Seniors in Lebanon
Lebanon hosts the largest concentration of refugees per capita in the world including the largest number of Syrian refugees per capita, at least 1.5 million Syrian refugees in a country of about 6 million inhabitants. It also hosts an additional 18,500 refugees from other countries, and more than 200,000 Palestinian refugees. The economic crisis particularly affects access to and provision of services for older Lebanese nationals only supported by family members, without social security or health insurance.
Our interventions focus on protection and health, with the aim to promote protection and inclusion of displaced Syrian and Lebanese older persons and those with physical disabilities in the humanitarian response. To date, we have supported 15,171 older persons and those with disability with health-related services in Lebanon.
The COVID-19 pandemic has overburdened the health system in Lebanon and exaggerated a pre-existing political and economic crisis. In response to COVID-19, we are implementing activities that focus on risk communication and education on prevention of COVID-19, distribution of hygiene kits and PPE materials, as well as providing psychosocial support to older people stuck at home either due to a disability or other barriers to movement.
Following the massive explosion on August 4, 2020, in the Beirut Port, HelpAge found older people had a high need for cash, food, and in-kind assistance. Reports of abuse and fraudulent activities towards older people began to abound. Many older people cannot access health services and medicines, compounding the underlying problem of effectively dealing with COVID-19, where more than half of the population reported having a person with chronic disease, diabetes, and hypertension at home.
In response to the Beirut blast, HelpAge has started the intervention to address the increased health needs to support older people and persons with disabilities living in the affected areas through:
1) Deploying a roving medical outreach team to provide home-based nursing care
2) Forming community outreach volunteer teams to provide homebased care
3) Referring older people and their family members to Primary Health Centres
4) Providing emergency cash assistance
It is our hope to help build capacity and infrastructure to support older people for the long term in Lebanon. Canada is home to many Lebanese Canadians and we are proud to support older people in Lebanon who face tremendous barriers to live in good health, safety, and dignity.
Rapid Needs Assessment
A Rapid Needs Assessment (RNA) was conducted by HelpAge International in June 2020. The RNA highlights long term healthcare amongst priorities for recovery.
Hayat survived the Beirut explosion.
Hayat Taleb is a sixty-year-old Lebanese woman who lives in Karantina with little access to health care and poor living conditions. She recalls what happened to her when the explosion happened in the port of Beirut.
“All I can remember about six o’clock in the evening on August 4th is that I was cleaning on the balcony. I started to hear crackers but continued my work. Then the voices started getting louder. I can’t remember what happened next. I opened my eyes and found myself lying on the floor of my damaged house. My eyes and head were bleeding, but my only thought was to check on my children. I found them injured as well and together we rushed to the nearest hospital to seek medical help."
“I don’t know what happened, even the hospital was destroyed. After a long night, our wounds were bandaged, but we could not return home, and were overwhelmed by fear. Now, more than a week after the disaster, all I want is to feel safe. I only want to find safety and peace in Lebanon."
“Life is difficult in Lebanon, even for younger people who are full of vitality and energy, so how about it for older people like us? It is impossible for us to find a job at this age, and in return there is a huge gap in services available for old age.”
Collected by Amel Association in Beirut.
Amal's Story of Survival
"My family and I live in a neighborhood in Karantina. On that day, I was sitting with my sister and my mother when we saw the smoke starting to rise from the port area. At first we thought it was just a fire and went on with our conversations but as soon as the fireworks began to explode, we realised that we were in danger.
Until now, I have no clue what happened and how I broke my arm. All I remember is trying to escape with my mum and sister. I woke up in our neighbour's car with blood on my face and body. My children and I walked in search of a hospital, with many other wounded people around us, as if we were emerging from a bloody war.
Since that day, I wake up every morning thinking that what happened is nothing but a nightmare. I cannot believe it. My house is destroyed. And being an older woman in Lebanon, I barely have access to healthcare and have very few resources. I cannot afford to buy my medicines. All I need is my right to healthcare and to feel safe and secure."
Collected by Amel Association in Beirut.
HelpAge Canada is currently providing emergency COVID-19 services to Syrian and Lebanese seniors (60+) and adults (40+) with chronic medical conditions.
Below are the initiatives associated with our current program.
