Ensuring aid promotes peace not conflict in Lebanon

Waiting roomIn Lebanon, we help healthcare clinics and NGOs to ensure they don’t exacerbate tensions between the local population and Syrian refugees.

The small waiting room of the governmental health clinic in Chhime is filled with the usual buzz of a summer morning. A couple of Syrian families patiently wait to see a doctor or pick up their prescription drugs, the children busying themselves exploring the place. A Lebanese woman has also stopped by to collect her medication, provided by the Ministry of Public Health.

Over the past year Lebanese patients have slowly become a minority in many primary healthcare centres around Lebanon. Villages like Chhime, which host thousands of Syrian refugees, feel the biggest strain on public services.

"Today I have registered 10 Syrian patients and only one Lebanese," says Nurse Mona (pictured below), as she opens the thick registration books. She has one for Syrian refugee patients and another for the Lebanese. Clinics need to keep separate records of patients because of funding reasons.

"Before we used to have breaks and now we can’t breathe," explains Mona. The workload in the health clinic has multiplied over the months in parallel with the growing number of Syrian refugees. In July 2014, close to 1.5 million Syrian refugees were registered by the UN Refugee Agency (UNHCR) in Lebanon.

Nurse Mona registers Syrian patients

Many Lebanese are frustrated with the high number of Syrian refugees that have settled in their villages. "Syrians are taking over," complains one Lebanese patient. "There are more Syrians in my village now than Lebanese."

Yet the poor in Lebanon face everyday difficulties similar to those of the refugees: jobs are scarce, services are expensive and the dry winter is promising more severe water cuts. On top of all this, when they need a doctor, they now have to wait in a long line together with Syrian patients. "Sometimes Lebanese patients come, see lots of people waiting and leave. Many stopped coming altogether," says Nurse Huda, a head nurse in the Social Association Chhime, an NGO-run health centre in Chhime. "In order to keep the Lebanese patients, we fast-track them."

Longer waiting times are not the only reason that stops Lebanese patients from seeking help in the health clinics. "They are afraid of getting sick with scabies and other diseases," explains Huda. "There was a Lebanese woman with her kids coming the other day. They waited at the door and refused to sit in the waiting room together with the refugees."

Medical staff are increasingly aware that the Lebanese people who once used primary healthcare clinics now choose to go directly to specialised doctors. But specialised care is largely private and such choices come with a price tag. Some clinics are fast-tracking Lebanese patients, others are splitting the waiting areas, and there are even examples of doctors seeing Lebanese patients at separate times.

Nurses and doctors are also concerned that they cannot offer the same service to Syrian refugees and Lebanese nationals. Most clinics charge the refugees less than what they charge Lebanese patients, and refugees’ bills are partially covered by UNHCR.

"We only have medication for the Syrians," says Huda’s colleague, Nurse Iman, who is in charge of drugs distribution to chronically ill refugees. "Before we used to buy medication for the Lebanese and sell it to them at a lower price. Now we cannot do it because of a new regulation. If someone comes, we try to hide the medication we have [for the refugees]."

The different rules that apply to the refugee and host communities have exacerbated existing tensions.

To address these challenges, Alert is working with healthcare clinics and NGOs to ensure the services and aid they provide do not exacerbate tensions between the local population and Syrian refugees. You can find out more about this project here.

If you would like to support our work, please donate today.