Perpetual crisis: Health conditions for Palestinian refugees in Lebanon

Next year, Palestinian refugees in Lebanon will mark 70 years of displacement as a result of the Nakba when, in 1948, 700,000 Palestinians were expelled from or fled their homes at the hands of militias during the creation of the state of Israel. Around 100,000 took refuge in Lebanon.

More Palestinians were displaced to Lebanon by the war of 1967, events in Jordan in the 1970s, and the ongoing conflict in Syria.  Of the surviving refugees and their descendants, still blocked by Israel from returning to their homeland, more than half live in 12 official camps and other ‘gatherings’.

Despite up to seven decades as refugees in Lebanon, Palestinians have seen neither an increase in their economic, social or political rights (such as employment and property rights), nor the area of the camps where they are permitted to build. This means that many camps are dangerously overcrowded, and infrastructure such as sewage and water systems has been unable to expand to meet the increased demand of the population.

Earlier this month, MAP’s Advocacy and Campaigns Team were in Lebanon to assess the health and living conditions for Palestinian refugees living there. One issue discussed repeatedly by Palestinians was the problems caused by the Lebanese government’s continuing prohibition on their access to professions, currently 39 of them – including many jobs in medicine, engineering and law. These restrictions contribute to the high unemployment rate amongst Palestinian refugees: 23% (52% among Palestinian refugees from Syria), with most of those with jobs self-employed and working as labourers. The rate of poverty is incredibly high, and 65% among Palestinian refugees from Lebanon and 90% among those who have fled Syria.

With corresponding high levels of poverty, many Palestinians cannot afford to undertake medical training, and in some cases – such as midwifery – courses are taught in French as a second language, rather than the English which Palestinians learn in UNRWA schools.

Staff in hospitals and medical organisations explained to us that these and other challenges not only  hold Palestinians back from working in the Lebanese healthcare system, but also threaten the viability of healthcare provision for Palestinian refugees. At the Haifa Hospital in Burj al Barajneh Camp – the key secondary healthcare centre for Palestinian refugees in Beirut, run by the Palestinian Red Crescent Society (PRCS) – we heard that their youngest doctor is 45 years old.

Aside from the employment issues, perpetual displacement and a lack of political resolution means that Palestinian healthcare remains in a state of continuing crisis in other ways, too. We heard about regular stock shortages for medicines and equipment in PRCS hospitals, and the high cost of healthcare in the Lebanese health system.

The cost of healthcare means difficult decisions for refugees. Sitting with us in the single, dark and damp room in Beddawi Camp near Tripoli in north Lebanon that was all they could afford, one grandmother who had fled Syria told us that they had been forced to prioritise healthcare for their children – one of whom has a developmental disability – at the expense of treatment for her own pre-existing heart condition.

There is, of course, a direct link between poverty and physical and mental health. A study by UNRWA and the American University of Beirut  recently found that Palestinian refugee households living in extreme poverty are nearly twice as likely to have a family member with a disability, and that impoverished families are significantly more likely to have a member with a chronic disease. This relationship is likely cyclical: conditions of poverty (such as limited access to sanitation, poorer housing) are likely to cause ill-health, and ill-health itself creates a financial burden on families which can drag them into poverty. This latter point was bolstered by another UNRWA finding that households with more than one illness have higher expenditure on healthcare.

As well as meeting researchers, NGOs and others, we had an opportunity to see for ourselves the vital work MAP is doing to support Palestinian refugees in Lebanon. We sat down with MAP’s team of community midwives to hear how their unique service – providing check-ups and health advice for pregnant women, new mothers and at-risk babies – is helping to improve health through increased breast feeding, referral for specialist care, and better nutrition. Their successes demonstrate just how much can be achieved through direct international action to bolster the right to health of Palestinians. It is literally life-saving work, and we are grateful to all of you who support it.

MAP’s projects continue to do transformative work in increasingly challenging circumstances. Meanwhile, in the lead up to the 70th anniversary of the Nakba in May next year, MAP will be researching the health and healthcare needs of Palestinians, and advocating for wider international action to ensure the realisation of Palestinian refugees’ rights to health and dignity.

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