Chronic diseases start out in secret, with symptoms often taking years to emerge. By the time they come out into the open, they can be life-threatening – unless they are treated.
Syrian refugees in Lebanon are particularly vulnerable to these ‘silent killers’, as many have no access to healthcare.
When they do discover they have hypertension, diabetes or cardiovascular disease, it may already be too late.
Others know they have chronic diseases, but cannot afford the treatment.
Major consequences
“We have one Syrian patient – a 35-year-old man – who has had diabetes since childhood,” says Médecins Sans Frontières/Doctors Without Borders (MSF)’s Dr Marc Gerhard, who works in Lebanon’s Bekaa Valley.
There, he works with other MSF staff to provide free healthcare to Syrian refugees.
“For many years, his diabetes was badly controlled," he says. "As a result, his foot had to be amputated, and his kidneys failed.
"He needed dialysis, but the hospital sent him away because he couldn’t pay for treatment.
"When he arrived at our clinic in Baalbek, he was in a very bad state.”
However, Dr Gerhard admits that this patient’s story is more dramatic than most.
“The majority of our patients are in a stable condition due to the regular follow-up they’ve received from our clinic for the past three years,” he says.
Chronic conditions: longterm and expensive
Some 365,000 Syrian refugees are living in Lebanon’s Bekaa Valley, mostly in informal tented settlements, without running water or electricity.
Healthcare in Lebanon is mostly private. As such, few refugees can afford to pay for medical fees, particularly for chronic conditions which require longterm care.
“I can’t always follow what the doctors advise me to eat. Sometimes this food isn’t available or I can’t afford to buy it. So I eat what I can.”
The clinic where Dr Gerhard works is just one of four MSF-run centres, providing basic healthcare and maternity care in the Bekaa Valley, all free of charge.
“Just over one-quarter of consultations are for patients suffering from chronic diseases,” says Dr Gerhard.
These include asthma, epilepsy, hypothyroidism and chronic obstructive pulmonary disease, as well as hypertension, diabetes and cardiovascular disease.
"Without medication I would die"
Many patients have more than one chronic condition.
“I am diabetic and I have also hypertension,” says 50-year-old Naema.
Naema is a refugee in Lebanon, from the Syrian city of Homs. She now lives in the village of Duris in the Bekaa Valley.
For the past three years she has been coming regularly to our clinic in Baalbek for treatment.
“I try not to miss my appointments,” she says. “I know it is important – without medication I would die.”
But Naema struggles to follow the doctors’ advice in full.
To stay healthy and keep her condition under control, she needs a healthy diet, but obtaining the right food can be hard.
The cheapest and most easily available foods are carbohydrates such as bread, rice and potatoes, while fruit, vegetables and meat are all relatively expensive.
“I can’t always follow what the doctors advise me to eat,” she says. “Sometimes this food isn’t available or I can’t afford to buy it.
"So I eat what I can.”
The struggle to stay healthy
Many of the refugees struggle to maintain a healthy lifestyle.
“They live under very difficult circumstances – they live in tents with nothing,” says Dr Gerhard. “They also have many other sorrows, and it can be difficult for them to follow the treatment.”
Our team takes this into consideration when advising the patients.
“In normal circumstances, as a doctor, you tell your patients to limit their carbohydrate intake and to take exercise. But how do you say this to refugees?"
“In normal circumstances, as a doctor, you tell your patients to limit their carbohydrate intake and to take exercise,” says Dr Gerhard. “But how do you say this to refugees?”
“We try to tell them that they shouldn’t eat too many carbohydrates and that they should do some sport.
"Even though it’s very difficult for them, as they don’t have appropriate clothes and they aren’t necessarily motivated to take up sport.”
Making treatment easier
Our teams do what they can to make treatment easier for the refugees.
Recently they have begun providing diabetic patients in the Bekaa Valley with glucometers, enabling them to measure the level of sugar in their blood at home, without having to travel to the clinic.
Patients write their findings in a ‘diabetic passport’, and when they return to our clinic, the doctor can determine the dose of insulin that each patient needs.
With regular treatment, chronic diseases are manageable and not life-threatening.
Syrians in Lebanon face all kinds of problems, but our clinics in the Bekaa Valley give refugees with chronic diseases one less thing to worry about.
MSF in Lebanon
MSF runs 13 clinics in Lebanon providing basic healthcare, alongside three mother and child care centres.
Our teams in the Bekaa Valley provide around 11,000 outpatient consultations per month.