen

Painol

500 mg

Tablet

11,088

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Profinal

400 mg

Tablet

77,000

133

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Oxycodone

Availability ("Available", "N/A" if

N/A (requires spe-

not available, "Partly available". If cial approval)

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Sumatriptan

Availability ("Available", "N/A" if

N/A

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Other (antihistamines, sleeping pills, vitamins, etc.)

Cholecalciferol (d-vitamin)

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Magnesia

Maxi-D 10,000

10,000 IU

Capsule

137,454

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Mavit

Magnesium 100

mg, Pyridoxine 10

Tablet

89,935

Form

# of units in container

Price per box

134

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Promethazine

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Sildefanil

Prometal

25 mg

Tablet

26,752

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Omeprazole

Segurex

50 mg

Tablet

139,000

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Cetirizine

Omezol Benta

20 mg

Capsule

104,000

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Cetallerg

10 mg

Tablet

72,432

135

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Tresiquens

Availability ("Available", "N/A" if

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Available (but no

demand for this

medication ac-

cording to the

pharmacist)

Brand name

Dosage

Form

# of units in container

Price per box

Tamsulosin

211,000

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Allopurinol

Prostafine

0,4 mg

Capsule

111,574

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Calcium

Aluric

300 mg

Tablet

42,000

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

OSTRONG

Vitamin D3 500IU,

Calcium hydrogen

phosphate 600 mg

Tablet

85,711

Form

# of units in container

Price per box

136

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Finasteride

Availability ("Available", "N/A" if

Available

not available, "Partly available". If

"Partly available, specify time hori-

zon for when it will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Sterifine 5

5 mg

Tablet

117,566

137

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Saida DT Pharmacy

prices according to exchange rate on 14/10/22

Cardiac complications and hypertension

Simvastatin

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Atorvastatin

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Clopidogrel

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Acetylsalicylic acid

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Available

Simvastatin nor-

mon

10 mg

Tablet

108,110

Available

Apo-atorvastatin

20 mg

Tablet

213,247

Available

Ceruvin

75 mg

Tablet

101,364

Available

Aspicot

100 mg

Tablet

100

138

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Price per box

Losartan

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Bisoprolol

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Enalapril

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Doxazosin

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

55,439

Available

Losanet

50 mg

Tablet

136,574

Available

Biscordex

5 mg

Tablet

163,706

Partly available,

generally experi-

encing supply

problem

10 mg

N/A

139

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Isosorbide monotritate

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Partly available,

generally experi-

encing supply

problem

10 mg

Amiodarone

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Partly available,

generally experi-

encing supply

problem

200 mg

Digoxin

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Available

Lanoxin

0.25 mg or 0.05

mg / ml

Tablet / elixir

100 / 60 ml

90,605 / 129,678

Available

Furosemide

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Lasix

500 mg

Tablet

310,860

140

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Warfarin

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

N/A

Amlodipine

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Available

Amlo Tad

5 mg / 10 mg

Tablet

50 / 50

313,719 / 536,833

Available

Spironolactone

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Aldactone

25 mg / 100 mg

Tablet

20 / 10

100,232 / 193,101

Partly available,

general experienc-

ing supply prob-

lems

Diabetes type I and II

Fast acting insulin: Insulin aspart, Insulin glulisine, Insulin lispro,

Insulin human

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

141

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Intermediate-acting insulin: Insulin isophane

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Partly available,

general experienc-

ing supply prob-

lems

Long-acting insulin: Insulin detemir, Insulin glargine, Insulin de-

gludec

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Partly available,

general experienc-

ing supply prob-

lems

Metformin

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Available

Dialon

1000 mg

Tablet

114,594

Available

Gliclazide

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Glyzide

80 mg

Tablet

215,135

Devices for diabetes type I and II

142

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Blood glucose meter for self use by patient

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Price

Available on re-

quest

Blood glucose self test strips for use by patient

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Price

Depending on the

company

Available

18 USD

N/A

Insulin pump

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Price

Continous glucose monitoring (CGM) implanted device

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Price

N/A

Mental health (alcohol and drug abuse, psychotic disorders, PTSD)

