From Syria to Ain el-Helweh: alleviating the suffering of refugees in Saida

May 21, 2013

From Syria to Ain el-Helweh: alleviating the suffering of refugees in Saida © Aurelie-Lachant

I’m deeply sad inside, but I need to appear strong in front of my family. It’s very difficult. Seven of my relatives were killed by the bombings and shootings in Syria. We saw their mutilated bodies. I buried them myself and buried my neighbours too. My son disappeared. One month later, my brother disappeared. I’m sure they got killed and this is causing me a lot of sadness”, tells Mahmood, who left the Yarmouk Palestinian refugee camp near Damascus 45 days ago. He now lives in Ain el-Helweh with his wife and six-year old son in a narrow room, separated in two by a plank of wood to accommodate another family.

Around 60 other families have gathered in and around what used to be a social and cultural centre in the Palestinian camp of Ain el-Helweh in Saida. More than half of them share 19 overcrowded tents, while the rest is crammed in rooms. This is just one of the areas of the camp accommodating Palestinian refugees who fled the war in Syria. The majority come from Yarmouk and other Palestinian camps in Syria.

Created in 1948 to accommodate 10,000 people, Ain el-Helweh has become the largest Palestinian refugee camp in Lebanon, now hosting an estimated 80,000 people for the same surface. The ever-increasing number of people residing in the camp somewhat manage to get around high population density and find living spaces by building additional floors on top of their houses.

In the past six months however, an estimated 2,400 families fleeing Syria – mostly Palestinians, but also Syrians – have taken refuge in this already overcrowded camp, living with host families, renting accommodation or gathering in collective shelters and some tents in the camp. Both the camp residents and newcomers need to adjust to their new living conditions – a situation which has translated into growing needs for mental health services.

Most common diagnosis: depression, anxiety, trauma

On the other side of the plank of wood, Rabeeh, a young man, shares a narrow living space with his wife. She was pregnant, but lost her baby during the war in Syria. “Rabeeh keeps thinking about his brother who went missing. He’s very worried and depressed, because he doesn’t know what happened to him. He’s crying most of the time and has constant nightmares. He doesn’t know how to deal with this situation”, explains Nissreen Moghamis, MSF social worker. “This is just one amongst the many stories we hear everyday”.

Depression, anxiety, and post-traumatic stress disorder are the most common diagnoses amongst MSF’s patients coming from Syria. “There’s a high level of trauma: many have witnessed the killings of relatives and friends, the burning of their houses, some of them have been tortured. A lot of people suffer from panic attacks, memory gaps, nightmares, somatisation, etc. On top of this, they face very difficult living conditions and struggle to find basic life necessities”, says Manal Kassem, a psychotherapist working in one of MSF’s clinics.

Difficult living conditions and intra/inter familial tensions:

Numerous conflicts arise between family members due to the very narrow living spaces that they have to share. “With 10 or more people from different families sharing a single room and one public toilet for everyone, people suffer from the lack of hygiene”, explains Abu Saleh, a Palestinian refugee who’s been living in the camp since 2006 and is managing the refugee gathering where Mahmood and Rabeeh live.

Domestic violence has increased because people find it difficult to adjust to their new situation. In some instances, roles of family members are being reversed. “It is the women who ask for assistance and bring back food, milk, diapers to the household, while the men are struggling to find jobs or are too embarrassed to ask for help. In most cases, the causes of conflict within families are trivial, but things turn sour because of the poor living conditions”, continues Abu Saleh. In other cases, conflicts arise between families due to unfair distributions of assistance from private donors.

At the same time, the already overcrowded camp has been absorbing a large number of newcomers, putting a lot of pressure on Palestinian communities who were residing in the camp before the Syrian crisis. “They’re sharing houses and borrowing money to support five, six families, because they cannot say no. They follow the tradition of hospitality although they cannot afford it anymore. But they worry about their future. Many of them only eat once a day now”, says the MSF psychotherapist.

MSF’s mental health programme:

In Saida, MSF has been running a community-based mental health programme since April 2011, working in five health facilities and targeting primarily the Palestinian population of Ain el-Helweh, as well as other vulnerable populations groups living in and outside the camp, including the Lebanese.

Some people tell me: give me a shelter and my mental health will be fine”, says Mohamed Zeidan, one of MSF’s social workers doing daily house visits, providing social assistance and psycho-education, and referring people to other organisations to benefit from non-medical services, such as financial support to pay their rent, for example. “We provide at least first psychological aid and support them mentally”, says psychotherapist Manal Kassem. In some cases, if not treated on time, a person suffering from post-traumatic stress disorder may develop more severe psychological symptoms over time.

MSF’s community health workers and social workers sensitize people about mental healthcare services and play a nursing role, providing medication education and making sure that patients requiring psychiatric treatment attend their consultations. MSF also provides free treatment to refugees who were on medication before and had to stop their treatment because of war and financial difficulties.

Since the beginning of the year, the mental health team has registered a progressive increase in the number of patients coming from Syria – mostly Palestinian refugees, but also Syrian nationals – representing now 43% of MSF’s new patients. “Their numbers keep increasing and their needs in mental health care are very high,” says Rola Charlieh, Head of MSF’s medical activities in Saida.

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