LEBANON

PROJECT TITLE: Mental Health Training Programme For UNRWA and NGO Staff Working With Palestinian Refugees

PROJECT AREA: 12 PALESTINIAN REFUGEE CAMPS ACROSS LEBANON

CONTEXT OF THE PROJECT

The number of Palestinian refugees registered with the United Nations Relief and Works Agency for Palestinian Refugees in the Near East (UNRWA) in Lebanon is currently 394,532 or an estimated 10% of the population of Lebanon. Of these, 223,956 live in overcrowded conditions in the 12 official camps and the rest live in and around Lebanon’s major urban centres, often close to the camps.

Palestinian refugees in Lebanon face specific problems. Unlike the camps in Syria and Jordan, their camps have not been redeveloped, the infrastructure is deteriorating and outbreaks of disease causing death and disability are common. 12% of the refugees (the highest percentage of any country) live in abject poverty and are registered with UNRWA’s ‘special hardship’ programme. They do not have social and civil rights and have very limited access to the government’s public health or educational facilities and no access to public social services. The majority rely entirely on UNRWA (supported by local and international NGOs) as the main provider of education, health and relief/social services.

Palestinian families living in Lebanese refugee camps have experienced displacement and lengthy periods of conflict, and now face a daily battle for survival with little immediate prospect of a change in fortune. Most have suffered bereavements and disability as a result of conflict and disease. Successive generations of children are growing up in a situation that is both abnormal and demoralising. Women, who are already disadvantaged through the lack of educational opportunities, have further suffered from broken families, the death of husbands and fathers, reduced marriage prospects and the absence of accessible reproductive health care. Furthermore Palestinian refugees in Lebanon (unlike those in Jordan and Syria) are prohibited by law from working in more than 70 trades and professions so unemployment is very high creating greater poverty and loss of self-esteem among those searching for work.

In addition thousands of Palestinians, as have Lebanese, been illegally detained and tortured in Israeli Detention Centres and prisons over the years. Amnesty International and ICRC have interviewed former inmates of detention centres and testimonies are available on the Amnesty International website. Detainees almost invariably describe torture in the weeks after their detention and repeated ill-treatment including beatings through their stay. The torture methods reportedly included electric shocks, suspension from poles with usually only the toes touching the ground, whippings after being doused in water and threats of rape of wives and female relatives. Ill-treatment included solitary confinement in cells too small to stand or lie in, severely rationed food and beatings if detainees tried to pray. Such experiences have resulted in a myriad of physical and psychological conditions that continue to damage individuals and limit their opportunities many years after their release. Neither UNRWA nor ICRC have a clear idea of how many former detainees are now living as refugees in Lebanon but they are disproportionately represented among those with mental health problems and those registered with the ‘special hardship’ programme.

UNRWA and a variety of NGOs provide basic health care services within the camps but there is no specialist mental health service. UNRWA does provide assistance towards the cost of specialist mental health care but with the rise in such costs in the 1990s and a reduction in their budget, UNRWA has been forced to increase the percentage of cost sharing by the refugees themselves (up to 40%) as well as limit the number of referrals and discontinue reimbursements for certain treatments. In Lebanon most of the refugees are unable to cover their share and so cannot get the treatment they need.

The situation of the victims of torture and wider refugee community where normal social support networks have disintegrated has resulted in high levels of stress-related illnesses and a disturbing increase in cases of severe mental illness (depression and psychotic illness). UNRWA and NGO staff (particularly those providing health, education and social services) are painfully aware of the lack of mental health care provision within Lebanese camps. They are handicapped by the lack of any specialist mental health training, including the rehabilitation of victims of torture. Response International was approached by UNRWA’s Chief of the Field Health Programme and asked to consider ways in which these needs could be addressed which resulted in the project described below.

RESPONSE INTERNATIONAL’S PLANNED PROJECT

We are currently seeking funding for a twelve month project, which aims:

• To establish mechanisms for the promotion of mental health and the early detection of mental illness within the refugee population
• To train relevant UNRWA and NGO staff to provide simple therapeutic interventions based on the cognitive behavioural approach
• To train relevant UNRWA and NGO staff to provide community-based support for those with enduring mental illness (eg schizophrenia, manic-depression)
• To train relevant UNRWA and NGO staff to identify serious mental illness that requires referral to mental health specialists
• To specifically address the mental health needs of those Palestinian refugees subjected to torture in Israeli detention centres and prisons

The direct beneficiaries of this project are the multidisciplinary group of 100 UNRWA and NGO health, education and social care workers who will complete the training programme. They will be chosen by their organisations to cover all 12 official refugee camps. The indirect beneficiaries will be the 394,532 Palestinians currently registered as refugees in Lebanon with a focus on those refugees previously held and tortured in Israeli detention centres and prisons.

SPONSORS AND PARTNERS

A three month pilot project, funded by the United Nations Voluntary Fund for Victims of Torture (UNVFVT) and the William A Cadbury Trust, will begin in February 2006, with a number of applications currently being processed to secure the remaining budget.