When 10-year-old Lea complained of difficulty breathing, her mother took her to the clinic close to their house in the Mousaitbeh neighborhood of Beirut. “This wasn’t the first time Lea experienced this, but it was the worst. She was coughing heavily, too,” said her mother Noha Shamieh.

Lea has been suffering from allergies since birth. She’s taken a slew of different medicines, including cortisones, without much effect. “Some doctors mentioned Lea’s allergies will improve as she gets older, but she’s still suffering from allergy attacks,” Noha said.

Mousaitbeh is a crowded area of Beirut that has been heavily impacted by the city’s rising air pollution. The average concentration of particulate matter in Beirut’s air exceeds World Health Organization limits by an astounding 150-200%, and is partly caused by conflict in the Middle East. The high level of Beirut air pollution causes allergic respiratory symptoms like dry cough and bronchitis.

“The quality of the air we breathe definitely affects Lea’s case,” said Noha. “But we can’t move because our life, work and schooling are all in Beirut.”

Beirut air quality suffers from conflict in the Middle East.

WHO estimates that 1,434 people die from air pollution-related diseases in Lebanon each year.

Donated Zirtek Combats the Effects of Beirut Air Pollution

After their first visit to the Development Services Center of Mousaitbeh, the doctor prescribed Zirtek. “Just couple of days after taking the medicine, Lea’s condition improved a lot. She can breathe comfortably now and her cough has really died down,” her mother said.

The Zirtek syrup that relieved little Lea’s symptoms was part of an in-kind medical donation from International Health Partners. ANERA distributed thousands of medicines to dispensaries around Lebanon to be available free of charge to underprivileged community members. The medicine was donated in-kind by International Health Partners and the shipment was made possible through contributions from the Zakat Foundation.

“The quality of the air we breathe definitely affects Lea’s case. But we can’t move because our life, work and schooling are all in Beirut.”

The Development Services Center is a social center governed by the Ministry of Social Affairs in Lebanon. It includes a dispensary for health services and psychosocial services. The small center serves more than 900 people each month. Over one-third of the patients are Syrian refugees.

“Many people come to this clinic because they know we have medicines for seasonal conditions, like allergies,” said Iman Sleiman, the director. “These donations are a great support to the dispensary. Over-the-counter drugs like Zirtek are in high demand.

“Seasonal allergies are very common in Lebanon in the autumn and spring. We see many cases like Lea’s,” said Fida Zaiter, pharmacist at the Development Services Center. “Unfortunately we are often out of Zirtek. Then we have to direct patients elsewhere or pay for it from local pharmacies,” she added.

Winter has brought a strong chill to the village of Al Sawarha, Gaza. At the local Atfal Mustaqbal preschool, children sniffle as their breath turns to steam in the cold air. Winter in Gaza is cold and wet, with heavy rains and wind coming in from the sea.

“The children have to walk for 30 minutes to reach the preschool,” said Om Ayman Sawarha, head of the preschool and a longtime resident of the village. “Families are too poor to provide transportation to school.”

Widespread poverty means that many children don’t even have to shoes to make the walk to school a little easier. The children consider themselves lucky if they have second-hand shoes from relatives or older siblings – even if they don’t fit.

“It’s tragic to see children walking in the cold with tattered shoes,” added Om Ayman. “Some have to share shoes with their brothers and sisters, no matter what their sizes are. But nothing is worse than the poor children that have to walk around barefoot.”

In the cold, wet, winter in Gaza, cousins Mohammed and Salem walked to school in sandals.

Cousins Mohamed and Salem love to play outside, but their yard fills with puddles in the cold, wet winter, and they only had tattered old sandals to protect their feet – until now!

A Happy Day at School: Boots for All

Since 2013, ANERA has delivered four shipments of TOMS shoes and boots throughout Gaza.

Cousins Mohamed and Salem Abu Khalil are two students at the Atfal Mustaqbal preschool. This morning began like any other weekday morning for the tiny pair. Through the windows of the poorly-lit preschool, their faces shone with curiosity. “There was good news to come,” smiled Om Ayman.

Both boys wore old sandals covered in wet mud. Their walk to school took them through orange groves left muddy from Gaza’s winter rains. When their teacher called their names, they jumped up together to get their new TOMS boots, which fit perfectly.

At noon, traces of sunlight warmed up the playground. The ecstatic preschoolers bounded into the play area to enjoy the sun and their new boots. The two cousins live together in the same family house. The unfinished house hosts almost 20 members of the extended family, as well as a backyard full of livestock. Without proper shoes, walking in the yard after a rainy night is a struggle. Now, the two cousins can run and skip with joy through the puddles.

Even during winter in Gaza, the boys sit on the bench outside.

Salem (left) and Mohamed (right). “We always find them on the wooden bench. They are the same age and they have their own secrets,” said Mohamed’s mother.

Mohamed and Salem love to sit on their backyard bench, where they share stories and tease each other. “We always find them on the wooden bench,” said Mohamed’s mother Wafaa. “They are the same age and they have their own secrets.”

