• Syrian refugees Mahmoud (R) and his son Abboudi both have diabetes. Since resettling in Lebanon, they have struggled to access the medication they need. (SBS Dateline)
Why are so many Syrian refugees dying of treatable diseases? We hear shocking stories from Lebanon’s refugee camps where more than a million Syrians live with little or no healthcare.
Airdate: 
Tuesday, August 22, 2017 - 21:30
Channel: 
SBS

As Syrian families flee the country in search of safety and security, many are finding life as a refugee is just as fraught as living in a war zone.

In this week’s Dateline, Syrian-born reporter Sarah Abo goes inside Lebanon’s refugee camps, which are overflowing with Syrian arrivals and struggling to meet their basic human needs; food, water, medical supplies.

The huge influx of refugees has led to an undersupply of medical services, which can be deadly – even for people with treatable illnesses.

17-year-old Asra has type 1 diabetes and while living in Syria she was able to manager her disease with insulin injections three times a day. But after seeking asylum with her family in Lebanon she is unable to find the care she needs.

“There was a period of time when I had no medication, so I took [insulin] once a day,” she says. “It was not enough.”

Asra has had to ration her insulin intake since coming to Lebanon, which has caused her to slowly lose her vision. She is fearful she could lose her vision permanently, as a result of a condition she was easily able to manage while in her war-torn country of birth.

There’s an imbalance in supply and demand for medication and access to doctors. At a small Syrian-run clinic in the Bekaa Valley, where there are an estimated one million Syrian refugees, Dr Beshr Alkhateeb says they see between 150 and 200 patients each day.

A 14-year-old diabetic boy named Abboudi, who arrived at the clinic while Dateline was filming there, was so unwell doctors had to rush him onto a glucose drip, believing he was minutes away from slipping into a coma. “I felt faint, I collapsed,” Abboudi says later. “I couldn’t take it anymore, I was very hungry.”

Abboudi’s father Mahmoud, who is also a diabetic, says the effects of his condition have been heightened since he left Syria and resettled in Lebanon.

“In Syria, I didn’t feel that I was diabetic, it was like I didn’t have diabetes,” he says.

“Over there in my country I was happy, then we came here and things have changed. For instance, if my son got sick, I’d take him to any hospital, free. They wouldn’t charge us.

“Everything was available. Schools were available, everything. Free medication, everything…we were happy. It’s very hard to see your country being destroyed.”

Lebanon hosts more refugees per capita than any other country. In mid-2016 Lebanon had 173 refugees per 1,000 inhabitants, almost double the next highest country Jordan, which hosts 89 refugees per 1,000 inhabitants.

Much of the country’s refugee intake is a direct result of the Syrian civil war. In 2011, before the war began, Lebanon hosted only 8,000 refugees – now that number is around 1.04 million. The movement of people into the country was so overwhelming that in 2015, the government implemented new measures to bar the UNHCR (the UN refugee agency) from registering newly arrived refugees, effectively closing the border to many legitimate asylum seekers.

Lebanon is overstretched and unable to provide care for the continuing influx of refugees. In under-resourced camps, the poor conditions can be a factor in the transmission of illness or disease. “If you didn’t have bad health to begin with, you’re certainly going to get it here,” says Annie Sparrow, an Australian paediatrician who comes to Lebanon each year to help.

Sparrow says many of the camps in the Bekaa Valley are not adequately resourced.

“None of the refugee camps here are official so they're not run the way that Zaatari or the other camps are in Jordan, where there are services set up,” she says.

“They have all the problems of the first world, so chronic diseases we know – diabetes, heart disease, high blood pressure, cancer – and they have all these problems that we think of with developing countries; malnutrition, infectious diseases, typhoid, hepatitis, dysentery, and on top of that they have all the trauma of war.”

Asra, the young diabetic girl, sometimes imagines what her life would be like if she could see.

“I’d go to school. I would learn. I would read novels. I would watch television,” she says.

“I love school and I wanted to be a teacher, a teacher for children, to look after them, too.

“This is what I wanted to be, but none of this is happening. A woman my age should be able to see, but I can’t see.”

