MIDDLE EAST: HEALTH CARE IN CRISIS

Persistent crises, people forced to leave their homes, chronic epidemics and endemic diseases: millions of people’s health is at threat in much of the Middle East. Sandrine Chapeleau, Première Urgence Internationale’s Middle East and Europe health advisor, regularly makes field visits and can confirm that the situation is critical, in particular regarding the refugee crisis and displaced persons.

WHAT IS THE SITUATION LIKE FOR PEOPLE IN THE MIDDLE-EASTERN COUNTRIES WHERE YOU ARE WORKING?

In the Middle East, I am the health advisor for Jordan, Syria, Lebanon, Iraq and Yemen. The situation varies from country to country. But the main health-related issue in all these countries, except Yemen, is the refugee crisis and displaced Syrians and Iraqis. Health care facilities exist and there is medication. But large numbers of people do not have access, or only have partial access, to them for different reasons: difficult security conditions, weakened health care systems, their refugee or displaced person status, in some cases without legal documents.

Health care costs in host countries are very real obstacles to care, for the most vulnerable populations. In Yemen, the situation is slightly different. A conflict which has been devastating the country for more than ten years, the collapse of health care infrastructures, a very high level of acute malnutrition and a major cholera epidemic are all leading to a catastrophic humanitarian situation in this country.

HOW ARE THE REFUGEES AND DISPLACED PEOPLE YOU MEET IN YOUR WORK SUFFERING?

The refugee crisis is causing significant difficulties with access to basic health care, in particular when people suffer a decrease, or loss, of income, due to their displacement. The result is that they are sometimes forced to break off their treatment, which may have been prescribed for chronic illnesses such as diabetes or high blood pressure. These illnesses need long term, and often expensive, health care.

I had the opportunity to meet a Syrian refugee in Iraq. He was suffering from a degenerative heart condition and he had been receiving high quality treatment in his homeland. Unfortunately, once he arrived in Iraq, he was not able to find and be prescribed the same medication. His health could rapidly worsen if he doesn’t have regular medication. With the difficulties he is facing on a daily basis, his illness has had to take second place. In this situation, immediate vital needs predominate, such as food, water and shelter.

WHAT ARE THE EFFECTS OF THE CONFLICT ON PEOPLE?

At ground level, I have seen great distress among refugees and displaced populations, which leads to psychological trauma. This results from the conflicts they have fled, many violations and infringements of their rights that they have suffered, or are sometimes still suffering, from. The effects of conflicts on mental health and psychological well-being are profound. Life is extremely difficult for refugees and displaced persons, and more and more so as the refugee crisis carries on.

Within the framework of our health projects, we are therefore taking the psychological dimension into account. We are implementing psychosocial support activities, carried out by psychologists and social workers. Implementation of this type of project needs to entail developing activities specifically for prevention, detection, care, monitoring and referral that are suitable for these populations.

SO IS PREMIÈRE URGENCE INTERNATIONALE WORKING AT ALL THESE LEVELS?

It all depends on the environment and the country. We prioritise responding to the populations’ primary health care needs. With winter coming, for example, seasonal illnesses such as acute respiratory infections will recur in the camps for displaced persons and refugees where we are working. These camps are sometimes unsanitary and do not have access to a water network or quality hygiene.

Refugees living outside the camps are also living in very difficult conditions. In Lebanon, during my last visit, I met a group of Syrian families living in makeshift shelters, built on farmland. Access to water was clearly unsatisfactory and the adults, as well as the children, were being exploited by the farmers. These families only wanted one thing: to go back to Syria. They had already been ‘stopping’ on this land for 4 years.

AND WHAT IS YOUR ROLE, AS HEALTH ADVISOR?

I’m working within the technical department (STC), which is based at Première Urgence Internationale’s headquarters. This department is made up of several health experts and a pharmacist. We are all allocated our own geographical area, which works well, as the problems and crises in each area are very different. In Africa, for example, care mainly covers basic needs.

For the Middle East, I am bringing my medical expertise to the field. I am responsible for strategic and technical support throughout the different phases of a project cycle, for any medical and public health questions, treatment protocols, epidemiological monitoring, training curriculum. Together with the technical department’s pharmacist, I check that the pharmaceutical and medical equipment orders sent by missions are technically appropriate.

WHAT IS YOUR AIM AT GROUND LEVEL?

The aim is to improve the quality of care provided to the populations supported in our projects and to ensure medical ethics are respected. We are taking care to ensure that Première Urgence Internationale’s humanitarian principles are applied in the missions.

I also help with project implementation, if needs be. For example, in Gawilan Camp in Iraq, I helped with setting up the camp health centre. My tasks are varied, especially as the environment is very volatile in this region. Everything can change very quickly. It can happen that from one day to the next, medication supply can become a real headache in a country, where it hasn’t caused us a problem for years. And these countries are not immune to fighting or to epidemics that can suddenly appear.

Unfortunately, I can see on a daily basis that we are far from being finished with these crises. After over 5 years of the Syrian refugee and displaced persons’ crisis, 2 years of conflict in Yemen, and practically incessant chaos in Iraq, we humanitarian workers remain ready for anything. We carry on despite daily difficulties and despite sometimes feeling powerless to fight ever-worsening humanitarian crises. But we have to carry on…