Advisory Clinic on Reproductive Health Issues in Ein el-Helweh Camp
17 September 2009
Ein el-Helweh Camp
●Date of establishment: 1949 by the International Committee of the Red Cross.
●Geographical location: Near the city of Saida, south of Beirut.
●Area: 301,039 square meters
●Ownership: Private property of the municipality of Saida.
●Number of Residents: 45,337 total registered refugees according to UNRWA.
●Educational services: 9 UNRWA elementary/preparatory schools and 1 secondary school for 7,544 enrolled pupils in 2003/2004.
●Health services: 2 UNRWA Health Centers.
MAP has been working with Nabaa - "Developmental Action Without Borders" - a Lebanese organization that works with Palestinian communities in the camps and gatherings in Lebanon. Nabaa works in an integrated way, involving a wide range of individuals and organizations within the community to build a shared approach to achieving their vision, mission and aims.
MAP's programme, which benefits thousands of residents in the largest Palestinian refugee camp in Lebanon, has opened an open advice clinic that offers a range of medical, psychological and social support.
MAP recently met up with some of Nabaa's senior staff to discuss the conditions in the camp:
"A lot of recent work has been done in the field of community development looking to protect young people from the camp who are dropping out of school. Many will adopt risky behaviours like smoking and taking drugs. Some 30-40% of students are failing to reach basic standards of education. Low standards combined with high drop out rates mean that we are in danger of losing a generation to risky behaviours that impact on their long term health.
"There are a whole range of dangers facing young Palestinians growing up in the camp. The very environment of the camp makes life hard. The density of houses in the camp means unavoidable heat and overcrowding. This means that people have chronic lung infections leading to chronic heart and respiratory illnesses. There is no space for children to play, and all camp residents must constantly avoid the electric cables that crisscross the narrow alleyways.
"The employment restrictions on Palestinian refugees in Lebanon means high levels of unemployment. The politics of having so many factions in one camp means there is a constant state of tension. I feel that at any time on any day, violence could break out. Drug problems are on the rise in the camp, and in particular people are taking a combination of cough medicine and pills. Some of the drug dealers are linked to influential people and are therefore immune from any consequences.
"There is a history of 'political NGOs' working in the camp and we have to protect and emphasise the importance of our neutrality. Our projects deliver services to those who need it. It's as simple as that.
"We've been sending nurses into schools to address students of all ages. They adopt a participatory approach to teach students about reproductive as well as general health issues. One of the consequences of Palestinian doctors not being allowed to work in Lebanon sees them running private clinics in the camps.
"There are two UNRWA clinics that both open daily until 1pm, but the demand for their services is far in excess of their resources as there are too few doctors and too many patients. One doctor may see over 50 patients in the space of a few hours, it's simply not long enough to give good quality care. We're careful not to replace UNRWA or duplicate their services with our clinics, but rather fill in the gaps of care that are missed".
The MAP-Nabaa clinic is staffed by two doctors, a urinary tract specialist, a nurse, a councillor and a community health worker. This dynamic combination of people allows for effective clinical care as well as home and health awareness visits throughout the camp. The clinic is open six-days a week with each doctor operating with a personalised schedule.
MAP spoke with one of the gynaecologists working in the clinic, Dr Amona Saif. Dr Saif has been a practicing doctor for over twenty-three years and has worked for both the UN and the Palestinian Red Crescent Society in the past;
"There are a large number of issues linked to infections and problems with pregnancy that we see in the clinic. Health awareness is a simple, yet incredibly important method of effecting sustainable change for the quality of life of camp residents.
"The social, economic and environmental problems associated with the camp lead to high levels of depression. People simply have no physical space with which to deal with their problems, they are both anxious and worried about the future and suffer both political and personal endemic violence. In the clinic we have created a safe space where people can relax and be listened to.
"Women in the camp have large numbers of children, sometimes as many as eight or ten. We provide education about the importance of family planning and birth spacing. A lot of the time our work addresses misunderstanding about health issues linked to taboos within the camp that is becoming increasingly conservative. We are working closely with UNRWA to improve health awareness across the board.
"The results of our work can be richly rewarding. I had a patient not too long ago who had been married for twenty years without having children, she was considered infertile but after visiting our clinic we realised that it was her husband who was impotent. After we reached this diagnosis he had an operation and I'm happy to say that she is now four months pregnant.
"Through being able to spend more time with our patients (10-12 a day) and following up cases with home visits and relationships building we are able to make a real difference to the difficult lives that Palestinian refugees in Ein El-Helweh lead. The first bit of advice I give to any patient is 'make sure that you pass on all the information I've given you', we must make sure that as many people in the camp have access to the means to keep themselves healthy".
Susana is a community health worker who works alongside Dr Saif providing home visits and organising a series of activities for the clinic's patients.
"Not only do I deliver awareness building classes but often I arrange activities for the children, allowing mothers more time and space to care for themselves. Often problems like scabies with the children and a background to the high rates of anaemia are discovered through such home visits. I work with the clinic's doctors to provide a holistic hybrid approach to patient care. We make sure that we track the health of our patients, everyone has their own computerised records and we follow up visits with check-ups and feedback sessions".
