The challenges of humanitarian aid for Syrian refugees in Lebanon’s Wadi Khaled

The last two IRIN reports I contributed to, after travelling to Wadi Khaled (Northern Lebanon) in early December 2012. The situation was slightly better than six months before, although many Syrians were sleeping in sheds without any window…and the region is particularly cold in the winter. Medicines for certain diseases were completely absent, according to the complaints of the refugees. 

The first version of the report is the original one, which was significantly different and included a section on Lebanese local authorities allegedly stealing part of the aid for Syrians. This and some other considerations prompted the UNHCR to prevent the first piece from being published, as it was believed it would have harmed aid workers in Lebanon. I believe in transparency and i’m not a UN spokesperson, hence I leave the judgement to you on what’s detrimental for humanitarian aid. 

The second and the third report are the ones published by IRIN.

1. Lebanon’s Wadi Khaled: where Lebanese and Syrians compete to receive humanitarian aid

Syrian_refugees_in_lebanon

10 December 2012- Wadi Khaled (Akkar- Lebanon)

Out of the 133.000 Syrian refugees registered in Lebanon by the UNHCR, 10.862 live in the Wadi Khaled area, a North-Eastern strip of land secluded from the rest of the country by a military checkpoint in Chadra. Access is often a complicated issue to this remote area, where Syrians complained with IRIN about the slowness of sheltering and medical assistance. Some reports from both refugees and NGOs ascribe this also to a lack of transparency in the mediation of local actors, while all humanitarian actors stress the challenges presented by delivering aid in an already impoverished Lebanese context.

Shelters and medicines

In order to address the needs of Syrians, who cannot afford to pay rents, cash has been provided in installations to Lebanese landlords to rehabilitate houses and complete unfinished ones. “The rehabilitation has never been completed, look at that house without windows,” says Mahmud Ghazal, the Lebanese mukhtar of the village of Muqayble, while pointing the finger at a building in front of his residence, “here we have a cold wind penetrating your bones in the winter…How are refugees going to cope with this?” The mukhtar showed IRIN another apartment void of doors, where nylon substituted windows and a family of twelve people from Qusayr (Homs) has been waiting one month and a half without receiving fuel coupons to refill its stoves. “The UNHCR usually sends the first committee to verify the needs, then there’s another one to assess the costs, then a third one…too many committees without any achievement,” complains Mahmud Ghazal. As IRIN visited a school turned into a collective shelter, Syrians were particularly upset, as a result of the numerous fruitless visits they allegedly received from humanitarian workers.

“The Norwegian Refugee Council (NRC) is providing shelter to roughly 800 families1 in Wadi Khaled, but rehabilitations take from four to six weeks,” explains NRC’s program director, Martino Costa, “we’ve been the only organization offering shelter solutions since one month, thus being perceived as THE organization responsible for this, but we do face budget limits.” In consideration of the growing needs, even the UNHCR is currently revising for the fourth time its $84 million fund appeal.

Among the most widespread needs, there is the availability of specialized costless medicines. “He’s one of the two Syrians working out of 100 refugees living in this school,” says Mohammad* from Talkalakh (Homs), after a man in working suit entered the room, “the UNHCR is covering 85% of medical expenses, where do we get the remaining 15% from, if we are unemployed?” While Mohammad sits talking on a carpet, his daughter affected by the Down syndrome wanders with curiosity around the room. “According to Lebanese law, we cannot cover more than 85%, it’s the same percentage covered by the State for the healthcare of Lebanese,” objects UNHCR spokesperson, Dana Suleiman.

“Even Doctors Without Borders told us they lack medicines against thalassemia, asthma and diabetes, therefore people started to collect money to purchase them” says the mukhtar Ghazal. Among the twelve people from Qusayr living in the unfinished house, there is Latifah ‘Akkari*, a lady in her sixties, laying on a mattress in the corridor. “In the six months I’ve been here, I always had to pay on my own for medicines against high blood pressures and rheumatisms,” Latifah told IRIN.  The only drug she claims to have received is a box of Isodol, the Spanish trade name for nimesulide, an anti-inflammatory drug actually used for the symptomatic treatment of arthritis, but useless against blood pressure. In the school converted into a collective shelter, a woman from Talkalakh complained about the daughter being given a medicine not suitable for her age to treat an infection.  “We have doctors, what is needed is a dispensary with all the necessary medicines,” concludes Mahmud Ghazal.

