The crisis in Syria has seen one million refugees flood into Lebanon. Of these, 300,000 are children, some having made the perilous trip across the border unaccompanied. Read our report on this ‘lost generation’.
Farah’s wails filled the air, the haunting sound of tragedy reflecting the daily reality of this overcrowded Tripoli General Hospital. Cradling her son’s limp body the heartbroken mother held him close, wishing that the life coursing through her veins could sustain not just one but two. Rocking his 17-year-old lifeless frame back and forth her obvious despair matched the trauma etched on the faces of her other seven sons, huddled around the hospital bed. Dirty and despondent they looked on helplessly, absorbing yet another scene of loss that should be reserved only for a child’s worst nightmares. With a father unaccounted for in Syria and their oldest brother now dead, responsibility to look after the family would fall on 15-yearold Mohammad, a tradition of succession that is being repeated endlessly as Syria’s fathers, brothers and sons are slaughtered.
It is often said that children are the principal victims of war and the Syrian crisis is no exception. The silent majority of refugees streaming into neighbouring lands are under the age of 18, some accompanied by families, many not.
According to the latest UN figures, one million children have now been displaced and the burden of war they bear is unimaginable, says Unicef’s child protection specialist Anthony MacDonald. “We have many experts on the ground who have worked throughout the world in disaster zones and their reports say the trauma and the various levels of distress are unprecedented.”
Lebanon feels the strain
Syria’s smallest neighbour Lebanon is home to the highest number of these refugees. Government estimates suggest just over one million people are currently sheltering across 1,400 different locations in the country, while 3,000 people a day continue to stream over the perilous border. Sometimes that number is far higher and aid agencies are struggling to cope with the influx. “The numbers are swelling day by day,” says Dr Mohammad Al Safadi, health area director from Qatar Red Crescent. “Last week 15,000 people entered the country in just 24 hours and many of these people require urgent medical attention.”
In Lebanon, the Office of the UN High Commissioner for Refugees (UNHCR) says the current number of registered refugees and those awaiting registration stands at 720,000, of whom around 300,000 are children. Astonishingly, the number of child refugees has increased so dramatically over the past few months that they now make up 25 per cent of all children in the country. Of these, Unicef says 3,500 have crossed the border unaccompanied, having either lost their families to the conflict, or having been separated from loved ones in the exodus. “Children have been the most affected in this crisis as is usually the case in emergency situations,” says Miriam Azar from Unicef. “Many have lost their families and been forced to flee alone… these particular kids are among the most vulnerable.”
Child refugees whether orphaned or accompanied, run a very high risk of exploitation and disease in whichever country they chose to seek refuge. However, children reaching Lebanon are entering into another context of war, especially those who choose to settle in Tripoli.
In the country’s second largest city where 51 per cent of residents live on a salary of less than $4 (Dh14.70) per day, the influx of refugees has exacerbated an already complex situation. Extreme poverty coupled with an already tense rivalry between the majority Sunni population, who oppose Syria’s President Bashar Al Assad and the smaller Alawite community who support his regime, has further divided Lebanese and Syrians. The situation has caused many to voice concern that the Syrian conflict will spill over and last month’s twin car bombs in Tripoli that killed over 45 people during Friday prayers seemed to echo the war next door.
Yet despite the tense security situation, this northern port city is provisionally called home by more than 42,000 Syrian refugees, despite the fact it can offer them very little in terms of shelter. Like the rest of Lebanon, Tripoli does
not have recognised UNHCR camps. As a key ally of Assad, the Shiite Hezbollah-dominant government has refused to allow official refugee sites, possibly fearing that the mainly anti-Assad refugees will remain.
So Syrians arriving here are left to survive on their own, either renting tiny rooms with no sanitation facilities at over inflated prices, moving into decrepit derelict buildings or making chaotic improvised camps where tents roast under the summer sun. As Roberta Russo, a communications officer for the UNHCR, explains, “We have requested transit sites in the case that there is a further escalation of conflict but the government is reluctant and at the moment we don’t have a roof to put over many of the refugees’ heads. We’re seeing a lot of informal tented settlements mushrooming all over the country in areas far from services so they don’t have adequate shelter, sanitation, access to water or educational facilities.”
The bacteria that breed in these types of unsanitary environments can cause havoc on young immune systems and high numbers of children are being admitted to Tripoli’s local governmental hospital daily with illnesses ranging from dehydration to gastroenteritis, often needing emergency medical assistance.
Dealing with a funding deficit
The paediatric ward at Tripoli’s governmentrun hospital is overrun. Innocent cries spill out of its hot, crowded rooms where flimsy curtains hang at open windows, doing little to alleviate the oppressive summer heat, the defunct air-conditioning units an obvious sign of underfunding.
