Palestinian refugees struggle to survive

Precarious conditions define the lives of refugees around the world, but some are worse off than others. Recent surveys of Palestinian refugees in Lebanon show that they not only live in poor surroundings, but that their environment has a negative impact on their physical and mental well-being.

Two teams of researchers lead by professors of public health from the American University of Beirut recently conducted surveys in refugee camps in Lebanon to assess how living conditions are affecting physical and mental well-being of the 450,000 Palestinians living there.

They found a strong link between chronic illnesses and inferior housing, as well as high levels of poverty, food insecurity and poor health in general. "There was a positive association between chronic illness and water leakage [in the refugees' homes], while poorer mental health in particular was associated with crowded housing, water leakage, and [poverty]," says Rima Habib, an environmental health expert and co-author of one of several studies published in The Lancet.

The first study focused on the environmental conditions of 356 Palestinian refugees. More than 40% of the houses surveyed had water leaking from the roof or walls. Nearly a third of them reported chronic illness and 24% reported an acute illness in the previous six months, with women fairing worse. The report highlights the strong correlation between water leakage and chronic illness, supporting the link between poverty and health in these communities.

The second study assessed food security among 11,092 Palestinian refugees, where nearly two thirds of households reported food insecurity, lacking access to sufficient, safe, nutritious food all the time. Of the 59 per cent of households below the poverty line, 15% reported suffering severe food insecurity. Those households were also more likely to have at least one member with a chronic disease, a disability or a mental illness, compared to the rest of the community.

Dangerous camps

Life under occupation doesn't make it easy to maintain good health systems.

Refugee camps in Lebanon are packed with narrow, over-crowded alleyways and chaotic bundles of electrical wires strewn across buildings. The refugees have few economic opportunities and are paid less than Lebanese doing the same work. The national laws of Lebanon forbid refugees from more than 30 occupations and they are not permitted to own land.

"They have more concerns than fixing the electricity system or removing electricity wires from water," says Salah Hamzeh, a Palestinian who used to live and volunteer in a refugee camp in Beirut. "They need to go out and work and bring back bread for their families. They don't plan or save. They live day by day."

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) has registered more than five million refugees living in Lebanon, Syria, Jordan, the West Bank and Gaza.

"Palestinian refugees do not have access to the services covered by the Ministry of Public Health for Lebanese citizens," says Hoda Samra, UNRWA's public information officer in Lebanon. "[Only] UNRWA is responsible for the provision of health services to Palestine refugees in Lebanon."

Challenges in Gaza

The 1.1 million Palestinian refugees living in the narrow Gaza Strip face similar problems.

According to the Initial Health Assessment Report: Gaza Strip, released by the World Health Organization (WHO) in December 2012, nearly 10% of children under five suffer from stunting. The rate of acute malnutrition in this age group has more than doubled since 2000. Additionally, a quarter of them were found to be anaemic.

"There are quite severe shortages of drugs and consumables particularly in the past six months [arising] from financial problems faced by the Palestinian Authority, which supplies drugs to Gaza and the West Bank," says Anthony Laurance, WHO representative in the occupied Palestinian territory.

Gaza has been under an economic blockade since 2007. While Israel promised to ease restrictions in 2010, hospitals continue to report shortages of medicines and cannot get needed equipment. According to the WHO report, hospitals in Gaza face shortages of more than 40% of essential drugs and more than 50% of common medical supplies.

Additionally, anyone who travels out of Gaza needs to apply for a travel permit from Israel. About 10% of travel permits from Gaza to Israel or the West Bank for medical reasons are denied by Israeli authorities, and others face delays that force them to miss appointments, according to the WHO and Gisha, an Israeli organization promoting the right of freedom of movement in Gaza.

"Life under occupation doesn't make it easy to maintain good health systems and health infrastructure," says Sari Bashi, executive director of Gisha.

"There are resources available, but the biggest concern is the restrictions on movement and access," Bashi says. "Some of the Israeli restrictions make it difficult to get equipment. For example, it's difficult to properly run magnetic resonance imaging (MRI) and other equipment because there are restrictions on [parts] and it's difficult to get the machinery out of Gaza for servicing."

There is only one working MRI machine in Gaza. Of the five CT machines there, three are out-of-order until spare parts arrive, states the WHO report.

The Gaza in 2020 report, released in August 2012 by the UN, details how Gazans are worse off than they were in the 1990s, and will have continued shortfalls in housing, electricity, water and sanitation, health, education and economic opportunities, particularly if the current political status quo continues.

In both Gaza and Lebanon, economic development is seen as an important factor in improving their lives.

"Economic marginalization must end, their access to adequate health services must improve, and the poor conditions that they live in must be remedied," says Habib. "Giving Palestinians unconditional universal rights that are their basic entitlement as human beings would certainly have a positive influence on their health."

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