IMC-Lebanon Situation Report, 14 August 2006

ERT LEBANONDAILY SITUATION REPORT

Date Submitted: Monday, 14 August 2006 / Submitted By:Farah Kaiksow
Time Period Covered by this Report: Daily Report / Site: Lebanon/Syria
Country Status: Emergency

Operational Environment

Security

Despite the unanimous adoption of a cease-fire resolution by the UN Security Council, bombings continued throughout the weekend and ahead of the Monday morning implementation deadline. Additionally, Israeli military forces continued to push north towards the LitaniRiver in increased numbers. Due to the wording and structure of Resolution 1701 it is likely that ground battles will continue in southern Lebanon until the Lebanese and French military forces arrive to support the UNIFIL troops. It is therefore also likely that little will change regarding the ability of NGOs to travel safely to the south for at least the next week or two.

Weekend Security Developments:

An increase in anti-American and anti-Israeli posters has been observed around Beirut, specifically in the Sanayeh neighborhood.
Air strikes hit power stations in Tyre and Sidon, cutting off electricity to surrounding areas.
Despite being given security clearance from IDF, an Israeliair raid struck a convoy of civilians and members of the Lebanese Joint Security Force traveling from Marjaayoun to Zahle; 14 killed.
Lebanese Internal Security Forces reported on Friday that 861 people have been killed and 3,314 have been wounded.
IDF officials reported on Friday that 85 military personnel and 40 civilians have been killed, and 330 military personnel and 800 civilians have been wounded.

Coordination

In order to more effectively and efficiently provide assistance within Lebanon, IMC has commenced the following coordination activities:

Registered with UN Office for the Coordination of Humanitarian Affairs (UNOCHA) in Beirut.
Working with International Organization for Migration (IOM) to coordinate delivery of non-food items (NFIs).
Member of Health Cluster, Primary Health Care (PHC) sub-cluster, Psychosocial Health sub-cluster, and Reproductive Health sub-cluster.
Establishing a partnership with World Health Organization (WHO) in order to receive and distribute medicines collaboratively.
Developed a relationship with Farah Social Foundation as a potential national partner for support of IDPs in districts of Aley, Chouf, Hasbaya, and Rachaya.
Met with Merlin and CARE-France to discuss coordination of planned program activities.

IMC Program Activities

IMC Lebanon

Ongoing and Future Activities

In addition to the activities listed in the tables below, IMC has undertaken the following:

At the national level, IMC has produced health education materials in cooperation with AUB and the Ministry of Social Affairs (MoSA) to be distributed nationwide. IMC is also working with WHO and MoSA to establish a nationwide training program for health educators, and with UNFPA and MoSA in order to formulate an approach to psycho-social issues. IMC is identified as the key INGO partner by the Lebanese Ministry of Health (MoH) and MoSA, WHO, and AUB.
Southern Lebanon: The contents of a NEHK were distributed among hospitals and clinics in Marjaayoun, Tebnine, Hasbaya, and Nabatiye.

