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Refugees in Lebanon receive wider, cheaper access to hospital services

Making a Difference, 28 January 2011

© UNHCR/A.Yungrova
Iraqi refugee children draw in a community centre in Beirut. The new agreement is good news for their health care.

BEIRUT, Lebanon, January 28 (UNHCR) A landmark cooperation agreement, supported by UNHCR and Lebanon's Health Ministry, will allow refugees to receive medical treatment at four state-run hospitals around Lebanon at affordable prices.

The cooperation agreement was signed last week in Beirut by representatives of the four hospitals and some of UNHCR's local implementing partners. It follows similar recent agreements with five private health facilities across Lebanon.

Before the agreement, Iraqi refugees in Lebanon only had access to basic health services at reasonable rates, but access to emergency services was often denied and hospital treatment was beyond the means of most refugees and much more expensive than that charged for Lebanese citizens.

The latest agreement has been welcomed by Iraqi refugees, UNHCR and the government. "The state cannot see a person die and turn its face away. We have taken up our responsibilities as a state," Health Minister Mohammad Khalifeh said at the signing ceremony.

"Today we can say that not only does Lebanon stand apart from many nations in its appreciation and commitment to good health for its citizens, but that it extends this consideration to refugees," added Ninette Kelley, UNHCR's representative in Lebanon.

With quality medical care becoming more accessible and affordable for registered refugees, their health will improve, as will the health of the communities in which they live.

Among the first to benefit from the new arrangement was 20-year-old Hussein, who had been mutilated by militants in Baghdad before fleeing to Lebanon last year. One foot had been partially amputated and the toes on the other chopped off, while his legs were badly burned.

Hussein urgently needed surgery costing US$8,000 to save his legs, but he could not afford it. He approached UNHCR for help in applying for asylum and also sought the agency's help for immediate medical care.

"I had no money for the surgery. I had to borrow money from friends to live. So I approached UNHCR and they helped me," he said, sitting on his hospital bed. Under the cooperation agreement, the surgery cost half the price Hussein would have had to pay as a private patient. UNHCR and one of its partners shared the costs.

But for some refugees, like 28-year-old Wajiha, the agreement has come too late. The pregnant mother of three, who fled from Iraq 11 years ago with her family, went into labour prematurely and needed urgent medical care.

Wajiha had trouble getting admission to the hospitals she went to in Beirut last year because they required that refugees pay the full fees in advance or show proof of payment from UNHCR or its partners.

"I was rejected by two hospitals even though I presented my UNHCR refugee card. Finally I found one that admitted me," she recalled. "I had the baby immediately after I was admitted. The baby and I were not well and a week later my child died."

She mused that if the agreement with the hospitals had been in force, "maybe I wouldn't have lost the baby." With the new arrangement, the more than 9,000 mostly Iraqi registered refugees in Lebanon will feel more reassured about gaining access to crucial health care without having to worry about the cost.

By Wafa Amr and Ziad Ayad in Beirut, Lebanon

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Stateless in Beirut

Since Lebanon was established as a country in the 1920s there has been a long-standing stateless population in the country.

There are three main causes for this: the exclusion of certain persons from the latest national census of 1932; legal gaps which deny nationality to some group of individuals; and administrative hurdles that prevent parents from providing proof of the right to citizenship of their newborn children.

Furthermore, a major reason why this situation continues is that under Lebanese law, Lebanese women cannot pass on their nationality to their children, only men can; meaning a child with a stateless father and a Lebanese mother will inherit their father's statelessness.

Although exact numbers are not known, it is generally accepted that many thousands of people lack a recognized nationality in Lebanon and the problem is growing due to the conflict in Syria. Over 50,000 Syrian children have been born in Lebanon since the beginning of the conflict and with over 1 million Syrian refugees in the country this number will increase.

Registering a birth in Lebanon is very complicated and for Syrian parents can include up to five separate administrative steps, including direct contact with the Syrian government. As the first step in establishing a legal identity, failure to properly register a child's birth puts him or her at risk of statelessness and could prevent them travelling with their parents back to Syria one day.

The consequences of being stateless are devastating. Stateless people cannot obtain official identity documents, marriages are not registered and can pass their statelessness on to their children Stateless people are denied access to public healthcare facilities at the same conditions as Lebanese nationals and are unable to own or to inherit property. Without documents they are unable to legally take jobs in public administrations and benefit from social security.

Children can be prevented from enrolling in public schools and are excluded from state exams. Even when they can afford a private education, they are often unable to obtain official certification.

Stateless people are not entitled to passports so cannot travel abroad. Even movement within Lebanon is curtailed, as without documents they risk being detained for being in the country unlawfully. They also do not enjoy basic political rights as voting or running for public office.

This is the story of Walid Sheikhmouss Hussein and his family from Beirut.

Stateless in Beirut

The Winter Triplets: a Bitter Sweet New Year's Tale

The birth of triplets on New Year's Day in eastern Lebanon's Bekaa Valley should have been cause for celebration, but there was a terrible cost attached. The newborns' mother, Syrian refugee Amal, died shortly after giving birth, never having a chance to see her boys.

In a twist of fate, Amal's own mother had died giving birth to her. Amal, whose name means "hope," had been excited at the prospect of having triplets and had been confident about the birth. She named the three boys before they were born - Riyadh, Ahmed and Khaled - and told her husband to take good care of them in case anything happened to her.

The weather in the Bekaa Valley seemed to reflect the torment of Amal's family. Less than a week after she died, the worst winter storm in years swept through the region bringing freezing temperatures and dumping huge amounts of snow across the Bekaa. And so this family, far from home, grieve for their loss as they struggle to keep their precious new members safe and warm. Photojournalist Andrew McConnell, on assignment for UNHCR, visited the family.

The Winter Triplets: a Bitter Sweet New Year's Tale

Surviving the Storm

A fierce winter storm swept through the Middle East this week bringing icy temperatures, high winds and heavy snow. In Lebanon's Bekaa Valley, more than 400,000 refugees have been enduring freezing conditions since snow levels not seen in many years arrived. Refugee accommodation in the Bekaa ranges from abandoned buildings to garages, sheds, apartments and informal settlements. Conditions are most difficult in the settlements, with roofing on makeshift shelters liable to collapse under the weight of the snow.

Although a great deal of winter aid has been provided, UNHCR remains concerned. Despite the agency's best efforts, the situation in Lebanon remains precarious for refugees, given the extremely poor conditions in which they live and the scattered nature of the population. It is a constant challenge to ensure that refugees across more than 1,700 localities remain safe and warm during the winter months and have sufficient resources to withstand severe storms.

Photojournalist Andrew McConnell spent two days in the Bekaa Valley, documenting the situation for UNHCR.

Surviving the Storm

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