Bridging the gap: the health workers who visit Palestinian refugee camps in Lebanon

19 March 2013

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A narrow alley in the largest Palestinian refugee camp in Lebanon.

(Ali Hashisho / Reuters)

Just under half of Palestinian refugees registered in Lebanon are aged under 25. One of the most striking features of any visit to the country’s Palestinian refugee camps is the visibly high number of children among the population. Accordingly, one of the greatest medical needs within the camps is for comprehensive and effective obstetrical care.

Yet this is complicated by Lebanese labor laws, which bar Palestinians from working in professions that require syndicate membership, including both medicine and midwifery. Palestinians in the camps are therefore reliant on receiving these services from Lebanese health professionals, most of whom work in the national health system. That system is in turn unavailable to many Palestinians because as non-citizens, they are not entitled to government assistance with the high costs of medical care.

In Lebanon last month, I accompanied midwife Mariam and nurse Lamis on an ante-natal home visit within the Palestinian refugee camp of Ein al-Hilweh, near the city of Sidon. Mariam and Lamis’ backgrounds reflect Lebanon’s complex social and political situation; like most midwives in the country, Mariam is Lebanese. Lamis, meanwhile, is a Palestinian, born in Lebanon to parents who had fled their hometown of Acre in 1948.

Her family have not been able to return and are now dispersed across Lebanon and Jordan. Yet unlike most Palestinians in Lebanon, Lamis does not live in one of the refugee camps and explained to me that she had not spent much time inside them until her job required her to do so. As a Palestinian, she cannot work as a midwife, but she has been able to qualify as a nurse. Indeed, it has conventionally been easier for Palestinians to train as nurses rather than as midwives in Lebanon, partly because of the lower costs; Palestinian nurses have therefore always worked inside the camps.

Changes to labor law

Yet it was not until very recently that a change in the policy of the Lebanese order of nurses allowed Palestinians to practice nursing within the national health system. They have now have gained the right — at least in theory — to work in national hospitals under regular contracts.

Lamis and Mariam drove me to Ein al-Hilweh, telling me the background to their work there. Their words painted a vivid picture of the many challenges that the camps pose to health professionals; poverty and systemic discrimination against Palestinians in Lebanon mean that there is a great need for their services. The fact that this particular camp has been frequently blighted by political violence and fighting only exacerbates the problems.

As we drove through one the main streets, Lamis told me, “This street is called the street of death.” It was nearly destroyed during the civil war, and many families there have lost relatives to the fighting.

After parking the car in one of Ein al-Hilweh’s makeshift car parks we made the short walk to the home we were visiting. We were going to see Fatima, a 42-year-old Palestinian woman 34 weeks into her first pregnancy. Mariam had been visiting Fatima since the early stages of her pregnancy and had established a strong relationship with her.

I was looking forward to meeting Fatima, but we had to get there first — and reaching Fatima’s flat was itself indicative of the daily difficulties of life in Ein al-Hilweh. As Lebanese law prohibits Palestinian camps from expanding outwards, residents are often forced to build homes on top of one another in order to accommodate the growing population.

Housing restrictions

Fatima’s home had been built on top of a second-story flat, and could only be accessed by climbing up a set of shaky steps — so shaky, in fact, that only one person could be on them at a time. As Mariam, Lamis and I teased each other about who was the most nervous, and joked about our unsuitable shoes, I tried not to think about a heavily pregnant woman making that trip on a daily basis, or about the fact that she would soon be doing it while carrying a newborn baby.

Fatima was evidently pleased to see Mariam and welcomed me with typical Palestinian hospitality. She was very close to her due date and was having a difficult pregnancy, suffering from ongoing nausea and sleeplessness. The calm confidence with which Mariam talked to her was both inspiring and reassuring to see, with Fatima clearly very comfortable discussing her concerns with the midwife. Towards the end of our visit, Fatima’s neighbor, Aziza, came in to ask if she was feeling better. I continued to learn more about the multi-layered difficulties of life there as Aziza took me into her own home and told me about her situation.

Her husband had spent many years in prison and was only released to die at home when he became very ill. Aziza is now the sole carer for her children, and to add to the pressure she recently took in a family of Palestinian refugees from Syria. She showed me around a small room in which nine people are now living, with an adjoining kitchen. It was a cold day but neither Aziza nor Fatima had any heating in their homes; Aziza was sitting close to the stove to stay warm.

Accompanying Mariam and Lamis on this home visit opened my eyes to the far-reaching impact of their work. Fatima is clearly benefiting from Mariam’s consistent support and advice, but the positive effects do not stop there. While both Mariam and Lamis have lived in Lebanon their whole lives, neither had previously spent time inside the Palestinian camps and they both admitted that they were initially anxious and even scared at the thought of it.

After countless home visits, Mariam and Lamis are now well-integrated into life inside Ein al-Hilweh and thoroughly familiar with the camp. Lamis even told me that she goes there to do her shopping, having discovered some gems in the camp markets.

Fatima is expected to give birth to a baby girl next week. Mariam will continue to make post-natal home visits to Fatima in the coming months to monitor both her and the baby’s health, a relationship that will endure despite Lebanon shutting Palestinians out of the system.

Some names in this article have been changed. A version of this article was first published by New Matilda.

Anne Irfan holds a master’s degree in Middle Eastern history and currently works for the nongovernmental organization Medical Aid for Palestinians.