Coronavirus in Lebanon’s Refugee Camps... A Silent Outbreak 

Refugee Camps
Refugee Camps

Health | 04 Feb 2021 | Pascal Soma

Throughout Lebanon, the second wave of coronavirus appears to be more fierce and widespread, even with the renewal of quarantine measures and general lockdown. However, the implementation of the isolation regulations does not meet the severity of the tragedy, as Lebanon has been recording more than 5,000 infections per day since a while now, which raises an urgent and necessary question: how are the camps’ residents coping with the terrifying propagation of the pandemic? 

It might seem easy to answer this question, had we been talking about another country, the capital of which did not explode on 4 August 2020, does not suffer an economic crisis accompanied by a humanitarian and health crisis that overwhelmed the state capabilities, and does not suffer a chronic corruption epidemic along with the political authority’s failure to manage crises. 

From the Bekaa Valley to northern Lebanon, where most of the Syrian refugee camps are located, we posed this question to the concerned parties, the camp residents, and people who struggled with this disease.

According to the United Nations High Commissioner for Refugees (UNHCR), “Since recording the first confirmed case of covid-19 among the Syrian refugees in Lebanon in April 2020, 2529 accumulative cases have been registered, so far, 71 of whom are currently hospitalized, and 104 died. 

However, the real outbreak can be seen, according to what this investigation examined, among unconfirmed or unrecorded cases, more precisely the infections that have been not detected using coronavirus test kits and were rather treated as flu or a cold.

According to the UNHCR, about 860,000 Syrian refugees live in Lebanon, and since the approximate rate of infections is 3.7 percent compared to the overall demographic rates, assuming that this ratio can be applied to refugees, we can expect about 31,820 infections in the Syrian camps. 
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How the infected were quarantined? Did they get the luxury of being isolated from their families in the tent-rooms, in which most Syrian families live? Do they have access to medical assistance? And before that, did the ones who suffered from symptoms or contacted an infected person in the camps get a PCR test?

Al Khader - Baalbek

Mohammed Al-Amin, an official (shawish) who is responsible for more than one camp in the Al-Khader-Baalbek region, explained that “there are dozens of infections with the virus in the camps in his area, but most refugees cannot afford the costs of the test, while most of the cases go unreported.

When a refugee experiences the coronavirus symptoms, he/she tries to quarantine himself/herself inside the tent using some kind of fabric to insulate his/her area, or tries to take a distance from the other members of the family as much as possible, despite the fact that everyone lives in the same tent!

The cost of getting a coronavirus test varies from one hospital to another, as it can amount to 150,000 or 200,000 Lebanese pounds. Thus, the Ministry of Health had decided to reduce the test expenses in public hospitals to 100, 000 Lebanese pounds, but the refugees still cannot afford it. Besides that, public healthcare facilities are crowded with a huge number of people who want to be tested, which also makes these spaces a hotbed of coronavirus infection.

Many refugees complained repeatedly during this investigation about the high costs of tests. One of the most alarming indicators in light of the complex crises that Syrian refugees face in Lebanon is the sharp increase in the number of families living in extreme poverty, reaching 89 percent in 2020 compared to 55 percent in 2019, according to the UNHCR’s estimates.

Each Syrian refugees lives on about 300,000 Lebanese pounds per month, which is less than half the minimum wage in Lebanon (675,000 Lebanese pounds). This monthly income, which is secured by the UNHCR, has decreased in value with the collapse of the Lebanese pound, as one US dollar is worth more than 8000 Lebanese pounds nowadays.

This impoverishment afflicts all the residents in the Lebanese territory, but the refugees are the most vulnerable category, especially in light of the outbreak of the pandemic, given the fact that the camps are a favourable environment to the spread of the virus.

“No one is helping the refugee during the coronavirus crisis, and of course there are no hospitals or vacant beds for critical cases, neither for refugees nor for anyone else. The situation is very difficult. Only the Lebanese Red Cross is trying to help us, and we go to them when the condition of one of the infected refugees gets worse. The Red Cross teams come to provide assistance and oxygen inside the tents, if possible," Al-Amin said.