Governorate/Mohafazat: Beirut
District/Caza: Beirut
Area/Village / # IDPs / Current IMC Activities / Planned IMC Activities
Burj Hammoud/East Beirut/Sinn El Fil / 12,000-15,000 / Delivered hygiene supplies, house cleaning products and baby formula to IDP population. / Through MOU with Armenian Red Cross and a local NGO, will supply medicines, develop a health education campaign, and re-establish ambulance services.
Governorate/Mohafazat: Mount Lebanon
District/Caza: Byblos(Jbail)
Area/Village / # IDPs / Current IMC Activities / Planned IMC Activities
Byblos(Jbail)/Batroun / 30,000 / Two Lebanese program officers are conducting assessment and contacting municipal authorities and health facilities to begin assistance to Primary Care centers. Delivered hygiene materials, baby formula, and powder milk. / Implementation of OFDA-approved activities including distribution of NFIs, provision of PHC, health education, and public health interventions.
Governorate/Mohafazat: Mount Lebanon
District/Caza: Baabda
Area/Village / # IDPs / Current IMC Activities / Planned IMC Activities
El Qmatiye / 10,000 / Distribution of contents of NEHK (1) (split with Kfoun). / Delivery of medications and NFIs.
Governorate/Mohafazat: Mount Lebanon
District/Caza: Aley
Area/Village / # IDPs / Current IMC Activities / Planned IMC Activities
Entire District / 10,000-15,000 / Delivery and distribution of contents of NEHK (1) plus an additional $15,000 worth of medications (split supplies between Aley and Chouf).
Ech Choueifat / 9,000 / In cooperation with local NGO (Farah Social Welfare Agency), operation of a fixed clinic and a mobile clinic to serve outlying areas. / Development of a community health plan with training materials and identification of CHWs. Delivery of NFIs.
Governorate/Mohafazat: Mount Lebanon
District/Caza: Kesrouan
Area/Village / # IDPs / Current IMC Activities / Planned IMC Activities
Kfoun / 30,000-40,000 / Collaborating with local municipal authorities to assist with water chlorination procedures and NFI support to three apartment buildings housing approximately 700 IDPs each. IMC has identified a water engineer in Kfoun who will contact UNICEF counterparts to establish a joint WatSan program. Distribution of contents of NEHK (1) (split with El Qmatiye). / Delivery of medications and NFIs.
Governorate/Mohafazat: South Lebanon
District/Caza: Tyre(Sour)
Area/Village / # IDPs / Current IMC Activities / Planned IMC Activities
Tyre(Sour) / Unknown / Provision of medical supplies to Hiram Hospitals. Establishment of three Mobile Medical Units (MMU) providing curative and emergency services. / Further Health Care activities, distribution of NFIs, WatSan, Psychosocial programs.
Governorate/Mohafazat: South Lebanon
District/Caza: Sidon(Saida)
Area/Village / # IDPs / Current IMC Activities / Planned IMC Activities
Sidon(Saida) / 30,000 / PHC services established in outskirts. Assessment to begin on Tuesday, 15 August 2006. / Further Health Care activities, distribution of NFIs, WatSan, Psychosocial programs.

Between 3-5 August 2006, the IMC team did an assessment of the Eklim El Karroub Municipalities (Chouf district in Mouth Lebanon). The results are as follows:

Area / # IDPs / Current Health Status / Needs / Notes
ChhimVillage / 1,152 families for a total of 5,365 people. 4,557 IDPs in private homes; 808 in public facilities. / Outpatient "dispensary" only. Referrals are made to CentralHospital in Chhim or OsmanHospital in Siblin. / According to the Mayor: bedding, medications, medical services, clean water, enhanced sanitation, detergent for clothes washing, personal hygiene items, some basic food supplies. / Most aid goes to residents of public facilities, leaving the vast majority of IDPs with no assistance.
BarjaVillage / 1,200 families for a total of 6,200 people. 5,270 in private homes; 930 in public facilities. 700 children under 5. / No hospital in Barja; care provided by 2 general clinics which are currently overwhelmed by the number of patients. / According to the Mayor: bedding, medication for children and chronic illnesses, detergent, women's hygiene items, diapers, cooking utensils. / No INGOs currently working in Barja. A few Lebanese NGOs are providing NFIs only.
KetermayaVillage / 278 families for a total of 1,480 people. 1,067 are in private homes; 73 are in public facilities. 370 children under 5. / Further assessment needed. / Food is being provided to IDPs in public facilities; major need is to serve IDPs in private homes.
El-QurdaniyeVillage / 767 families for a total of 3,835 people. 2,552 in private homes; 1,283 in public facilities. 206 children under 5. / Municipality established an emergency dispensary at beginning of conflict. Further assessment is needed. / Further assessment needed.
MazboudVillage / 410 families for 2,050 people. 1,170 in private homes; 880 in public facilities. 99 children under 5. / Further assessment needed. / Further assessment needed.

