As fighting continues to escalate in the Gaza Strip, so too does a catastrophic humanitarian crisis that's left millions in a tightly populated region without food, water or access to medical care.
One agency continues to dominate headlines when it comes to voicing the size and shape of that crisis: UNRWA, formally known as the United Nations Relief and Works Agency for Palestine Refugees in the Near East.
The U.N. group is the "last remaining lifeline for the Palestinian people in Gaza," according to Philippe Lazzarini, the agency's commissioner. But he has also said it's perched "on the verge of collapse," struggling to carry out operations as Israel's total siege over the territory continues to sap resources.
Here's an overview of the organization, its history and what it's doing now.
What is UNRWA and why was it started?
UNRWA was formally established in 1949 by U.N. resolution and tasked with carrying out direct relief to 700,000 Palestinians who were displaced by the Arab-Israeli war of 1948.
For over 70 years, the U.N. General Assembly has continued to renew UNRWA's mandate, instructing the agency to provide health care, housing and financial assistance to Palestinian refugees throughout Gaza, the West Bank, Jordan, Syria and Lebanon.
Before the latest conflict began, education made up the bulk of UNRWA's funding, with the agency running schools for half a million school-age children.
UNRWA's services are available to those who are registered as a Palestinian refugee, which the agency defines as a person whose "normal place of residence was Palestine during the period 1 June 1946 to 15 May 1948, and who lost both home and means of livelihood as a result of the 1948 conflict."
The descendants of male Palestinian refugees, including adopted children, are also eligible.
According to the agency's website, more than 5.9 million people are currently registered under that criteria, including roughly two-thirds of the estimated 2.3 million people living in Gaza.
As of last month, the agency said it employed more than 13,000 aid workers, including refugees themselves, in the Gaza Strip alone. Those workers operate more than 150 permanent and temporary shelters and run 80 mobile health teams, including some that have been damaged or destroyed in the most recent conflict.
Who funds UNRWA?
While the U.N. continues to give UNRWA a mandate to provide services to refugees, it doesn't guarantee the organization much funding to deliver on that mandate.
Over 90% of UNRWA's funding comes from "voluntary contributions" from U.N. member states, according to recent financial data. The agency says it received over $1 billion in total pledges last year. With a contribution of $344 million, the U.S. was the largest individual donor in 2022, followed by Germany and other European countries.
For many of these countries, the incentive for funding UNRWA is maintaining a sense of stability in the region, said Anne Irfan, a lecturer at University College London who studies the international refugee system.
"Historically, the primary concern, certainly on the part of the U.S., was that Palestinian refugees might be susceptible to communist recruitment," she told NPR in an interview last week. These days, some politicians have swapped the word "communist" for "terrorist," the official U.S. designation for Hamas fighters. But the rationale remains similar.
Irfan compared it to the Marshall Plan, the U.S. policy of providing financial aid to Western European countries following World War II.
But over time, support for the strategy has, at times, given way to political pressure.
In 2018, the Trump administration withheld millions of dollars in aid funding for UNRWA and other Palestinian aid groups. Administration spokespeople said the holdup would pressure UNRWA to undergo reform, but the then-president tweeted that the cuts were related to Palestinian leaders refusing to "talk peace."
Under the Biden administration, the U.S. has resumed funding for UNRWA and other Palestinian aid groups, but has also seen that aid criticized by congressional Republicans, creating a permanent layer of uncertainty for UNRWA's operations.
Even before the latest war broke out, UNRWA's funding was so unstable that it put the agency at risk of unraveling, according to a report from the International Crisis Group, a nonprofit think tank that advocates for resolving armed conflict.
What is UNRWA saying about the war?
On Oct. 7, Hamas-led militants crossed from Gaza into southern Israel, killing about 1,200 people and taking over 240 hostages, according to counts from Israeli authorities.
Israel has responded with a total siege, heavy bombardments and a ground offensive in Gaza that have left more than 11,000 Palestinians dead and many more displaced, according to Gaza's Health Ministry.
When it comes to the latest conflict, UNRWA is not solely administering aid to those that remain in the territory, but also actively trying to get more of that aid into Gaza.
Israeli defense forces have closed all but one border crossing into Gaza and are imposing strict limits on what can pass through out of concerns that Hamas, which rules Gaza, might co-opt the supplies to further its own fighting.
An average of 30 trucks a day have passed through the Rafah border crossing with Egypt since the first aid trucks entered Gaza on Oct. 21, but UNRWA says that's nowhere near what's needed to meet demand.
The agency has placed a special emphasis on the lack of fuel, which it says is needed to power generators for everything from hospitals to water treatment plants.
In a more big-picture sense, UNRWA has backed a call for an "immediate humanitarian cease-fire," a permanent cessation of violence to stop what it called the "horrific" and "unacceptable" killing of civilians.
Among the fatalities in over a month of war in Gaza are at least 99 UNRWA aid workers, the agency's commissioner said at an international conference on Thursday.
"That's the highest number of U.N. aid workers killed in such a short amount of time," Lazzarini said.
And UNRWA officials confirmed to NPR on Wednesday that at least one-third of the staff were killed south of the Wadi Gaza line. Israeli leaders had told civilians in Gaza to relocate to that southern area for safety as they stepped up attacks in northern Gaza.
What's UNRWA's relationship with Israel?
Israel affirmed UNRWA's ability to operate in Gaza with "the full co-operation of Israel authorities" in a 1967 agreement.
Its commitment to that agreement is "begrudging" but necessary, as Irfan, the University College London scholar, describes it.
"On the surface, Israel is really critical of UNRWA," she said. But behind the scenes, "they see it as preferable to the alternative. UNRWA provides the services which would otherwise come under Israel as the occupying power."
Following a deadly round of fighting in 2007, Israel implemented a strict land, air and sea blockade on Gaza, which not only limited the region's economic prospects but has severely limited the inflow of basic goods like food and medicine over the last decade and a half.
Even before the latest war broke out, the aid that UNRWA was delivering was "in some cases, really basic, essential stuff," Irfan said. "It's water rations or food provisions — stuff we would probably consider emergency relief."
But Israeli politicians, including current Prime Minister Benjamin Netanyahu, have at times called for UNRWA's dismantling, saying that the agency does the work that should be done by a government that includes elected Hamas officials.
"Israel regards UNRWA as part of the problem," said Ahron Bregman, an Arab-Israeli relations scholar with the King's College in London. "With UNRWA support to Palestinian refugees — feeding them, educating them, providing them with health facilities — Hamas is free to fight."
Bregman told NPR over email that a common grievance among Israeli politicians is that UNRWA regards the children of Palestinian refugees as refugees themselves, which has increased the number of dependents treated by the agency over time.
As a former director with the agency pointed out to NPR, that policy is consistent with how other U.N. organizations treat refugees around the world.
"UNRWA is not a political organization," Scott Anderson, the then-director for the agency's West Bank operations, said in a 2018 interview with NPR. "It's part of the social fabric that exists in Gaza."
NPR's Ruth Sherlock contributed reporting to this story.