Lebanon hosts the largest number of Syrian refugees per capita, with a Government estimate of 1.5 million Syrian refugees (including 950,3341 registered as refugees) in a country of about 6 million inhabitants. It also hosts an additional 18,500 refugees from Ethiopia, Iraq, Sudan and other countries, as well as more than 200,000 Palestinian refugees under UNRWA’s mandate. The presence of such a large refugee population, in a small country struggling to maintain its own delicate demographic balance and regain its pre-crisis economic growth, is increasingly affecting the protection space and putting pressure on infrastructure, services and the environment.
The most recent political turmoil in Lebanon is an indication of the frustration people are experiencing due to poverty, poor access to services, availability issues and high cost. This was followed by an economic crisis affecting access and provision of services especially for older people who do not have any social security or health insurance and are mainly supported by their family members.
The pandemic has exacerbated the already devastating economic crisis, exposing the inadequacies of Lebanon’s social protection system, and putting burden on the health system. The pandemic-related lockdown measures have compounded the poverty and economic hardship in addition to movement restrictions leaving vulnerable populations unable to afford basic necessities and access services.
Impact on older people
HelpAge undertook a multi-sector Rapid Needs Assessment (RNA) on older people in COVID-19 in June 2020 to better understand the needs of older people during this situation and gaps that should be addressed in humanitarian intervention based on reliable disaggregated data.
As Lebanon faces a harsh financial crisis crippling the State’s ability to face health crises, the Lebanese people are increasingly anxious about the novel coronavirus.
The Lebanese government has announced a far-reaching travel ban but there are doubts the country can cope with a full outbreak due to an unprecedented economic crisis that has weakened its economy and basic service provision such as the health system. The number of confirmed cases is continuing to increase which adds the burden on the economic situation and lead to further breakdown of access to basic services and deterioration of the general situation.
In addition to limited access to food and basic needs, older people are facing challenges in their awareness around the available health services and accessing it. Moreover, there is a big concern related to the limited capacity of the health system and the preparedness of the service providers to respond properly to the COVID-19 crisis.
HelpAge’s Work in Lebanon
HelpAge’s key focus in Lebanon is on the inclusion of older people in humanitarian response, NCDs specifically targeting older people with hypertension and diabetes and psycho-social support interventions. This body of work has been supported by DEC through Age International, OCHA, World Diabetes Foundation and BMZ. HelpAge aims also to promote protection and access to services for people with specific needs (PwSN) namely displaced Syrian and Lebanese older men and women, and adults with physical disabilities. This was achieved in Akkar District, North Lebanon through capacity building of humanitarian actors, care providers and community volunteers on protection mainstreaming for older people and PwSN, making two existing centers age and disability friendly community safe spaces, psycho-social and peer support activities, awareness raising, dissemination of information related to health and protection, provision of assistive devices, physiotherapy sessions, and home-based medical services to older displaced Syrian people and Lebanese host community members with restricted mobility and to adults with physical disabilities.
At present HelpAge is implementing a project that started in 2016, in collaboration with Amel Association International, Imam Sadr Foundation, Makassed Foundation and the Young Men Christian Association (YMCA) Lebanon, funded by the German Federal Ministry for Economic Cooperation and Development and the German Relief Coalition. It was co-funded by the World Diabetes Foundation for two years.
The project’s main objective is to alleviate the suffering of chronically ill Syrian refugees and host community members, as well as to reduce morbidity rates of type II diabetes and hypertension. Project activities revolve around early detection and management of hypertension and diabetes, provision of psycho-social support for older Syrian refugees and host community members, and capacity building of healthcare providers on various topics related to older people and NCDs. The project is being implemented in close coordination with the Ministry of Public Health, MOSA the relevant UN clusters and in line with WHO guidelines.
Integrating Covid-19 Activities
The current project activities are continuing and have been tailored in response to the emerging COVID-19 crisis. Currently the activities include:
- Health education is taking place in one-to-one form to older people visiting the PHCs to avoid group gatherings and raise awareness on COVID-19 and the correct hygiene practices and precautions to be taken using MoPH and WHO IEC material.
- Distribution of sample hygiene kits to older people as part of the awareness raising activities.
- HelpAge and partners’ staff are participating in meetings held by the different working groups to stay updated on the COVID-19 situation in Lebanon, related recommendations and to work on a coordinated response.