When we asked Ahmed.N, 25, (from Baalbek) If he is considering taking a coronavirus test or a member of his family if they had any symptoms, his answer was: "My son is colour-blind, and he will soon lose his sight. I could not afford to treat him, do you think I can pay for a coronavirus test?"

To Arsal

We asked the same questions to head of the health committee of Ayadi El Kheir initiative in Arsal, Walid Rahma, who also complained about the high cost of the coronavirus test and the absence of periodic checks in the camps.

He said: "Some time ago, a committee from the health ministry tested refugees in Arsal camps free of charge, and discovered 35 infections.”  

Every camp in which covid-19 are recorded should be isolated, as individual quarantine is almost impossible inside tents where families of five, eight or more people live together. 

Rahma pointed out that "medical and livelihood aid provided to camps is very modest and limited some local associations and individual initiatives." 

It is noteworthy that Arsal, which is located in the northern Bekaa, includes about 105 camps, where about 75,000 refugees live, and with undisclosed cases of infection, one can imagine the number of infected people who suffer in silence inside the tents.

Rahma told Rozana journalist that two refugees died in Arsal recently due to the absence of ventilators or a hospital bed, while pinpointing to the major difficulties that camp residents face when the infected condition worsens. 

Storms can double the risk

As a result of the extreme weather and the arrival of snow and the rainy season in Arsal, Baalbek, and other areas, hundreds of people were forced to abandon their tents and move to live with other refugees in other tents or homes.

These conditions naturally enhance the propagation of the virus with more people crammed in one house, and makes all attempts to quarantine the infected futile.

In light of the unsatisfactory official intervention to contain the pandemic inside and outside the camps, it was time for civil initiatives to intervene. The health committee of Ayadi El Kheir initiative is a solidarity committee established by the refugees to help each other by contributing with a monthly fee to secure part of the health coverage for the sick.

Rahma indicated that "1200 families contributed to this committee with us. Each family used to pay 1000 liras per month, and now the fee increased to 2000 liras."

He added: “We work to distribute aid and ensure health coverage to those in need of treatment or surgery, and we try to pay 30 percent of the hospital bills for our folks in the camps.”

“Now in the time of the coronavirus pandemic, we collected an amount of money to provide each infected person with a hygiene basket, and we are trying to secure the medicines too. We bought three oxygen canisters to be available to those in need," Rahma continued. 

"I have asthma"

Mohammad M, a Syrian refugee in Arsal region, told Rozana describing his experience with the disease: “I suffer from asthma and I use a nebulizer most of the time. The coronavirus symptoms were very harsh on me, and I suffered a lot. Sometimes I would suffocate and go out of my tent so I could breathe. My wife also got sick and after the test, we had to quarantine ourselves for 14 days.”

He added: "I needed a ventilator urgently, but I was afraid to go to the hospital."

The refugee continued: "First, because of the stigma of being infected with the coronavirus, as if one was guilty, and secondly because the hospitals are full and it will be difficult to find a ventilator or a bed. On the other hand, my status is not legalized, so I was afraid of getting arrested."

“I had to endure the agony in my tent in silence,” said Mohammed

He asserted: "They were calling us from the municipality and the United Nations High Commissioner for Refugees to check on us and ask if we had any symptoms, but I did not tell anyone that I needed oxygen or a ventilator. I was overwhelmed by the fear of stigma, the costs of treatment, or getting arrested."

Minya - Akkar

Activist Mohammed Al-Dehaibi explained that the situation is tragic in most of the northern camps from Minya to Akkar, adding that "in the Bekaa, the camps are somewhat organized, but here the chaos is overwhelming."

Al-Dehaibi added: "There are camps dating back to before the Syrian crisis, others have been recently established due to the displacement of thousands of Syrians fleeing the war, so it is very difficult to count the number of infected people or even provide comprehensive assistance." 

He pointed out that "most of the refugees cannot afford to get a coronavirus test, so they try to handle the infection the way they treat a cold, in their tents and with their families."

