In Lebanon, one in every three people is a refugee. The effects of the refugee crisis have been well-documented in urban centers like Beirut. But what about the effects on rural areas, where services are few and far between?

It’s estimated that 86% of Syrian refugees reside in rural areas, most notably in the Bekaa Valley region of eastern Lebanon. In 2015 there were about 410,000 Syrians in Bekaa – almost equal to the number of Lebanese who already lived there.

The population boom in Bekaa put unprecedented pressure on services and infrastructure. Because of this strain, municipalities in the region are incapable of providing residents access to basic services like health care.

For this reason, refugees in Bekaa often use local dispensaries for health care. Like many Lebanese citizens, refugees access health care services out-of-pocket. They spend roughly 18% of their income on health care.

In the village of Kamed Allouz, many residents from Syrian and host communities go to the Mohammad Ali Waked Dispensary.

“The fees are minimal and medicines are provided free of charge,” explained Khaled Othman, the clinic manager. Othman said that when it comes to dental health care, lab tests, x-rays, and medicine, the rates are 40-50% lower than in private clinics. However, he added, “the shortage of medicine is the biggest challenge we face.”

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Khaled Othman, executive manager of the Mohammad Ali Waked Dispensary, says that the biggest problem faced is a shortage of medicine.

Recovery from Surgery within Reach

“My family always comes here for health care,” said Mohammad Hammoud, a local from Kamed Allouz. He makes little income at a small village shop and his wife doesn’t work. So finding affordable health care for his family of four has been a challenge. He added, “the services here are of excellent quality and the doctors are experienced.”

Mohammad comes to the dispensary for Naproxen tablets, which was prescribed to his teenage son after surgery left him with critical bleeding. Naproxen is a painkiller used for post-surgical recovery. However, underprivileged patients often choose to forego painkillers, said ANERA pharmacist Lina Atat. “They find it a burden to purchase them among a long list of other medicines.” 

Health Care Assistance from a Coalition of Partners

The dispensary in Kamed Allouz serves about 600 patients each month. Lebanese, Syrians and Palestinians from Kamed Allouz and neighboring villages go to the clinic to for their health care needs.

 ANERA delivers assistance to the clinic through its longtime in-kind partner, the YMCA. A donation from International Health Partners, with funds from the Zakat Foundation, allowed ANERA to deliver the painkiller and other vital medicines. Donations like these let refugees access health care in the face of poverty.

Just outside of Bethlehem lies the village of Al-Walajeh in the West Bank. It’s within Area C, where any construction needs to be permitted by the Israeli government. That’s why the project ANERA just completed—the construction of the Walajeh Clinic—is so important.

Before the clinic was built this year, there was no health facility of its kind in the area. The village’s 2,500 residents had to use a small mobile clinic with limited operating hours and services. Since so many common ailments couldn’t be treated there, villagers often needed to travel to Bethlehem for basic health care.

With funding from USAID, ANERA was able to construct a state-of-the-art clinic on land donated by the Walajeh Village Council. The clinic is fully equipped with a laboratory, pharmacy, reception area, and rooms for vaccinations, doctor’s examinations, and mother and child health care. It’s fully furnished with equipment and examination beds. The reception area is fitted with chairs and water coolers so patients can wait in comfort.

Walajeh Clinic in area c before and after

The people of Al-Walajeh only had a small mobile clinic with limited facilities until the Walajeh Clinic was built.

This building project also created 230 short-term jobs for Palestinian workers.

“The clinic is very spacious,” said Dr. Fatheye Mesyef. “In the old mobile clinic, patients were cramped in a tiny space. But now, I’m able to provide better care because of the facilities. Patients can wait comfortably in the waiting area, and more importantly, this clinic is designed to respect the privacy of the patients when being treated.”

A doctor treats a child at the first clinic in Al-Walajeh, a small village in Area C

Dr. Mesyef treats a child at the new clinic in Al-Walajeh, a small village in Area C.

The Walajeh Clinic blends function with form—its sleek, modern look is fully handicap-accessible as even patients on wheelchairs can roll right up to the front door without any stairs in the way. “I love the new clinic’s design,” added Dr. Mesyef.