Many here cannot afford treatment. The mother of one-and-a-half-year-old twins Abdullah and Ahmad says, “My boys have gastroenteritis; we have been here for 10 days. At first we were turned away but a doctor saw how sick my boys were and admitted us. We have medical costs covered by the UNHCR and [Qatar] Red Crescent but we still have to find an extra [Dh500]. It’s too much, we can’t even buy bread!”
In the case of UNHCR-registered refugees at Tripoli General, 75 per cent of their medical bill is paid by the organisation, while a further 15 per cent of the bill is paid by Qatar Red Crescent. Families must find the money for the remaining 10 per cent, and those who cannot afford it are sometimes not admitted. This deficit in medical care costs didn’t always exist; initially the UNHCR was able to provide 85 per cent coverage. However, with the rising number of refugees and the financial repercussions, and having raised only 26 per cent of its required $1.7 billion funding, it has been forced to cut costs.
In the case of refugees not registered with the UNHCR, however, The Qatar Red Crescent is able to cover 100 per cent of their costs. Consequently, many registered families seek out Dr Al Safadi on his rounds, pleading for financial assistance.
In the neonatal intensive care unit, the situation is the same – rows of premature babies lie incubated, some with parents by their side, others alone. One mother holds her tiny child in her arms, desperate to take her home. She says that because their child was born premature, she and her husband have incurred huge medical bills and cannot take their baby away until they find $2,000. Her husband has told her to abandon the child – better that, than not be able to feed the rest of her family.
Back in the main ward stories of despair are in abundance. Zaara, 12, has been waiting two agonising days for an operation on two broken shoulders as her family can’t find the 10 per cent charge of $250. Her brother, Rabih, says
they were forced to pay for a taxi to get here as all the ambulances refused since her condition was not life threatening. Rabih, 16, says the responsibility for finding the money lies with him now. He recounts losing his father in Syria, the death of his family and friends, his face emotionless belying the trauma. When asked where he sees himself in a few years he replies, “I’m just grateful if we make it to tomorrow.”
Addressing psychosocial needs
Rabih’s obvious psychological issues are the norm for almost all of Syria’s child refugees. Unicef’s MacDonald explains, “Many of the children are severely affected; the great majority are dealing with huge negative experiences of losing family and friends. In some cases we have had young girls and boys witnessing severe violence, such as the brutal murder of a parent, and you can imagine the impact is huge, not just for the short term, but the long term.”
Child amputees wait around the hospital, hopeful that perhaps their wish for prosthetic limbs will be granted. “My arm was blown off when a bomb hit our garden, thankfully it was just me that was hurt,” says 14-year-old Fadil. “I’ve been here for two weeks on my own, my family is in the mountains, they couldn’t afford to be with me and I don’t have any phone credit to call them. So I’m just here, waiting.”
Most teenagers waiting for a prosthetic limb would be accompanied, but such are the hardships borne by Syrian children now and the psychosocial effects of their past and current experiences are huge. Psychosocial care is an aspect of health services previously overlooked, but it is rapidly being recognised that the implications of not addressing distress at all levels, basic or post traumatic, are huge. As MacDonald says, “If we don’t respond to cases of post-traumatic distress or other forms of psychological illnesses now, then of course that child is at immediate risk of harm to himself or others because [the distress] can manifest itself in many forms. Psychosocial care is life saving.”
In June, the UN announced that Syria’s war had reached “new levels of brutality” with evidence of children being taken hostage, being forced to watch torture and even take part in beheadings. Children who have witnessed the kind of atrocities that most of us will never see in a lifetime desperately require counselling.
By the end of this year Unicef hopes to have provided 81,500 children with access to psychosocial support services and given them back a sense of normalcy. They are carrying out recreational activities with other children in safe spaces.
MacDonald says, “Failure to acknowledge their distress and help them find ways to build resilience can end up in negative coping mechanisms where they expose themselves to exploitation and abuse. In some cases they may not be able to fully integrate into school systems and teachers will misdiagnose them as problem children rather than children affected by this horrendous war.”
This explains why the primary aid agencies are providing psychosocial interference not only in the home but also in schools. Unicef’s Back to Learning campaigns and out-of-school support are helping to prepare the most traumatised for their eventual reintegration back into the school system. Teachers are also receiving training in psychosocial support so they can be better equipped to identify the signs and provide a more tailored approach to classroom management.
Classrooms are traditionally associated with safety, security and development, the very basic rights that have been denied to these children for almost two years. Getting them back in school, in the right contextual environment and with specifically trained teachers, is tantamount to the healing process. If the appropriate care is not provided, children will be impacted in all areas of their lives as they grow up and they will be further robbed of their childhood, education and future prospects.
The lost generation
Nearly all of the million child refugees have had no rights to an education for over two years now and the long-term consequences for their lives and for post-conflict Syria are disastrous. By the end of the year an estimated 500,000 refugee children will need schooling in Lebanon alone.