Now they have their own pair of winter boots, too. “The quality of the boots is so high,” added Wafaa. “They are well-suited to the children of our village, who love to play outdoors”

The Abu Khalil Family Works Together

Like many others in this village who can barely eke out a living, the Abu Khalil family struggles to provide for their children. Most villagers depend on welfare assistance for goods like flour and rice. The boys’ grandfather uses two donkey carts to deliver these staple items to other villagers. They get paid a reasonable price for their work. “It’s a service to the community and it helps us under these difficult conditions,” said the grandfather.

This Gaza family uses a donkey cart to make deliveries and earn income.

Salem shows off the brightly decorated donkey cart that his family uses to make delivers – and make a modest living.

In his warm new boots, Salem jumped to show off the colorfully decorated donkey carts. Mohamed held his grandfather’s hand as his mother looked on, pleased that the children will not have cold or injured feet. “Tomorrow, I will be able to wave goodbye to the boys without worrying as they start their journey to school,” said Wafaa. “The warm and fur-lined boots ease my mind.”

Forget blackboards and desks, quizzes and calculators. Palestinian preschoolers have some new gadgets in the 150 ANERA-renovated preschools across Palestine: toys and games to make learning fun.

Through a holistic approach, ANERA’s Early Childhood Development (ECD) program has drastically changed the way teachers teach and children learn. Palestine preschools now have activity centers in which children can read stories, play puppet theater and practice hands-on science and art. They come complete with safe and child-friendly furnishings painted in bright, happy colors.

Puzzles and Paint Teach Palestine Preschoolers New Skills

The toys and games are locally produced by manufacturers in Gaza and the West Bank. Among them are musical instruments, puzzles, painting easels, card and memory games, dominoes, board games and more.

In the quiet corner, there is a small group of children working in pairs with building blocks. Meanwhile, another group is listening intently to a teacher narrating a lively children’s story. In the adjacent room, children play with water and sand, amused by the texture of wet sand and slowly grasping the concept of “empty” and “full.” Their classmates offer them warm tea and freshly-baked cake, all prepared in the toy kitchen unit with a little help from stuffed animals.

Toys like these are locally made in Palestine.

Young girls play with a pretend tea set at Al Auja preschool in one classroom. In another, children read in small groups.

Through active learning, children learn lessons in visual discrimination, eye-hand coordination, sorting and classification, mathematical logic, critical thinking and self expression. They also develop their motor skills, curiosity and character, and explore the world around them with all senses engaged.

Active Learning Replaces Rote Education

“You see troubled kids completely immersed in games, 100 percent focused on building and creating.”

Before ANERA implemented its early childhood framework at these preschools, teaching was often conventional, haphazard and rigid. Children did not get the chance for one-to-one learning with their teachers and peers, and were instead taught as a mass group.

In Al Auja, a deprived part of Jericho, children’s first encounter with these toys was chaotic. Head teacher Itaf Njoom recalls, “They would mix the puzzle pieces with letter games or numbers, not knowing how to play with them. You’d find them playing with blocks and pinning boards together, not realizing they were different games. This is when their learning journey began and our training as educators came into play.”

Children watch a puppet show in a Palestine preschool.

Children at Al Auja preschool are entranced by a puppet show.

Itaf has been a preschool teacher at the same school for over 16 years. She has seen many classrooms full of children that never get to see such enchanting toys and games at home. Poverty is rife and does not allow for toys and games. In addition, many parents don’t see the value of active learning with these fun tools.

“As a community, the concept of learning through play is not accepted,” said Itaf. “That’s another reason why Palestine preschools lack toys. Parents send their children to learn the alphabet and numbers, and they expect them to know how to write simple words and develop simple math skills. So the preschools would focus on that aspect, ignoring children’s innate need to play.”

Broken Old Toys and Furnishings Get Replaced

Before ANERA’s intervention, The Al Auja preschool was poorly furnished. Most of the games had missing pieces, and were worn out and unsafe to use. According to the teachers, the old toys had accumulated over the years through different charitable donations. But regardless, Itaf points out that the old toys were not used correctly.

“It was simply haphazard. We had no ultimate goal—we were just letting them play. Through training, we learned how to correctly engage the child with structure and purpose.”

In Palestine preschools, kids now play and learn in small groups.

Before the preschool embraced active play, kids mix up the toys and games, not knowing how to play with them properly.

Halfway through the school year, the kids at Al Auja now know each game and toy. They know exactly which toy they want to play with and how to play with it. They even put the toys away neatly when playtime is over.

“The kids are more calm and communicative, and less likely to resort to violence,” said Itaf. “The educational material has played a huge role in that. You see troubled kids completely immersed in games, 100 percent focused on building and creating. They are stimulated on all levels: their muscles, thought and imagination. All in just one game!”

