Peer-reviewed article
Age trajectories of infant mortality among Palestinian refugees born in 2010–2020: evidence from electronic health records
Selin Köksal, Yu Chen, Zeina Jamaluddine, Seita Akihiro, Francesco Checchi et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This study used electronic health records from UNRWA to estimate how many Palestinian refugee children born in 2010–2020 survived to age 1. Overall survival to age 1 was 98.64%, with small differences by sex and larger differences by place and gestational age. Very preterm babies had far lower survival than term babies. The authors argue that electronic health records can help monitor child deaths where reliable data are scarce, such as in forced displacement settings.
Key points
- Overall survival rate to age 1 was 98.64%, slightly lower for males (98.57%) than females (98.68%).
- West Bank refugees had the lowest infant mortality (99.08% survival) and Jordan refugees the highest (98.22% survival).
- Survival to age 1 was 98.85% for term births and 73.32% for very preterm births.
- Survival was 98.78% for births up to 2015 and 98.42% for births after 2015.
- This is described as the first study to assess the data quality of these UNRWA electronic records and to estimate age trajectories of infant mortality for Palestinian refugees.
Limitations
Only the abstract and summary boxes are available, so details on data quality, missing records and the reasons for differences between settings and cohorts are not given. The data cover only refugees registered with UNRWA health services, so the results may not apply to other children.
Abstract
Abstract Objectives To estimate age trajectories of infant mortality among Palestinian refugees using electronic health records, addressing the scarcity of reliable mortality data in forced displacement settings. Setting Palestinian refugees living in Gaza, West Bank, Jordan, Syria and Lebanon. Design We fitted a Bayesian Negative Binomial model to observed death counts, using a flexible parametric function (a shifting power function) to capture the shape of the infant mortality curve, across strata to infer age trajectories of infant mortality. Participants Palestinian refugees born in 2010–2020 and registered with UNRWA health services in Gaza, West Bank, Jordan, Syria and Lebanon. The sample was stratified by sex, field, gestational age and birth cohort. Main outcome measures Survival rate to age 1. Results Overall, the survival rate to age 1 was 98.64%, with slightly lower rates for males (98.57%) than females (98.68%). Across settings, West Bank refugees had the lowest infant mortality (99.08% survival rate), and Jordan refugees had the highest (98.22% survival rate). Results by gestational age showed a 98.85% survival rate at age 1 among term births compared to a 73.32% survival rate among very preterm births. Survival rates by cohort (births up to 2015 or after) were 98.78% and 98.42%, respectively. Conclusion Our findings highlight the potential of electronic health records for mortality monitoring in forced displacement settings as they reveal consistent mortality trajectories by sex and gestational age, while identifying meaningful variation across refugee settings and subgroups. Summary boxes What is already known in this topic We searched PubMed and Google Scholar for articles published between Jan 1, 2000, and Feb 20, 2026, in English, using the terms “Palestinian refugees,” “infant mortality,” “neonatal mortality,” and “UNRWA.” We found a handful of studies estimating infant mortality among Palestinian refugees, mostly based on household surveys (eg, MICS, national statistical office surveys) or UNRWA surveys using preceding birth techniques. The preceding birth technique has notable limitations, including recall bias, small sample sizes, and selection bias. The majority of these studies focus exclusively on Palestinian refugees residing in Gaza. Estimates for Gaza suggest a sustained decline, from around 127 deaths per 1,000 births in 1960 to 20.2 per 1,000 births in 2006, with a slowdown thereafter and an increase in more recent years. A combined estimate (excluding Syria) across four settings where Palestinian refugees reside measures infant mortality at 18 per 1,000 births in 2011. What this study adds This study uses a unique data linkage bringing together UNRWA’s obstetric and child health records, providing more extensive information and a larger sample size than previous studies. This is also the first study to assess the data quality of these electronic records and to estimate age trajectories of infant mortality among Palestinian refugees. We developed a statistical strategy that estimated infant mortality trajectories covering all five UNRWA fields (Gaza, Jordan, Lebanon, Syria, and the West Bank) for children born in 2010-2020, and examined differences across subpopulations by sex, field, gestational age and cohort.