“We do cover chronic primary diseases like diabetes, but not those requiring hospitalization,” explains the UNHCR spokesperson, Dana Suleiman, “Wadi Khaled is a remote area, some of the refugees cannot even commute to an area where medicines are available, but our mobile medical units are a response to this.”

In general, NGO workers reply by belittling some of the complaints of refugees. “In the end refuges complain about everything,” says NRC’s Martino Costa, “for example, we brought them food in the Biqaa valley and they asked TVs and refrigerators!” In late October, when IRIN visited the Biqaa village of ‘Arsal, the Syrian refugees stressed the need to receive support for rent expenses. “They’re lying to receive more money, the Norwegian Refugee Council is actually covering their rents,” Amel Association’s coordinator, Maraay Flity, told IRIN, after having listened to the complaints in a collective shelter. NRC is indeed working in ‘Arsal through its sheltering programs based on rehabilitation.

Access to Wadi Khaled and transparency of local actors

Having said this, the discontinuous access to Wadi Khaled due to security reasons is recognized as an obstacle in speeding up humanitarian aid.  “The army is one of the main obstacles, we haven’t been able to access Wadi Khaled for almost three weeks between September and October,” remembers Martino Costa, “as we work through installments, Lebanese landlords ended up threatening us, for the delays we faced in settling debts with those who paid in advance.” Access was also restricted over the last weeks, as the Syrian army shelled bordering areas on the 27th of November. During IRIN’s visit, mortar shots were clearly audible on the Syrian side and the Lebanese military intelligence cautioned against circulating after the sunset, due to frequent gunfire.

The Norwegian Refugee Council voiced its suspects on the transparency of the Lebanese intermediaries. “The Qataris put lots of money in the hands of local people in Wadi Khaled, maybe their relatives, but not the Syrians,” adds Martino Costa. Some of the refugees proved equally skeptical of the role played by local intermediaries. “Humanitarian aid is delivered to the Lebanese responsible of the protection of a number of families [N/A: the so-called mahsubin],” affirms Hassan Bayut, a 40-year-old Syrian from Bab ‘Amro (Homs), who arrived one year and a half ago, “I’m not blaming Mahmud Ghazal, but many other mukhtars are stealing!” It should be taken in consideration that, in Wadi Khaled, the mukhtars are in charge of communicating the names of those in need of UNHCR mobile registration, as they crossed the border illegally and they cannot travel outside the valley.

Nevertheless, UNHCR rejects the idea of local corruption being a relevant problem. “The system became more efficient, after initial reports of corruption,” says UNHCR’s Dana Suleiman, “we distributed something through mukhtars, as some of them opened their houses to refugees, but now each registered family must pick up personally the kits.”

A poor hosting community

The main obstacle in delivering aid seems to remain the impoverished conditions of the Lebanese hosting community.

“The initial reaction of the Lebanese community was different, they were even picking up Syrians from the border, but 20 months have passed since then,” says Dana Suleiman, “we prefer to sign contracts with local shops and distribute food coupons among the refugees to benefit also the Lebanese community.”

Some locals tried to exploit the situation at their advantage. “Some Lebanese landlords attracted Syrians into their houses to have them rehabilitated by us,” says NRC’s country director Mads Almass, “when they got told that their houses didn’t meet our criteria, we received threats to expose us to the media.”

The unique feature of Wadi Khaled in the Lebanese context is that those Syrians who entered illegally cannot live the valley, due to the military checkpoint in Chadra. Such a restriction on freedom of movement has prevented Syrians from finding jobs outside this impoverished area. “There’s no job here and I cannot leave,” complains Hassan Bayut from Bab ‘Amro, “I came here without any documents and I’m wanted in Syria: if I reach the checkpoint they’ll send me back to my country.”

Rather than creating job opportunities for Syrians and fostering resentment in the poor hosting community, the UNHCR is working to normalize the legal status of people like Hassan. “Legalizing the status of those who crossed the border illegally would serve the purpose of helping Syrians to find a job,” says Dana Suleiman, “we already had a positive response from the Lebanese General Security: Syrians are not required to renew their residency permit at the border anymore and the $200 renewal fee has been officially waived.”

