New research has uncovered the hidden health toll that refugee life in Lebanon has taken on more than 400,000 Palestinians.
UK medical journal The Lancet has published a series of abstracts drawn from a meeting of public health researchers, The Lancet-Palestine Health Alliance, in Beirut in March 2012. The Alliance aims to "strengthen and expand the capacity of Palestinian scientists to study, report and advocate for the health of their own people," explained Richard Horton, The Lancet’s editor-in-chief.
While much of the research investigates the negative physical and mental health impacts of living in the occupied Palestinian territory, several studies also explore the health and well-being of Palestinians living in Lebanon, which has hosted Palestinian refugees for more than 60 years.
Poor living conditions
According to one of the studies, by researchers from the American University of Beirut, “discriminatory laws and decades of marginalisation” have left Palestinian refugees in Lebanon socially, politically and economically disadvantaged. Over half of them live in increasingly overcrowded camps, where “the provision of housing, water, electricity, refuse and other services are inadequate and contribute to poor health”.
Out of 2,500 households surveyed, 42 percent had water leaking from their walls or roofs, and 8 percent lived in homes made of dangerous building materials such as asbestos.
Hoda Samra, a spokesperson for the UN Relief and Works Agency for Palestinian Refugees (UNRWA) in Lebanon, said many refugees live in shelters lacking ventilation and daylight. While about 5,000 shelters are in need of rehabilitation, the agency has funding to repair only 730. Samra added that there is also a lack of funding to address rundown infrastructure in four out of 12 of the camps.
Camp populations continue to grow but the land allocated for them has not; the resulting overcrowding has exacerbated public health problems.
“Some of the camps are growing vertically but not horizontally,” said Samra, noting that many of the structures were built haphazardly, too close together and without proper foundations.
The study found a direct correlation between poor housing conditions and poor health among respondents; 31 percent had chronic illnesses and 24 percent had experienced acute illnesses in the previous six months.
Poverty and illness
The researchers also found a strong link between poverty and ill health. Palestinian refugees living in Lebanon are ineligible for social services, including healthcare, and they are banned from some 50 professions. UNRWA and the International Labour Organization have lobbied the Lebanese government to ease employment restrictions, but amendments to labour legislation enacted in August 2010, which would make it easier for refugees to secure work permits, are still awaiting an implementation decree from the Department of Labour.
According to another study in The Lancet series, also by researchers from the University of Beirut, 59 percent of refugee households live below the national poverty line; 63 percent reported some food insecurity, while 13 percent were severely food insecure. Only the poorest - about 13 percent - qualify for food rations and small cash grants from UNRWA.
The combination of poor nutrition, unhealthy living conditions and feelings of hopelessness breed "all kinds of illnesses", said Samra. But while primary health care is freely available through UNRWA's clinics, and patients referred to UNRWA-contracted hospitals are treated free of charge, specialized care is only partially covered. Refugees in need of complex surgery or treatment must foot at least half of the bill themselves.
"This is a big, big challenge for them," said Samra. "They often find themselves unable to cover the rest of the bill and have to run up debts they can’t repay or simply forgo surgery or treatment."
She spoke of an 18-year-old in need of a liver transplant that costs US$95,000, which neither he nor UNRWA can afford. "We can't cover that. We're trying now to approach some private sector companies to collect the funds needed."
Need for mental health care
Lack of mental health services presents another challenge. A 2009 study by UNRWA, also published in The Lancet, found that mental disorders related to chronically harsh living conditions and long-term political instability, violence, and uncertainty were a public-health concern among Palestinian refugees living in Syria, Jordan and Lebanon. One of the recent University of Beirut studies found that 55 percent of respondents were "psychologically distressed".
UNRWA offers only basic counselling services, referring refugees in need of psychosocial support to NGOs such as Médecins Sans Frontières. "We’re always pushing project proposals for mental health services to donors with the hope they get funded; there is a need," said Samra.
"When taken together,” writes Lancet editor Horton, “these data expose the hidden crisis facing Palestinian refugees, whose health needs have been sorely neglected.”