As Lebanon is drawn into its neighbour's conflict, sectarian tensions mount and the cost of hosting more than 700,000 refugees takes its toll.
The welcome mat so graciously rolled out by the Lebanese for Syrian refugees is now becoming frayed at the edges.
In the Bekaa Valley even the few tented settlements once permitted are now under pressure to close. Visiting one such site holding no more than 20 families in two neat and tidy rows, one can be forgiven for thinking it rather idyllic with its power lines, a few fridges and food rations from UNHCR. But on closer inspection there is no electricity, so the fridges are empty, and every family in each tent has their own tale of horror and hardship.
Upon arriving in Lebanon refugee claimants are given an entry card and then registered with local authorities. To be registered as a refugee, and thus be eligible for assistance, the newly arrived families must get an appointment with the UN office, something which can take months.
Meanwhile many are reduced to begging and doing menial work just to rent a tent and find enough food to survive. Although the UNHCR assured me that the registration process had quickened thanks to a new registration hotline, the reality is quite different. One family, I was told, has been unable to get through for four months and has given up calling.
While touring one settlement, my eyes were drawn to a handmade tent flapping in the wind, clearly located outside of the official settlement area. Inside were two couples and two small children, newly arrived after a perilous 24-hour journey to escape from the violence in Syria.
The head of the family, Ahmed, was a shopkeeper in Aleppo. He also owned a laundromat. He had enjoyed a good life in Syria but was forced to flee with his family as the war came closer. Along the way he was taunted and forced to pay bribes.
At one checkpoint, his documents were torn up -- something which would force him to bribe the family's way into Lebanon, as the country had begun restricting entry to those without onward plane tickets or full documentation.
Once in the Bekaa Valley he and his family found and rented a tent made from bed sheets and blankets. They camped under a bridge for seven days. One night a car full of drunk men approached. The men said that Ahmed's family could stay with them, but only if Ahmed would "look the other way" sometimes -- in other words, allow them to sleep with his wife. Tears welled up in Ahmed and his wife's eyes as he recounted this event.
He went looking for work, and a shopkeeper gave him shampoo to sell.
"It's simple," he says. "If I sell, we will eat. If not, well, we shall see."
Having sold the family's jewelry and other possessions, Ahmed hopes to rent a room. He was offered a barn for US$400 a month.
"I never imagined that this could happen to me. Now I'm living in a tent."
I met a number of families in Lebanon, each with their own story of trials and tribulations, but one in particular weighed on me. This is the story of Mahmoud, a bear of a man with an infectious laugh who refused to be overlooked during my visit. He called us over to show us his shattered right arm, suffered in a mortar attack in Damascus. The X-ray showed his arm shattered in several painful pieces. My eyes fixed on it laying limply at his side.
He said "no matter, my other arm is strong." I told him his heart was strongest of all and he grinned with pride.
Mahmoud's wife Leila and their young, traumatized son fled political persecution in Syria, first to Leila's parents' village. Later, bombing forced them to flee to Lebanon. Leila's parents rented a room there, while Mahmoud stayed behind in Damascus driving his taxi and sending money to the family.
Then one day in late June Mahmoud's neighbourhood was hit by a barrage of mortar. He abandoned his taxi and sought shelter but was hit before he could get out of the street. In shock, Mahmoud ran 500 metres to get help before passing out.
When he awoke in a field hospital, his arm had been sewn up. He was afraid to go to a proper hospital for further treatment because authorities were rounding up wounded people, presuming them to be part of the opposition.
When Mahmoud arrived in Lebanon he was welcomed in the rented flat. Later the owner objected that there were too many people, and Mahmoud and his family were forced out.
They secured a tent and lived in a cemetery for several days before good fortune struck. At a semi-official refugee settlement nearby, a friend of the camp leader learned of Mahmoud's son's psychological trauma from the war and offered the family a spot in the camp. When I met Mahmoud, they had been living there for seven days.
Mahmoud received pain medication from the MSF clinic, but he needs reconstructive surgery. His son was scheduled to start psychological counseling the following week. But the family was slated to become homeless again by then.
The bright spot is that the family had managed to get registered with the UN, and thus get food rations. How, I asked, did they manage to register so quickly?
With pride Leila said, "I was persistent. I called [the hotline] and got through."
"You won the lottery," I said, to another hearty laugh from Mahmoud. For someone who had lost so much, he was raising my spirits.
All of the hundreds of Ahmeds and Mahmouds that I met were proud, hardworking people just trying to avoid the war and to care for their own families. They never imagined their country would be in flames and that they would be dependent on outside assistance.
Had they arrived in Iraq, Turkey or Jordan they would, as refugees, receive free shelter, food rations and secondary medical care. These are the basic building blocks of life.
Here in Lebanon, with the state overwhelmed and much of the assistance promised by the international community failing to arrive, hundreds of thousands of would-be refugees are struggling just to get registered and get by.
While as MSF we are unable to meet all the needs, we are accompanying the families in their predicaments and providing primary care and mental health support. Surely as aid actors and citizens of the world, we should and can do more. Receiving healthcare, food and shelter is a refugee's right and together we share a responsibility to help provide these necessities.
This is the first blog in a three-part series called Focus on Syria, about my thoughts and observations after travelling to Syria and the surrounding region earlier this year.
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