Watch the full story at the top of the page.

More

The Intern Diaries: Robbed of a Homeland
Dateline reporter Sarah Abo talks about her latest film, which looks at why so many Syrian refugees are dying of preventable diseases.
What Trump's executive order means for the Syrian health crisis
With the collapse of the country’s health system, Syrians are already dying of treatable diseases. Now, none of them have a hope of making it to the U.S.
Growing up in the shadow of Syria
As millions of Syrians flee conflict and seek shelter in refugee camps across Lebanon, there is a lack of resources to provide the care they need and deserve, writes Sarah Abo.
Where can Syrian refugees go?
Millions of displaced Syrians are looking for a place to be resettled, while countries around the world continue to reject them.
Three things could happen to Lebanon as Syrian refugees rush in
Lebanon's health and education systems are struggling to cope with the huge number of refugees fleeing the Syrian civil war.
How to help refugee children get through the trauma of what’s happened to them
Young refugees have complex mental health needs and struggle with PTSD, depression and anxiety, compounded by poverty and in some cases exploitation and neglect.

Credits

Reporter: Sarah Abo

Producer: Ronan Sharkey

Camera: Clayton Carpinter

Associate Producer: Kelly Hawke

Local Producer: Patricia Boy Nassif

Editor: Simon Phegan

Transcript

REPORTER (Translation):   Hello, how are you?  Hi. 

CHILDREN:  Hello.

Six years after war began in Syria, I've come to an unofficial refugee camp in neighbouring Lebanon. I see the kids first. I used to be just like them - running around with other Syrian kids many years ago.

REPORTER (Translation):   How are you? Are you fine? How old are you? How old are you?

KHADIJA (Translation):   I am four.

Little Khadija is 4 years old the same age I was when my familiar live left Syria, but in entirely different circumstances. My family left Syria because my parents wanted a better life for their children. The kids in this camp are nowhere near as lucky, stuck in a land that doesn't want them, everything in short supply.

KHADIJA (Translation):   Dad, I want water.

REPORTER (Translation):   She wants water. Do you have water?

FATHER (Translation):   We don’t have water.

Khadija is one of more than 500,000 Syrian kids who have fled to Lebanon - officially. Unofficially, there could be twice as many. Lebanon hosts more refugees per capita than any other country - which is why the government stopped counting Syrian refugees a few years ago unable to cope with the influx.

I grew in Syria never expecting it to descend into the chaos that we're seeing it today and when you look around the camps just like these that are dotted all around Lebanon, it's really heartbreaking because there are children just like Khadija and all the kids around us now who are missing out on the basics that were available to them in a country like Syria.

With no end to the war in sight, Syrians - young and old - are dying from treatable and preventable diseases. I wonder how you stay alive, let alone stay hopeful, as your old life slides further and further away. Australian paediatrician Annie Sparrow doesn't claim to have all the answers.

DR ANNIE SPARROW, PAEDIATRICIAN:   If you didn't have bad health to begin with, you're certainly going to get it here.

Every year she comes to Lebanon to help in any way she can, she's an expert in humanitarian health crises. This year, she's already visited half a dozen times.

DR ANNIE SPARROW:  I started working on the war maybe five years ago, I thought it would be for a year. But I come back because I can help in many ways to meet the need that they have to meet these terrific health challenges, and I come back to because the Syrians themselves are fantastic and I love to work with them.

We're heading to the Bekaa Valley, home to an estimated of one million Syrian refugees. In truth no-one know it is real number. Many of the refugees are undocumented which means they can't legally work and send their kids to school or travel to the valley to get healthcare.

DR ANNIE SPARROW:  Given that none of the refugee camps here are official so they're not run the way that Zaatari or the other camps are in Jordan where there are services set-up. So the burden of child health is huge and same for adults too. Imagine they have all the problems of the first world, so according to these we know, diabetes, heart disease, high blood pressure, cancer and they have all these problems we can think of in developing countries, malnutrition, the infectious disease, Typhoid, hepatitis, dysentery and on top of that they have all the trauma of war.

