TENS OF THOUSANDS of people have been forced to flee their homes in southern Lebanon as fighting between Israel and Hezbollah has escalated in recent weeks.
The healthcare system and humanitarian NGOs working in Lebanon are struggling to cope with the growing number of people displaced by the fighting, as the country enters its fifth year of financial crisis.
“People need mattresses, clothes and medications,” Abbas Chite, from Kfarkila in south Lebanon told the medical NGO Doctors Without Borders (MSF).
“We left everything behind when the bombardment became heavy. We can’t even go back to get our medical prescriptions or clothes.”
The Journal spoke to one humanitarian group in Beirut, who said they are training healthcare staff in how to deal with major casualty incidents in case the situation escalates.
The low-intensity conflict has involved Israeli airstrikes, rocket launches from Hezbollah and exchanges of live fire across the Lebanon-Israel border since the 7 October attack by Hamas against Israel.
The fighting has ramped up in its intensity since Israel allegedly assassinated two senior Hamas leaders in southern Lebanon and the capital Beirut, with Hezbollah leader Hassan Nasrallah promising a harsh response. Israel has denied responsibility for the attacks.
This week, an Israeli strike killed a senior Hezbollah official in the south of the country.
“If the enemy thinks of waging a war on Lebanon, we will fight without restraint, without rules, without limits and without restrictions,” Nasrallah said in a televised speech.
“We are not afraid of war.”
In a statement issued on Tuesday, a group of UN experts said of the Israeli strike that all states are prohibited from ”arbitrarily depriving individuals of their right to life in military or security operations abroad, including when countering terrorism.
“Killings in foreign territory are arbitrary when they are not authorised under international law. Israel was not exercising self-defence because it presented no evidence that the victims were committing an armed attack on Israel from Lebanese territory.”
Israeli Prime Minister Benjamin Netanyahu has declared his intention to kill Hamas leaders outside of Palestine, saying in November 2023 that Israel will “assassinate all the leaders of Hamas wherever they are”.
The Israel-Hezbollah conflict has made it unsafe for civilians on either side of the border to remain in their homes, forcing them to seek refuge elsewhere. More than 82,000 people have been internally displaced since 8 October, according to the UN’s International Organisation for Migration.
Medical needs
One NGO that has been supporting the efforts of the embattled health service in Lebanon, especially in the south, is Médecins Sans Frontières (MSF).
The Journal spoke to MSF’s medical coordinator for Lebanon Caline Rehayem, who is based in Beirut, about the conditions of those displaced by the violence and their healthcare needs.
She says that people have been internally displaced to areas within the south of Lebanon or further to the north.
“And of course, this has affected their access to health care, in addition to essential needs and for some of them sheltering needs,” she says.
“Since 2019, the ongoing economic crisis has affected the country and the people living in Lebanon and also has put strain on the healthcare system, whether it be primary health care centres or hospitals, or secondary and tertiary healthcare centres.
“So this escalation in military activity and the impact comes is leading to compounding impact on the healthcare system.”
MSF has a mobile medical team that is supporting two health centres in Nabatieh district in the south, providing care for patients with chronic diseases as well as psychological first aid.
Patients treated by MSF staff have presented with various medical problems, from chronic illnesses like diabetes and hypertension, to mental health issues resulting from escaping airstrikes.
Another common issue is that, because people have had to leave all of a sudden, many did not bring possessions with them, including medical records and prescriptions, something MSF and Lebanese healthcare workers are assisting with.
“So with displacement, people leave their homes and so might not have the time or the capacity to have taken their medical records, medical prescriptions or medications,” says Rehayem.
“So MSF has deployed a mobile medical unit that is supporting two primary health care centers in the south, … where we are supporting internally displaced patients to have a continuity of care and continue to access medical consultations and have access to their medications.”
These efforts are being made in coordination with the Lebanese Ministry of Health.
Basic necessities are in short supply for those displaced by the ongoing violence. People are in need of things like mattresses and blankets, food and water and personal hygiene items, Rehayem says.
The prospect of the conflict escalating further is something that MSF and the Lebanese health authorities are taking into account as well. Rehayem says their teams have “upscaled their preparedness and response capacity” in anticipation of that possibility.
“In addition to the mobile activity that I mentioned, MSF teams have also provided training, also in line with the Ministry of Public Health, Emergency Preparedness and Response Plan.
MSF doctors are training health personnel in different hospitals in Lebanon in trauma care and mass casualty incident management. The NGO has also prepositioned medical supplies “in order for this to be reachable for use in case of escalation,” Rehayem said.
Compounding crises
Estella Carpi, a lecturer in humanitarian studies at University College London, says that the Lebanese economy has been under pressure for over a decade, but particularly in the last few years. The country’s reception of refugees from Syria and Palestine has exacerbated the strain on public services and the activities of NGOs, which were already struggling, she explains.
“Since 2011, Lebanon has been hosting the largest number of refugees ever in its history because of the conflict in Syria. So that definitely put an extra burden on local welfare provision and services and NGOs have been increasingly under-resourced… facing budget shortfalls as never before, basically.”
The effects of the Covid-19 pandemic have also compounded these difficulties, Carpi says.
“The other thing is surely the pandemic… as [with] anywhere else, it made the economic collapse in Lebanon even more severe.
“Lots of people lost jobs, lost their livelihoods, and of course in this scenario, refugees have always been the the weakest segment of the local population, as you can imagine, because they normally struggle to generate their own livelihoods on a daily basis even in times of, let’s say, stability or economic decency.”
Carpi mentions another notable incident in recent years that did damage to the Lebanese economy and the reputation of the government: the explosion at the Port of Beirut in August 2020, which killed over 200 people and injured more than 7,000.
Despite an influx in foreign investment and financial aid from other countries in the aftermath of the explosion, much of that money has gone towards promoting tourism, nightlife and the service economy, rather than to addressing the needs of those most in need, Carpi explains.
“As always, investments coming from outside try to create their own ground for benefits in the economic interest for foreign agendas, rather than prioritising the needs of the weakest segments of the local demography, as it has always been in the history of reconstructions in Lebanon.
“I think these three historical moments [the war in Syria, the pandemic and the port explosion], in a sense, have made things even worse in Lebanon economically speaking, so even before the break out of this sort of low intensity conflict between Israel and Hezbollah,” she says.
What happens next
The potential for the violence to intensify remains, but the current level is already hampering the ability of NGOs to provide care to affected people in the south, says Carpi.
“I’m afraid that if it remains low intensity, you’re not going to have lots of NGOs helping out there because, of course, it’s not the priority as the largest humanitarian crisis is happening in Gaza, and not in Lebanon,” she says.
“And also because many NGOs that were the ones compensating for the state not providing anything in Lebanon, even to refugees, like kind of moved to Ukraine in 2022. And so you saw lots of offices shutting down.
“People are really not receiving much. I’m in regular conversation like with people in the South that I’ve known for years and there is really not much help for the internally displaced honestly.
“So the long term is quite scary to their eyes because you’re just living in a school and you don’t know how to continue your daily life, basically.”
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