IMC Syria

Displaced within Syria

The Government of Syria (GoS) and the Syrian Arab Red Crescent Society (SARC) have taken the lead role in registering, accommodating and assisting the most vulnerable of the people displaced from Lebanon. However, they have indicated that their resources and capacity will soon be exhausted and have welcomed the support of the UN and NGOs. Syria is a strategic transit point not only for those fleeing Lebanon to other countries in the region and beyond, but also for the delivery of humanitarian supplies to Lebanon.

There are currently approximately 160,000-180,000 refugees from Lebanon in Syria, plus 50,000-60,000 persons who entered the country but have already left. It is estimated that there is a net influxof 5,000-7,000 people into Syria from Lebanon each day. At present, most refugees have mixed in with the host populations either by renting houses, purchasing apartments, or staying with relatives and/or friends.

It was initially estimated that some 161 sites were hosting 40,000 refugees, based on data collected by UN agencies and other national and international organizations. These sites are mainly schools, public city buildings, mosques, and Pioneers camps. That number has now grown to 54,000 people house in 176 public sites. The dynamicity of the refugees moving from private accommodations to public shelters (and vice versa) continues, and it is estimated that at least 1,500 are doing this on daily basis. This has made it very difficult to collect accurate demographic data on the population in need.

Furthermore, the government is planning to evacuate all temporary public shelters and move the residents there to eight Pioneer camps in Homs, Hama, Tartous, Lattakia, Aleppo, Deraa, Sweadia, and Damascus. Each camp can house between 1,500 to 2,500 persons. Once this transfer occurs, the city commissioner will take over the management of these camps, the MoH will be responsible for the health services, and the Ministry of Civil Affairs will be responsible for the shelters themselves. Hot meals are scheduled to be supplied by the Ministry of Trade. SARC is to provide additional help on need.

However, the resources of all of the above agencies in terms of financial and human resources are limited, exhausted and have already begun to be depleted even before the transfer of the displaced Lebanese to these camps. SARC has therefore put out a call to all INGOs, individual countries, and UN agencies to start contributing to the relief effort in Syria as that country faces this massive wave of refugees' demands and needs.

Displaced on the Border

Palestinian refugees from Lebanon are facing additional challenges as the GoS has restricted their entry into Syria because of fears that Palestinians fleeing Lebanon will choose to remain permanently in Syria. Because this policy was not put into place for a few days after the initial migration from Lebanon, UNRWA estimates that there are currently 1,700 Palestinian Lebanese in Syria who passed into the country in the first few days.

IMC is currently operating MMUs in the unofficial UNRWA Al-Yarmouk Camp in Damascus where eight schools house1,884 displaced people from Lebanon, the vast majority Palestinians. There are an additional two schools that just opened their doors to receive incoming Palestinianrefugees who were allowed to enter into Syria at the initial phase of the crisis.

Since the restrictions on entry, 1,000s of Palestinians have reached the Syrian border and then been denied entry. Some of these people have returned to their homes in Lebanon, and some have crossed illegally in Syria. Of the more than 100 Palestinians remain at the Masnaa-Jdaidah border crossing, most are either too poor or too ill to travel any further; they require all types of humanitarian assistance including medical care, sanitation support, and NFIs such as mattresses and pillows. Two cases of tuberculosis (TB) were discovered at this Masnaa-Jdaidah border area. To address some of these problems, IMC launched a MMU anda reproductive health team at this border-crossing area.