While the international aid community is bogged down in bureaucracy, Annie tells me about the thousands of Syrians losing hope because they can't get basic medicine for common diseases like diabetes. On our first house call, we're about to meet a diabetic patient. We're being introduced by a local aid worker, Dr Beshr Alkhateeb.  Asra is 17.

DR ANNIE SPARROW:  Asra, my name is Annie. I’m a doctor.

DR BESHR ALKHATEEB, MULTI AID PROGRAMS (Translation):   Please have a seat.

We're surrounded by Middle Eastern hospitality, and Asra slowly opens up about her struggle with diabetes.

DR ANNIE SPARROW:  So even though it was difficult, you could still access treatment and had no problems.

ASRA (Translation):   I got used to the situation.  I have been like this since I was little. It’s okay, it makes no difference. I was two years old when I became sick so I am used to it.

After three year as a refugee in Lebanon, Asra is once manageable diabetes could now see her lose something very precious.

DR BESHR ALKHATEEB (Translation):   But you were going to school…

ASRA (Translation):   Yes, I was at school in Syria.

REPORTER (Translation):   What has changed?

ASRA (Translation):   Here I couldn’t go because my eye sight is deteriorating and I can’t go. There was a period of time when I had no medication, so I used to take it once a day.

DR BESHR ALKHATEEB (Translation):  This period…

ASRA (Translation):   It was not enough.

DR BESHR ALKHATEEB (Translation):  When?

ASRA (Translation):   We tried to ration it.

DR BESHR ALKHATEEB (Translation):  Was this last year or two or three years ago?

ASRA (Translation):   Last year.

DR ANNIE SPARROW:  It's often very hard because the eyes are not equal and because the poor blood sugar control means there's often blurriness. But, um... You know, her vision is going to change from - often from day-to-day particularly if she's not getting regular insulin.

But Asra has had to ration her insulin since she came to Lebanon, highlights a health system that can't cope. In their bear living room, no-one can bring themselves to talk about the future. And what must be Asra's biggest fear - whether she'll lose her sight all together. The strain shows, especially on her mother.  With heavy hearts, we leave Asra and her family.

REPORTER (Translation):   What really worried me about meeting Asra, obviously her diabetes is having a massive impact on her life but you could tell her mental health was also affected by it.

DR ANNIE SPARROW:  Of course. It's entirely normal to be depressed. It's catastrophic, she's losing her sight, which is about the most precious thing we all have, and she knows it's just a dream for us, it's blurry, it's deteriorating and without that, she's - she has a 17-year-old girl whose future is just not dim right now, it's dark and terrifying.

Annie has come to tend of her visit to Lebanon. But I plan to meet Asra again tomorrow at a doctor's clinic where hopefully she'll get more news about the state of her eyesight.

Wow, it's crowded in here, there's dozens of people, there’s clearly a lot of need in this area. I find Dr Beshr Alkhateeb who was with us at Asra's apartment. Today, he's running around trying to deal with all these patients.

REPORTER:   So how many patients do you see here everyday?

DR BESHR ALKHATEEB:  I think everyday we have between 150 to 200 patients.

REPORTER:  Wow.

This clinic is run by Syrians for Syrians. Beshr also had to flee war, but instead of emigrating further away, he chooses to stay close by in Lebanon to help his fellow Syrian refugees.

DR BESHR ALKHATEEB:  People trust more the Syrian physicians because they are the same culture, they're doctors inside Syria, and now when they come here, still the same doctors and still they know their patients.

Beshr is about to see Asra. Inside the consultation room, we find her and her mum putting on brave faces. Asra's type one diabetes means her body doesn't produce insulin. A finger prick test will let doctors know how bad things are.

DR BESHR ALKHATEEB:  I think it's 20/40 here, this means it's hyperglycemic.

Asra’s blood sugar levels are more than double what they should be.

DR BESHR ALKHATEEB:  She is fasting, so it is a high number for a fasting blood glucose.

REPORTER:  Oh really?

DR BESHR ALKHATEEB:   Yeah, it’s 240.

REPORTER:  What should it be?

