The Sahrawi health system offers good access and coverage in terms of primary health care, with 31 dispensaries, four regional hospitals and two central hospitals. All Sahrawi refugees (100 per cent) enjoy free access to primary health-care services. The Sahrawi health system is well organized and exclusively implemented by the community itself but it depends heavily on humanitarian aid and therefore needs constant financial and technical support to guaranty its sustainability and efficiency. Brain drain and demotivation of staff (in 2018 four medical doctors and 14 nurses left the health system), precarious health infrastructures and medical equipment, lack of medicines (only 70 per cent of essential medicines is covered) and weak logistical means are the main impeding factors of the local health system.

In light of the above and taking into account the epidemiological transitions currently happening in the whole region, the overall health status of the population continues to be fragile and at risk of being unsatisfactory; hence, constant attention and continuous support are needed to maintain the stability of the public health situation.

As a comprehensive response to the above, UNHCR plans to tackle issues related to human resources by contributing in the motivation of health staff by paying incentives, improving working conditions in health structures and ensuring continuous capacity building for the staff.  In terms of material resources, UNHCR will provide logistical support to health programmes in order to ensure regular field outreach activities and monitoring. In order to avoid the recurring breakdowns of medical equipment, connection to the electricity network will be improved in Dakhla and Awserd camp hospitals and maintenance of solar panels will be provided in Laayoune camp health structures. All hospitals will be provided with cleaning items and sanitation conditions will be improved. UNHCR will also implement the final phase of equipping all health centres with air-conditioning and diagnosis kits. The second phase of upgrading Boujdour hospital to a level 2 hospital will be implemented and the road leading to Dakhla camp hospital will be paved. UNHCR will also cover all needs related to auxiliary services (laboratory, medical imaging and dentistry care) and cover the gaps related to medicines (30 per cent) and will support the biological waste management by ensuring the maintenance of incinerators in regional hospitals. In terms of health care delivery, prevention and information/communication, UNHCR will contribute to the strengthening of the implementation of the main programmes by providing support in terms of incentives and logistics, and will continue supporting multidisciplinary health commissions coming from abroad as well as the specific referral system destined to patients in need of haemodialysis in Tindouf and palliative care in Algiers.

As a matter of priority, UNHCR will focus on covering critical interventions with direct impact on the overall health status of PoCs. UNHCR will therefore continue to cover incentives of 43 Sahrawi medical doctors, PISIS staff (200) and health technicians under auxiliary services (47); cover 100% of expressed needs under HIS project and auxiliary health services (laboratory, X-ray and dentistry care); support the medical commissions coming from abroad, strengthen referral system in the five camps with special attention to patients in need of haemodialysis and palliative care in Tindouf and Algiers; provide capacity building for health staff and training of skilled midwives and nurses, as well as the reinforcement of the weakest health infrastructures in terms of electricity connection (Dakhla, Laayoune and Awserd camps regional hospitals), provide cleaning items to all regional hospitals and continue the implementation of the final phases of upgrading the Boujdour camp hospital and equipping health structures with air conditioning.