Abstract
No matter where they are in the world today, every Palestinian has a Nakba story. They likely know the village their family originally came from—perhaps they could even point to the specific house, or ruins of the house, where their grandparents or great grandparents had once lived. They might even still have the key.
The Nakba (Arabic for “catastrophe”) was the mass displacement of more than 700,000 Palestinians in 1948, when the state of Israel was created. Under threat from Zionist militias, including the risk of massacres such as those that occurred in villages like Deir Yassin and Lydda, Palestinians fled their homes and villages, assuming they would soon be able to return once the hostilities had ended. “They ran like cats,” said Yehoshua Zettler, the commander of the Deir Yassin operation, about the fleeing Palestinian villagers:
I won’t tell you that we were there with kid gloves on. House after house . . . we’re putting in explosives and they are running away. An explosion and move on, an explosion and move on and within a few hours, half the village isn’t there any more. (Aderet, 2017)
Indeed, instead of returning home, many Palestinians who fled in 1948 never saw their homes—and in some cases, Palestine itself—again. They were forced to settle elsewhere in what are now called the occupied Palestinian territories (the West Bank and Gaza Strip) or in neighboring nations like Syria, Jordan, and Lebanon, as refugees, living and dying in exile. Today, they and their descendants, many of whom still hold the keys to their original family homes, face an entirely different looking world but a similar status; stateless, exiled, and living under multiple forms of structural oppression.
As a result, these refugees face significant challenges to their health. While those who remained within the borders of Israel finally received citizenship in 1980 and have access to the Israeli health system, many of those that settled outside of the state of Israel are barred from ever returning. Those that live in the occupied territories face a taxed and fragmented health system along with ongoing Israeli restrictions and violence, and those that settled in other countries face discrimination in their host countries, all with varying access to humanitarian services. Some may not have consistent access to care at all. This means that this population engages with a wide variety of health actors—public, private, and humanitarian—and suffers a different health burden depending on where they are and what their legal status is, making broad health interventions impossible.
The Longest Refugee Crisis in Modern History—With No End in Sight
By the end of 2024, an estimated 123.2 million people had been forced to flee their homes, most due to conflict or risk of persecution. Of those, 42.7 million are refugees who have fled their country entirely, with more than 70 million others living as internally displaced people somewhere within their home country. Just 30 years ago, the total number of displaced people was 47.5 million, indicating a nearly threefold increase (UNHCR, 2025).
Most of these refugees fall under the mandate of the United Nations (UN) Refugee Agency (UNHCR), which was established in 1950 by the General Assembly (UNGA) of the newly formed UN to support the millions displaced after World War II. The nearly 6 million registered Palestinian refugees fall under the mandate of an entirely different UN agency—the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA). This agency was established at the same time as UNHCR by the UNGA to specifically provide relief to those who were recognized as Palestinian refugees, defined as any person whose “normal place of residence was Palestine during the period June 1, 1946 to May 15, 1948 and who lost both home and means of livelihood as a result of the 1948 conflict.”
UNRWA operates in five areas: the West Bank, the Gaza Strip, Jordan, Lebanon, and Syria. Its mandate is to provide relief, primarily in the forms of schooling, health care, and other social services. Yet the agency has frequently been attacked by Israel and its allies, generally for unsubstantiated claims of terrorism. Many argue that the underlying reason for the long-standing vitriol for UNRWA is far more straightforward—the agency’s continued recognition of Palestinian refugees and their rights, including to return (Sparks et al., 2024).
The Right to Return, the Right to Exist
Over the past 77 years, the very existence of Palestinian refugees has been treated as a controversial issue. As has been established in international law and norms, including in Article 13(2) of the Universal Declaration of Human Rights (1948), UNGA Resolution 194 (1948), the 1951 Convention Relating to the Status of Refugees, and the 1966 International Covenant on Civil and Political Rights, all refugees have the right to return to their homelands if they choose to do so or be compensated otherwise. But for many of these Palestinians, their homeland was now a different country entirely—one that has explicitly denied their ability to return and one where their homes were seized or destroyed, and their towns renamed as if they never existed.
At the same time, they often faced discrimination and expulsion in their host countries, limiting their access to education, employment, and health care. Once it became clear to host nations that these refugees would not just be temporary visitors, many changed their policies toward them to deny them citizenship status and, in the case of Lebanon, the right to work in certain industries or access certain health or educational services entirely, creating deep poverty. Nations like Egypt, Syria, and others maintained tight restrictions on their Palestinian refugees, and sometimes even expelled them completely even though they had no status to go elsewhere (HRW, 2002). Decades of research have shown poor health outcomes in these populations, especially for those living in camps, including in Jordan (Chaaya et al., 2021), Syria (Giacaman et al., 2009), and Lebanon (Habib et al., 2012). Their living conditions and seemingly unending precarity have also led to a high mental health burden (Abu-Ras et al., 2024).
The subsequent decades have seen concentrated resistance of any discussion of right of return for Palestinian refugees, especially by Israel, which has in fact continued policies that displace Palestinians, destroy their homes, and seize their land. Israel is currently engaged in mass forced displacement campaigns in both the Gaza Strip, in what has been increasingly recognized as a genocide by human rights organizations and scholars (CIP, 2025), and the West Bank, which in 2025 has seen the largest forced displacement of Palestinians since 1967. The health system in the Gaza Strip has been essentially destroyed, and siege conditions have deprived the population of adequate access to food, water, and medicine for nearly 2 years (WHO, 2025). In the West Bank, violent raids and extrajudicial killings by Israeli forces and settlers have increased the need for health access, limited by more than 700 recorded attacks on health facilities by Israeli forces since October 2023 and hundreds of movement restrictions, including growing reports of ambulances blocked at checkpoints (MSF, 2025).
There has also been an accelerating campaign by Israel and the United States to defund and discredit UNRWA, with the United States, previously the agency’s largest donor, cutting funding in 2024 while Gaza was being bombarded daily. That same year, Israel banned the agency’s operations entirely. These actions have severely decreased health care access for many Palestinians, especially in the Gaza Strip.
Palestinian Health Justice Requires Reckoning With Root Causes
Like all human beings, Palestinian refugees are entitled to live freely of the threats of violence, discrimination, statelessness, and ongoing displacement. They will not be able to attain their full right to health until these fundamental structural determinants are resolved. At a moment of such acute violence and deprivation across the Palestinian territories, as well as fragile conditions in most other states hosting significant numbers of Palestinian refugees, the trauma of the lived reality of Palestinians is increasingly becoming a topic of consideration anywhere issues of justice and equity are concerned, including in medical and public health communities.
Despite accelerating efforts at repression for those advocating for Palestinians, it is becoming increasingly difficult to argue that starving, maiming, attacking, and displacing an entire group of people, purportedly because of the actions of some members of that group, is a justifiable form of warfare. In medicine and public health, we have paid increased attention to the role of social, political, and economic determinants in recent years, recognizing we cannot untangle the realities of people’s lives from their health. Similarly, we cannot improve the health of refugees—whether they were displaced from Palestine nearly eight decades ago or from Syria eight years ago—without contending with the issues that created their displacement to begin with.
In 1948, a UN mediator working in the region and witnessing the mass displacement of Palestinians warned, “It would be an offence against the principles of elemental justice if these innocent victims of the conflict were denied the right to return to their homes” (Boling, 2001). It is this ongoing delay of justice that is the largest cause of poor physical and mental health in Palestinians, and justice is the only remedy.
Footnotes
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.