As refugees keep flooding Wadi Khaled, the challenge of the coming months will be to keep the balance between Syrian and Lebanese beneficiaries of humanitarian aid. “There are also untraditional actors, let’s call them like this, who come into Lebanon without any control with either in kind distribution or cash coming from people in the Gulf,” says NRC’s Mads Almass, “their assistance is getting to Syrians rather than Lebanese and this creates differences.”

1 The average is of five persons per family.

*The interviewee didn’t wish to reveal his/her real name.

2. UN: To avoid tensions with refugees, Lebanese hosts need support

28 January 2013 (IRIN) – Donors channelling funds towards Syrian refugees in Lebanon must also assist their poor Lebanese hosts to diffuse rising tensions, aid workers and a government official said ahead of an international pledging conference for humanitarian aid to Syria and its neighbours.“We have seen a growing sense of resentment among the Lebanese host communities that see assistance going to refugees and not to them,” Robert Watkins, humanitarian coordinator in Lebanon, told IRIN. “It is causing some tensions.”Most of the more than 220,000 Syrian refugees who fled to Lebanon have settled in the poorest parts of the country, in districts like Akkar in the north and Ba’albek or Hermel in the eastern Beka’a Valley.The North Governorate is home to 20 percent of Lebanon’s population but 40 percent of its poor, with more than half the people living under US$4 a day, according to a 2005 study.

Despite their poverty, people of the north have been undeniably welcoming to refugees, taking them into their homes for months and covering their food, water and electricity needs, aid workers said.

Nearly two years later, more than 60 percent of the refugees are now renting their own homes. But their presence – in some 550 villages across the country – has depleted government-provided supplies in pharmacies, increased competition for jobs, raised the price of housing, and, in some cases, more than doubled the population of the town or village.

“Changing winds of opinion”

“We are reaching the point of suffocation for Lebanon,” said Hala El Helou, emergency coordinator at the Lebanese Ministry of Social Affairs, which is responsible for helping the refugees.

“There have been many reports by the security forces of an increased number of security incidents that include Syrians,” both as aggressors and as victims, she told IRIN, pointing to killings, beatings and thefts. Reports of forced prostitution, early marriage and child begging have also increased, she said. “It’s a reflection of the social and economic situation.”

One of the early incidents was the October launching of a Molotov cocktail into a municipal building hosting refugee families in a village in Akka’rs Wadi Khaled area. No one was injured.

“It was simply a sign of the changing winds of opinion whereby the period of unrestricted hospitality and generosity was beginning to change,” said one aid worker who preferred anonymity.

In a more recent incident this month, explosives blew off the roof of a house sheltering refugee families near the town of Aidamoun, also in Akkar.

Sahar Atrache, an analyst with the International Crisis Group in Lebanon, said Syrians are now taking an unfair share of the blame for all the ills in society: “Whenever you have a robbery, a rape, it’s because of the Syrians, as if Lebanese don’t do these things.”

“The initial reaction of the Lebanese community was different,” explained Dana Sleiman, spokesperson of the UN Refugee Agency (UNHCR) in Lebanon. “They were even picking up Syrians from the border. But 20 months have passed since then.” 

Implications for aid

This tension has also had implications for aid workers.

One Western researcher said locals near Qobayat Village in Akkar initially “welcomed” aid workers there with stones, a sign of the indignation at the aid delivered only to Syrians in a region historically neglected by the Lebanese government.

Some locals have also tried to exploit the situation to their advantage.

“Some Lebanese landlords attracted Syrians into their houses to have them [the houses] rehabilitated,” said Mads Almass, country director for the Norwegian Refugee Council, which gives landlords funding to make their homes more fit to shelter refugees. “When they got told that their houses didn’t meet our criteria, we received threats to expose us to the media.”

Watkins said the aid community has seen this shift in the feeling of host communities and tried to design programmes accordingly, focusing on improving the overall conditions and services in these areas to benefit both refugees and their hosts. These include programmes that would buy drugs to replenish pharmacies, inject cash into the economy by offering cash-for-work projects for Lebanese people, and provide credit to help small businesses start up.

