Unipol, one of the largest insurance groups specialized in healthcare protection in Italy, will provide humanitarian assistance to forcibly displaced people in Lebanon through UNHCR, an ideal implementing partner given its leading role in addressing the Syrian crisis. This will be done by contributing a cash donation to provide treatment for emergency and lifesaving secondary and tertiary healthcare, including diagnosis and treatment performed in specialized hospitals or health centers to an estimated 319 Syrian refugees in 2016 and 2017. The average cost of delivery and lifesaving procedures is $630 per patient.
The health system in Lebanon is highly privatized and many refugees are unable to afford its services. Rather than establishing new services, UNHCR will offset costs of medical care to ensure that Syrian refugees can access quality public healthcare. UNHCR will provide 75% of hospitalization fees and refugees will cover the remaining 25% of the costs for treatment for normal and caesarian deliveries, and life-threatening and emergency interventions, including hospitalization costs and surgeries. Moreover, UNHCR will contribute to 90% of the hospitalization cost for refugees assessed as being severely vulnerable, as well as infants and children in need of intensive care.
Treatment will be provided through referral to a network of hospitals with which UNHCR has established agreements. Applicable rates, and whether the patient will pay any costs, will be determined by the Ministry of Public Health. This network will be constantly assessed and adapted to ensure adequate quality of care and sufficient coverage for the growing number of cases. UNHCRs support for lifesaving and emergency health care is in line with the overall strategy established by the National Public Health and Nutrition Sector working group led by UNHCR and the World Health Organization (WHO) under the overall leadership of the Ministry of Public Health. UNHCR will implement, monitor and evaluate the implementation through public health staff assigned to its main office in Beirut as well as its field offices.
Unipol will also provide in-kind support to UNHCR, and will implement a communication, awareness and fund-raising campaign in Italy targeting Unipols clients, employees, shareholders, as well as the Italian public. In times of forced displacement, advocacy is key to influence the public to adopt practices that ensure the protection of those in need, which is particularly true in countries like Italy given its geographical location as a host of refugees. With approximately 15,000 employees, 3,000 promoters and over 16 million customers thanks to its vast network of agencies, Unipol will give UNHCR the opportunity to reach a widespread audience at no cost. UNIPOL will therefore play an essential role to help UNHCR complete its critical work.
In addition, clients subscribing to Unipol life insurances will be given the option to indicate UNHCR among their beneficiaries, providing a key fundraising opportunity to UNHCR. In Italy, many people choose not to write a will as it is a complicated and expensive process, and life insurance policies offer an alternative to reach the same purpose of a legacy as a will but in a much more flexible, cheap, and safe way. At the same time, premiums of the policy are tax deductible and the assets at the end of the contract are tax free and not reclaimable by the heirs which makes life insurance policies a valuable fundraising tool.
Starting in September 2016, and throughout the duration of the commitment, Unipols contribution will allow UNHCR to support lifesaving and emergency healthcare for refugee patients. To ensure the most effective use of donor funds, UNHCR uses a third party administrator (TPA) to administer and audit medical and financial services provided by contracted hospitals. The pathway to access hospitalization services follows the below steps: 1) the patient goes directly to the hospital or is referred through his doctor and contacts the TPA, 2) TPA approves the admission to the contracted hospital if the patient is eligible and within standard operating procedures, 3) cases less than $1,500 are approved by the TPA medical consultant, 4) cases exceeding $1,500 are considered exceptional cases and are submitted to UNHCR Exceptional Care Committee (ECC) for review. The ECC is composed of UNHCRs Senior Public Health Officer, and three independent health professionals, who carefully examine each referred exceptional case for approval of coverage. The decisions of the ECC are primarily based on the prognosis, followed by cost considerations.
Between September 2016 and December 2017, a total of 319 Syrian refugees will have access to life saving and emergency healthcare in Lebanon, estimated to be 73 children and 246 adults. To harmonize access to secondary healthcare and manage costs, UNHCR has put in place referral guidelines and standard operating procedures (SOP) to support access to life saving and obstetric care.
The following emergency obstetric, medical and surgical interventions will be covered: normal and caesarian deliveries; neonatal intensive care, acute severe respiratory diseases in children and adults, infectious and parasitic disease, injuries, and poisoning.
In Italy, over the course of the commitment, several communication and awareness activities will be carried out by Unipol, such as a press conference, a field trip with Unipols Board members and employees in May 2017, and a final event in the Cubo exhibition center in Bologna in December 2017/January 2018 to share the commitments results.
The impact of the Syrian crisis has been profound on Lebanon, which is now hosting over one million registered refugees, as reported by the United Nations High Commissioner for refugees (UNHCR). With a national population of approximately four million people, Lebanon is currently host to the highest number of Syrian refugees in the world in proportion to its population size. As of June 2016, Syrian women constitute 52% of the total refugee population in Lebanon, and 25% are between 18 and 59 years old. The most recent assessment estimates that 23% of Syrian refugee households have either a pregnant or breastfeeding woman.
While it is not a country party to the 1951 Geneva Convention relating to the Status of Refugees, access to the country was largely unrestricted and Lebanon generously welcomed Syrians refugees until October 2014, when the government gradually introduced residency restrictions for Syrians. No official camps have been established and refugees live throughout the country in over 1,750 localities.
Refugees in Lebanon have access to most basic services through public institutions which places significant strain on government agencies and organizations supporting refugees. Without adequate access to health care, refugees health can be compromised by the often difficult and traumatic experiences they faced in Syria and during their flight, as well as from complications arising from the extremely poor conditions in which most of them live. Although the Government of Lebanon has permitted refugees to access health services and a wide network of health providers is available, affordability is a significant barrier to health care for refugees and other displaced populations. Health services in Lebanon are largely privatized and based on user fees. This is particularly challenging at a time when refugees are struggling to meet even their most basic needs. Five years after the start of the war in Syria, most refugees savings are exhausted, their ability to find work is limited, and humanitarian assistance has dwindled due to a shortage of funds. According to a 2015 UNHCR, UNICEF, and WFP study, nearly 90% of Syrian refugees in Lebanon are in deepening debt and 70% are living below the national poverty line of $3.84 per day.
According to the 2015 Vulnerability Assessment of Syrian refugees in Lebanon, 31% of refugees surveyed said that at least one member required secondary health care. An alarming 78% of refugee households could not access required secondary health care because of the high costs. According to the 2015 UNHCR report, Referral Care at a Glance, refugees primarily seek care for pregnancy and childbirth, as well as respiratory diseases, infectious and parasitic diseases, neonatal and congenital diseases, injuries and cardiovascular conditions.
UNHCRs resources are not able to meet all hospitalization needs for Syrian refugees in Lebanon. In 2016, UNHCR estimates that $52 million is required to support access to 99,000 secondary health care interventions. As of August 2016, 16 % of the total funds received by UNHCR Lebanon were earmarked for secondary health care intervention. Without sustained humanitarian support, access to lifesaving and emergency hospital care for refugees will decrease and avoidable deaths will increase.