Michael Goldfarb

Editor's note: Earlier this year, Michael Goldfarb, media relations manager for Doctors Without Borders/Médecins Sans Frontières (MSF)-USA, traveled for a week in Lebanon with MSF staff working on projects providing medical assistance, including mental health support. The team documented a severe deterioration in humanitarian, health and living conditions for Syrian refugees.

Goldfarb cites a "free for all" in which extended families shelter in make-shift and abandoned structures, the Lebanese government forbidding the United Nations High Commission for Refugees (UNHCR) from operating formal refugee camps.

"The coping mechanisms on display and the palpable sense of community and dignity among the refugees was striking," said Goldfarb. "While many live literally in filth, their 'homes"'are spotless and orderly.  It's a coping mechanism, to be sure, but it's also an act of quiet defiance and a determination to achieve at least some normality, which is hugely admirable given the seemingly insurmountable odds stacked against them.  Also impressive are the solidarity and poignant acts of charity extended to them by host communities, a significant strain on local resources."


Deir Zenoun, Bekaa Valley 

A particularly harsh winter in Lebanon made already dire living conditions intolerable. The lack of formal camps with adequate shelter has forced people to make do in improvised settlements. In what is otherwise a picturesque farm nestled in the valley floor below the snow-capped Lebanon Mountains, more than five hundred Syrian refugees live in ankle-deep mud, fresh from January’s snowfall. They are crammed into ramshackle shelters made of recycled vinyl billboards.


The consumer item advertisements emblazoned on the sides of "houses" belie the grim reality for refugees here, who didn’t even have access to clean water. There are no proper latrines and camp residents suspect a nearby well is contaminated. Many children in the camp display signs of communicable disease. “The situation is extremely bad,” one camp resident told me. “We have no sewage system. When it rains the water flows into the tents, so the kids get sick.” 


Arsal, Bekaa Valley

This Syrian woman sleeps in a stone-cutting factory in Arsal - a two-room structure - with her husband and three adult sons, two of whom are mentally disabled. They fled fighting in Syria nine months ago. The factory workers provide them with food.


A mother of eight I spoke with thought her family would be safe in Arsal. Sitting in the cold, half-built mosque that is now home to her family, she displayed empty packages of valium as she frantically recalled her ordeal to a Doctors Without Borders social worker, wringing her hands as tears cascaded down her weathered cheeks. After her 65-year-old husband had been kidnapped and tortured by Syrian government security forces, then inexplicably released, she'd spirited the entire family over the border, escaping the embattled city of Hama, where their house had been bombed. Her husband, rendered mute and immobile from the beatings, sat propped up on a foam mattress, covered in blankets, fingering worry beads and staring blankly ahead. The village was not safe, however, but rather full of spies, she said, so she moved the family out of town to a snow-swept mountain-top, isolated and far from any reliable sources of food or aid. She harbored hopes that an uncle in Berlin might sponsor them to come to Germany, she said, but it's unlikely; the piece of paper with his phone number lies in the rubble left behind in Hama.   


Majdal Aanjar, Bekaa Valley

They didn’t want their faces photographed, but they wanted to tell their stories:  All nineteen members of the family sheltering in the concrete shell of an unfinished house in this farming town had survived shelling in the Damascus countryside. They managed to escape over the border into Lebanon, where the structure's owner took pity on them and let them stay.


There is no glass in the windows, so the rain and biting wind slices into the living quarters. While there’s plumbing, there’s no hot water. “I haven’t washed for 15 days,” one of the refugees, a 21-year-old woman, told me.  

Nor is there work to be had. “It’s more secure here, but life is extremely expensive,” said the family's patriarch. “We don’t even have fuel for heat. I have no idea how long we can do this.” Once refugees register with UNHCR they are eligible for regular aid distributions and health care, but lengthy delays leave many refugees with nothing, totally reliant on neighbors and aid groups. 


The Cattle Ground, Tripoli

An elderly and unregistered Syrian refugee suffering from Parkinson's disease sleeps in a room in a ramshackle home on a cattle ground surrounded by his daughter-in-law and granddaughter.  He and 19 members of his family, forced from their home in Idlib, Syria, because of the war, live in two cramped rooms in the fetid settlement. His son, who can't find regular work, can't cover the costs of his father's medications. The family pays $175 for the shelter, which has no heating or refrigerator. They draw water from a nearby well, which we deemed likely contaminated by cow manure. 

The aid system has not kept pace with the influx of refugees. Particularly vulnerable are the refugees living with chronic medical conditions, including cancer, whose treatments were interrupted when they fled Syria. Before the war, they benefited from a well functioning and advanced healthcare system at home. In part due to lengthy refugee registration delays in Lebanon, many can't resume the care they need. For those who are registered, the UN covers up to 85 percent of medical costs.  But for many, coming up with the remaining 15 percent is simply impossible.


On a Lighter Note, in Deir Zenoun...

MSF published its findings in this report: Misery Beyond the War Zone; Life for Syrian refugees and displaced populations in Lebanon.