Background: Refugees are particularly vulnerable to the negative consequences of the pandemic due to pre-existing challenges, but the impact of the pandemic on this group remains to be understood. In this study, we aimed to uncover the effects of the Covid-19 pandemic on the mental health of Palestine refugees in Gaza, disentangling the role of social determinants. We further aimed to explore views on the effectiveness and acceptability of policies and strategies the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) implemented during the pandemic.Methods: This qualitative study took place between August and November 2020. Twenty-nine key-informant interviews were conducted with UNRWA Headquarters, Gaza Field Office, Health and Relief and Social Service staff and with community leaders and members residing in Rafah and Jabalia camps. We collected information on UNRWA’s strategies, people’s perception of those strategies, and personal and professional stressors during the pandemic. Data was coded based on the framework for social determinant of mental health. Results: Interview data suggest that the pandemic and social determinants mutually aggravated one another resulting in a major impact on the physical and mental health of Gazans. Women, children and daily-paid workers were acutely more disadvantaged than other groups of the community, experiencing violence and anxieties. Financial strain, violence, food insecurity, and disruption in the education process were reported by all participants. UNRWA reconfigured its methods of service delivery to continue the provision of essential services. The strategies enacted by UNRWA during the pandemic were generally perceived as helpful, yet not enough to respond to Gazans’ needs.Conclusion: The pandemic serves as a stark reminder of the need to broaden the public health response beyond disease management and prevention to address social determinants in order to improve refugees’ health and decrease their vulnerability to future shocks. UNRWA deployed telemedicine and mental telehealth services at short notice and the need to evaluate these new modes of remote service delivery is essential. The use of a hybrid approach, a combination of online and face-to-face therapy, could be useful as a long-term solution.

Health for Palestine (H4P) was established in 2018 as a refugee-run community health worker program in the occupied West Bank to provide social accompaniment, address health barriers, and initiate monitoring and support for chronic disease patients. n A study from 2 Palestinian refugee camps indicates that accompaniment-based community health worker programs are feasible and effective in improving diabetes and hypertension control in camps experiencing chronic violence under military occupation.

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Background Due to pre-existing difficulties, refugees are especially susceptible to the negative effects of the pandemic; nonetheless, the pandemic’s effect on this group is still unclear. The purpose of this study was to determine the effects of the COVID-19 pandemic on the mental health of Palestine refugees in Gaza by identifying the role of social determinants. During the pandemic, the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) enacted a number of policies and measures. The purpose of this research was to assess their efficacy and acceptability. Methods This qualitative study took place between August and November 2020. Twenty-nine key-informant interviews were conducted remotely with UNRWA Headquarters, field and clinical staff in Gaza and with community members, aged ≥18 years and residing in Rafah and Jabalia camps. We sought informed consent verbally or via email. Data was coded based on the framework for social determinants of mental health. Results Interview results indicated that the relationship might be unidirectional, with COVID-19 causing the degradation of living conditions and vice versa, with living conditions exacerbating the COVID-19 situation by facilitating virus transmission. In other instances, the association between mental health determinants and COVID-19 might be bidirectional. In terms of experiencing violence and anxieties, women, children, and daily-paid employees were significantly more disadvantaged than other groups in the community. UNRWA modified its service delivery techniques in order to continue providing essential services. In general, UNRWA’s strategies throughout the pandemic were deemed beneficial, but insufficient to meet the needs of Gazans. Conclusion The pandemic highlights the need to go beyond disease treatment and prevention to address social determinants to improve refugees’ health and reduce their susceptibility to future shocks. UNRWA has rapidly implemented telemedicine and mental telehealth services, making it imperative to assess the efficacy of these novel approaches to provide care at a distance. A long-term option may be to employ a hybrid strategy, which combines online and in-person therapy.