“But these [kinds of programmes] are, unfortunately, very difficult to find donors attracted to,” Watkins said.

“Conceptually, [donors] understand how important that is,” he continued, “but if they are told they have a limited amount of resources and they will choose between injecting cash into the Lebanese economy to help the Lebanese population or injecting cash into a relief operation which is providing food and shelter to refugees who are bereft of both, they generally opt for the latter.

“But there are tensions, and those tensions will only get worse.”

Donor interest?

An international conference to take place on 30 January in Kuwait aims to garner funding for aid projects inside Syria and in neighbouring countrieshosting nearly 700,000 registered refugees. The appeals amount to more than $1.5 billion, but donors have given less than $50 million since they were launched in December.

UNHCR has implemented so-called quick-impact projects – such as equipping mosque halls, opening a public library, and supporting agricultural co-operatives – after holding sessions with Lebanese communities at which residents expressed their village’s needs as they saw them.

The UN Development Programme (UNDP) has also done similar projects in Wadi Khaled and in the Beka’a Valley’s Arsal town, both home to many refugees. Country Director Luca Renda said he hopes to expand these kinds of programmes across the country and is in contact with many donors on this issue: “We hope the Kuwait meeting will yield results,” he told IRIN.

The Regional Response Plan, spearheaded by UNHCR, includes projects supporting host communities, as does the Lebanese government’s separate appeal for $180 million, which was launched in December and is currently being revised in line with the constantly growing refugee numbers.

Observers say the government’s capacity to deal with the mounting refugee crisis is limited, given the economic problems the country is facing and its polarized politics. Lebanon is the only neighbouring country in which refugees are not housed in camps, but rather are living in towns and cities with the support of local people.

The Minister of Social Affairs, Wael Aboufaour, recently told the Lebanese newspaper The Daily Star that camps may soon be the only solution.

One quarter of population

El Helou said there were 811,000 Syrians in Lebanon – including refugees, migrants and visitors. Added to a Palestinian refugee population of at least 450,000, the foreign “guests” are equivalent to a quarter of the Lebanese population. The UN expects the number of Syrian refugees in Lebanon, already equivalent to five percent of the population, to increase to at least 300,000 by June.

“Without additional support, Lebanon cannot handle that,” El Helou said. “Lebanon has reached the limit.”

At all levels, observers say, the government has become consumed by the Syrian crisis and its impact on Lebanese soil.

As a result of upheaval in the region, the Lebanese government has downgraded economic growth estimates for 2013 from 4 percent to 1.5 to 2 percent, Sami El-Daher, adviser to the prime minister on economic affairs and development, told IRIN. The crisis has hit Lebanon’s exports through Syria, border trade with Syria and tourism industry.

Aid agencies have already tried to tailor their programmes accordingly. Instead of distributing food, for example, the World Food Programme (WFP) gives refugees vouchers to redeem food at local shops with which it has signed contracts. Instead of creating jobs for Syrians specifically, UNHCR is trying to regularize the status of those refugees who entered illegally to make it easier for them to move around freely and access the common job market. The UN Children’s Fund (UNICEF) is rehabilitating schools in which both Syrian and Lebanese students study in an effort to ensure that its emergency work for Syrian refugees feeds into long-term development of the region.

ag/ha/rz

3. Lack of funds hits refugee health care in Lebanon

BEIRUT, 8 February 2013 (IRIN) – The Lebanese government and UN Refugee Agency (UNHCR) say they are trying to scale up their assistance to hundreds of thousands of Syrian refugees but are hampered by a lack of funds.

On 7 February Médecins Sans Frontières (MSF) released a report, entitled Misery Beyond the War Zone, which painted an alarming picture of the living and health conditions of refugees in Lebanon and called on both the UN and the government to increase registration and aid.

In December, MSF surveyed 2,100 refugees in three areas of Lebanon and found more than half of those interviewed, whether they were officially registered or not, were housed in substandard structures and could not afford medical care, with nearly one-third of them having suspended treatment already under way because it was too expensive.

