BEQAA VALLEY — “Having corona[virus] is like having scabies; people shun you,” Riad al-Faraj lamented. After being hospitalized, this Syrian refugee is now recovering from COVID-19, but his neighbors in the Informal Tented Settlement (ITS) in the Beqaa Valley in eastern Lebanon still avoid him and the kids in the camp refuse to play with his children.

The stigma, misinformation about the virus and the reluctance to report to authorities augur a dark scenario for the overcrowded Syrian refugee camps in Lebanon, a country immersed in an economic meltdown that has witnessed a spike in COVID-19 cases in the last few weeks. As of yesterday, Lebanon has registered 115,242 confirmed cases and 894 deaths; among them, 1,369 Syrian refugees tested positive, and 31 died of COVID-19, according to WHO and UN figures. 

Amidst a two-week lockdown that has started on November 14, Syria Direct documented how COVID-19 has changed life in Syrian refugee settlements in the Beqaa Valley. 

The PCR race: between stigma and misinformation 

The UNHCR covers the cost of Polymerase Chain Reaction (PCR) tests and COVID-19 treatment for Syrian refugees in Lebanon. In theory, when a refugee shows symptoms, they can contact the UNHCR, an NGO partner of the UNHCR or the municipality, and then these actors coordinate with the Ministry of Public Health to send a team to the field.

However, most of the Syrian refugees interviewed in this report paid 150,000 LBP [$100 at the official exchange rate] to do the PCR test, or did not get tested and just isolated themselves in their tents. Some of them were unaware the PCR cost could be covered, while others, to avoid stigma and raising concerns among neighbors, went on their own to a hospital and paid for it.

“It is all about the corona stigma. When they have symptoms, they don’t want to tell everybody that they have corona,” Dr. Mohammad al-Taglibi, the lead physician at Endless Medical Advantage (EMA), originally from Damascus, told Syria Direct. EMA supports around forty camps in Saadnayel and al-Marj (Beqaa). When the medical team is alerted of a suspected case, they visit the patient in the camp, start medical treatment and “educate” the patient and the family on COVID-19 protocols. “We’ve discovered a lot of corona cases in the last few weeks in the camps, but most are mild to moderate cases; we only saw three severe cases who were hospitalized,” al-Taglibi explained.

“People are hiding or not reporting cases and this contributes to infecting other people,” Patrick Wieland, Head of Mission of Médecins Sans Frontières (MSF) in Lebanon, added. Both al-Taglibi and Wieland agree that official figures on the spread of coronavirus in refugee settlements are understated.

Screenshot of the World Health Organisation website. Source: WHO

Arsal sees a dangerous spike in corona cases

In early November, an MSF team swabbed Bonyan al-Qalamoun and Masaken al-Qalamoun  camps in the northeastern region of Arsal. Out of the 40 PCR tests, 16 came back positive. “The problem is that when we do swabbing, the results come between four to six days later; this is too late,” Wieland said.

Since March, Arsal has registered 160 cases, and currently the municipality accounts for twenty cases among Lebanese citizens and twenty-four among Syrian. On November 13, the mayor ordered the 150 families living in the two Qalamoun camps to quarantine, banning them from exiting the camp. “They received food assistance, and NGOs that coordinate with the town council are allowed to enter,” Basel Ahmad al-Hajjiri, the mayor of Arsal, told Syria Direct.

In November alone, Arsal registered nine deaths from COVID-19 among Lebanese citizens. But according to al-Hajjiri, “we cannot confirm the cases of deaths among the Syrians because sometimes they do not report to us.” MSF was aware of six Syrian refugee deaths in Arsal; three of them are confirmed COVID-19 deaths while the other three are suspected cases. 

Additional obstacles

Dr. Mohamad al-Taglibi checks a patient in the EMA mobile unit in an informal tented settlement in the Beqaa Valley, 16/11/2020 (Syria Direct)

In overcrowded refugee settlements, social distancing is next to impossible. Lebanon has twenty isolation centers, but Wieland has noticed that people in the camps are unwilling to go to these centers. “They don't want to be stigmatized; they prefer to remain at home with their family.” 

Wieland also pointed to “administrative issues” when referring patients from ITS to hospitals, such as complications associated with not being registered with the UN, or encountering problems when crossing checkpoints. 

Around 488 refugees with medical backgrounds are doing “community health surveillance” in coordination with UNHCR. Abdulaziz al-Abbas is one of them. Through  the NGO International Orthodox Christian Charities, this nurse from Homs has reached 350 Syrian refugee families in the northern city of Tripoli where he lives. “Syrian refugees sometimes feel there are obstacles between them and the hospital or between them and the health authorities. Maybe they consider the services will not be provided to them easily because they are Syrians,” he explained. Al-Abbas’s role is to convince them that when they suspect there is a COVID-19 case, they can report it and be treated at no cost. 

The UNHCR has distributed hygiene kits and organized awareness sessions on COVID-19, reaching 480,509 refugees in ITS. In West Beqaa, the Union of Relief & Development Associations (URDA) has distributed hygiene kits to more than 2,000 families; they have sterilized camps and distributed awareness flyers, said Omar Jannoun, the Beqaa office manager for URDA.

“There is a huge number of Syrian refugees that think that this is propaganda, but after an increase in the cases, they are starting to fear,” Jannoun added. Mistrust in the PCR test, self-medication concerns and allegations that the virus is a hoax are among the seventeen rumors identified by Maharat Foundation and Internews in their Rumor Bulletin.

Further, during the lockdown, there has been a spike in gender-based violence. In a study of the Syrian NGO Women Now for Development, out of a sample of 55 women in the Middle Bekaa, 40% reported an “increase in violence against them during the COVID-19 crisis,” from psychological to verbal and physical abuse. And “most of the women” reported “an increase in house and family chores, including teaching children, with men not participating at all in these chores.” Also, 40% of the women lost their job during the lockdown.

With inflation on the rise and the Lebanese pound currently trading at 8,000 per dollar in the black market - while the official exchange rate is 1,500 - 55% of the population lives under the poverty line, and economic suffering has deepened since the lockdown and the Beirut explosion in August.

The health care system, mostly private, is struggling to keep up with the pandemic. In Caretaker Prime Minister Hassan Diab’s announcement of the current lockdown, he stated that they feared reaching a point where “people die in the streets in the absence of vacant places in hospitals.”

This pandemic has pummeled refugees who are facing extreme poverty. “Sometimes, they cannot even afford a mask. Their priority is to buy food,” Abdulaziz said. “Some refugees say ‘I die from corona or I die from hunger,’ hunger is the kafir [infidel].” 

A Lebanese man left a note paraphrasing Lebanese singer Ziad Rahbani’s verses, “I am not an infidel, hunger is an infidel,” and then took his life in Beirut last July. In February, a Syrian refugee set himself on fire in Beqaa; this month, another Syrian refugee did the same in Beirut. Desperation born of economic collapse does not know borders; neither does the coronavirus.