Since April, a rising tide of anti-refugee sentiment in Lebanon has fueled intensified raids and security measures to address the issue of unregistered people in the country.
As a result, Syrian refugees seeking health care at Doctors Without Borders/Médecin Sans Frontières (MSF) clinics in Baalbek-Hermel governorate face growing impediments to accessing health care due to fears and restrictions on their freedom of movement. For many refugees in this governorate, the decision to seek medical help is now fraught with fear.
MSF has been present in Baalbek-Hermel governorate, in northeastern Lebanon, since 2010. For over a decade, our teams have provided free high-quality medical services including pediatrics, sexual and reproductive health care, treatment for noncommunicable diseases, vaccinations against preventable diseases, and mental health support for both refugees and the local community. Currently, MSF runs a clinic in Arsal and another in Hermel, and we support access to secondary health care through partner hospitals. Yet, even with this assistance, numbers of missed medical appointments are soaring as fear tightens its grip on the refugee community.
The toll on physical and mental health
“I wish for death,” said Umm Khattab, a Syrian refugee who for years has called a flimsy tent along the northeast border of Lebanon home. “We live in constant anxiety and terror. Death has become more merciful than living here."
Her words capture the stark reality faced by tens of thousands of refugees in Hermel, Qaa, and Arsal, Lebanon, where makeshift camps of tarps and scraps dot the arid landscape. Refugees, already crammed into inadequate spaces with dirt floors and no heating, must also grapple daily with the fear of security checkpoints and local tensions.
“Fear keeps my family of ten crammed together in the tent all day,” says Wael, a 36-year-old father with hypertension and diabetes. “We never leave the tent after 6:00 p.m., as that is when the curfew on Syrians is imposed. The children never go out, and they face bullying from the local children.”
Wael has been a patient at the MSF clinic in Hermel for a few years now, receiving vital medication for his chronic condition, but recent measures have made access to life-saving care increasingly difficult.
"I always feel anxious when I have an appointment at the MSF clinic,” said Wael. “I fear the security checkpoints. My appointment was on May 20, but I was afraid to go out because of a security campaign in the area, so I decided not to go. The fear causes my blood sugar to rise, and I worry I won’t have the means to lower it.”
During these security campaigns, Syrian nationals with expired papers are often captured at checkpoints and forcibly deported back to Syria, usually without the chance to contact their families in Lebanon.
Other patients with chronic disease have resorted to rationing or abandoning medication altogether out of fear of leaving their tent to get them. A few miles away in neighboring Qaa, Amer, another 36-year-old living with hypertension, had completely run out of his medication in April.
“I ran out of medicine and don’t have the means or courage to go for a refill,” Amer said. “I have nightmares of being chased by the authorities. I do not dare cross the checkpoint and be taken away from my family perhaps forever.”
“I suffer from high blood pressure,” said 60-year-old Talal from the floor of his battered tent in Arsal. “I started taking medication two months ago because of rapid heartbeat, and my blood pressure regularly spikes above the normal range.”
The only way Talal was able to traverse the mountainous landscape of Arsal to get his medication was on a ramshackle motorbike that was recently confiscated. A recent countrywide crackdown on unregistered vehicles in Lebanon has resulted in many Syrians losing their motorcycles, which often serve as their only means of transportation. “It was our only means to take care of our needs,” he lamented. “If I want to go buy food for my family or get my medical consultation and medication from your clinic, I will need to rent a motorbike or a ‘tuk-tuk’ cart, which is cheaper than a car but still too expensive for us.”
Two tents down from Amer’s shelter lives Umm Omar, who gave birth to a baby at home less than a month ago. Umm Omar’s memory of the night her water broke unexpectedly is hazy, but she recalls clearly how the community’s fear of crossing army checkpoints kept her confined to the tent’s dirt floor, battling the pains of labor without anesthesia.
“I was screaming in the dead of night, and no one could take me to a clinic,” said Umm Omar as she swaddled her newborn. “They called for a fellow refugee here whose mother was a midwife. She thankfully delivered my baby by memory of the practice. But I still can’t leave the camp to get him a birth certificate.”
A warm welcome soured
Initially welcomed by the warmth of the host community after fleeing conflict and hardship in neighboring Syria, their sanctuary has since soured amidst Lebanon's economic meltdown. “At first, the municipality helped us when we came to Arsal,” said Maya, who has spent more of her life in Lebanon than in Syria. “They gave us some items to sit on and use. Then they enrolled me in school, and I started going to school. The community initially welcomed us and did not make us feel like strangers.”
However, as Lebanon strains under its fifth year of severe economic crisis, Syrian refugees face growing intolerance in the country. The economic hardship, compounded by fear of movement, has forced refugees into an impossible choice between their safety and their health. Even lower on the list of priorities for refugees at the moment is their mental health.
"We live in constant anxiety and terror. I can't even sleep due to these security campaigns and my fear for my children,” said Umm Khattab, who has been suffering breakdowns since her son was deported in late 2023. “Our children's hearts race with fear and anxiety during these campaigns, and we only hear the phrase, 'Here they come!' I try to comfort my children, but inside I am more afraid than they are."
"After several years of displacement, some Syrian refugees have developed further psychological symptoms," said Amani Al Mashaqba, MSF’s mental health activity manager in Baalbek-Hermel. "High psychological distress is present in the refugees because of repeated crisis events. Changes in behavior related to exposure to traumatic events have been reported by our mental health patients in both adults and children. Their daily lives have been impacted and changed; nothing is like before. They go out less, have fewer relaxing moments, families are separated, and people have become not as open as they used to be. People are tired. They feel insecure, depressed, and down. Their youth are unsure how to cope with life—they cannot go back, but they also cannot move forward. They are stuck in a 'dead middle,' a state of perpetual limbo, that affects the entire family."
“Everyone is on edge,” Umm Khattab said, inadvertently describing the symptoms of post-traumatic episodes. “When we hear someone speaking loudly or a loud noise, we think a security raid has begun, and we panic.” Similar testimonies have been shared by refugees in Arsal and Hermel.
The physical and mental toll on the refugee population is profound. “Our main hope is to live in safety and not be approached by the security forces. Fear is our primary suffering here," said another refugee. This pervasive fear is not just a barrier to health care but a constant companion in their daily lives.
"Believe me, if our place in Syria was safe, I wouldn't stay here for a minute. What will we do in Syria? We have nothing left there. Now we wish for death because death has become more merciful than living here,” said Umm Khattab.
Vulnerable people’s access to health care should never be hindered by fear or intimidation. Patients should not have to choose between their safety and seeking medical help.
*Names in this article have been changed to protect anonymity.
