Global Refugee Context
Since March 2011, the conflict in Syria has resulted in large scale displacement internally and across the region which could be the greatest humanitarian crisis in modern history. With hundreds of thousands injured and fatalities, millions internally displaced people (IDPs) and more refugees in neighbouring countries, largely in Lebanon, Jordan, Turkey and Iraq. The situation has now reached a crisis point with an estimated 9.3 [AB2] million people requiring humanitarian assistance.
“The reasons for leaving Syria are clear, the severity of the conflict, fear of atrocities committed against civilians by both sides, and declining resources inside the country have made it impossible for millions of Syrians to stay. Those who leave often face difficult journeys to reach the safety of neighbouring countries. At the same time, the sheer number of Syrian refugees and the duration of their displacement in countries such as Jordan and Lebanon has put a great strain on the resources and capacity of host governments and communities”  including water supplies, basic goods and commodities and sheltered accommodation.
For Lebanon, over 1.5 million people have entered the country since the commencement of the war, and the continued flow of Syrian weapon wounded and other persons with disabilities (PwDs) is notable, thus increasing the burden on existing health structures. Inadequate surgery for the Syrian weapon wounded has resulted in many complications resulting in infections and consequently amputations. Make-shift Post-Operative Centres (POC) have been established largely run by Islamic based NGOs, and Syrian based organisations to cater for the needs of the weapon wounded, however limited financial resources and clinical expertise have largely hampered the recovery process. Refugees have dispersed throughout the country making follow-up by the aid agencies (e.g.UNHCR) all but impossible. Tensions between the Syrians and the host communities are rising and the longer the situation continues, the risk of local clashes is frequent.
Around 40,000 Palestine refugees from Syria (PRS) who fled the violence in Syria are currently residing in Lebanon. Already prior to the outbreak of this conflict, the approximately 280,000 Palestine refugees in Lebanon (PRL) were highly marginalized, with limited rights and restricted access to public services and employment. The UNRWA health, education and relief services on which PRL depend, were already stretched and camp infrastructure was in dire need of maintenance and rehabilitation. The challenging conditions for PRL have further deteriorated with the influx of PRS, heightening community tensions and negatively impacting stability and security in Lebanon and the region at this critical time. UNRWA remains the lead coordinating agency and primary provider of aid to Palestine refugees in Lebanon.
Within a challenging context, people with a disability and the elderly are among one of the more vulnerable groups. The lack of specialized services for persons with special needs has been highlighted as a major gap in the current response to the Syrian crisis in Lebanon. In general, the access of Palestine refugees with special needs to public services is limited in Lebanon, and there is a visible gap between demand and supply of services. Compounding this, many PRS have moved into Lebanese Palestinian Refugee camps, and have put increased strain on the host community. As a result, both PRS and PRL are struggling to access specialist services in an already extremely stretched system. Identified challenges include: provision of assistive devices/prosthetics; rehabilitation services for people with newly acquired and long-standing disabilities; and access to mainstream and special education.
Many persons with a disability and their families have complex protection issues crossing both medical and social sectors, which require timely comprehensive assessment, coordinated direct support and referral to multiple agencies. A number of challenges aggravate their marginalization in society, among which include:
- limited access to and availability of specialised rehabilitation services in the country,
- inadequate awareness of needs, and
- insufficient protection of the rights of persons with disability.
For instance 30% of children with a disability are excluded from the Educational System. Within this context the project will provide about 500 Palestinian refugees with disabilities (SSN and Non-SSN), who have physical and sensory disabilities in need for prosthetic and orthopedic devices like artificial limbs, hearing aids ,other types of prosthesis, mobility devices and movable beds.
Overall resources available to ensure the equitable provision of quality, essential health services for Syrian refugees is limited. Syrian PwDs face even greater challenges to obtaining needed services from a health sector beset by inaccessibility at all levels. Syrian refugees suffer a high incidence of traumatic-related, adding morbidity to the high prevalence of NCD. In a recent survey, 24.7% of Syrian refugees in Lebanon reported the Syrian conflict as the cause of their disability. For those with a physical disability, the 71% who continued using mobility aids experienced difficulties in walking. It is unclear whether those issues were a result of inappropriate fit, lack of long-term support and provision of services, or the economic burden on the individuals and their families. The majority of PRP beneficiaries are Syrian children with disabilities that are living in Bekha valley, most of them are acutely affected by the poor availability and quality of basic services. A high number of those children suffer from musculo-squeletal conditions (such as clubfoot, hip dislocation, birth defects…) or congenital disease which require specialized services, like ortho-pediatrics surgery and comprehensive rehabilitation services which are lacking.
There is evidence that People with disabilities are more likely to have poorer overall health than the general population, due to a variety of possible mechanisms which may be different for people with different impairments. In fact, people with disability are at higher risk of both secondary health conditions which have a causal link to the primary diagnosis or impairment or co-morbidity factors. It can include as well (related to the primary impairment) mental health problems in an individual with a long-term physical disability due to social exclusion or poverty. Barriers to healthcare access for People with disabilities are increased significantly caused by the physical environment associated with transport to services (financial and access) including to PRP clinics. Many of the Ministry of Public Health’s primary healthcare centres and dispensaries are not currently accessible to this population group. Many of people with disabilities healthcare needs continue to go unmet due to a lack of accessible information and awareness regarding the availability and location of specific services that are needed.
A number of challenges aggravate their marginalization in society, among which include: limited access to and availability of specialized rehabilitation services in the country, inadequate awareness of needs, and insufficient protection of the rights of persons with disability. For instance, 30% of children with a disability are excluded from the Educational System. These include prevailing social norms and attitudes towards disability, a lack of budgetary allocations supporting inclusion in the public education system, limited teacher capacity, limited access to education spaces and tailored programmes, a lack of effective teaching strategies to provide appropriate instruction, and limited access to schools with adequate facilities. The lack of specialized services for persons with special needs has been highlighted as a major gap in the current response to the Syrian crisis in Lebanon. There is a visible gap between demand and supply of services. For the Palestinian communities, many Palestinians from Syria have moved into Lebanese Palestinian Refugee camps and have put increased strain on the host community. As a result, both Palestinians from Syria and Palestinian from Lebanon are struggling to access specialist services in an already extremely stretched system. The identified challenges include: provision of assistive devices/prosthetics; rehabilitation services for people with newly acquired and long-standing disabilities; and access to mainstream and special education.
In overall there are insufficient rehabilitation services to serve the needs of the population (Lebanese citizens, Palestinians and Syrian refugees). This subsequently impacts on quality of life with the ongoing effects and burden on the health infrastructure. The absence of a unified and standardized prosthetic and orthotic coverage procedure make the access to PO services unclear and difficult to access. As the Syrian is going to have a long-lasting effect on the region, Syrian refugees residing in Lebanon need to get their assistive devices more frequently repaired/ adjusted or have it replaced. Those services are only provided by humanitarian actors which is mainly depending on the humanitarian sector for the time being. High costs for treatment, limited opportunities for movement within the country and a limited response from the humanitarian community risks additional long-term impairments and possible fatal complications. As long the current situation of governance continues, it is unlikely that ministries concerned will reinstate a budget ensuring the access to reliable physical rehabilitation services. Poor Lebanese needing important devices are confronted with lengthy waiting list or depends from private charities.
- Froehlich-Grobe. K et al. Impact of Disability and chronic conditions on health disability health. J. 2016 9 (4)-600.8
- GHI AUB. Magnifying Vulnerabilities | The Plight of Syrian Refugees: Persons with Disabilities. Available from: http://www.youtube.com/watch?v=6824BIEtpF0[last accessed 30/08/20]