Syr­i­ans treat pa­tients un­der the radar

Un­li­censed health pro­fes­sion­als work­ing for lower rates a boon for those in need

The Daily Star (Lebanon) - - LEBANON - By Abby Sewell

BEIRUT: At a small clinic, its walls painted a cheery blue, on a nar­row street in a Pales­tinian refugee camp in Beirut, Abed re­ceives a steady stream of Pales­tinian, Syr­ian and Le­banese clients at his den­tal prac­tice.

Abed, who asked that his full name not be pub­lished, is Syr­ian, and like nearly all non-Le­banese health pro­fes­sion­als, he is legally banned from prac­tic­ing in Le­banon. But the Pales­tinian camps, which op­er­ate largely out­side of the purview of Le­banese author­i­ties, of­fer a gray area.

Trained in the United States, Abed had prac­ticed in the Gulf be­fore com­ing to Le­banon four years ago. He was work­ing with the United Na­tions to open a den­tal clinic in Ye­men, he said, when the war in that coun­try forced them to with­draw. With the civil war in his own coun­try and the threat of mil­i­tary con­scrip­tion should he re­turn, he came to Le­banon.

De­spite the reg­u­la­tions, Syr­ian health pro­fes­sion­als con­tinue to prac­tice un­der the radar through­out Le­banon, some run­ning their own clin­ics, oth­ers work­ing un­der the ta­ble for Le­banese physi­cians or for NGOs will­ing to turn a blind eye to their le­gal sta­tus.

The num­ber of Syr­ian health work­ers prac­tic­ing clan­des­tinely is not known. A United Na­tions refugee agency spokes­woman said the num­ber of un­li­censed health pro­fes­sion­als “is not some­thing that we have the abil­ity to track, and the only in­for­ma­tion we have is anec­do­tal, there­fore it is very dif­fi­cult to de­ter­mine the ex­tent of the prac­tice.”

Fouad M. Fouad, co-di­rec­tor of the Refugees Health Pro­gram at the Global Health In­sti­tute at the Amer­i­can Uni­ver­sity of Beirut, who coau­thored a re­port on Syr­ian health pro­fes­sion­als prac­tic­ing clan­des­tinely in Le­banon, es­ti­mated there are no more than 150 Syr­ian physi­cians prac­tic­ing in the coun­try. Oth­ers be­lieve the num­ber to be higher – Abed es­ti­mated 300 or more.

Ge­orges Ak­oury, a con­sul­tant to the Health Min­istry, said the min­istry also does not know how preva­lent the prac­tice is. The min­istry does not proac­tively check on clin­ics’ reg­is­tra­tion sta­tus, but re­sponds when it gets a com­plaint about an un­li­censed prac­tice from the Le­banese Or­der of Physi­cians or oth­ers, he said.

“When we have any in­for­ma­tion about a Syr­ian doc­tor or any [nonLe­banese] doc­tor work­ing in Le­banon, they have to stop and the clinic will stop also,” he said.

The ban on non-Le­banese health pro­fes­sion­als is meant to pro­tect Le­banese jobs, but Fouad ar­gued that the reg­u­la­tions do not take into ac­count the mas­sive in­crease in pa­tient load that came with the in­flux of Syr­ian refugees.

“If we ac­cept that there are 1 mil­lion Syr­ian refugees in Le­banon reg­is­tered at the UNHCR, the es­ti­mate of physi­cians to serve 1 mil­lion peo­ple at least should be 1,000,” he said. “We know that this num­ber, 1,000 ex­tra physi­cians in the Le­banese sys­tem, is not avail­able. So there’s a need to have other physi­cians than just Le­banese, and Syr­ian physi­cians are here, or some of them are, and they are trained.”

Last month, author­i­ties an­nounced that they had closed down an il­licit plas­tic surgery clinic op­er­ated by a Syr­ian doc­tor and his wife in Beirut’s Hamra neigh­bor­hood. Apart from the charge of prac­tic­ing medicine with­out a li­cense, a woman had also filed a sex­ual ha­rass­ment claim against the doc­tor.

