Liban, Shatila : A country in the grip of multiple crises

For the last two years, the country has been going through an unprecedent politico-economic crisis, leading to popular uprising, a deep political crisis and a complete collapse of the economy and the public services of the country. People cannot access their money anymore. The tensions between communities are rising and violence is increasing. The arrival of COVID-19 and a massive explosion in Beirut dealt further blows to Lebanon’s health system, already fragile following a year of economic, political and social unrest.

Besides, Lebanon remains the country with the highest number of refugees per capita in the world, mostly Palestinian and Syrian.

The target population of MSF project is the refugee populations living in Shatila, Sabra and Burj Al Barajneh camps, in the south suburbs of Beirut. The project is intended primarily for Syrian refugees but is open to Palestinians who have fled from Syria and other residents of the camp (Palestinians, migrant workers etc.) and vulnerable Lebanese population. While the Lebanese medical sector is highly privatised, most of the population cannot afford to pay for these services.

Poverty rate has doubled from 42% in 2019 to 82% of the total population in 2021. While people have limited means to access private insurance, an increased number of families have no health care coverage. Consequently, the surge of people seeking subsidized care is putting additional pressure on the public health system and onprimary health care level. The cost to access health care has largely increased while the quality of care found has decreased.

MSF is one of the rare international humanitarian actor not driven by covering a certain profile of people defined by origin or administrative profile but by the needs only. We are recognized as such by the communities.

MSF has worked in Shatila refugee camp since 2013 and Burj Al Barajneh refugee camp since 2016.

MSF response

In Shatila camp, MSF’s clinic provides patients with care for non-communicable diseases (NCD) on an outpatient basis; home-based care for homebound patients and vaccinations. We also provide mental health support, health promotion services and refers patients when required to specialist services. Besides, MSF assumes the part of the costs of the referrals that are not covered by UN agencies.

In 2020, the existing clinic in Shatila is converting to a more holistic and patient centred Family Centre, keeping a horizontal short term NCD care capacity with an empowered patient-centred approach, a nurse-led NCD patients care for homebound patient as well as patient psychosocial support and education next to other activities such as sexual and reproductive healthcare (SRH) and mental health support.

In Burj Al Barajneh camp, MSF provides primary healthcare and runs a Family Centre which focuses on mental health, mother and child healthcare (including family planning, antenatal care and postnatal care), home-based care for patients with chronic NCD and care for survivors of sexual and gender-based violence (SGBV) and domestic violence as well as a safe abortion care.

Beyond the camps, MSF manages a birth centre within the compound of Rafik Hariri University Hospital (RHUH). This birth centre includes training nurses, advocating for them to play a stronger role within the Lebanese health system, and advocating for childbirth to be de-medicalised, thus successfully decreasing caesarean rates and improving health outcomes for both mothers and babies.

In 2021, MSF participated in COVID-19 vaccination, vaccinating 5,500 people with a mobile team (elderly, homeless) and 6,000 people in fixed sites. Similarly, our team realised almost 30,000 COVID-19 test swab sampling.

In 2022, MSF also aim to integrate more medical activities into the Lebanese national health system and to increase access to healthcare to vulnerable Lebanese population. MSF wants to support one selected primary health care centre outside of Shatila and Burj-el Barajneh camps to ensure antenatal care (ANC); and to ensure technical support, training and supply in case of drugs shortage in other selected health centres; to further roll out the integration of NCD cohort into MoH health centres and to continue working on the midwifery model at our birth centre and prepare its handover to Rafik Harari hospital team.