This operational guidance note is anchored on the principles of universal health care for all persons of concern fleeing the ongoing conflict in Syria and in need of international protection in Lebanon. However, with a rapidly growing refugee population and limited funding we propose: o to prioritize public health interventions, o to focus on those that impact a large proportion of the refugee population, o to concentrate on diseases and conditions that have the potential to result in significant morbidity and excess mortality and o to ensure the most vulnerable refugees have access to health care in a highly complex and expensive health care system. The Lebanese public health care system is based on cost-sharing and for all services provided through the Ministry of Public Health and the Ministry of Social Affairs. A minimum contribution of LBP 10,000 is levied per visit in a primary health care facility. Public secondary and tertiary health care institutions are semi-autonomous and charge often commercial rates. Till April 2013, UNHCR and its partners provided extensive subsidized health care package, regardless the socio-economic status of refugees. The use of secondary and tertiary health care services by a small number of refugees accounted for a significant proportion of health care expenditure to the detriment of funding preventive primary health care services and urgently needed reorientation. This policy guideline outlines a shift in focus from secondary to universal access to primary health care integrated within the national framework. UNHCR’s overarching goal is to ensure that refugees access primary health care services that are scientifically sound, effective and available at a cost the that the refugee population can afford while being sustainable.