Treating the Displaced Populations

Data regarding the composition of refugees within and near Syria are not accurate or regularly updated, but the estimated percentages of certain vulnerable populations are as follows:

Target Population / Percent
<15 years / 28.4%
>65 years / 6.6%
Pregnant women / 2.0%

Immunizations

After the discovery of four cases of mumps and one case of measles among the refugee population, 52 vaccination teams were formed and began their work on 30 July 2006. It should be noted that these vaccination teams reached only those persons sheltered in public sites, not those mixed in with the host population. To date, the following vaccinations have been completed:

Vaccination / Age Group / Percent
OPV / Under 5s / 97.4%
MMR / 10-59 months / 85.6%
Measles / 6-15 years / 86.2%
Meningitis / 24-59 months / 88.7%

Reproductive Health

Neither primary reproductive heath care, prenatal, nor antenatal care currently exists at either the official or unofficial settlements. At the borders, the situation is worse; after one of the two pregnant women at this site had an abortion, the Syrian authorities still refused her entry to receive secondary medical care. At the Zabadani Camp there are approximately 100 pregnant women who have no access to antenatal care except by referral to nearby hospital.

Special Health Needs

Refugees with disabilities, chronic mental and physical diseases, and malignancies suffer the most as they have limited or no access to medical services. Additionally, there are a number of newly disabled patients due to the violence in Lebanon; such disabilities include physical impairments (amputations, blindness, joint disorders) and mental retardations.

Between 20–25% of the adult population suffers from high blood pressure, while around 9% of young adolescents (aged 10–14 years) are recorded as having elevated BP and 18% of young adolescents were hypercholesterolemia.

Lebanon has a prevalence of non-insulin dependent diabetes mellitus (DN)that is almost double that of industrialized countries, reaching around 13% in the adult population. Among the Palestinian population, DM, and in particular type 2 DM, seems to be a serious health problem among the middle-aged.

Nutritional Problems

Though food distribution programs continue in Syria, children under 5 and especially those under 1 are seriously at risk for malnutrition. Policies and cultural norms surrounding breastfeeding in particular pose challenges for humanitarian efforts. Another problem is one of identifying and accessing needy populations; many are unidentified as they live with host families or relatives.

Mental Health and Psychosocial Programs

IMC doctors have witnessed noticeable behavioral changes in children and adolescents. Many children have taken on the role of provider and have become preoccupied with the distribution of supplies. This has brought on increased incidents of violence and quarrelling, with conflicts about food, water and clothing occurring between refugee and internally displaced children standing in distribution lines.

Young children are experiencing higher rates of sleep disturbances such as fear of the dark and nightmares. The absence of employment and leisure activities, combined with the stressful circumstances of refugee life, has brought about a tendency toward violence in adolescents.

Of particular concern to parents of displaced children and to mental health professionals is the continuity of their children’s education. Consistency and the sense of community that comes with school are essential to any child’s emotional well-being.

Fear of having to change shelters is prevalent among children of displaced families. This has led to many families being unwilling to leave the public sites where they were originally housed, thus causing problems for authorities trying to evacuate the displaced to official camps.

Water, Sanitation and Hygiene

Though the water and sanitation (WatSan) situation is under control in the current temporary camps, there are concerns regarding the circumstances in the eight Pioneer camps to which the displaced are to be moved. In Zabadani Camp, for example, IMC team members observed the spread of a wave of diarrheal diseases following a 2-day breakdown of the water system. Additionally, particularly in crowded camps and border settlements, personal hygiene is either neglected or impossible due to lack of supplies.

Education

Looking forward to scenarios such as the prolonged presence of displaced Lebanese in Syria, it is possible that the Syrian Ministry of Education will need NGO support for the integration of these displaced into its school system. Contingency plans for such a situation are being developed.

Human Resources(Expatriate)PositionCurrent Location

Edi CosicCountry DirectorBeirut

Dr. Jeff GoodmanHealth Officer (Coordinator)Beirut

Nicholas HoltProgram OfficerDC

Trevor HughesSecurity OfficerChhim/Sidon/Tyre

Lynne JonesMental Health SpecialistUK

Marijana MijuskovicFinance OfficerCyprus

Bassem Sa’adoonLogistics Officer (Syria)Damascus

Dina PriorProgram OfficerBeirut

Dr. Haider SahibHealth Officer (Syria)Damascus

Philippe SchneiderProgram Officer (S. Lebanon)Chhim/Sidon/Tyre

Marin TomasLogistics Officer (Lebanon)Cyprus