In 2012, the Ministry of Health issued a decree providing Syrian refugees access to public primary healthcare facilities at the same level as Egyptians. As a result, any Syrian can access public primary healthcare services in Egypt. Under the auspices of the Ministry of Health, humanitarian partners in the health sector have developed a mainstreaming strategy to integrate Syrian refugees into public health services. This has included efforts to strengthen existing national health systems, upgrade services in refugee-hosting areas, and scaling up community outreach to facilitate access and awareness of available services.

Despite these efforts, health facilities in areas hosting a high concentration of Syrian refugees are overstretched. It has been noted that the affected quality of health services remains a central barrier to refugees’ utilization of these services. Further, Syrian refugees experience a high incidence of chronic disease, such as diabetes and hypertension, and other health issues not comprehensively covered by primary healthcare in Egypt. Additionally, the 2012 decree did not tackle costs for emergencies and life threatening conditions, the high cost of secondary and tertiary health care services and the relative burden of chronic disease management expenditure, which are primary constraints for UNHCR.

Syrian refugees have significant health needs with a high prevalence of chronic conditions including hypertension, diabetes mellitus, and disability and cardiac diseases. Meanwhile, humanitarian resources to provide financial support for complex and acute needs are limited, with priority given by UNHCR to life-threatening conditions. 

In 2015, some 1,000 emergency life-saving cases were supported by UNHCR and partners. There is a pronounced need for emergency and secondary care services as well as a standardized, timely and effective referral service to be put in place, particularly for emergency care.
The mainstreaming strategy put forward by UNHCR to integrate Syrian refugees into public primary health care facilities and to gradually phase out from parallel health care services with a view to enhancing resilience and sustainability has improved Syrian refugees’ access to public primary healthcare preventive and curative health services. Nevertheless, the substantive deterioration in the quality of health care services in Egypt is a key challenge.  Furthermore, the wide geographical spread of Syrian refugees in the country creates many operational challenges related to standardization of monitoring and evaluation, Health Information Systems and treatment protocols.

UNHCR and the Ministry of Health signed a Memorandum of Understanding (MoU) in January 2016 to enhance access of refugees to public primary health care and emergency care services on equal grounds with Egyptians. UNHCR will continue to work closely with the Ministry of Health for the operationalization of this memorandum of understanding, with a focus on the hospitals and facilities in areas with high concentration of refugees, with a view to overcome barriers, enhance the technical and operational capacity of these facilities, as well as monitor and improve the quality of the health care service provided for refugees and the host population.

In 2017, UNHCR will sustain a central referral mechanism that provides cost-effective services within a comprehensive network of mainly public hospitals and medical facilities. UNHCR will also continue to use the HAUS (Health Access and Utilisation Survey) to understand the barriers and obstacles to access health care among Syrian refugees to inform, plan and monitor a multi-year strategy.