“Something has to be done. We can’t accept that someone who is fleeing a war has to negotiate with NGOs to get medical assistance,” Fabio Forgione, head of mission for MSF Lebanon, told IRIN.

Aid agencies in Lebanon are facing growing difficulty keeping up with worsening conditions, as the number of refugees increases and the financial situation of those already present degrades.

There are 163,036 Syrian refugees registered with UNHCR in Lebanon, another 74,587 awaiting registration, and a further 50,000 unregistered refugees, according to MSF estimates, though others have given much higher figures.

In November, IRIN visited dusty Muqayble village in the remote Wadi Khaled area of northeastern Lebanon. One of the most widespread needs refugees expressed was medicine. UNHCR covers 85 percent of medical expenses, in line with the Lebanese government’s coverage for its own citizens. But so high is the need, that for some, even this is not enough.

“Where do we get the remaining 15 percent, if we are unemployed?” asked Mohammad*, a refugee from Homs. He lived in a school sheltering 100 refugees. Only two of them had work.

In one of the unfinished homes nearby, Latifah*, in her sixties, lay on a mattress in the corridor. She suffered from high blood pressure and rheumatism, but said she has received nothing but an anti-inflammatory drug in the six months she had been there. Instead, refugees and host communities had been collecting money among themselves to pay for medical expenses.

Problem with the registration system?

According to the MSF report, the most vulnerable refugees are the ones who are not registered with UNHCR. While some NGOs do specifically target unregistered refugees with assistance, 63 percent of the unregistered refugees interviewed by MSF said they had not received any assistance.

“There is a lack in the organization and the delay to be registered is too long,” Forgione said. “In the meantime, the unregistered refugees don’t get sufficient assistance.”

MSF, which will increase its own activities in Lebanon, called on the Lebanese government and UNHCR to scale up their registration system, set up transit sites for new refugees, and help unregistered refugees.

Ninette Kalley, UNHCR representative in Lebanon, acknowledged the delays but said the organization is constantly scaling up. It has increased staffing levels from around 60 at the start of the crisis to more than 250 today.

“We have double shifts in some of our centres. New registration centres will be opened in Beka’a and Tyre this month. We are also working to increase registration capacity in Beirut, where waiting periods are longest,” she told IRIN.

In January, UNHCR registered 38,000 refugees, compared with 24,000 in December.

“We have agreements with several NGOs to help any refugee, even the unregistered ones and we’re expanding these partnerships,” she added.

UNHCR said it is working with the Lebanese government to identify transit sites, focused around Beka’a and the north of Lebanon. This would allow for identification of vulnerable persons in the unregistered population, and rapid assistance in a situation of increased influx.

Urgent need for new funds

Nevertheless, UNHCR and its partners in Lebanon have received less than 15 percent of the funding needed for aid work until June, as part of the Regional Response Plan for Syrian refugees.

“This necessitates the prioritization of activities,” Kalley said. “The first priority is saving lives. From this point, there are competing priorities for shelter, food, health care, cash assistance.”

On 30 January, donors pledged more than $1.5 billion in humanitarian aid for Syrian refugees and those in need inside Syria, but aid agencies are worried nonetheless.

“We don’t know when the money promised will be sent. The situation cannot wait,” Forgione, of MSF, said.

To face this emergency situation, the Lebanese government announced in December a plan – now updated to seek $370 million – to be able to help refugees.

“Lebanon is now sounding the alarm,” Lebanese President Michel Sleiman told donors in Kuwait.

Last week, Hala El Helou, emergency coordinator at the Lebanese Ministry of Social Affairs, told IRIN the government had only received a few in-kind donations from Saudi Arabia, Iran and China, some financial contributions from the UN to do capacity-building, as well as $700,000 from Norway, and around a $1 million grant to be channelled through the World Bank.

“We’ve had some pledges and we’ve had some promises. Very few have so far provided us with actual funds,” she said.

The government had received no contributions for the health sector of its plan, “which is one of our most crucial at this point…

“We have a huge lack of medication at the centres of the Ministry of Social Affairs and the Ministry of Public Health. The medication we have is barely enough for the Lebanese,” she said.

According to UNHCR, the number of refugees fleeing Syria to neighbouring countries could top one million by June 2013.

*not a real name

ag/ar/ha/cb

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