Refugees in Lebanon – problems and some solutions

5 August 2022

ReBUILD for Resilience recently submitted written evidence to the UK government’s International Development Committee on the subject of UK aid for refugee host countries. This topic is of particular relevance to the consortium; the ReBUILD partners from American University of Beirut (AUB) have recently conducted research on close-to-community health care providers in Syrian refugee camps in Lebanon, and Dr Fouad M Fouad, who leads the team, is himself Syrian and understands the challenges faced by refugees in the country. The following is an adaptation of our submission.

Three countries – Lebanon, Jordan, and Turkey – host the vast majority of refugees in the Middle East region. Lebanon hosts more refugees per capita than anywhere else on earth, the vast majority of whom are Syrian and Palestinian. This influx of people comes with substantial social, health and economic issues, for the host country as well as the refugees themselves.

The situation in Lebanon

The main challenge currently facing the country as a whole is the political and economic collapse. A consequence of this is multiple exchange rates for the Lebanese Lira, which means people are often forced to accept poor rates. Banks have put monthly limits on withdrawals which limits cashflow. Refugees are especially vulnerable to such fluctuations and restrictions, with direct payments and remittances for humanitarian aid being adversely affected. The situation needs to be addressed.

The war in Ukraine has affected food imports to the country, particularly of bread and other wheat products, with increasing prices hitting the poorest the hardest. There is a recognition that the conflict has shifted attention from the dire situation in Lebanon to refugees in Europe, and concerns that the country faces cuts to refugee funding that it can ill afford.

These crises and uncertainties hit all in the refugee community, but some are hit harder than others. Young people are the most marginalised in the refugee community, having limited access to education, few occupational opportunities and little ability to leave the country. The future is bleak for young refugees, however, they are not the focus of many support programmes. Old people are also neglected, being left behind by children who have left for a better life elsewhere. They are also often unable to access the healthcare they require. Women also face chronic challenges which may be better understood but are not necessarily addressed. Support needs to be provided for these marginalised people.

Who pays?

A major problem in Lebanon and in other host countries is who pays for the refugees seeking shelter within its borders. In Lebanon – and to some extent, in Jordan – refugees are not granted work permits which means that they cannot work to support themselves and their families. The exceptions are the construction, agriculture and street cleaning industries which allow employment of refugees. Consequently, many are forced to work without permission, which in practice means that 80-90% of working refugees are working illegally with no legal protections. Despite steps to improve the working conditions of Syrian refugees in host countries, through agreements such as the Lebanon and Jordan Compacts, the COVID-19 pandemic and deteriorating economic situations in both countries have contributed to worsening conditions for refugees.

Similarly, in Lebanon, 80% of refugees do not have legal residency documents. This is a direct result of the Lebanese government banning the United Nations High Commission for Refugees (UNHCR) from registering Syrians arriving in Lebanon in 2015 . This was a deliberate act as the government raises income through granting legal residence outside of the UNHCR framework.

Essentially, refugees in Lebanon are prevented from becoming active members of the local economy. This situation prevents integration between the local and refugee communities which adversely affects both. It also reinforces the perception that refugees are a burden which brings its own political and social problems. The current situation is depriving refugees of their human rights, leaves them completely dependent on humanitarian aid, and often forcing them to work informally without legal protections.

Child labour

Being unable to work, or being restricted to insecure, badly-paid jobs, also impacts negatively on child refugees. Syrian refugee children in Lebanon are being forced into child labour to boost their families’ incomes. According to UNICEF, more than 180,000 Syrian children are estimated to be working in agriculture and construction . Syrian refugees as young as 5 years of age are working in hard conditions, missing their chance of an education and being deprived of a childhood. There is an urgent need to tackle the problem of child labour in Lebanon and children’s access to education.

