Editor's note: This is the second in a three-part series looking at one of 2013's most undercovered stories: the effect of Syria's war on its fragile neighbor Lebanon. More than a million struggling Syrian refugees have fled there, swelling the country's population by 25 percent. This humanitarian crisis threatens to overwhelm a country trying to maintain peace after its own civil conflict.
TRIPOLI, Lebanon — Former Syrian opposition fighter Abu Yami endured much to get to Lebanon: the siege of his city of Homs. Shrapnel tearing through his body. Crawling wounded through a thousand-foot sewer pipe to avoid army checkpoints. Surgery in a field hospital. Transport through the frozen mountains of western Syria. Infection and amputation of his arm.
The hardest part was still to come.
Days after the amputation, Yami began working as a patient relations officer at Al Zahra hospital in Tripoli, Lebanon, where even the horrors of his past couldn’t prepare him for the difficulties facing Lebanese hospitals.
In the nearly three years since the war in Syria began, health-care workers across Lebanon have been overrun by waves of sick refugees. Hundreds of thousands of men, women and children living in squalid refugee camps have placed a weight on a system ill prepared for the influx. Now, doctors and administrators struggle to treat their new patients, allocating money and medicine that are both in short supply.
“They’re refugees. Of course they get sick and need help,” said Hasan Ghadban, a doctor at Amel Health Center in El Ein village in the Bekaa Valley. “Lebanon is a small country and can’t support a large number of refugees. A small country needs to breathe.”
The number of patients that pass through the doors of the clinic where Ghadban works has tripled since May of last year. The number of families in the surrounding village has increased by 1,400 percent, according to the director of the health center.
Many illnesses stem from conditions in the tent settlements that house most of the refugees: scabies, intestinal diseases and food poisoning.
Doctors described patients living in barns and eating expired food.
The United Nations High Commissioner for Refugees (UNHCR) had been providing free primary care, but budget shortfalls have recently forced the agency to institute a $2 fee. Though small, the sum is expected to prevent many refugees from seeing doctors and getting medication.
For emergency procedures, the UNHCR pays 75 percent of the cost, down 10 percent from earlier this year.
Ninette Kelley, the UNHCR representative in Lebanon, said that given the large number of refugees and the immense cost of supporting them, the UN has been forced to prioritize by focusing on the most urgent cases.
“We can only afford to subsidize life-saving treatment,” she said. “The increased demand is taking its toll in the standard of services for the Lebanese, but there are also great gaps in what the international humanitarian agencies are able to fund for the refugees.”
That means those dying from chronic illnesses often can’t get help. Kelley said, “People who need cancer treatments over prolonged periods of time, we’re simply not able to cover those kinds of interventions.”
Health-care workers have been forced to find alternative means of raising money.
Abu Yami, the opposition fighter who now works in Tripoli, said there was a time when operations were paid for one-at-a-time with support from abroad.
“We were forced to wait for news from the airport and wait for someone’s visit,” he said.
A delegation from the Union of Arab Doctors in Egypt arrived to cover three operations, followed by a relief organization from Saudi Arabia that paid for two more, all while patients waited in bed.
Later, the International Federation of the Red Cross and Red Crescent stepped in to cover the costs of several operations.
Even when health centers can provide care, they face shortfalls of essential medicine.
“We don’t have the drugs we need,” said Ehsan Hammad, the director of a health center in the Bekaa, where dozens of women, most of them carrying children, wait in the small lobby.
“In particular, we don’t receive drugs for children, cough syrup. We don’t receive vitamins, iron. Many kids have very low iron, but we can’t give them anything. We have very few drugs for chronic diseases like blood pressure and diabetes.”
UN-funded health centers provide the drugs they have free of charge, but when they run out they must send patients to private pharmacies with a prescription in hand.
“Sometimes, they buy the drugs,” said Ali Baqi, director of the health center in El Ein village. “And sometimes they throw the prescription away, because they have no money.”
Administrators in Tripoli also said providing drugs was one of their biggest challenges. Al Zahra hospital spends $50,000 a month to give medicine to patients currently admitted to the hospital and those who have been discharged but return to the hospital for care.
Dr. Hisham Suleiman, the director of a health center in Tripoli, said his hospital had been forced to go heavily into debt to buy needed drugs.
He said that the United Nations did not cover the cost of diseases that had only recently found their way into Lebanon and required expensive treatment, including cases of leishmaniasis.
The disease, known informally as “Aleppo’s pustule” after the city in Syria, is a lesion-producing fungus that until recently had been found primarily in that country. Three hundred cases now come to the hospital for treatment twice a week.
The lack of medicine has left some patients without many good options.
Hanna, 21, who preferred not to share her last name citing privacy concerns, had spent the last month in Tripoli trying to get care for herself and two brothers. One brother lost an eye in the shelling of Homs.
She had come from the Syrian capital of Damascus, where she said hospitals had closed and drugs had become impossible to find. She was at the health center for a gynecological problem. She saw a doctor, but he couldn’t help.
“I couldn’t get the drugs I needed here, and I’m not sure where I’ll be able to get them,” she said. Her brother fared no better.
The medicine for his eye was too expensive in Tripoli, so someone would have to go back to Homs to try to find some.
After her consult, Hannah sat in the reception area, waiting for her father. A long line of patients stood at the pharmacy window, hoping to fill prescriptions that would ease their pain.
Many would leave empty-handed.
This series was produced with the support of Focus on Syria. The final installment, publishing on Dec. 30, is about a Palestinian camp in Beirut that serves as a warning of what can happen to neglected refugees in a country that refuses to accept them.