As a result of the outbreak of a violent conflict between the Lebanese Armed Forces (LAF) and the armed group Fateh El Islam in Naher el Bared Camp (NBC) on May 20th, 2007, more than five thousand families residing in the camp found themselves displaced. Although the conflict affected the whole of the country, it’s most significant repercussions and impact were mainly focused on the lives and livelihoods of the NBC camp and its surrounding villages, especially that the communities at NBC and the surrounding areas lack the basic safety-net infrastructure and face harsh economic conditions and a wide-spread lack of accessibility to services.
The conflict had serious consequences on the economic, social, and psychological and health situation of the affected communities, and to a much lesser degree of the country as a whole.
The clashes had precipitated the suspension of schools, the closing of various community-based women’s health centers, and an overall halt of pre-existing community services, which were replaced by emergency services provided by the local, national and the international humanitarian community.
Three years after the end of fights, Nahr El-Bared camp is still far from what it used to be, large sections of its community are still displaced, or residing within temporary residence within the camp premises, services have partially resumed, but due to the slow-reconstruction process and its related legal and political complications, recovery had not yet been reached.
The target group for this study is Palestinian women, (as key-persona capable of describing and giving insight about the situation and conditions of Palestinian households) who have been displaced from NBC.
Displacement had affected all facets of women’s lives and their families; about 61% of the surveyed households remain labeled as “semi-returnees” (returned to temporary housing within NBC but not to their actual homes), while others are still displaced either in the already overcrowded Beddawi camp or neighboring areas in North Lebanon namely Jabal el-Beddawi and the outskirts of Tripoli.
The objective of this study is two-fold, on one hand to present a general overview and assessment of the psychosocial well being of the NBC families, and on the other to look into the general reproductive health conditions of NBC women.
Quantifying the impact of the crisis on the displaced population’s psychosocial and reproductive health is very difficult, yet the survey was able to present a global overview of the situation delineating the main aspects of psychosocial and reproductive health conditions of the NBC community.
B- Mental Health and Psychosocial Well Being:
Experience of loss and ties with the community
The Nahr El-Bared Crisis is generally considered as a man-made disaster or catastrophe, where 19.5% of respondents specifically describe it as “Nakba" , 20% consider it as a “tragedy”, and another 20% consider it as a “catastrophe”, and 13% consider it as an “injustice” while the rest (27.5%) describe it in different wordings, which all have strong negative connotations such as: “murder”, “crime”, “terrorism”, “destruction” and “nightmare”.
61% of the respondents noted that they are facing restrictions in movement, and 92% of respondents noted that they are still able to keep their cultural beliefs, customs and lifestyles in their current living space. The main barriers for those who could not maintain their cultural and social habits (8%) were related to bad economic conditions, significant changes in livelihoods and in their psychosocial well-being.
Moreover it has been observed that only 4% were unable to maintain ties with the larger community and their extended family, while 96% of respondents expressed that they are managing to keep full or partial ties.
Most respondents noted that changes in their social and recreational spheres resulted in psychological distress, sadness and instability.
Most respondents noted that geographic distance and harsh economic conditions are the main direct consequences of the crisis, yet uneasiness and distress is widely common (99.5%) yet the level of distress differs between areas, 75% of those living in NBC have admitted having distress, psychological complications and are experiencing sadness and grief, while the percentage is 65% for those residing in Beddawi Camp and 65% for those in Jabal El-Beddawi.
Although there are differences between locations, the reasons behind distress are common, as 70% of respondents in all areas mentioned “instability” to be a main factor in their uneasiness and distress.
Visiting family members and neighbors, taking part in recreational activities and seeking moral support are some of the most used and relied upon coping mechanisms for the surveyed population.
Relation with the surrounding communities
The majority of respondents observed no negative changes in their relation with their neighbors (Palestinians) from NBC.
Relations between the respodent’s families and their relative neighbors form Nahr El-Bared Camp (Palestinians)
While in looking at the relation with the surrounding Lebanese community, we notice that 78.7% stated having “no relationship”, compared to only 13.3% consider having “good relations” with the surrounding Lebanese communities.
80% of respondents indicated that they intend to return to their homes in NBC, while about 8% wanted to be integrated in the current host community.
Changes in family structures and conditions of children
85% of respondents indicated that children require additional special needs after displacement, and 8% experienced changes in family roles within the household.
Within those who have experienced changes in family roles (8%), 35% of the women and 22% of sons and daughters became the breadwinners of the family.
Relying on external financial support or whole working families also became a more prevailing feature within the community as a result of displacement.
Only 70% of the displaced children are continuing their education in schools, universities and vocational centers regardless of their current location leaving 30% of children out of any academic or educational institution. 98% of those continuing their education get along well with their peers and 89% of the mothers are satisfied with their children’s’ performance in schools and their social behavior.
The majority of respondents (94%) believe that their children are getting all available and equal opportunities for education compared to other children in the area.