A young Palestinian girl plays with a toy at Al Auja preschool.
Drawing is a part of early childhood development in Palestine preschools.
ANERA's holistic approach includes one-on-one time for teachers and students.
Colorful building blocks are a lot of fun for boys and girls!
Child-sized furniture is part of ANERA's plan for Palestine preschools.
Children read age-appropriate books at Palestine preschools.
New toys for the boys and girls in ANERA-renovated Palestine preschools.
A girl laughs at the puppet show in Al Auja preschool.

Children at Al Auja preschool are fully captivated by their toys and games. Teachers report they are calmer and more communicative.

Drawing and coloring gives students a way to express themselves and practice motor skills.

ANERA's holistic approach includes one-on-one time for teachers and students.

Colorful building blocks are a lot of fun for boys and girls!

Child-sized furniture holds the toys and games, which the children put back when they're done playing.

Reading age-appropriate books in small groups or one-on-one helps children develop literacy skills.

A boy plays with a colorful set of building toys.

A girl laughs in delight at the puppet theater– a new feature in the Al Auja preschool.

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Back home in Syria, Nadia Al Hammoud had a house and a little farm. Now the mother of four is a refugee, living in a cattle barn in Lebanon. She fled Al Qusayr, Homs with her husband and four children in 2012, as the war took away all they had.

The family of six ran away to save their lives, leaving behind any legal documents. Paperless, they settled in Wadi Khaled, a rural region on the Syrian-Lebanese border. “There are about 10,000 families residing in Wadi Khaled, equally divided between original Lebanese residents and refugee families who fled the civil war in Syria,” said Ali Al Badawi, the Mayor of Al Rama village in the Wadi Khaled area.

Poor Living Conditions for Syrian Refugees in Winter

Syrian refugees in winter need light and warmth, like Nadia who lives in a barn.

“We use candles at night, but now we have this battery-powered light,” said Nadia. “It’s a great support.”

Nadia and her family live in a single shoddy room in the cowshed. It has a cement floor that becomes frigid in the winter, walls that leak rainwater, and a roof rusted with asbestos. There are no glass windows in the shed, only open holes that let in the cold despite Nadia’s best efforts to seal them with nylon bags. But at 600 meters above sea level, the region is cold and windy. Winters see heavy snows.

Syrian refugees in winter live in harsh conditions like this converted barn in Lebanon

The converted barn, where Nadia lives with her family of six, offers very little protection from the cold.

This winter, ANERA distributed winter protection kits to 1,500 Syrian refugee families like Nadia’s. The families reside in Wadi Khaled and Berkayel, both in northern Lebanon. The UN reports that the area is one of Lebanon’s “most deprived regions.” Of the 1.1 million residents, roughly 65% are under the poverty line. The crisis in Syria greatly affected the region, as 300,000 refugees have settled there after fleeing war.

Winter Boots and Battery Rechargeable Lights Support Moms Like Nadia

Syrian refugees in winter need battery powered lights because they have minimal electricity.

Battery rechargeable lights are a necessity in villages like Wadi Khaled, where residents get only three to six hours of electricity per day.

The winter kits include warm clothing, boots and battery rechargeable lights to address the lack of reliable electricity. On average, there are three to six hours of electricity per day, and many Syrian families cannot afford to buy generators.

“We use candles at night, but now we have this light,” said Nadia. “The light is a great support to me, especially when one of the kids wake up at night.” Zahraa, Nadia’s youngest, was excited to slip on her new cozy winter boots and stow away her slippers for the summer. “My siblings will be very happy when they return from school and see the new things we’ve got,” said Zahraa.

ANERA distributed the kits as part of its annual winterization program to help protect Syrian refugees in winter. Most of these families are enduring harsh conditions. As winter sets into the cold, hilly regions of Lebanon, these kits are a necessity for helping Syrian refugees keep warm.

Zahraa wore sandals before receiving boots .

Before Zahraa received her winter boots, she wore plastic sandals in Lebanon’s cold and snowy winter.

In Lebanon’s Nahr El Bared refugee camp, trash is dumped everywhere. It fills the streets and covers sports fields. As the camp runs out of space, residents dump waste dangerously close to the sea. To make matters worse, scavengers often tear open bags to find recyclables that they can sell, leaving a huge mess. They burn the remaining garbage.

For the 30,000 Palestinian refugees in the camp, the situation poses huge health risks. So this year, ANERA initiated a pilot project to address the issue. Now, a volunteer team of youth in the camp act as ambassadors for the project. First, ANERA trained the inspirational young adults in environmental health. Then, the team set out to engage their community. The teens teach families to sort trash on a household level and host clean-ups in the camp.

The project involved a model neighborhood of 350 households in the camp, where families were enthusiastic about getting their neighborhood cleaned up. ANERA distributed bins to each household for sorting waste and recyclables. Then, we coordinated trash pick-up and training with the United Nations Relief and Works Agency (UNRWA). Finally, people like you funded tree-planting days. The new trees encourage Nahr El Bared residents to keep their environment beautiful. Watch the film to learn more.

Watch: Youth Lead Clean-Up of Nahr El Bared Camp