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Shatila ist ein nur 4 Kilometer von  der Innenstadt Beirut (Lebanon) entferntes Flüchtlingslager. © Elisa Fourt/MSF

Lebanon

“Refugees rely primarily on humanitarian assistance”

Testimonies 
Wilma van den Boogaard - MSF medical coordinator
Wilma van den Boogaard, LuxOR team member in Luxembourg, went to Lebanon for two years as a medical coordinator. Now that she has been on site for eight months, she takes stock of her experience.

    What is the situation in Lebanon?

    Lebanon has a history and context of cohabitation. There is cohabitation between different communities and different religions, between refugees and locals, who all seem to live in harmony under the gaze of the many tourists. In reality, when you look more closely at the relations between these groups, the tension is palpable.

    The tensions can be explained in part by the diversity within Lebanese communities (Christians, Sunnis, Shiites, Druze, etc.) which coexist alongside one another. That is compounded by the fact that Lebanon has over 1.5 million refugees for a national population of around six million. A large percentage of them are Syrians, as well as Palestinians, some of whom have been refugees since the 1950s.

    With such diversity and such a surge in the population, the tensions are understandable, but not always easy to manage. Indeed, we also have them within our MSF teams, which are quite heterogeneous.

    What are the needs and how is MSF addressing them?

    When one knows the context and the situation in Lebanon, the most pressing needs are quickly apparent: those of the refugees, who rely primarily on humanitarian assistance because they have very few rights on Lebanese soil. Thus, there are quite a lot of healthcare needs ad MSF is addressing them with primary healthcare, mental healthcare, reproductive healthcare, treatment for chronic illnesses and with a new in-home healthcare service for the 10% of the population who are ill but cannot travel to the MSF clinics and health centres.

    The MSF operations I supervise are located in northern Lebanon in the governates of Akkar and the Bekaa Valley where the organisation is going to open a hospital specialising in generalist surgery, in Beirut in the Shatila camp where MSF manages a primary healthcare centre and a maternal health centre and in the Burj El-Barajneh camp where MSF launched the in-home care service for persons suffering from chronic illnesses, as well as in Saïda in the Ein-el-Hihweh camp where a team continues to offer in-home healthcare and is building the capacities of the paramedical staff in the region to handle urgent cases triggered by violence.

    What is your role on the ground?

    I am the medical coordinator for MSF in Lebanon, which means I am jointly responsible for MSF's medical strategy in the country. I spend a lot of time interviewing the medical teams about the quality of our response to get the opinions of the people who work on our various projects on a daily basis. Lebanon is a very (even excessively) medicalised country, so my role is to encourage a perceptual change amongst our staff, our partners and the population in general. For example, in Lebanon C-sections deliveries are systematic. It is important for patient health that the MSF teams, in partnership with the Ministry of Health, hospitals, doctors and the population, break free from these habits and return to approaches that are simpler, but just as effective.

    Another part of my job is to represent MSF vis-à-vis our national partners with regard to medical operations. Therefore, in conjunction with the Head of Mission, I participate in discussions with the Ministry of Health and other partners in Lebanon about objectives and the agreements to negotiate.

    Finally, I am right in the thick of medical discussions when MSF decides to set up a new project in the field, such as a new hospital, a new activity or a new type of treatment. I ask questions about the necessary resources, equipment, partners, etc.

    You previously worked for LuxOR. Are you continuing your research on site?

    I care deeply about LuxOR's mission and I spend my free time on it. I am still actively involved in several studies, including one on “Perceptions and beliefs about mental health problems and services among Syrian refugees and the host population in Wadi Khaled in northern Lebanon” which one of our psychologists was able to present at the MEMA (Middle East Medical Assembly) Conference in Beirut on 19 April 2018. Our epidemiologist also presented a study on “Field evaluation of Joachim clinical score and rapid diagnostic test for paediatric bacterial pharyngitis in a refugee camp in Beirut, Lebanon” on Operational Research Day on June 1st in Brussels. These two presenters completed training on how to conduct research amidst operations, a course which I coordinate or teach as a mentor.

    I also travelled to Johannesburg in March for the SORT-IT qualitative research course. In that capacity, I am a mentor for the next study: “What are the medical and psycho-social effects of in-home treatment for patients affected by chronic illnesses and for their care givers in two Palestinian refugee camps in Lebanon?”

    There are many operational research projects under way and I take part in them as much as I can!

    What is the expatriation experience like for your family? What are the challenges?

    It is a very enriching experience, but of course it is riddled with challenges.
    The biggest challenge is my kids, who are 14 and 17 years old...teenagers. It's a complicated age already, then one adds the demands of adapting to a new culture, meeting new people and being far from friends. Even in the French high school in Beirut, all the students speak Arabic, so they talk in Arabic during breaks, which really does not help them with integration.

    The other challenge is knowing when to stop working! My husband and I both work for MSF and anyone who has done this knows that it is much more than a job. It's a commitment. As I mentioned earlier, I also use my free time to pursue my work and research for LuxOR and, on top of all that, I decided to take Arabic lessons: that makes for very full days and does not leave me much time with my family.

    It is a two-year investment and a thrilling learning experience that I think is absolutely worth it.

    Do you have any stories to share?

    In the Ain El Helwe Palestinian refugee camp near the city of Saïda, we starting offering in-home care to patients with chronic illnesses who could not come to the clinic. 
    A woman with diabetes had a huge wound on her foot because her insulin-dependent diabetes was not under control. She could not even walk anymore; she could not leave her house and was completely dependent on her family.

    Our team, composed of a doctor, a nurse and a social worker, went to visit her, treated the wound on her foot and tried to find someone willing and able to give her an insulin shot every day at the same time. Because her family did not want to do it, the social worker went to ask the neighbours. She found a devoted neighbour, who was then trained by the nurse on how to give the shots and by the doctor on the importance of the injections.

    After three months of treatment, the woman was able to walk again and to leave her home. It is hard to express just how much the quality of life of that woman improved...with so little help.