Laurent Ligozat, MSF’s deputy operational director, gives this account of the turmoil facing Syrian refugees in Lebanon, as more and more people make the traumatic journey across the border.  MSF has extended activities to offer primary health care and mental health services to both adults and children.

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"The turmoil in Syria is not improving. For escapees, the shelling, the journey to safety and the resettlement in Lebanon have all been deeply traumatic experiences – for adults as much as for children. They find themselves reliving disturbing past events, such as the loss of their relatives and of their houses.

Many are overwhelmed with feelings of fear, insecurity and uncertainty about the future – and this comes on top of the economic difficulties they are facing.

"Constant fear related to traumatic events"

We identified mental healthcare as a particular gap in the medical services on offer. In November 2011 we started providing consultations and running support groups, psycho-education sessions and family therapy in the northern region of Wadi Khaled.

Children are particularly vulnerable. Many children have experienced the disappearance of family members and the deaths of relatives and friends. They may have witnessed killings and beatings, have had to leave their homes under dangerous conditions, and are often anxious about relatives who stayed behind. In terms of mental health, we have seen cases of mutism, but the most common symptoms are bedwetting, regressive or aggressive behaviour and constant fear related to traumatic events.

Adults, of course, share the same fears, and our mental health teams have found people with acute symptoms including suicidal thoughts, post-traumatic reactions, physical complaints related to psychological distress, and acute psychosis. Depression and anxiety are the most common diagnoses.

MSF medical teams have carried out over 4,600 primary healthcare consultations and over 900 individual psychological and psychiatric consultations, all of them free of charge. We have also covered the hospitalisation costs for 86 medical emergency cases, including deliveries, dialysis treatments and lifesaving operations.

"Many locals have opened their homes to refugees"

Local non-governmental organisations have worked closely with us throughout, and played a crucial role in helping us reach out to groups of vulnerable refugees. They have also loaned us premises so that we can get our medical services up and running fast.

The local communities – both in Wadi Khaled and the Bekaa valley – have done a huge amount to lighten the burden suffered by Syrian refugees. There is a great sense of solidarity, and many have opened their homes to the refugees, sharing living space and food.

But there are still many new arrivals in need of a place to stay. In March we helped refurbish five public buildings to house Syrian families in the border town of Aarsal.

"Basics like food, baby milk and nappies needed"

Shelter is already a serious issue, especially in Aarsal and Tripoli. This is because the refugees keep on coming, and the host community just doesn’t have the space to take in any more. I visited houses where two or three families were already sharing just one or two rooms.

A newly-arrived Syrian family in Bekaa, close to the border.  Lebanon 2012 © MSF
The Syrian refugees often arrive with almost nothing and, without a way of making a living, their economic situation can deteriorate fast. They are in need of basics like food, baby milk and nappies, hygiene items, cooking equipment, mattresses and blankets.

Between January and May, we provided about 2,150 people in the mountainous Aarsal region with relief items, including fuel and wood for heating.

"Medical assistance is still limited"

The Syrian crisis is having a growing impact in Lebanon, especially in the border regions and Tripoli. Since mid-April, we have expanded our mental healthcare services to Tripoli governmental hospital, located in one the most conflict-ridden areas, and an MSF emergency doctor is also helping in the hospital’s emergency department. MSF plans to reinforce its capacity to provide  emergency medical care for civilians directly or indirectly affected by the violence by working in a hospital and two health centres.

I acknowledge that MSF’s medical assistance to Syrians is still limited, especially when you take into account the vast medical needs today in Syria. For several months, we have been seeking official authorisation to work in the Syrian governorates most affected by violence. Unfortunately, to date, none of our efforts – either directly with the Syrian authorities or through intermediaries – have met with success. In the meantime, we are continuing to support networks of Syrian doctors in Homs, Deraa, Hama, Damascus and Idlib, delivering supplies and medicines from neighbouring countries.”