Conditional aid agreements

There are solutions to these problems. For example, future aid agreements with the governments of these two countries should be conditional upon them giving refugees work permits. Recently, the Lebanese Minister of the Displaced announced that he will work to send 15,000 refugees back to Syria, claiming that the situation in the country is now safe . The Lebanese Prime Minister backed his minister, sending a message to the international community and donors that he will approve and support the plan unless Lebanon is paid €3 billion to help addressing refugees’ needs. This financial support should be negotiated with the international community, in return for which the Lebanese government should be required to respect refugees’ rights under international law, including UNHCR principles. Refugees in Lebanon should have the right to work, have access to all services – including health and education – and be able to obtain residence permits so that they may become self-sufficient, active, productive members of the community. Essentially, refugees in Lebanon should be integrated in the national system.

It may also be possible to work around national administrations. In practice, refugees find that local authorities (on the municipal level) are more accommodating and flexible than those at the national/central level. They are strategic partners and should be supported directly by the international community. Such a step would probably be of direct benefit to refugees and would enable them to circumvent the bureaucracy and inefficiency of the central authority.

Refugee representation

Representation for refugees in Lebanon is also an issue. Up until now, the UNHCR has represented the refugees’ interests to the national government, however, it has not been effective in advocating for rights. This is a sensitive topic in Lebanon – these are not Lebanese nationals and many consider them a burden on society – but the situation has to change. At the moment, nobody is speaking on behalf of refugees nationally and foreigners cannot register their own organisations in order to lobby government themselves. There is an urgent need to encourage the creation of routes to representation through officially registered organisations.

Access to health care

Even before the multiple crises which have recently befallen the country, the Lebanese health system was relatively privatized. About 82% of hospital beds in Lebanon are run by the private sector and are inaccessible to most refugees. The COVID-19 pandemic further exposed a health system that has become less accessible, impacting most on vulnerable people across the country. Secondary and tertiary care and advanced diagnosis and treatment have been particularly affected; the government has taken away all subsidies for medication and many treatments, including cancer treatments, are lost from the market.

Syrian refugees have their own health system which is run under the auspices of the UNHCR, while health services for Palestinian refugees in Lebanon are sponsored and run by UNRWA (both UNHCR and UNRWA are UN agencies for refugees). The UNHCR healthcare system only covers primary healthcare for Syrians. Secondary and tertiary care requires approval from a special UNHCR committee, and even if approved refugees have to pay 25% of the medical cost. However, this is true only for life-threatening cases. If not life-threatening then the entire cost of the treatment must be raised from charities or the patient’s family. This includes medium and long-term conditions like cancer treatment and renal dialysis. Consequently, refugees do not have access to the health care that they need. The health care support that refugees have received has created tension with the host communities who themselves are struggling under the weight of multiple crises.

Ironically, a resilient health system has actually been created by health workers in the refugee community. They have created an informal but effective system that needs to be supported by regulation/legalisation and/or financial support. This would help reduce the burden on the national health system.

There is an urgent need for Universal Health Coverage for all in Lebanon, accessible via a single system that treats all fairly and equally. This must include Lebanese nationals, refugees, stateless people (such as new-born Syrian babies who are not registered anywhere), and Syrian refugees who moved to Lebanon after May 2015, many of whom are not registered at the UN agency (see earlier point UNHCR and Syrian registrations since 2015).

To summarise:

• Refugees in Lebanon want to work, to support themselves and their families, and to become integrated into their communities. International donors can pressure the government to issue work permits and residency documents to achieve this objective.
• Giving refugees the right to work will go some way towards addressing the problem of child labour in Lebanon.
• Local/municipal administrations may be a viable target for donors, being more flexible than the national level.
• There is an urgent need for Universal Health Coverage across Lebanon.
• Refugees need a voice.

Further information

• Addressing challenges faced by Syrian refugees working in the informal economy: case studies from Lebanon and Jordan – Maysa Baroud & Nour Zeidan [opens new tab]
• Why Syrian refugees in Lebanon are a crisis within a crisis – Omer Karasapan and Sajjad Shah [opens new tab]
• Lebanon: 180,000 Syrian refugees are forced into child labour, suffering precarious conditions and low pay – Business & Human Rights Resource Centre [opens new tab]
• UNHCR ‘refuses’ plan to repatriate Syrian refugees in Lebanon, says minister – The New Arab [opens new tab]

Image: Refugees living in an abandoned factory near Saida, Lebanon. Anthony Gale via Flickr  [Opens new tab] Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0)