State of the World's Minorities and Indigenous Peoples 2013 - Case study: Palestinian refugees in Lebanon

by Hanan Hammoudeh

The poor conditions in the camps in Lebanon where Palestinian refugees have been living for more than 60 years lead to chronic ill health and mental health problems.

'[Health issues] are a result of the pressures of life, poverty, the lack of movement, the electricity, the water, and the overcrowding.' Ahed Khalil, aged 22, Burj el Barajneh refugee camp resident.

Often calling themselves 'forgotten people', Palestinian refugees make up10 per cent of the population of Lebanon. Facing marginalization and discrimination, these residents are without basic human rights. Besides their lack of political and civil rights, they are denied access to public health care and largely depend on aid and the charity sector for health provision. Today, most of these refugees live in camps and locations that are characterized by water contamination, where health risks are exacerbated by overcrowding. Meanwhile, laws prohibit the expansion of the camps. A peek into the life of the camps illuminates the intersection of marginalization, social exclusion, poverty, and the consequent health impact among the present minority.

Doctor visits and hospital care

On average, a doctor at a health clinic run by the United Nations Relief and Works Agency (UNWRA) sees 117 patients daily. Hospital care is often inaccessible to Palestinian refugees due to high costs, and those in need of care often seek aid from charities and other people in order to pay hospital fees. Poor health is both a symptom and a cause of economic hardships among the refugee community. An American University of Beirut report published in 2010, which took into account mental, physical, acute and chronic health issues, indicated that 57 per cent of households said they had made visits to a doctor or incurred medical costs resulting from chronic illnesses; thus chronic illness is the most common reason for receiving medical care. The most common of chronic illnesses was found to be hypertension, which was at a 32 per cent prevalence among Palestinian refugees with chronic illnesses, compared with 14 per cent among the Lebanese population. Overall, the study found a 31 per cent chronic illness incidence among Palestinian refugees, compared with the 17 per cent among the Lebanese population.

Health behind camp walls

According to the report, 66 per cent of Palestinian refugee camp homes were affected by leaks and dampness, with water leaking from every one in three ceilings. The report also indicated that higher illness prevalence was associated with some housing traits common to camp infrastructure. People who lived in homes that had asbestos, eternit, or wood in their walls had an astounding 100 per cent of chronic illness prevalence. Homes in which four or more people lived per room were associated with higher prevalence of functional disabilities and acute illnesses. Ahed, a 22-year-old resident of the Burj el Barajneh refugee camp in Beirut, described the overcrowding of the camps as 'nas fo' ba 'ad', a figurative phrase in Arabic literally meaning 'people piled on top of one another'.

The Palestinian refugee population has double the prevalence of disability of the Lebanese population, despite no significant difference in birth defects, and 20 per cent of disability cases among the Palestinian refugee population are the effects of accidents. When describing the environmental factors contributing to poor health in the camps, Ahed referred to, '[T]he electricity. Old infrastructure and water pipes intertwined with electricity wires ... Children are dying as a result of this.' Among these is Ahmad Yakoub, a Burj el Barajneh resident who was 14 at the time of his electrocution and subsequent death. Between the years of 2010 and 2012 in the Burj el Barajneh camp alone, an estimated 20 people lost their lives as a result of electrocution. At a minimum, one electrocution-related death in the camp is estimated to take place every 2-3 months.

Mental health and the political environment

With regard to mental health, 21 per cent of Palestinian refugees surveyed for the American University of Beirut study reported psychological problems, including distress, depression and anxiety. It was suggested that the stresses of the Lebanese civil war and lack of civil rights within the country have contributed to these burdens. Ahed said that the environment was a principal factor tied to the mental health issues among the camp population, caused by 'poverty, the lack of movement, the electricity, the water, and the overcrowding'.

Palestinian refugees in Lebanon have long been victims of political scapegoating. Due to Palestinian factions' role in the Lebanese civil war, the population has long been stigmatized and has been approached with defence rhetoric. Ahed says that the camps are approached from a security angle, and this has thwarted adequate responses to issues such as health. Deprived of basic rights due to claimed security measures and embedded fears of permanent settlement, the health predicament of Palestinian refugees continues.