- HelpAge and partners’ staff have attended trainings implemented by WHO and the Lebanese Red Cross on COVID-19 so that they are able to implement preventive measures and disseminate information on the virus.
HelpAge will build on the existing activities and use the available structure and platforms to integrate the interventions focusing on COVID-19 with the aim to reach out to the older Syrian and Lebanese populations in target areas. These proposed activities will be implemented in close coordination with the Ministry of Public health (MoPH), Ministry of Social Affairs (MOSA), health and protection clusters and other key players actively working on the COVID-19 response. The major focus will be on prevention through information sharing, guidance on steps needed if one has symptoms, who to contact if one suspects he/she has symptoms, information sharing on available services in the target areas, and through the provision of hygiene kits. In this regard, the following activities are proposed:
Key activities at community and health centre levels:
- Capacity building of health centers’ staff on COVID-19
- Awareness raising sessions on preventive measures for older people visiting the centers and using social media platforms and dissemination of Age-Friendly educational material on COVID-19
- Counselling sessions by a psychologist
- Distribution of PPEs material
- Screening of older women and men for COVID-19 symptoms in health centers
- Provision of hygiene kits to screened older women and men
- Service mapping and referral to other related services
- Advocacy on issues of older people
Project Location and Target Communities
The project will target older Syrian refugees and vulnerable host community (40+ years old with underlying medical conditions and 60+ years old with/without other medical conditions) through Wadi Khaled Primary Healthcare Center (PHC) in Akkar, North Lebanon.
The target location was chosen based on findings from the Rapid Needs Assessment conducted by HelpAge to meet the identified needs of the most vulnerable populations in Akkar who showed reduced access to healthcare services.
Wadi Khaled is one of the most impoverished and politically marginalized areas of Lebanon. Most of its residents did not receive full citizenship rights for more than four decades. Wadi Khaled was among the first Lebanese regions Syrian refugees moved to at the start of the Syrian crisis in 2011, given its proximity to some of the early conflict hotspots such as Homs. The Syrian crisis has had a huge toll on the area’s economy, after the northern border between Lebanon and Syria was closed and it led to a decrease in trade on which the area’s economy relied. That was accompanied by the decrease in the number of employment opportunities, which made life hard for the people in Wadi Khaled, for both Lebanese and Syrians.
In Wadi Khaled today, the number of refugee families is significantly higher than at the onset of the war. Many still preserve perfectly good relationships with their Lebanese neighbours, due to the region’s strong cross-border commercial links and many mixed marriages. Based on the Health Information System and beneficiaries’ database of Wadi Khaled Primary Healthcare Centre, a total of 46,150 people reside in the centre’s catchment area (Al Hysheh, Al Rama, Mashta Hassan, Mashta Hammoud, Al Moqaibleh, Rajm Issa, and Rajm Hussein), out of which 10% are older people with Syrian refugees constituting around 43% of the total population.
In the COVID-19 context, the State is leading the health emergency response and therefore the project will be implemented with their and other relevant stakeholder’s support. Makassed Association will be key partner for field-based implementation with technical support from HelpAge and MoPH.
Makassed has 4 Primary healthcare centers and 3 MMUs which are working in Beirut, Mount Lebanon and North and has been present in Wadi Khaled / Akkar since 2003; they have been providing health and protection services in collaboration with local municipalities in 5 communities, 1 PHC and 1 medical mobile unit. Makassed currently implements a reproductive health project in Wadi Khaled PHC and local communities. The project will build on the existing services and on the relationships that Makassed has built with PHC staff, local health authorities and communities. The existing structures will be used in order to implement this project and some staff will contribute to awareness raising at community level.
HelpAge has been working in partnership with Makassed since 2016. They have implemented multiple health and protection projects in different areas across Lebanon. In the past year, they worked together to support older people and persons with specific needs in Akkar and currently they are implementing a health project focusing on non-communicable diseases for older people in Beirut area.
HelpAge will work in close coordination with the Ministries of Public Health and Social Affairs and their designates to collaborate in the implementation of capacity building trainings on COVID-19 and in the development of age-friendly educational material as well as other relevant activities. HelpAge will also work closely with the health and protection clusters and WHO to ensure an informed and coordinated response.