Healthcare: A Privilege Refugees in Lebanon Cannot Afford

“It’s winter,” says Zeinab, a 34-year old Syrian refugee based in Bar Elias, Lebanon’s Bekaa Valley. Uttering those two words, she strokes her pregnant belly and throws a fast glance at her three children, an extremely anxious look escaping her.

“Winter in Bekaa is very harsh,” she continues, trying to explain the reasons for her worrying. “It gets very cold and we don’t have enough fuel to warm ourselves. The children are the most susceptible. They fall ill, and here begins the struggle.”

With three children and a fetus to look after, providing healthcare becomes a real struggle for Zeinab and her husband. Zeinab is aware of the financial support provided by the United Nations High Commissioner for Refugees (UNHCR) and other governmental and non-governmental agencies. But this support, as explained by Zeinab, remains unable to meet the increasing healthcare needs of a growing Syrian refugee population.

With her delivery coming up in three months, Zeinab fears any complications that would arise before then, putting her household under greater financial pressure. And although the UNHCR covers about 75% of the delivery cost, Zeinab and her husband are unable to pay for their share of the hospital fees, and worse, unable to afford transportation to the hospital. Zeinab recalls witnessing several home deliveries that took place because of the lack of financial resources, saying, “I hope it won’t come to this. I prefer to give birth in a hospital, under the watch of a doctor.”

Reproductive Healthcare for Syrian Refugees
In fact, an UNHCR report titled “Health Access and Utilization Survey Among Syrian Refugees in Lebanon” shows that “5.8% of deliveries were reported to have taken place at home and a further 5.8% were reported to have been at a midwife clinic” with “cost and not knowing that UNHCR provided financial support for deliveries being the main reasons for home delivery.”

Furthermore, the results of the survey indicate that 70% of the proportion of surveyed 15-49 year-old females accessed antenatal care (ANC) in the past two years. As for those who didn’t seek it while pregnant, 61.4% of them stated the inability to afford fees as the main reason for not accessing ANC, while 15.9% of them reported not being able to afford fees or transport, according to the report.

Soon after Zeinab gave birth to her younger daughter Hiba, two years ago, she suspected that her baby was suffering from a breathing difficulty that was shortly after diagnosed as pneumonia, for which Hiba had to receive neonatal intensive care. With much hardship, the baby’s parents were able to summon up the money needed for her treatment.  Zeinab embarrassedly confesses, “we couldn’t always afford the doctor’s visits or medication fees.”

According to the UNHCR survey, 24% of the respondents couldn’t pay neonatal hospital fees in full, and 71.9% of those who didn’t access postnatal and neonatal care reported not knowing that UNHCR provides financial support for the cases, while 13.5% reported high cost of service and 7.5% reported restricted movement as the reasons for not accessing needed postnatal care.

With the crisis of war and displacement, women and children are considered to be the most vulnerable of the population. Maternal and child healthcare therefore become a heavy burden. For this reason, the non-governmental sector has developed programs that target female and child healthcare specifically. UNFPA (United Nations Population Fund) is one of the main organizations offering sexual and reproductive health services. According to UNFPA’s data, 39% of its funds are directed towards reproductive health, but those funds only cover 27% of the resources needed, leaving a gap of 73% of unmet medical needs.

Among the organizations offering financial support for healthcare is Medecins Sans Frontieres (MSF) which has eleven clinics spread all over Lebanon. Those clinics, in addition to MSF’s delivery centers, provide RH services completely free of charge, according to Dr. Renée Bou Raad, MSF’s Medical Activity Manager.

“We provide female healthcare including delivery, antenatal and postnatal services for the majority of the Syrian population, and for Palestinians refugees as well,” explains Bou Raad. “The most needed healthcare services are pregnancy-related, or have to do with sexually-transmitted diseases,” she adds.

Another concern for healthcare providers is family planning. Organizations like MSF and UNFPA hold awareness campaigns on family planning and contraception use. However, there remains a gap in the domain as well, with UNHCR’s survey showing that only 38.1% of respondents, among those who have a sexual partner, use family planning methods, with 39.7% of the population “not wanting to use contraceptive methods”.

Reproductive Healthcare for Palestinian Refugees
The Palestinian refugees are another population unable to access the costly Lebanese healthcare system. Palestinian refugees have no public health coverage in the Lebanese health system and are not recognized under any of the Ministry of Public Health schemes. This community relies on UNRWA (United Nations Relief and Works Agency) for Palestine refugees in the near east.

According to a source at UNRWA, “Palestinian refugees spend, on average, around 12 percent of their total expenditures on health. UNRWA, on its part, provides primary health care services through 27 health centers located in the areas of concentration of the Palestine refugees.”

UNRWA applies a “gender mainstreaming policy” [1]toll projects involving health, according to the Director of UNRWA affairs in Lebanon Mr. Hakam Shahwan.

“The health of women is critical to the health of families,” says Shahwan. “This is why UNRWA provides services that focus on the health of Palestine refugee women, especially for care before and after the birth of a child.”

Shahwan further explains that the organization adopts what is called “The Maternal Health Program”, a comprehensive program that caters to the health of the female from preconception through family planning, including prenatal and postnatal services, breast-examination, contraception methods, and delivery for high-risk pregnancies.

UNRWA’s coverage of delivery is thereby restricted to high-risk pregnant women exclusively. This is due to the revised hospitalization policy that UNRWA adopted in 2016, introducing some modifications to its coverage of medical cases, among which was the elimination of the coverage of regular delivery for normal pregnancies, which was once included in its policy.

Those revisions to UNRWA’s health policy come in light of its struggle to receive sufficient funds, a struggle to which the Syrian displacement crisis has contributed. With more international financial support directed towards the relatively recent Syrian refugee crisis, fewer and fewer resources are targeted towards issues of the Palestinian community. UNRWA, however, also assists to the needs of Syrian-Palestinian refugees. This growing refugee population requiring greater support continues to see an increase in the gap between its needs and the support provided by local and global communities.

Whether they are Syrian or Palestinian, refugees in Lebanon have to overcome enormous obstacles in order to enter the realm of healthcare. Female refugees carry the additional load of responsibility for reproductive healthcare. Pregnant women and mothers feel responsible for their health and that of their fetus and children, and often feel helpless in the face of this double and triple burden. With such barriers, healthcare no longer belongs to the realm of human rights, but rather to that of privilege; privilege that Syrian refugees cannot afford.

[1] terminology used by UNRWA to describe their policy that takes gender into consideration.