A healthcare system under strain

"I am sorry but the medication you see is not for you, it is for the Syrian refugees", says a Lebanese nurse with a shrug, and waves the Lebanese patient away. Loud protest and raised voices fill the room.

Until recently this has been a common situation in healthcare centres across Lebanon, which are struggling to deal with the effects of the Syrian crisis. Supplies are short and medication for the Syrian refugees is more regularly in stock than that for the locals.

This time, however, the situation is acted out. The scene unfolds during a three-day training for healthcare workers organised by International Alert as part of our Promoting Conflict-Sensitive Aid project funded by the European Union, aimed at increasing health workers’ understanding of the tensions in the waiting room and strengthening their skills to work in crisis situations.

The trainings, which covered conflict mitigation, stress management and communication skills for health workers, were held in December and January in four different locations across Lebanon. Most of the participants were nurses and receptionists, but a few clinic directors have also found the time to join.

Participants were able to share their experiences and discuss some of the issues they face on a daily basis. Many of the tensions they encounter are related to the presence of Syrian refugees: health workers are under increased pressure, working longer hours, and facing situations where they need to intervene in arguments between Lebanese and Syrian patients.

The causes of these tensions vary from competition over aid, jobs and public services, to deeply ingrained negative attitudes. The health workers attending our trainings tried to identify how they can play a more positive role in this complex environment. Through a role-play exercise (pictured above right), participants played out the concerns they faced, and shared personal solutions and tips on how to deal better with certain situations. In the discussion following the exercise, they discussed the importance of clear communication, flexibility and patience.

The second and third days of the course focused on improved communication and dealing with stress in the workplace. Participants in the Beqaa region, which is facing the highest number of Syrian refugees – given its proximity to the Syrian border – participated in an active listening exercise (pictured left) with great results. The first group was told to pretend to listen to the second group, which was telling them a story, while in the next round the second group was told to listen carefully to what the first group had to say. Participants overwhelmingly noted the positive impact that active listening could have in their day-to-day work. As one participant said: “I was surprised when the person in front me was listening to my story and paying attention, given I had ignored him in the first round. It makes such a difference and made me feel appreciated and respected.”

There was an overall consensus among participants that healthcare staff get very little time to build their capacity in reflecting on and addressing existing tensions in the workplace. “This training has been interesting and useful for me”, said a receptionist at a health centre from south Lebanon. “I think it is also important for directors of health centres to attend this training, in order for them to be made more aware of these issues we are facing as frontline staff, [which are] affecting our wellbeing at the workplace and our performance.”

To build further upon the trainings, two months after each session the groups will reconvene to share their observations and experiences in dealing with tensions and stress in the waiting room since.

The trainings are part of Alert’s work on improving the conflict-sensitivity of humanitarian aid and healthcare services related to the Syrian refugee crisis in Lebanon. This involves training and supporting health and humanitarian organisations in implementing their programmes and providing services in a way that helps decrease the tensions between Syrian refugees and the Lebanese host communities.

Our work is part of a larger EU-funded project on reducing tensions in Lebanon through improved healthcare, led by the national Ministry of Public Health and implemented by the UN Refugee Agency, in partnership with the World Health Organization, UNICEF, International Relief and Development, and International Alert.

You can find out more about our work on this issue here.