Three years ago, Sydney-based physician Dr Chatu Yapa was working in a Syrian refugee camp in Iraq. She recalls how, back then, the promise of peace, freedom, and a swift resolution felt within reach.
“The mentality at that time was quite different to what I saw now,” Dr Yapa tells SBS, as she describes how the refugees she treated felt about the war. “There was hope still in their stories and in their voice.”
Fast forward to now and the war doesn’t appear to be ending anytime soon. She says that sense of hope is now a distant memory.
“What I feel when talking to Syrian refugees now that really this is a protracted crisis. That people are losing hope. They really feel like there is no home to go back to anytime soon,” she says.
Dr Yapa is a medical coordinator with Medecin Sans Frontieres (MSF). Also known by its English moniker, Doctors without Borders, it is a not-for-profit that provides medical services in politically unstable regions across the globe.
Dr Yapa, a Sri Lankan-born Kiwi who's lived in both Samoa and Australia, has just returned from her fifth mission with MSF - this time stationed in the Bekaa Valley of eastern Lebanon where her team provided primary health care to a host of refugee and local patients.
“Primary health care consists of basically what you and I would go see a GP about,” downplays Dr Yapa.
But the list of illnesses she later describes extends well beyond simple cold and flu symptoms. Her teams treat respiratory tract infections, diarrhoea, and a gamut of chronic diseases like diabetes, hypertension, epilepsy, and asthma. They also provide psychological first aid, as well as sexual health services.
“We also had two maternity centres where we provided free delivery for pregnant women, and did basic neonatal and paediatric care,” she shares, proudly. “We’re the only ones who provided this service for free in the area.”
Teams working at Bekaa Valley clinics in Baalbek, Majdal Anjar, Aarsal and Hermel carried out a total of 126,000 outpatient consultations and assisted 768 deliveries during the year.
These clinics are set up under marquee pop-up tents, Dr Yapa describes. Due to licensing laws, only national Lebanese doctors service patients on the ground.
As helpful as all their services are, access to good affordable secondary health care is where refugees suffer most, she says.
Lebanon’s secondary healthcare is highly privatised, Dr Yapa explains, as both government and private hospitals charge heavily for their services.
She admits that some of the financial burden is alleviated by the UNHCR who has agreed to cover 75 per cent of hospital fees for refugees in the region, but she still feels it isn’t enough for a lot of patients.
“In my opinion, that is the biggest challenge facing these refugees. Both access and cost,” she explains. “But fortunately MSF are looking at opening a hospital in Lebanon, and plans are underway to do that.”
A more pressing challenge for many of these refugees is the uncertainty that comes with fleeing to Lebanon.
Dr Yapa describes one patient, a woman in her late 60s from Aleppo who had to travel by foot along a mountainous road to avoid persecution.
“From Damascus to a city called Majdal Anjar there’s an illegal road through which they can access Lebanon. There’s no active patrol of that border but if they were caught by police they’d be sent back by the Lebanese armed forces,” describes Dr Yapa.
The senior woman, who travelled with her two daughters, told Dr Yapa she had to abandon her farm, the source of her livelihood, in order to find safety abroad. She also mentioned Lebanon was not her final stop. She had a son in Jordan and another in Turkey where she and her daughter would finally settle.
“I guess her story struck me because the lady’s about my mum’s age. And when she talks about her sons, when she talks about Aleppo, to me it’s a picture of someone who really didn’t want to leave her home,” Dr Yapa recalls.
For now, they live in Baalbek, hosted by their former Aleppan neighbours who had left Syria a couple years prior. The apartment is a cramped one-bedroom lodge where 13 people live. But that didn’t stop the neighbours from opening their doors and letting in this woman and her daughters when they needed help most, says Dr Yapa.
“This neighbour has seven children. So, this lady and her two daughters were sleeping outside, because there wasn’t enough space in the small room,” she describes. “This is what I found a lot; neighbours really helping each other out.”
Ultimately, Dr Yapa believes what makes the Syrian refugee crisis so heartwrenching is just how relatable the situation is for people from the Western world.
“When we think about refugees in Africa, we think of a chronic situation where people didn’t have a lot to begin with,” she explains, “but Syria was a country that was doing really well. It had a good healthcare system, people lived well, they had good houses. So this fall is a huge fall”.
“I’m not saying it’s any harder for a Syrian than for an African, but it's more relatable to me, I guess, because I can imagine it could easily happen to us in Australia, say, if we had a different kind of government.”