Syrian refugees in Lebanon find it hard to access healthcare, says charity

BMJ 2013; 346 doi: (Published 08 February 2013) Cite this as: BMJ 2013;346:f869
  1. Anne Gulland
  1. 1London

About half of the Syrian refugees in Lebanon are not getting the medical care they need, the charity Médecins Sans Frontières has said.

The medical charity conducted a survey of refugees from 2124 households in the Bekaa Valley region and the cities of Saida and Tripoli, who have fled the fighting in Syria.1

The charity found that more than half of all interviewees (52%) could not afford treatment for chronic diseases and that nearly a third have had to suspend treatment because it was too expensive.

It has warned that the humanitarian situation was deteriorating. A similar survey it carried out in June found that 19% of interviewees could not afford medical treatment for chronic diseases and that 40% said that high costs and insecurity meant that they could not access hospital treatment.

The latest figures from the United Nations High Commission for Refugees (UNHCR), published on 6 February, show that 172 361 Syrians have registered as refugees in Lebanon, with a further 88 582 people contacting the commission to be registered. The numbers have grown from around 77 000 refugees at the beginning of last November.

However, not all refugees are registered, and Médecins Sans Frontières estimated that the number of unregistered refugees in Lebanon could be about 50 000. Registration made it easier to get assistance, it said, though this was not always the case.

Some 8% of the women surveyed needed antenatal care, but two thirds could not get the services they needed. Only a third of children were reported to have received vaccinations, and just 19% of respondents were able to show a vaccination card.

Jean-Clément Cabrol, director of operations at Médecins Sans Frontières, said that its main concern was refugees’ health and living conditions. There are no established camps, and refugees are dispersed around the country, often relying on the local population for help. “The Lebanese health service will accept some refugees, but in some places they cannot help,” he said.

He added that tensions among different religious groups in Lebanon worsened the security situation for refugees.

Cabrol said that in the Bekaa Valley unregistered refugees were finding it particularly tough to access healthcare, with just 11% getting free treatments, as against 24% of the registered population, and 20% getting free hospital care, compared with 56% of the registered refugees.

Paul Spiegel, deputy director of the programme support and management division at UNHCR, described the situation in Lebanon as “horribly challenging.” Refugees were dispersed throughout the country, so providing services was difficult, he said. Lebanon’s health system is privatised and patients have to pay for services.

He acknowledged that registration of refugees was a problem but added that between 2000 and 3000 people were approaching UNHCR every day to be registered. People waiting to be fully registered were given a pre-registration document that entitled them to the same access to medical services as those who had been fully registered, he said. Except in the most vulnerable cases, UNHCR pays 85% towards medical costs and the refugees 15%.

He added, “The big issues in Lebanon are healthcare and shelter. There are no camps, which in some ways is a good thing, as there are dignity and dependence issues [in camps] and you get epidemics as well. But the capacity of the host population has reached a maximum.”

An update issued by the UNHCR said that 42 000 Syrian refugees received primary healthcare services last month in Lebanon, including treatment for chronic diseases. And 7850 Syrians were admitted to hospitals. In January hospitals saw a 16% rise in the number of refugees admitted with respiratory tract infections, probably because of the poor weather.

In January an international donor conference in Kuwait saw pledges of more than $1.5bn (£1bn; €1.1bn) to assist people in Syria and those who have fled the country. About $314m of this will go to the Lebanese government, said the UNHCR.

Médecins Sans Frontières is calling for the humanitarian response to be scaled up, including greater access to refugee reception centres. It is also urging the UNHCR to ensure that vulnerable groups have access to free healthcare.


Cite this as: BMJ 2013;346:f869