Due to space limitations and language barriers, only one in four child refugees is currently attending school in the country. Lebanese public schools are already full to capacity and their English-focused curriculum rather than the Syrian Arabic curriculum has led to a large drop-out and failure rate for Syrian children.
Strengthening public school capacity is a primary aim and many schools nationwide are rolling out a shift-based programme, allowing Lebanese to be taught in the morning and Syrians in the evening.
But the problems do not stop there. Many refugees do not send their children to school because of the high costs of transportation, books and uniforms. Some feel that enrolling their children in school means they are accepting that their refugee status is long term.
Also, in some cases, young children are required to start working so as to put food on their families’ tables.
Hassan is one of these children and at just 17 he works on a construction site instead of attending school. Toiling for 10 hours a day he receives just $15, barely enough to feed himself, let alone the family of 11 he is providing for. He says his father and older brother have not been able to cross the risky Syrian border as they are wanted by regime forces, so he is the sole breadwinner for his siblings. When asked if he has found himself a nice girl to take as a wife he smiles briefly but responds, “I don’t have time to think about those things. First I should concentrate on finding food for the mouths of my family.”
His situation is common across the country. UNHCR’s Russo says, “Unfortunately we’re seeing that many children are forced to work to sustain themselves and their families so they opt not to go to school. School is an expense and many have to work to pay for food, rent and all their other basic needs.”
Some schools run by the Educational Islamic Society are assisting by providing free schooling,
books, uniforms and transportation to counter the cost issue. The Iman School in Tripoli is accepting Syrian children this term for the second year in a row and will provide classes for 2,800 children between 3.30pm and 6.30pm every day.
The newly appointed director of the Syrian stream of schooling, Rassmie Al Masazani, is also coordinating the system across six Iman schools in the north, providing free education to a total of 8,000 students. The 250 teachers they have hired are all qualified Syrians who will receive salaries as opposed to the many volunteers across public schools. The organisation feels this is the most effective way to provide the best education for the children.
Masazani, who has held a position at the school for 32 years, will continue to be assistant principal for the Lebanese children while working in the evenings as the Syrian school director.
Changes have been made this year at the school to address the high failure rate – only 10 of the students passed their exams, dashing the hopes and dreams of those who felt their lives slowly begin to resemble some sort of normalcy. Many children who fled Syria without their ID cards, let alone proof they had passed exams before the conflict began, failed their exams due to insufficient documentation required by the Lebanese government.
This year The Iman School produced a new curriculum that will be rolled out for Syrian children, it has been passed on to Syria’s main opposition, the National Coalition, in London who have authorised it as an accepted and official exam.
For those children not enrolled in these schools, options are trickling in too. Aid organisations are particularly focused on getting kids back into school and in the meantime have rolled out mobile units to bring learning opportunities to communities that can’t access school, something Unicef’s Azar says isn’t ideal but is necessary. “It’s an expensive way of doing it, but it needs to be done here in Lebanon. When you have a situation like this where refugees are scattered across some 1,400 localities it really makes it much more difficult to provide schooling.”
A slow tsunami
Unless something is done, the million child refugees across the region facing the multiple devastating consequences of war will not only have their futures destroyed, but the knock-on effect will be disastrous for post-conflict Syria. As MacDonald explains, “Failure to address these concerns now will have the greatest longterm impact upon the displaced populations.”
The needs of the refugees young and old are a very real modern-day disaster that is not going away anytime soon. The UNHCR, as the biggest provider of assistance to the two million displaced and having raised only a small portion of its required funding, is hard-pressed to meet the critical needs.
As the years of civil war drag on and public empathy becomes less intense, so critical funding decreases, something Miriam says can be ill afforded. “It’s just overwhelming and a huge issue is funding because the needs are constantly growing. This is an emergency that’s rolling out like a slow tsunami.”
It is the world’s responsibility to ensure 15-year-old Mohammad’s generation is not lost to a war that children don’t even understand and that by seeking refuge their childhood is not lost, but found.
Victims of a war they don’t understand… (clockwise) one of the twin boys recovering from gastroentiritis at Tripoli General Hospital whose mother is battling to pay her bills; refugee children play on makeshift swings in Kobbeh; and a little refugee boy holds his small bag of belongings in the Lebanese region of Akar on the Syrian border
A difficult life: (clockwise from top left)The Kobbeh neighbourhood of Tripoli where many Syrians have sought refuge; a deserted playground in Tripoli; area health director of the QRC Dr Al Safadi attends to sick refugee children at Tripoli General; refugees have been forced to live in makeshift homes
An already tense situation in Lebanon’s northern port city Tripoli has been exacerbated by the refugee crisis with pro- and anti-Assad fighters waging war on its streets