Health care should never be out of reach. The construction of the Al-Walajeh Clinic brings that human right to this under-served village in Area C for the first time.  

Education is a fundamental human right, yet it is out of reach for many refugees in Lebanon. According to the UN, half of all Syrian children and about one-third of Palestinian refugee children from Syria are not in school at all. For older youth, aged 16-18, the enrollment rate is even lower: only 17%.

To provide education for refugees in Lebanon, ANERA launched a basic literacy and math program for youth between the ages of 14-24. It’s implemented in partnership with UNICEF, with funds from UK Aid, German Cooperation and KFW. Courses on English, Arabic, and math are taught by carefully trained teachers, and parental support is encouraged through awareness sessions. “The aim is to help youth develop basic competencies that they need in their practical lives,” explains Nisrine Makkouk, ANERA’s education program manager in Lebanon.

In addition to basic literacy and numeracy, students learn useful job skills and attend life skills sessions and other fun activities with their peers. 

Getting Acquainted with Computers

Young refugee girl uses the computer in ANERA program providing education for refugees in Lebanon.

“Before this workshop, I didn’t know how to use a computer,” says Walla, a 17 year old from Fnaydeh. “I learned Windows and Office, and now I’m learning PowerPoint.”

Jamil uses a computer for the first time ever in classes in Lebanon

Jamil, age 16, learned how to read and write in ANERA-funded workshops. Now he’s learning computer science. “This is the first time I’ve used a computer in my life!”

Eman teaches refugees in Lebanon computer skills like Microsoft Office

Mrs. Eman (left) teaches a computer science workshop that starts with the basics and advances to Microsoft Office. She has 22 students between the ages of 14 to 20.

Learning How to Read and Write in Arabic and English

Mona takes Arabic class for refugee youth in Lebanon

Mona, age 15, attends Arabic, English and health classes. “I only knew the basic stuff before coming to these classes,” she says, “and now I’m intermediate level!”

Arabic classes offer chance at education for refugees in Lebanon.

Mona and Iman, ages 15 and 14, learn how to read and write classical Arabic.

Refugee youth in English class in Lebanon

Raed is a 22 year old electrician living in Fnaydeh, Lebanon. He’s taking English classes so he can expand his skillset and have better job opportunities.

Health Classes Teach Vital Information

Health class in Fnaydeh, Lebanon, for refugee youth

Students learn about personal and public health in an ANERA-funded health class in Fnaydeh, Lebanon.

Health education for refugees in Lebanon.

Twenty three students aged 15-20 are enrolled in the health class.

So far, the program has enrolled 3,000 refugee teens in classes, and by the end of the year ANERA expects more than 5,000 additional students. Students with good performance are referred to the Accelerated Learning Program, which allows them to catch up with their peers in Lebanese schools. “It’s about offering the opportunity of inclusion to those who have been excluded,” adds Makkouk.

War has stalled the dreams of these young people, but their drive to learn survives.

When the mother of four-year-old Malek discovered dark spots and blemishes on his neck and back, she acted fast. She took him to Shejaiya’s only clinic, where local mothers get up early to wait in line with their children for routine checkups and treatment.

Malek’s condition was hard to diagnose, and his mother had already tried several medicines that hadn’t worked. Finally, Dr. Rami Tarazi diagnosed him with tinea corporis, or ringworm, a type of fungal skin infection.

“During summertime, there’s a rise in skin problems due to the high temperatures, which trigger excessive sweating,” said the doctor. “And with poor personal hygiene, it causes fungal infections.”

In the Shejaiya neighborhood of Gaza, narrow alleys are filled with trash and filth, and sewage overflows onto main streets. Residents can’t get to the city’s bustling market or its only clinic without passing through these heavily polluted areas.

Like other children, Malek plays outside, but the scarcity of water means that he can’t bathe frequently. Dr. Tarazi explains, “His father is jobless and access to hygiene items is a luxury for poor families living in this neighborhood.”

