Free healthcare for the vulnerable population of the Bekaa Valley,Lebanon
( reportage from the MSF Paedriatic unit in Elias Hraoui Governmental hospital in Zahlé)
Extract form the article for MSF Lebanon:
In the Bekaa Valley, surrounded by a wide vista of mountains and the Syrian border, is Zahlé.In this small town most of the vulnerable population of the valley live or found shelter few years ago in the intention of escaping the war happening just across the border.Around half of these vulnerable residents in Bekaa, are Syrian families living in the self-built settlements spread around the valley.
The rest are Lebanese with very little income or those who are stateless in Lebanon. Around 500 000 refugees live in the whole
Bekaa, the majority are women and children.As Lebanon rejects local integration and refugee status, (due to its refusal to ratify the Genova Convention), but hosts the biggest proportion of refugees in the world, they are struggling for survival. Not only financially, but also physically and emotionally. Displacement itself causes desperation, lack of money and opportunities and deprives them of their future and dreams.The people I spoke to said that their health had deteriorated drastically since they came to Lebanon. No wonder!The conditions they live in are very troubling. They lack sanitation and hygiene. In cold winters there is a lack of heating and sometimes even drinkable water. This makes their life hard and often unbearable.
In March 2017, in order to alleviate the suffering of the vulnerable population of the Bekaa Valley and ensure access to specialized healthcare, Médecins sans Frontiers (MSF) opened a new Paediatric Unit in the Elias Hraoui Governmental hospital in Zahlé.Their mission is to provide comprehensive paediatric healthcare.This includes in-patient and out-patient care, ongoing medical treatments and surgical procedures. Children treated are aged between 28 days and 15 years and are of all nationalities; Lebanese, Syrian or Palestinian.The main goal of the project was to establish PICU (Paediatric Intensive Care Unit) services and Thalassemia care in Central Bekaa, previously these children’s health services were unavailable free of charge, not only in Bekka but nationally too.
The Paediatric Unit of MSF in Centraal Bekka is the first of its kind to be established here. MSF cooperate with the Lebanese Ministry of Public Health and the international NGO WAHA (Women and Health Alliance) who provide free treatments at out patient level and strives to reinforce access to primary health care for the vulnerables of West Bekaa. If needed, patients are referred to WAHA from the MSF unit and the other way around. At the MSF Paediatric Unit, children are often hospitalised for infectious diseases, gastroenteritis, respiratory tract infections or pathologies related to a lack of vaccinations.Before the establishment of the MSF services in Zahlé, children were hospitalised in Elias Hraoui Governmental hospital, contracted by UNHCR. Firstly, this meant that the cost of the treatments for the refugees are covered by UNHCR. In some cases 75 % of the costs, in others 90 %, depending on the type of care and treatment. The patients are obliged to pay up to 25 % of the medical costs themselves. Even though for some of the refugees this percentage means a burden. If they are admitted to MSF services, children are helped free of charge, including intensive care and Thalassemia services.Admittance in most cases is based on the socio-economic vulnerability of the parents. Children admitted to MSF paediatric services are those who don’t have access to normal medical care, mostly due to financial constraints.In fact, both vulnerable Lebanese and refugee communities in the Bekaa Valley face a lack of access to affordable secondary and tertiary healthcare services, and those services that do exist are private and very costly.In the case of some Syrian refugees MSF paediatric services are their only option. They came to Lebanon often with no possessions at all. They had to escape the war immediately and all they took with them, were their children and relatives. Despite everything, they had to adapt to the dire living conditions in the camps .They are not officially allowed to work. If they do, their income is just enough to cover essentials. The war dispossessed them of their free health care and free education, which they had in Syria.
In one of the beds of the Intensive care unit (PICU) is Ali Kassab. Ali is the youngest of 5 children and has been suffering from health problems since birth.His mum Mona says: “Every time my child gets sick, I’m worried about the cost of his treatment, but every time I do whatever is possible to ensure he gets proper treatment. The doctors say that Ali needs a specific nutrition regime, but sometimes I can’t afford what is considered good food for him.”
Before knowing about MSF free services, Mona used to take Ali to hospitals in Beirut or in Bekaa. She used to get support from the Lebanese Ministery of Public Health that cover 80% of the hospital costs. Her husband usually borrowed money to be able to cover the rest. Till now she is still paying some of the debts accumulated over
Batoul 1,5 years old) Her family arrived to Lebanon 2 years ago. Batoul’s mum Anaam is just 20 years old and Batoul is her first child. Batoul is sick since she was 3 months old. She suffers from inflammation of spleen and liver and she comes to the hospital once or twice a month. Once she was in the hospital and doctor requested series of medical tests for Batoul, when Anaam said she can’t afford to cover the costs of the tests, he refered her to MSF paediatric services in Zahlé.
“ My biggest worry is Batoul’s health. I just want her to get well. This is all what I hope.” says Anaam
MSF also provides highly specialized paediatric care for in-patients at the hospital.
Batoul is Lebanese from Zahlé. She was admitted to MSF Paediatric ward in Elias Hraoui Governmental Hospital with gastroenteritis. Her grandmother is assisting her. Both Batoul’s parents have health problems, her mother is diabetic and her father is under dialysis treatment.
Her grandmother says: “I spent half of my life in the hospitals, for my son, my daughter in law, and you can imagine how expensive are the treatments. Three days ago, we brought Batoul to the emergency of Elias Hraoui Hospital, and they referred us to MSF.” She adds: “I’m very satisfied with the services in this hospital, the environment is so friendly, and we feel as if we are at home.”
The second patient in the PICU unit is Hamza. He is one month and 14 days old, born in Lebanon, but his family is from Raqqa, Syria. He is the youngest of five children and was admitted to MSF’s Paediatric ward with complications related to bronchitis.
Hamza’s mother states: “ We are suffering everyday, nothing will make us happy as long as we are away from home”.
Hamza being taken care of by his mum in Elias Hraoui Governmental hospital in Zahlé.,2019.
The next section of the MSF Paediatric unit is the Thalassemia day care department with 4 beds, open since November 2017.
Youssef ( 11) is one of the in-patients in the Thalassemia department.
“ I am Youssef. I am 11 years old. I have been suffering from Thalassemia (a genetic blood disorder) since I was six months old.I am from Aleppo in Syria, and I’ve lived in Lebanon in Bekaa for two years now. Our house was hit so we were forced to flee. I remember that my mother was running towards the refrigerator to save the blood bags that were stored for me. It was the most valuable possession we owned that we could take with us.When we arrived in Lebanon, getting blood and treatment was our priority.
My mother went into debt to get the $200 needed for every blood transfusion. But this treatment was not available. My mother even considered returning to Syria when we lost all hope of an affordable treatment. That changed when we heard from our neighbour about the Paediatrics department at the Elias Harawi Hospital in
Zahle, and that it provides free treatment for patients with Thalassemia. I’ve been here getting treatment for almost 10 months. The doctors say that I am strong and that my smile is beautiful. I enjoy my time here.”
Youssef (11) belongs to one of the sweetest patients on the unit
The last patient in the department that we talked to was Aya,
a 7 year old girl from Daraa, Syria. She was sharing the room with Batoul and was admitted to the unit with severe headaches and fever. She had to stay in the hospital for 5 days.
Aya’s family was looking for a hospital space for her before they were referred to MSF Paediatric ward in Zahlé. “The hospitals were full, and were not accepting new patients”, Aya’s mother said.
Aya (7) posing in the room of the In-patient department, Elias Hraoui Governmental hospital, Bekaa Valley