Chlordiazepoxide

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Disulfiram

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

N/A

143

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Brand name

Dosage

Form

# of units in container

Price per box

Methadone

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Morphine

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Buprenorphine

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Buprenorphine and naloxone

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

N/A

Available on re-

quest and with

special prescrip-

tion from the Min-

istry of Public

Health

N/A

144

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Form

# of units in container

Price per box

Olanzapine

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Chlorpromazine

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Haloperidol

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Risperidone

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Available

Olanzamed

5 mg / 20 mg

Tablet

30 / 30

258,248 / 856,663

Available

Chlorpromazine

100 mg / 25 mg/ 5

Tablet / Injectable

solution

50 / 10x5 ml

72,863 / 150,270

Available

Haloperidol

2 mg / 5 mg

Tablet

34,671 / 40,831

Partly available,

general experienc-

ing supply prob-

lems

145

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LE B ANON

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Form

# of units in container

Price per box

Clozapine

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Quetiapine

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Venlafaxine

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Sertraline

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Available

Lanolept

100 mg

Tablet

596,216

Partly available,

general experienc-

ing supply prob-

lems

Efexor XR

75 mg / 150 mg

Tablet

308,623 / 344,298

Partly available,

general experienc-

ing supply prob-

lems

146

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Price per box

Citalopram

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Mirtazapine

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Diazepam

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Lorazepam

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Generic name

Brand name

Dosage

Form

# of units in container

Price per box

Available

Cipralex

10 mg

Tablet

622,702

Partly available,

general experienc-

ing supply prob-

lems

Valium

5 mg

Tablet

84,376

Partly available,

general experienc-

ing supply prob-

lems

147

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Oxazepam

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

N/A

Pregabalin

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Available

Lyrica

75 mg

Tablet

95,057

N/A

Chronic obstructive lung disease

Formoterol

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Budesonide and formoteol (symbicort)

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

N/A

148

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Fluticasone propionate

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Partly available,

general experienc-

ing supply prob-

lems

Salbutamol

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

N/A

Fluticasone furoate, umeclidinium

bromide, vilanterol (Trelegy Ellipta)

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

N/A

Fluticasone propionate and salmeterol xinafoate

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Partly available,

general experienc-

ing supply prob-

lems

149

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Tiotropium bromide monohydrate

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Partly available,

general experienc-

ing supply prob-

lems

Beclometasone, formoterol/glycopyrronium (Trimbow)

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

N/A

Prednisolone

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Available

Predalone

15 mg / 5 ml

Syrup

100 ml

122,494

N/A

Devices for chronic obstructive lung disease

CPAP machine

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Price

Oxygen therapy with device and nasal catheter

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

N/A

150

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Price

Oxygen therapy with O2 pressure tank for use at home

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Price

Dependent on the

company

N/A can be bought

at medical supply

centers

Analgetics

Paracetamol

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Ibuprofen

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Oxycodone

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Available

Dolopan

500 mg

Tablet

127,670

Available

Brufen

400 mg / 100 mg /

5 ml

Tablet / Syrup

30 / 100 ml

120,249 / 153,462

N/A

151

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Sumatriptan

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

N/A

Other (antihistamines, sleeping pills, vitamins, etc.)

Cholecalciferol (d-vitamin)

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Magnesia

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Available

Maxi-D

10,000IU

Tablet

137,454

Available

Mavit

Magnesium 100

mg, Pyridoxine 10

Tablet

89,935

Available

Form

# of units in container

Price per box

Promethazine

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Prometal

25 mg

Tablet

152

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Price per box

Sildefanil

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Omeprazole

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Cetirizine

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Tresiquens

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

26,752

Available

Sildenafil Arrow

Lab

100 mg

Tablet

630,27

Available

Axipron

20 mg

Tablet

98,734

Available

Cetimed

10 mg

Tablet

73,743

N/A

153

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HE A L TH C AR E SE R VI CE S FO R P A LE S TI NIAN RE FU GE E S

Tamsulosin

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Available

Prostafine

0,4 mg

Tablet

114,574

Available

Allopurinol

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Aluric

100 mg / 300 mg

Tablet

50 / 30

33,087 / 40,127

Available

Calcium

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

O STRONG

Vitamin D3 400IU,

Calcium (car-

bonate) 500 mg

Tablet

85,711

Available

Form

# of units in container

Price per box

Finasteride (enlarged prostate)

Availability ("Available",

"N/A" if not available,

"Partly available". If

"Partly available, specify

time horizon for when it

will be available)

Brand name

Dosage

Form

# of units in container

Price per box

Finasteride

5 mg

Tablet

150,064

154