A donated medicine provides relief for Shejaiya children who often contract illnesses playing in dirty streets.

Poverty, lack of water and dirty streets make it difficult to practice good hygiene in Shejaiya.

“Lack of personal hygiene, frequent shortages of water and a huge shortage of medicine have triggered various skin ailments in Shejaiya,” said Dr. Tarazi. These problems afflict Shejaiya particularly because the city still has not healed from the war in 2014.

Thankfully, ANERA was able to provide some relief for Shejaiya patients like Malek. A recent medical donation contained just the medication Malek needed. The doctor prescribed Terbinafine cream and, after two weeks of treatment, Malek recovered.

In-kind Medicines Cure Variety of Ailments in Shejaiya

Dr. Tarazi says he typically sees around 70 cases of skin disorders each week. Among those cases was 14-year-old Mahdi, who had a painful bacterial infection. “He was in contact with animals like cats and birds and as a result of lack of hygiene, he contracted the disease,” said the doctor. Mahdi was prescribed the an antibiotic to ease his pain and cure the condition.

These medicines were part of an International Health Partners donation delivered by ANERA as part of the in-kind medical relief program. The shipment contained 30 other items, such as painkillers, antibiotics and oral anti-fungal gel. ANERA delivered the medicine to 18 clinics and hospitals in Gaza.

The administrative costs for this shipment were funded by the Zakat Foundation of America.

“I was born into a community where a girl’s daily life consists of eating and cleaning,” said 25-year-old Hanaa. Her dark eyes reflect the life she has experienced as a Palestinian refugee raised in a conservative society at Ein El Hilweh refugee camp in southern Lebanon.

When Hanaa was 10 years old her father passed away and her mother pulled her out of school. “Because I’m a girl I wasn’t allowed to learn, to go out, or to do anything a girl my age has the right to do,” she recalled sadly.

But Hanaa’s sister Raheel, by virtue of being younger, had a bit more freedom. Their mother had enrolled her in swimming classes for Palestinian refugee girls in the Women’s Program Center in Ein El Hilweh. When the director, Almaza Sherkawi, heard that there was an elder daughter kept at home, she insisted that Hanaa join the classes too.

And now here she is, dressed in bright red and white, sitting poolside at Hittine Swimming Club. Her story isn’t uncommon, either.

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Twenty-five year-old Hanaa Hilal poses poolside with her friend at Hittine Swimming Club.

“I always wanted to learn how to swim but never had the chance to,” explained Sabreen, a 24-year-old housewife who took swimming classes while pregnant. “My parents and husband both hesitated to allow me to participate, but in the end they accepted it because the pool is so close to my house.”

Even the swimming trainer herself struggled to get her parents to let her join the sports program as the lead swimmer. Rawan is a confident 18-year-old who comes from the nearby Mieh Mieh camp to coach girls at Ein El Hilweh. Rawan learned how to swim at a young age from her father, who was also a swimming coach. “I feel that I’m contributing to the lives of these girls,” she said. “They enjoy the sessions a lot.”

Fifteen participants took eight classes in ANERA’s initial month-long pilot class, one of several youth refugee sports programs. It was so successful that 50 girls have already signed up for the next round of courses and the club set aside Tuesdays as the special day designated for girls and women only.

“This is a radical change,” said Maya Jezzini, ANERA’s youth program officer. “Women never had access to any of the swimming pools in the camp.”

The Girls’ Swimming Revolution

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Rawan, center, is the young teacher of girls’ swim classes. Lina and Mona, beside her, are two of her students.

Lina is a 19-year-old swimmer who convinced her older sister Mona to join in the classes as she recovered from surgery. “I am here to support my sister for I believe every girl should know how to swim,” said Lina. “This is about empowering women to be able to stand up for themselves in the simplest form. And to swim without needing someone to save them.”

ANERA partnered with the Women’s Program Center and Tadamon Association in Ein El Hilweh to organize these swimming classes for Palestinian refugee girls and women ages 14-24. The initiative began with a pilot program last month, in partnership with UNICEF, and with funding from UK Aid, German Cooperation and KFW.