Distress and well-being and social support networks
Substantial mental health and psychosocial difficulties were marked during the conflict and at the current period. There is a negative correlation between conflict and psychosocial well being which is a result from the decline of conditions of all aspects of everyday life.
99.6% of the total respondents confirmed that these feelings of distress and uneasiness are widespread across the community who all retire or ask for “God’s” assistance and guidance. This feeling can be explained as a product of a “lack of stability” and as a result of displacement, loss of livelihoods, insecurity and bad housing conditions.
When feeling distressed most respondents often seek their family members for support (61%) or neighbors, friends and other people (25%). Some do not refer to any of those listed, and this applies to the surveyed population in all locations (Naher el Bared, Beddawi and Jabal el Beddawi).
Accessibility to services
On accessibility to social and health services, 88% of respondents mentioned that they are able to access these services, yet the rate of accessibility is highest among those currently residing in NBC and Beddawi Camp (90%), while in Jabal El Beddawi the rate drops to 63%, and most of those in Jabal El-Beddawi who have stated having no access to services relate the lack of access to distance and lack of knowledge about service providers and their current services.
Additionally, 14% mistrust the quality of the service and the health care provided respectively. Accessibility doesn’t translate into satisfaction, as 63% of those who are able to access current services are either not satisfied or partially satisfied with its quality. The existing services are generally perceived as insufficient; better quality of care and additional medical services are required along with better and more equal distribution of health care services.
The main issues that are provoking personal concerns among the population and need to be urgently addressed are: Stability and a promising future (54%); Return to Nahr El-Bared (29%); Education (22%); restoration of livelihoods (20%) and better access to health services (9%) .
It is also worth noting that levels of instability and job creation differed between areas, where instability levels are the highest in Beddawi Camp followed by NBC; whereas residents of Jabal el Beddawi are observed to be benefiting from higher levels of stability and better job opportunities.
Perceptions about the future of NBC
When asked about the perceptions about the future of the Naher El Bared camp and the actions that could be taken in order to improve the overall well-being of the community, 46% noted that the future is still “unknown”, 28% believed there will be “no return”, 10% believed that the matter was “in God’s hands” and only 26% believed that “the camp will be reconstructed”; also worth mentioning that the current residents of Naher el Bared Camp believed less in the possibility of reconstruction.
C- Reproductive health
Since the beginning of the conflict in Naher el Bared, the focus of humanitarian efforts was mainly concentrated around delivering the most needed food and non-food items to a an already under –privileged population in addition to working towards rebuilding the camp and putting an end to the forced displacement from what people considered to be their home.
Yet reproductive health has somehow been neglected, and it is too often considered as relevant only to childbearing women of reproductive age (15-44 years). It is true that women bear by far the greatest burden of reproductive health problems and that biological, social, cultural and economic factors increase a woman's vulnerability to reproductive ill health. But reproductive health has to be understood within the context of relationships between men and women, communities and society, since sexual and reproductive behaviors are governed by complex biological, cultural and psychosocial factors. Thus reproductive health is more than just the reproductive organs, and more than just reproduction; it is about how social and sexual behaviors and relationships affect health and create ill health; it is relevant to both men and women, and to persons of all ages.
The study findings show major gaps in terms of knowledge and information, where “lack of information” interfaces with cultural norms, customary laws and bad socio-economic conditions. The living conditions have deteriorated to an extent that people lost hope and lost their resilience. Women lack information and knowledge regarding family planning and they are culturally and socially bound to make decisions themselves without any guidance whether it be medical or social guidance, adding to that is the pressure of “baby-booms” which is internationally recognized as a post conflict phenomena.
Lack of information and knowledge about STIs and HIV can be considered as prevalent and can have a serious threat to women’s lives and to infants; professional follow up and health guidance seem to be a serious necessity to be a preventive measure against these threats.
Furthermore domestic violence is highly under reported, yet it exists, which could have a severe negative implication on women’s health on all levels of their daily lives, although apparently there is a culture of denial regarding this issue, yet it needs to be addressed from a human rights and medical perspectives.
Last and not least, severe high complication levels were reported in pregnancy history although are not correlated with the NBC conflict as the same complication rates were noted throughout the three different phases (pre-conflict, during conflict and post-conflict). Complications are quite common in pregnancy and if dealt with properly and efficiently, two lives can be saved. Thus specific programs should be undertaken to cope with this issue.
Moreover follow-up by social workers during pregnancy and post-pregnancy is rarely available and could be seen as peculiar gap within available reproductive health services.
The level of satisfaction towards present reproductive health services is “good” for most women, yet most women identified the need for better quality of services related to reproductive health.
Most reproductive health services are strictly dealing with pregnancy and to a degree family planning, yet postnatal care is widely missing.
Lack of follow-up and early screening for possible complications in pregnancy and delivery could be a main reason for the high rate of complications encountered by women (22%).