DR BESHR ALKHATEEB: It should be below 125.

REPORTER:  Wow, okay!

DR BESHR ALKHATEEB:  so it’s really high.

REPORTER:  So, that’s a dramatic increase.  What does that mean?

DR BESHR ALKHATEEB:  That means she's not controlling her disease. Because of the diabetes, yes, side effects of diabetes. So Dr Ramez was telling us that because of diabetes, she gets an injury in the retina, in her eyes, she had a bleeding, a haemorrhage in both eyes, left and right eyes, the left eye is more haemorrhagic than the right one.

She is seeing an ophthalmologist and she needs surgery in both eyes.  The problem is that the surgery’s cost is high. Each eye needed like $4500, yes, so it’s a big amount of money for refugees.

$9,000 to fix Asra's eyesight an impossible amount of money for her family, now, I understand why no-one was talking about the future yesterday.

DR BESHR ALKHATEEB:   The situation will be deterioration and she will go blind at home.

REPORTER (Translation):   How is your eyesight now?

ASRA (Translation):   Thank God, it’s alright but blurry.

REPORTER (Translation):   Now are you going home? What are you going to do at home?

ASRA (Translation):   I’m going home and I will stay at home and when the Azhan (call to prayer) starts, I will pray.

Asra may have escaped the bombs of Syria, but for so many chronically sick Syrian kids like her, surviving in Lebanon is becoming just as uncertain. Another diabetic child of war arrives at the clinic and he's not well at all. In fact, the blood tests reveals 14-year-old Abboudi is minutes away from slipping into a coma. They rush to put him on a glucose drip.

REPORTER:  How long does the process take?

DR BESHR ALKHATEEB:  This will take like 15 minutes.

REPORTER:  Okay. And then after about 15 minutes his blood glucose levels will return to normal.

DR BESHR ALKHATEEB:  Yes, he should be like normal.

REPORTER:   So he's pretty lucky that something like this happened here?

DR BESHR ALKHATEEB:   Yeah, he's so lucky because we can just manage it immediately.

REPORTER:   What would happen if he was at home?

DR BESHR ALKHATEEB:  If he didn't notice that and his parents didn't notice, he may be in a coma.

This simple glucose drip is potentially saving Abboudi's life. But it turns out that his unusually pale skin is a sign of another problem.

DR BESHR ALKHATEEB:  If he doesn’t control his blood glucose level, the kidney failure may be worse and he may go through the hemo-dialysis, and hemo-dialysis for refugees in Lebanon it’s a disaster. It will cost him about 1200 or 1300 dollars per month.

As refugees, Abboudi's family will never be able to afford dialysis for their son.

DR BESHR ALKHATEEB:  He maybe can stay for a week or two weeks without dialysis but then he may die.

REPORTER: So we're talking about life or death situation.

DR BESHR ALKHATEEB:  Yeah, that's it.

Abboudi's dad arrives just after the drama has passed.

DR BESHR ALKHATEEB:  Yeah, it’s a life or death situation.

I wonder if frightening moments like these are just part of life for the family? It turns out Abboudi and his dad, Mahmoud, share the burden of diabetes together. Mahmoud also has type one diabetes, both father and son have an easily treatable condition, but one of them is losing the battle.

REPORTER (Translation):   How are you?  How are you darling? Hello, how are you Abboudi? Aere you better now? Yeah? You are eating, that is good. Are you still unwell?

ABBOUDI (Translation):   No.

REPORTER (Translation):   How did you feel before?

ABBOUDI (Translation):   I felt faint, I collapsed, I couldn’t take it anymore, I was very hungry.

Good to see Abboudi eating with his family. They have got rice, potatoes and some yoghurt, much better now than he was when we saw him at the hospital earlier, which was pretty scary.

REPORTER (Translation):   You are better, right?

ABBOUDI (Translation):   Better.

REPORTER (Translation):   Better than before?

Their meal is high in carbohydrates, not ideal for a diabetic. In all likelihood, it is because they have no choice. Most of their meagre income goes towards rent on this apartment.

