Displaced Persons: The Syrian Context

Original Editor - Aicha Benyaich

Top Contributors - Naomi O'Reilly, Kim Jackson, Jess Bell, Kirenga Bamurange Liliane and Carin Hunter  

Introduction

Since March 2011, the conflict in Syria has resulted in large scale displacement internally and across the region. There have been hundreds of thousands fatalities and injuries, millions of internally displaced people (IDPs) and many more asylum seekers and refugees in neighbouring countries, largely Lebanon, Jordan, Turkey and Iraq. The situation has reached a crisis point with an estimated 6.8 millions people displaced across borders and 6.6 million people internally displaced who require humanitarian assistance. This means 13.5 million Syrians in total have been forcibly displaced, which is more than half of the country’s population.

“The reasons for leaving Syria are clear, the severity of the conflict, fear of atrocities committed against civilians by both sides, and declining resources inside the country have made it impossible for millions of Syrians to stay. Those who leave often face difficult journeys to reach the safety of neighbouring countries. At the same time, the sheer number of Syrian's displaced and the duration of their displacement in countries such as Jordan and Lebanon has put a great strain on the resources and capacity of host governments and communities” including water supplies, basic goods and commodities and sheltered accommodation.

Numbers

Over 1.5 million people have entered Lebanon since the commencement of the Syrian conflict in 2011. At the end of 2021, there were 845,865 refugees and 8,717 asylum seekers in the country. This is about one eighth of the total population of Lebanon. While the flow of Syrian people injured as a result of the conflict and other persons with disabilities (PwDs) has reduced, there continues to be a significant burden on existing health structures.

Inadequate access to surgery for Syrians wounded by weapons has resulted in many secondary complications including infection, and has often led to amputation. Make-shift Post-Operative Centres (POC) have been established. These are largely run by Islamic-based NGOs, and Syrian-based organisations to cater for the needs of those wounded. However, limited financial resources and clinical expertise have largely hampered the recovery process. Syrians displaced into Lebanon have dispersed throughout the country making follow-up by aid agencies (e.g. United Nations High Commissioner for Refugees (UNHCR)) all but impossible. Tensions between Syrians and the host communities are rising and the longer the situation continues, the risk of local clashes is rising, which creates further challenges.

Around 40,000 Palestine Refugees from Syria (PRS) who fled the violence in Syria are also currently residing in Lebanon. Prior to the outbreak of the Syrian conflict, Palestine Refugees in Lebanon (approximately 280,000) were already highly marginalised, with limited rights and restricted access to public services and employment. The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) health, education and relief services on which Palestine Refugees in Lebanon depend, were already stretched and camp infrastructure was in dire need of maintenance and rehabilitation. The challenging conditions for Palestine Refugees in Lebanon have further deteriorated with the influx of Palestine Refugees from Syria, heightening community tensions and negatively impacting stability and security in Lebanon and the region at this critical time. UNRWA remains the lead coordinating agency and primary provider of aid to all Palestine Refugees in Lebanon.

Vulnerable Populations

Within a challenging context, people with a disability and the elderly are among one of the more vulnerable groups. The lack of specialised services for persons with special needs has highlighted as a major gap in the current response to the Syrian crisis in Lebanon. In general, the access of Palestine Refugees with special needs to public services is limited in Lebanon, and there is a visible gap between demand and supply of services. Compounding this, many Palestine Refugees from Syria have moved into Lebanese Palestinian Displaced Person camps, which has put increased strain on the host community. As a result, all Palestine Refugees are struggling to access specialist services in an already extremely stretched system. Identified challenges include:

• Provision of assistive devices or prosthetics;
• Rehabilitation services for people with newly acquired and long-standing disabilities; and
• Access to mainstream and special education.

Many persons with a disability and their families have complex protection issues crossing both medical and social sectors, which require timely comprehensive assessment, coordinated direct support and referral to multiple agencies. A number of challenges aggravate their marginalisation in society, among which include:

• Limited access to and availability of specialised rehabilitation services in the country,
• Inadequate awareness of needs, and
• Insufficient protection of the rights of persons with disability.

Overall resources available to ensure the equitable provision of quality, essential health services for Syrian refugees is limited. Syrian people with disabilities face even greater challenges to obtaining needed services from a health sector beset by inaccessibility at all levels. Syrian refugees suffer a high incidence of trauma-related injury, adding morbidity to the high prevalence of non-communicable disease. In a recent survey, 24.7% of Syrian refugees in Lebanon reported the Syrian conflict as the cause of their disability. For those with a physical disability, the 71% who continued using mobility aids experienced difficulties in walking. It is unclear whether those issues were a result of inappropriate fit, lack of long-term support and provision of services, or the economic burden on the individuals and their families. The majority of the physical rehabilitation programme beneficiaries are Syrian children with disabilities who are living in Bekha Valley; most of them are acutely affected by the poor availability and quality of basic services. A high number of those children have musculoskeletal conditions, such as clubfoot, hip dislocation, birth defects or congenital disease which require specialised services, like ortho-paediatric surgery and comprehensive rehabilitation services which are lacking.

There is evidence that people with disabilities are more likely to have poorer overall health than the general population. This outcome could be associated with various factors, which may be different for people with different impairments. People with disability are at higher risk of both secondary health conditions, which have a causal link to the primary diagnosis or impairment, or co-morbid factors. These co-morbid factors can also include mental health problems, which are often related to the primary impairment in individuals with a long-term physical disability due to social exclusion or poverty. Barriers to access healthcare services, including physical rehabilitation programmes / clinics, are significantly increased. This can be due to factors associated with the physical environment (e.g. transport to services might be affected because of financial and access issues). Many of the Ministry of Public Health’s primary healthcare centres and dispensaries are not currently accessible to this population group. Thus, many of the healthcare needs of people with disabilities remain unmet due to a lack of accessible information and awareness regarding the availability and location of specific services.

30% of children with a disability are also excluded from the Educational System. This lack of access is due to: prevailing social norms and attitudes towards disability, a lack of budgetary allocations supporting inclusion in the public education system, limited teacher capacity, limited access to education spaces and tailored programmes, a lack of effective teaching strategies to provide appropriate instruction, and limited access to schools with adequate facilities.

Summary

Overall, there are insufficient rehabilitation services to serve the needs of the population (Lebanese citizens, Palestinians and Syrian refugees). This impacts these individuals quality of life and has ongoing effects and burden on the health infrastructure. The absence of a unified and standardised prosthetic and orthotic service makes access difficult. The Syrian conflict is going to have a long-lasting effect on the region, but Syrian refugees residing in Lebanon need to get their assistive devices more frequently repaired/ adjusted or have them replaced. These services are only provided by humanitarian actors. High costs for treatment, limited opportunities for movement within the country and a limited response from the humanitarian community risks additional long-term impairments and possible fatal complications. As long the current situation of governance continues, it is unlikely that ministries concerned will reinstate a budget ensuring the access to reliable physical rehabilitation services. Poorer Lebanese citizens needing important devices are confronted with lengthy waiting list or reliant on private charities.

Resources

UNHCR - Syria Emergency

Syrians on the Move

Displacement in the Middle East

Refugees and Displacement in the Middle East

Millions of Syrian Refugees Are Changing the Middle East Economy