ABSTRACT
Governing national health reform is always complex. Available resources are relatively, if not absolutely, limited, and the social and political environment does not always support change. Health sector reform is a “profoundly political process” according to Roberts et al. (2004, 61), thus it requires both technical and political feasibility analysis. The United Nations (UN) Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) has been engaged in the reform of its health delivery system for the last two years, and we continue to assess its progress. UNRWA manages the largest health delivery system of all UN agencies, serving around five million Palestine refugees at present. UNRWA’s health system is in the unique position of operating in multiple states while being managed not by the governments of those states, but by the UN. Additionally, because the situation of the Palestine refugees is heavily influenced by conflicting political forces in the region, the health system will likely persist for many years to come, and will need to adapt to the evolving environment.
