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Improving health care services in Lebanon in the context of the Syrian crisis: the EU/IfS programme

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Tripoli Governmental Hospital main entranceOne of the programme's objectives is to increase the capacity of primary health care centresLebanon has experienced an unprecedented influx of refugees due to the conflict in neighbouring Syria. This is putting a severe strain on the host communities and authorities. The Government of Lebanon estimates that 1.2 million Lebanese nationals are directly or indirectly affected by the crisis.

As of 3 March 2014, UNHCR has recorded 950 479 refugees, including both those registered and those awaiting registration. This represents close to 20% of the total population inside the country.

As the fighting in Syria becomes more sectarian in nature, the pressures on Lebanon’s fragile inter-community consensus are also increasing with the potential for further spill-over of the conflict into Lebanon.

Syrian refugees are, for the most part, sheltered among the poorest communities of Lebanon, sharing scarce resources with many Lebanese who live below the poverty line (85% of registered refugees are living in 182 locations in which 67% of the host population is living below the poverty line according to preliminary UNICEF data). This situation is causing increasing tensions.

The availability of cheap Syrian refugee labour is, for example, reducing wages and opportunities for many Lebanese workers, while many of the social services on offer cannot cope with the ever increasing demand. This is particularly true in the health sector where tensions arise due to an over-burdening of services resulting in less access to basic care for vulnerable Lebanese. A perception that Syrian refugees get preferential treatment, perhaps due to humanitarian assistance directly targeting them, is adding to the friction. Host communities also fear infectious disease outbreaks due to increasing numbers of refugees living in unsanitary informal settlements, as well as to regular rumours of disease outbreaks. This contributes to a vicious circle of increasing prejudices and stigmatization.

The scale of the refugee influx is unprecedented. Government, UN agencies, communities and nongovernmental organizations are struggling to respond adequately. The European Union is responding by mobilizing its Instrument for Stability (IfS) to provide humanitarian assistance through WHO Lebanon.

IfS is specifically suited to promoting conflict reduction in crisis or pre-crisis situations. IfS actions could be used both to reassure the host population with visible support and thus reduce tension while bridging humanitarian aid with development cooperation by strengthening existing governmental primary health infrastructure and systems. It would serve to reassure the Lebanese population while re-enforcing government public service institutions.

In this respect, the action aims to reinforce the EU’s objective in Lebanon of strengthening the State institutions' credibility through an improved delivery of basic services to the citizens – in this case by being able to provide for the health needs of its most vulnerable population.

The overall objective of this action is reduction of tension between Lebanese host communities and Syrian refugees, and this is done through several action points.

  • Reinforce the capacity of the Ministry of Public Health in terms of communicable diseases monitoring, early warning and response. This component will focus on: providing surveillance support; reinforcing response capacity; and infrastructure support to laboratories in public hospitals.
  • Reinforce the capacity of the Ministry to deliver quality primary health care and maternal and child health care. The focus is in: supplying primary health care centres with equipment and supplies; and capacity-building among health care providers.
  • Reinforce the capacity of the Ministry in sustaining the provision of chronic medications.
  • Increase the capacity of programme partners and other humanitarian actors to implement programmes using a conflict sensitive approach.

The theory of change which underpins this project is that by increasing the availability and quality of health services, particularly in areas which have traditionally not enjoyed a high level of state-provided services and are currently experiencing the impact of the Syrian refugee crisis, competition between host and refugee communities will be reduced.

The programme takes an approach which focuses on increasing the capacity of Lebanon’s Ministry of Public Health to respond to identified needs in a manner that is sustainable and contributes to the longer term goal of strengthening the Lebanese state to respond to the needs of its citizens.