Lebanon : Provision of emergency mobile primary health care services for Syrian refugees in the south of Lebanon
More than 2.5 million Syrians are now hosted in Lebanon, Jordan, Egypt, Turkey and Iraq, placing unprecedented strain on communities, infrastructure and services in these countries. There has been a massive escalation of the crisis in the past 12 months, with 70% newly registered as refugees during this period. The highest number, 945,461, are hosted in Lebanon. With ongoing violence and a worsening humanitarian crisis inside Syria this figure is predicted to rise to 1.65 million by December 2014.
To date 114,000 refugees are registered in the south of Lebanon, with 2,000 more awaiting registration (there is currently a one week processing period, except for cases classified as health and/or social emergencies). However, the situation is changing rapidly: the UN Refugee Agency (UNHCR) is reporting the secondary migration of refugees from the north, as there is less overcrowding in the south, cheaper accommodation and a relatively more stable security situation.
Women and children under five years of age constitute 70% of the refugee population, the vast majority of whom are completely dependent on humanitarian aid, arriving in Lebanon with little more than the clothes on their backs.
Living Conditions Of Refugees
The host communities in Lebanon are those characterised by the highest levels of poverty and deprivation even prior to this crisis. Competition for already limited social services and jobs against a background of rising inflation and security concerns is already reaching critical levels.
In the absence of properly established camps the early refugees were fortunate enough to find themselves shelter in rented accommodation, with host families or in the already overcrowded Palestinian refugee camps. However, as numbers have increased and prices have escalated these options have largely been exhausted. Increasingly the new arrivals are forced into small, informal “tented settlements” or to squat disused buildings. These improvised shelters are often substandard, with limited or no water or sanitation facilities, and located in areas prone to flooding and at risk of fires. The fact that refugees are so widely dispersed within host communities creates difficulties in terms of access and coordination, placing greater emphasis on community based outreach activities.
Partially built apartment blocks in Saida where refugee families are squatting
Many refugees have been hugely traumatised by their experiences in Syria and subsequent escape. They have no personal possessions or the means to purchase them. Within such a vulnerable population there are particular concerns for women and young children, the elderly, persons with disability and those with existing health problems.
Conditions in a couple of tented settlements in Tyre
Health Services For Refugees
UNHCR is subsidising the cost of primary health care (PHC) for registered refugees using pre-selected government and NGO health providers. However, refugees still have to make a variable contribution to the cost of this care and accessing services remains difficult because of the distances involved and cost of transport. Furthermore, the availability of medication for chronic diseases (eg. diabetes, heart disease) is extremely limited and even simple acute treatments are not always available.
For those patients with life threatening conditions, subject to approval by GlobeMed Lebanon (the recently appointed “referral contractor”), UNHCR will also cover 75% of the cost of secondary care at pre-selected hospitals (100% if the patient is classed as “vulnerable”). However, this still leaves the refugee having to cover 25% of the cost of life saving hospital treatment, and non-emergency cases are not covered at all.
Refugees queuing for food vouchers in Saida
In collaboration with a local partner NGO, Blue Mission, our project began in April 2014. The key objectives are:
- To prevent avoidable death, disease and disability through the provision of high quality, outreach PHC services
- To specifically address the essential health needs of women and young children
- To address emerging public health threats through the delivery of health/hygiene educational programmes and active disease surveillance
We have staffed and equipped a mobile clinic to provide outreach PHC services for a widely dispersed target population of refugees and members of host communities in Saida and Tyre, south Lebanon. Target sites are a mix of tented settlements, improvised shelters and disused buildings. To improve coordination and avoid duplication these sites have been agreed with UNHCR and the limited number of other emergency health care providers in the region.
The mobile clinic operates from 0800 to 1400, five days a week, visiting at least two target sites each working day, returning to each target site at least once every two weeks (according to a schedule agreed with beneficiaries and advertised using all available means. Community mobilisers have been recruited from the refugee population to improve coordination, help organise all health and related activities, and increase beneficiary ownership of the project. Although services are targeted at refugees we do not refuse care to any member of the host community who attends. Patients requiring further investigation and/or specialist assessment are transferred to PHC centres in Saida and Tyre, with onward referral to secondary care as necessary.