"We did not hear of random testing being conducted here, during the pandemic, and with the refugees' inability to pay for PCR tests the situation is getting more dangerous. Aid is provided only by some civil society initiatives and volunteers, and of course, it is not as adequate as it should," says Al-Dehaibi.

In addition to the Syrian camps crisis, the Palestinian camps in northern Lebanon and in other regions are witnessing a similar problem, and with poor living and health conditions and the lack of commitment to quarantine and prevention, the risk of infection and the spread of disease are multiplied silently.

Al-Dehaibi also stated that "the refugees are forced to hide their infection in order to continue working, as most of them are daily farm workers. Therefore, they cannot stop working and isolate themselves for two weeks without any help or aid for them and their families, which naturally increases the risk of mixing and transmitting the virus, and enhances the outbreak of the pandemic.”

This blackout and the lack of testing make the camps a time bomb that will explode at any moment. The refugees are left with two options, either to work and feed their children, or starve and take refuge from coronavirus.

In the areas of Akkar and Minya there are camps that host about 2,500 refugees, however, no infection cases were recorded and also no PCR tests were performed, according to a Syrian activist, who spoke on condition of anonymity. 

It is noteworthy that the Akkar and Minya camps hose about 150,000 Syrian refugees, but so far only a few confirmed infections have been recorded, which indicates that there are many undeclared cases.

Insufficient aid

On the other hand, the UNHCR stated to Rozana journalist that it is "following up with the infected people to ensure that they receive appropriate medical care and provide advice on self-isolation in line with medical guidelines on covid-19."

The UN body added: "According to the system that we have put in place to respond to the pandemic, UNHCR and its partners have provided refugees with food and disinfectants in order to help them meet their basic needs during the quarantine, while 100 percent of the cost of treatment is covered if someone is admitted to hospital."

UNHCR media spokeswoman Lisa Abu Khaled stated: "Since February, the UNHCR teams have made every effort to rehabilitate and boost the capabilities of seven public hospitals in Beirut, Sidon, Baalbek, Rayak, Zahle, Tripoli, and Halba. We have built facilities dedicated to expanding hospitals or restoration and renewing existing inoperative sections with new medical equipment".

However, these efforts to protect the camps and society as a whole from the spread of the pandemic between these small and closely packed
tents are still not enough. 

In this context, Nasser Yassin, professor of development and strategy at the American University of Beirut, believes that "the official and local response to the outbreak of the pandemic in the camps came too late."

Yassin added: "But if we want to think about saving the situation before the number of infections increases, we need to conduct random testing regularly in the camps, and not limit our effort to inconsistent and limited campaigns; and before that, it is necessary to provide adequate isolation centres near the refugees’ gatherings and camps."

Will everyone get the vaccine?

Lebanon expects to obtain 2.1 million doses of the Pfizer vaccine in batches, starting from February 2021.

The deal will include granting Lebanon 600,000 free doses out of the total number of vaccine units.

The 2.1 million doses will be used to vaccine more than 1 million of the total number of the population, knowing that each individual needs two doses. Thus, 300,000 refugees are expected to get the vaccine and 170,000 people working in the health care sector will be the first to be vaccinated.

Yassin emphasized the necessity to distribute vaccines according to urgency and age, and not nationality; so this type of vaccine that will arrive or any other deal that the state will conclude with pharmaceutical companies can help society fight the virus.

After announcing the deal and approving the necessary laws for the use of the vaccine, many criticized giving the vaccine to the non-Lebanese residents, and considered that the priority is for Lebanese nationality holders, which indicates a real failure to understand the seriousness of the transnational pandemic and how to confront it. 

The fight against the pandemic will not end in February and the 2.1 million doses are not sufficient to protect a country inhabited by approximately 6.8 million people. As a result, the camps will remain a hotbed for a silent outbreak of the pandemic that the concerned authorities have no regard for, due to the depletion of hospitals’ capabilities, the exhaustion of medical personnel, and the hesitant and inadequate government decisions. 

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