In a sep­a­rate case, a med­i­cal clinic in Minyeh, near Tripoli, op­er­ated by a Syr­ian doc­tor who had been smug­gling med­i­ca­tion from Syria, was also shut down.

Be­fore mov­ing his den­tal prac­tice to the Pales­tinian refugee camps, Abed had prac­ticed in She­baa and then in south Beirut’s Ouzai neigh­bor­hood, un­til his clinic there was shut down by author­i­ties.

“I didn’t get the chance even to get my stuff from the clinic – some­one just called me and said that the Min­istry of Health is here, don’t come back, and I left it like that,” he said.

Abed said the cur­rent, un­reg­u­lated sys­tem is danger­ous for both pa­tients and health work­ers. In one case, he re­called, a Syr­ian refugee in Burj al-Bara­jneh died af­ter seek­ing care from a Syr­ian who was prac­tic­ing as a phar­ma­cist with­out proper train­ing. The pa­tient, as it turned out, was hav­ing a heart at­tack, but the phar­ma­cist did not have the train­ing to di­ag­nose him and did not trans­fer him to a hos­pi­tal.

Prac­tic­ing un­der the ta­ble also leaves the health pro­fes­sion­als open to ex­ploita­tion.

Be­fore open­ing his cur­rent prac­tice, Abed said, he was work­ing in a clinic run by a Pales­tinian den­tist, where he was paid $700 per month out of the ap­prox­i­mately $8,000 in pa­tients’ fees he brought in.

“Imag­ine if you worked for this amount of money, and your salary is not even close to $1,000, and when you com­plain about it, he’s go­ing to say to you, ‘We have a lot of Syr­ian den­tists will­ing to ac­cept this job at an even cheaper price,’” he said.

The fact that un­li­censed Syr­ian health pro­fes­sion­als will work for lower rates, how­ever, can be a boon to pa­tients, par­tic­u­larly for refugees, who of­ten strug­gle to pay for med­i­cal care. The UNHCR pro­vides sub­si­dies for pri­mary care and life-threat­en­ing emer­gen­cies, but not for treat­ment of chronic health con­di­tions. A 2016 re­port on refugee health care ac­cess by the re­search or­ga­ni­za­tion Le­banon Sup­port noted that the short­age of af­ford­able health care fa­cil­i­ties – or in some ar­eas, a to­tal lack of health care fa­cil­i­ties – had led to the rise of in­for­mal, Syr­ian-run clin­ics in ar­eas with a high con­cen­tra­tion of refugees, like the Bekaa Val­ley.

“Thus, para­dox­i­cally, il­le­gal­ity be­comes the only pos­si­ble – and log­i­cal – way to ac­cess health ser­vices,” the re­port noted, but added that many of those in­for­mal fa­cil­i­ties had been closed down, lead­ing to per­sist­ing short­ages of care.

Fouad sug­gested that some sort of limited li­cense should be made avail­able for Syr­ian prac­ti­tion­ers.

“In­stead of let­ting them work il­le­gally, which they are, maybe it’s bet­ter to think about in­te­grat­ing them in the sys­tem and giv­ing them a li­cense to work at least with their com­mu­nity so they can work ei­ther in in­for­mal tented set­tle­ments or some of th­ese col­lec­tive shel­ters,” he said. “In that case, the Le­banese gov­ern­ment can ac­tu­ally ob­serve and mon­i­tor their qual­ity, their ca­pac­ity, train them if needed, and at the same time they can solve the is­sue of serv­ing a pop­u­la­tion of 1 mil­lion Syr­i­ans.”

Abed treats a pa­tient at his clinic. He said the cur­rent, un­reg­u­lated sys­tem is danger­ous for both pa­tients and prac­ti­tion­ers.

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