The Daily Star (Lebanon)
Syrians treat patients under the radar
Unlicensed health professionals working for lower rates a boon for those in need
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Abed, who asked that his full name not be published, is Syrian, and like nearly all non-Lebanese health professionals, he is legally banned from practicing in Lebanon.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.”