NEW research published in The Lancet has uncovered the hidden health toll that refugee life in Lebanon has taken on more than 400,000 Palestinians.
The British medical journal has published a series of papers drawn from a meeting of public health researchers, The Lancet-Palestine Health Alliance, in Beirut in March 2012 (‘Health in the Occupied Palestinian Territory 2012,’ 8 October 2012).
The alliance aims to ‘strengthen and expand the capacity of Palestinian scientists to study, report and advocate for the health of their own people,’ explained Richard Horton, The Lancet’s editor-in-chief.
While much of the research investigates the negative physical and mental health impacts of living in the West Bank and Gaza, several studies also explore the health and well-being of Palestinians living in Lebanon, which has hosted Palestinian refugees for more than 60 years.
According to one of the studies, by researchers from the American University of Beirut, ‘discriminatory laws and decades of marginalisation’ have left Palestinian refugees in Lebanon socially, politically and economically disadvantaged.
More than half of them live in increasingly overcrowded camps, where ‘the provision of housing, water, electricity, refuse and other services are inadequate and contribute to poor health.’
Out of 2,500 households surveyed, 42 per cent had water leaking from their walls or roofs, and eight per cent lived in homes made of dangerous building materials such as asbestos.
Hoda Samra, a spokesperson for the UN agency for Palestine refugees (UNRWA) in Lebanon, said many refugees live in shelters lacking ventilation and daylight.
While about 5,000 shelters are in need of rehabilitation, the agency has funding to repair only 730. Samra added that there is also a lack of funding to address rundown infrastructure in four out of 12 of the camps.
Camp populations continue to grow but the land allocated for them has not; the resulting overcrowding has exacerbated public health problems.
‘Some of the camps are growing vertically but not horizontally,’ said Samra, noting that many of the structures were built haphazardly, too close together and without proper foundations.
The study found a direct correlation between poor housing conditions and poor health among respondents; 31 per cent had chronic illnesses and 24 per cent had experienced acute illnesses in the previous six months.
The researchers also found a strong link between poverty and ill health.
Palestinian refugees living in Lebanon are ineligible for social services, including healthcare, and they are banned from some 50 professions.
UNRWA and the International Labour Organisation have lobbied the Lebanese government to ease employment restrictions, but amendments to labour legislation enacted in August 2010, which would make it easier for refugees to secure work permits, are still awaiting an implementation decree from the Department of Labour.
According to another study in The Lancet series, also by researchers from the University of Beirut, 59 per cent of refugee households live below the national poverty line; 63 per cent reported some food insecurity, while 13 per cent were severely food insecure.
Only the poorest – about 13 per cent – qualify for food rations and small cash grants from UNRWA.
The combination of poor nutrition, unhealthy living conditions and feelings of hopelessness breed ‘all kinds of illnesses,’ said Samra.
But while primary health care is freely available through UNRWA’s clinics, and patients referred to UNRWA-contracted hospitals are treated free of charge, specialised care is only partially covered.
Refugees in need of complex surgery or treatment must foot at least half of the bill themselves.
‘This is a big, big challenge for them,’ said Samra. ‘They often find themselves unable to cover the rest of the bill and have to run up debts they can’t repay or simply forgo surgery or treatment.’
She spoke of an 18-year-old in need of a liver transplant that costs $95,000, which neither he nor UNRWA can afford. ‘We can’t cover that. We’re trying now to approach some private sector companies to collect the funds needed.’
Lack of mental health services presents another challenge.
A 2009 study by UNRWA, also published in The Lancet, found that mental disorders related to chronically harsh living conditions and long-term political instability, violence, and uncertainty were a public health concern among Palestinian refugees living in Syria, Jordan and Lebanon.
One of the recent University of Beirut studies found that 55 per cent of respondents were ‘psychologically distressed’.
UNRWA offers only basic counselling services, referring refugees in need of psychosocial support to organisations such as Doctors Without Borders/Médecins Sans Frontières.
‘We’re always pushing project proposals for mental health services to donors with the hope they get funded; there is a need,’ said Samra.
‘When taken together,’ writes The Lancet’s editor Horton, ‘these data expose the hidden crisis facing Palestinian refugees, whose health needs have been sorely neglected.’
l As the West Bank olive harvest season begins, two Israeli rights groups released reports this week criticising Israeli authorities for failing to protect Palestinians from settler violence, or investigate attacks.
During last week, Palestinian farmers reported almost daily attacks on harvesters and olive groves in the West Bank.
Israeli rights group B’Tselem said last Thursday it had documented five of the attacks since last Sunday October 7th.
That day, the Abu Fahaida family found 25 ancient olive trees destroyed in al-Janiya, west of Ramallah.
B’Tselem said Israeli forces had been called to the same olive grove the day before after a group of settlers confronted the family, noting that the army’s presence did not prevent the vandalism.
Also on Sunday October 7th, farmers from nearby Beitillu village going to harvest were attacked with stones by ten masked settlers, who are also suspected of setting fire to the field.
B’Tselem said Israeli soldiers faced difficulties controlling the settler group and removed the Palestinian harvesters while firing in the air.
Last Tuesday, Palestinian farmers from Nablus villages Farata and Amatin found thieves had already harvested olives from around 220 trees on their land near the illegal Havat Gilad outpost.
In nearby Qaryut village the same day, farmers found more than 80 of their olive trees had been severely damaged.
Last Wednesday, Israeli authorities notified Ratib Naasan, from Ramallah village al-Mughayir, that his olive trees had been damaged. Naasan found around 140 olive trees stripped and vandalised.
B’Tselem noted that the farmer had olive trees vandalised in 2008, 2009 and 2010, but charges were only brought in one case, when the rights group provided video documentation.
It called on the army and police to investigate each incident and complaints that soldiers did not intervene to prevent attacks.
Meanwhile, rights group Yesh Din said last Thursday that of 162 attacks on Palestinian trees since 2005, only one case had led to charges.
The group said 124 files were closed on grounds of ‘perpetrator unknown,’ sixteen because of ‘insufficient evidence’ and two on grounds of ‘absence of criminal culpability’.
Others are still under investigation, or information was not provided, while case files were lost for two incidents.
The failure of Israeli police to investigate the attacks is ‘only one aspect of its continuous and broad failure to enforce the law against ideological crimes by Israeli citizens against Palestinians in the occupied territories,’ the group said.
The UN Office for the Coordination of Humanitarian affairs reported that over 2,500 olive trees were destroyed in September 2011, and 7,500 throughout 2011.
The attacks cost Palestinian farmers over $500,000 that year, according to an estimate by Oxfam and local agricultural organisations.
