BEIRUT: In the poorly lit stairwell of Haifa Hospital in the Burj al-Barajneh refugee camp, a large poster depicting the ancient city of Jerusalem, dominated by the gold crown of the Dome of the Rock, declares: “Visit Al-Quds.” It’s an aspiration that seems a long way off, as the Palestinian residents of the southern Beirut camp – facing poverty and heavy restrictions on rights to work – are struggling to access even basic health care services in a system under severe pressure.
Dr. Khalil Mohawech, the director of the hospital who sports a trim mustache and a navy polo shirt, recalled the glory days of public health for Palestinians in Lebanon. “When the PLO was here, funding was better,” he told The Daily Star, sitting beneath a large portrait of the organization’s late leader Yasser Arafat.
Hospitals in Palestinian refugee camps “were among the best hospitals in Lebanon at that time,” he said.
“After the PLO left Lebanon, the situation started to deteriorate.”
According to a report published Wednesday by British NGO Medical Aid for Palestinians, the health care system for Palestinians is in a dire condition across Lebanon.
Aimee Shalan, the organization’s CEO, said it is “stuck in an unsustainable limbo.”
Mohawech faces a number of challenges at Haifa Hospital. One of the principal issues is staff: the director said all his doctors are older than 40, while most are above 50, with new staff put off from entering the system by the issues of Palestinians’ right to work and a lack of funding.
The issue is compounded by low prospects for Palestinian students in the country. According to the MAP report, 40 percent of Palestinian refugee students do not begin secondary education. Those that do, frequently go abroad to study.
“They do not return because salaries are very low here and they cannot work,” Mohawech said. He added that ten of his hospital’s established doctors left in the past decade to seek opportunities abroad.
While a 2005 law technically made it legal for Palestinian refugees to work in Lebanon, it was conditional on obtaining a work permit from the Labor Ministry, which, according to the International Labor Organization, rarely happens – fewer than 2 percent of Palestinian workers in Lebanon have permits.
There are few incentives for employers to support such an application. Dr. Samer Chehade, director-general of the Palestine Red Crescent Society in Lebanon, said this means many Palestinians work “under the table” for lower wages than their Lebanese counterparts.
Palestinians also do not have access to Lebanese public services, including hospitals, and difficulties in obtaining a stable income is a barrier to looking to private health care. An UNRWA Health Department annual report for 2017 noted: “In Lebanon, Palestinian Refugees have very limited access to local health services.”
“We have many who would go to the private sector,” said Dr. Abed al-Hakim Chanaa, the UNRWA head of field health programs in Lebanon, “but when they have no money they are unable to.”
The health care system for Palestinians also suffers from decentralization, with a number of organizations providing services, but the majority of funding coming from UNRWA. This means providers are subject to knock-on effects from any funding difficulties. “If UNRWA reduces the fees paid to the Palestine Red Crescent Society, [which runs secondary care hospitals like Haifa], for the treatment of patients, PRCS cannot contract good specialists in order to run the service,” Mohawech said.
Regional issues have exacerbated the problem, with the large number of Palestinian refugees from Syria fleeing the country’s civil war for Lebanon, putting further strain on the system. “PRCS was not prepared for such an influx of refugees,” Mohawech said.
Funding difficulties are in abundance. Most notably, U.S. President Donald Trump axed in January $60 million of what was supposed to be a $125 million contribution to UNRWA’s core funds. As well as putting pressure on UNRWA’s capacity to pay for the secondary health care services provided by PRCS, the organization is also struggling to provide its own primary health care services in the Palestinian camps.
The MAP report said the average consultation time at a primary health care center between a doctor and patient was only 2.45 minutes. “If this financial crisis continues ... next September we will be unable to open the schools, and if we are unable to open the schools, we will be unable to run the health centers [that operate inside them],” Chanaa said.
The Lebanon Crisis Response Plan, a multiyear plan between the Lebanese government and its international backers, noted in its April 2018 update primary and secondary health services for 32,000 Palestinian refugees from Syria and 20,000 Palestinian refugees in Lebanon were at risk of being stopped during the first quarter of 2018.
Furthermore, the update said nearly 10,400 Palestinian refugee households living in extreme poverty would no longer be supported with the $100 of monthly cash assistance after April 2018. This is likely to put further strain on health services for Palestinians, given that poverty is one of the indicators of health care issues.
The MAP report also said two-thirds of Palestinians in Lebanon live below the poverty line, and food insecure Palestinian refugees in Lebanon are three times more likely to report three or more health problems. Meanwhile, according to the UNRWA report, the rate of chronic illnesses – such as cardiovascular conditions, hypertension, diabetes and cancer – is increasing by 5 percent every year for Palestinian refugees across the region.
Almost half of Palestinians in the country live in one of the camps, where conditions are notoriously poor. “These conditions cause all kinds of diseases,” Mohawech said, as a result of a “lack of good environmental conditions, whether air, pollution, no proper networks for water, sewage, humidity.”
Life in refugee camps can also increase the likelihood of mental illness. “People in the camps are living under stress,” Chanaa said. “The mental situation is very hard.”
While funding issues are causing immediate problems for Palestinian health care providers, Mohawech wants a long-term solution.
“Giving civil and social rights to Palestinians will improve living conditions. Or you can take the people and send them to Palestine,” he said, as a wry smile creased the edges of his mustache.