A global emergency
The Syrian refugee crisis is considered one of the worst problems facing the world since the WWII.
LEBANON, as a neighbour of Syria, has been in the eye of the storm that erupted in the beginning of 2011. Since then massive influx of displaced Syrians flooded Lebanon where current rough estimates indicate close to 1.5 million refugees live in Lebanon.
They are scattered over around 2,000 settlements and makeshift spaces all over the country. Estimates from UN agencies indicate that 1:4 is a Syrian refugee, the majority are women and children who are in growing need for livelihood support, health care, education, and protection.
Around my village, El Marj, meaning the meadow, refugees stay in six camps, the Baladieh camp being the largest. In addition, others stay in small rooms within local houses and apartments. Some spaces were made up by UNHCR, other spaces lacked basic livelihood items.
I run a community clinic in Bekaa region east of Lebanon within my village of 14,000 people which hosts close to 20,000 refugees. The main obsession of the women that I meet is to protect their children, as they mourn beloved children and family members that they have lost, and the lifetime of memories that they have left behind. They speak of their stay as temporary and returning to Syria is on their minds, always. There is no more sweeping gratification than being empathetic to people in need, these refugees are more than in need.
The government of Lebanon and the international and national agencies had mobilised available resources to cope with this humongous matter, notably focusing on health care across several domains:
- Maternal health received full attention with actions that covered antenatal care and hospital-based deliveries for most of the pregnant Syrian women. A minimal of 3-4 antenatal visits with proper workup and safe deliveries keeping indicators within safe range, with maternal mortality not exceeding average of 10 cases per year for close to 42.000 live birth. Issues of noncompliance and reduced visits were there due to financial and transportation reasons
- Adolescent marriage is another serious issue faced by young girls of refugee families. Trying to protect female children from sexual exploitation and for economic reasons, families would marry their daughters at very young ages (14-17), thinking they are keeping them safe from hardships of displacement and abuse
- Fertility and family planning was not high on the priority list like pregnancy care, especially that total fertility rate was believed to be rising along with growing gaps in unmet needs in family planning and cultural restriction on its use (male, religion, need to have more children to replace those lost in war). A study conducted by a team at the Faculty of Health Sciences published recently in RHM, showed that Syrian women and families wanted to have more children to make up for those lost in the war. Proper counselling on various types of contraceptives remains weak and UNFPA is supporting efforts to scale up birth control among Syrian refugees and host community towards SDGs 2030.
- Other reproductive health issues related to reproductive morbidity and cancer screening as well as midlife needs are not provided in primary health care for refugees at a wider scale. This is due to shrinking funds towards health issues as well as the priority health issues set by donors and the government
- Other important issues like violence and mental health are not receiving the attention needed despite few reports published and unpublished showing that women refugees felt concerned about harassment, abuse, rape, and did not feel safe in their spaces
The needs are however huge. Funds and resources promised by the international community are not really met and also are dwindling, making it difficult to provide new services and even maintain existing ones. UNFPA Lebanon is working with a Fund from the Canadian government to support contraception. Other NGOs are focusing on mental health support mainly for children and adolescents.
This crisis remains a global emergency. The grotesque status they are in is overwhelming. This is an emergency that has not only a health burden, but many other social, educational, and family short and long term consequences.
I strongly believe that being a doctor is being an agent of the poor and the needy and that’s what the philosophy of practice is all about.