03 Sep 13 03 Sep 13

Lebanon: Healthcare in the crossfire

Violent sectarian clashes between two of Lebanon’s most deprived neighbourhoods are cutting people off from healthcare. Médecins Sans Frontières/Doctors Without Borders (MSF) teams are providing medical services to people on both sides of the frontline.

Syria Street in Lebanon’s northern city of Tripoli is the frontline of a violent conflict between two neighbourhoods. On one side of the street is Jabal Mohsen, an Alawite neighbourhood of around 60,000 people. On the other side is Bab al-Tabbaneh, home to mostly Sunni Muslims and one of the country’s poorest districts.

Both sides of the street are lined with damaged storefronts, revealing the scars of a conflict that has dragged on for decades. But in the past two years, the violence between has escalated dramatically, echoing the war in neighbouring Syria.

Deaths and conflict

When the violence last flared in May 2013, at least 35 people were killed and more than 250 were wounded.

Since the Syrian uprising began in March 2011, more than 190 people have been killed and 1,200 wounded in fighting between the two neighbourhoods.  

Despite their sectarian differences, the two communities are alike in poverty, overcrowding and huge healthcare needs, made more acute by the recent arrival of refugees from Syria.

Jabal Mohsen

On one side of the conflict is Jabal Mohsen, a dense hillside settlement overlooking the city of Tripoli.

During the clashes, shops and schools close and many residents stop going to work, while tanks from the Lebanese army block Syria Street in a bid to impose peace by physically separating the two neighbourhoods.

With all entrances blocked, face enormous difficulties accessing healthcare. People who need urgent treatment had no choice but to attempt to cross the frontline.

Hospitals and healthcare


“There are no hospitals here,” says Sébastien Vidal, MSF’s field coordinator in Tripoli. “A pregnant woman in labour or a patient in need of emergency medical care can only reach the closest hospital in downtown Tripoli by crossing the neighbourhood they consider hostile.”

In November 2012, MSF started medical services in Jabal Mohsen’s clinic, the only health facility in the area.

“Since we started offering medical services, the patient flow has been constant, with our doctors and nurses working tirelessly to respond to the needs,” says Vidal.

“Crucially this includes stabilising the injured before they can be referred outside the enclave, as and when the security situation allows,” he adds.

Bab al-Tabbaneh

Bab al-Tabbaneh, on the other side of Syria Street, is home to some 80,000 Lebanese, as well as an increasing number of Syrian refugees.

“This neighbourhood is one of the most deprived districts in Lebanon and access to healthcare services is very poor,” says Vidal. MSF opened a clinic in Bab al-Tabbaneh in April 2013.

“On the day of the opening, the clinic was already full of patients, most of them women and children who had never had access to free or affordable healthcare,” says Vidal.

Consultations and treatment

Inside the clinic, two doctors and two nurses provide free consultations and treatment to an average of 60 patients each day. About 20 percent of these are Syrian refugees, a particularly vulnerable group.

“Most patients are young children suffering from chest infections or gastroenteritis due to the dire living conditions,” he adds.

“Many children also suffer from iron and vitamin deficiency because they lack access to nutrient-rich foods, making them even more vulnerable to infections.”

Between April and late-July 2013, more than 3,500 patients received medical attention at the clinic.

Medical emergencies

In addition to basic healthcare in Jabal Mohsen and Bab al-Tabbaneh, MSF supports the emergency room of Tripoli Governmental Hospital, the only public hospital in the north of the country.

Since May 2012, MSF has been training hospital staff and providing supplies and equipment for acute medical emergencies.

Since Syrian refugees began flooding into Lebanon in November 2011, MSF has been adapting its response and opening new medical projects in the country.

Syrian refugees

While the Lebanese community has made tremendous efforts to integrate and help the refugees, its capacity to cope – especially in already impoverished areas such as Tripoli or the Bekaa Valley – is reaching its limits.

“It is essential to guarantee support to the Syrian refugees, but also to the communities in Lebanon which are hosting them,” says Dr Gustavo Fernandez, MSF’s Geneva-based programme manager for Lebanon.

“MSF is committed to continue to bring quality medical care to people regardless of their religion or political affiliation.”

Update

On Friday 23rd August 2013, two bomb explosions near two mosques in Tripoli, wounded around 800 people and killed 48, according to official estimates.

MSF treated eight of the wounded in its Jabal Mohsen clinic and 10 in its Bab al-Tabbaneh clinic. Seven of the patients had severe injuries and were transferred to hospital.

More than 50 wounded people in need of intensive care were admitted to the emergency room of Tripoli Governmental Hospital.  

Read more about MSF's work in Lebanon