MAHMOUD, SYRIAN REFUGEE (Translation):   In Syria, I didn’t feel that I was diabetic, it was like I don’t have diabetes over there in my country and I was happy.  Then we came here and things have changed.

Mahmoud takes me up to the rooftop for a quiet talk. The shadow of their past life looms over them constantly. Syria is just a few kilometres away.

MAHMOUD (Translation):   You know, Syria’s over there.

REPORTER (Translation):  Over there? What do you think of when you are looking over there?

MAHMOUD (Translation):   What I think, I wish I could fly and be in Syria. In Syria, we were living happily, for instance, if my son got sick, I would take him to any hospital, free. They would not charge us. Everything was available, schools were available, everything, free medication, everything. Praise be to God, we were happy.  It is very hard to see your country destroyed, one’s country is like one’s child. So, it is as if I had lost one of my children, when your country is gone, you are worthless. If we have to do dialysis, first of all I would do it for him, at the end of the day, it would be a must.  As for the money, I can’t afford it at all.

You can almost see the weight on his shoulders. While Lebanon struggles to treat chronic diabetesics like Abboudi and Asra, there's potentially a much bigger crisis looming - the threat of contagious disease. So while Lebanon may not want Syrian refugees to stay, it knows it can't ignore them.

REPORTER:  Can't be easy staying healthy in camps like these - just seeing some open sewage right by a tent, someone's home, there are kids running around everywhere, playing with anything they find. It must be a real challenge to raise a family here.

One of the little girls I meet in the camp leads me to her family's tent.

REPORTER (Translation):   Hello, how are you? My name is Sarah.

NESRINE (Translation):   How are you?

REPORTER (Translation):   Hello. Hello. How are you?

Sham is one of five children being raised alone by her Nesrine, her mother, Nesrine, a widow.

REPORTER:  In the five years you have been in Lebanon, has anyone of the family gotten sick?

NESRINE (Translation):   Yes, but ordinary ailments. Thank God it’s not the very bad stages.  For instance, jaundice, my children have jaundiced, so I treat them my way. Dates are the best for jaundice.

Keeping kids physically healthy is hard enough. Gauging their mental health must be even more difficult. Nesrine says her older kids who knew a life before the war seem to be coping. It's her younger kids she worries about most, like Sham.

CHILD (Translation):   My sister Wesam, my sister Wiaam, my brother Mohamed.

NESRINE (Translation):   The war impacted on my children and me both positively and negatively. It wasn’t all negative.  The positive was that I became stronger so I can protect my children.  Negative because I got out of my country and emigrated and we got lost in the mazes of this world. It separated us from our family and our country.
My children are my whole world.  I hope they have a future.  Not to be lost in the vortex we are in now.  I hope they get their rights like all the other children and that they will study and achieve something, that they live in a house at least. The nightmare of the tent is very nasty for us.  The little one is starting to ask me, ‘Why don’t we live in a house?’ I feel very sad and distressed for her.

Even though Syria still dominates the news headlines, Syria's refugees in Lebanon are very much a forgotten people. And Lebanon has become a land of lost Syrian dreams. Asra tells me what she would do if she could see properly.

ASRA (Translation):   If I can see?  I’d go to school.  I would learn.  I would read novels.  I would watch television.  I would at least choose my own change of clothes.  I love school and I wanted to be a teacher, a teacher for children, to look after them too.  This is what I wanted to be but none of this is happening.  I need to be able to see with my eyes because a woman my age should be able to see.  But I can’t see.

Coming to Lebanon and meeting Mahmoud, I think about the worries all Syrian fathers must have. My father got the life he was hoping for for his children when we left Syria years ago. I'm not sure Mahmoud gets to dream that big anymore.

MAHMOUD (Translation):  What can I say?  Big worries.  Big family. Little income.  My son is sick.  This is more important than having no money, more important than the money. Second, there is no money.  What can I say? 

reporter
sarah abo

story producer
ronan sharkey

camera
clayton carpenter

associate producer
kelly hawke

local producer
patricia bou nassif

editors
micah mcgown
simon phegan
david potts

translations
dalia matar
sanae ouahib

22nd August 2017