Syrian refugees buckle under health care bills in Lebanon

“Who’s there?” asked Dr. Mohammad Farhat, director of Hamid Farhat Hospital in the Bekaa Valley town of Majdal Anjar. “The sick lady died last night,” said a man on the phone.

“Yeah, I know she died, what do you want me to do?” Farhat replied.

“They have 90 percent [of her hospital bill],” the man said hesitantly.

“They don’t want to pay the remaining 10 percent [of her bill]? What am I a charity? This is absurd,” Farhat quipped. “Tell them to get the money and come and get her. If they don’t like it they can just leave her in the freezer.

“These people are rude ... tell them if they don’t want to get her, they have to pay $100 a day for the freezer,” he added.

This is a snippet of a recorded phone conversation. The man speaking with Dr. Farhat is a friend of the deceased lady’s nephew – a Syrian refugee living in Majdal Anjar – who also works at the hospital.

He recorded the conversation using an app on his smartphone and it spread like wildfire throughout the refugee community.

The recording hit a nerve as many refugees are facing pressure to pay staggering health care bills while strained hospitals are using aggressive tactics to secure the payments, such as holding corpses and newborns or, more commonly, withholding refugees’ IDs.

These policies have long been in place for Lebanese people as well, but refugees unaccustomed to these practices are caught off guard. Funding shortfalls have left a vast number of Syrian refugees unable to meet their payments.

The nephewof the deceased lady in question is a typical example of most Syrian refugees in Lebanon. Ahmad, who asked not to use his real name, cared for his aunt as she was divorced and had been separated from both her sons during the war in Syria.

As his aunt was suffering from extreme malnutrition in late March, Ahmad took her to the hospital where she died after two weeks in intensive care. The United Nations High Commissioner for Refugees covered 75 percent of her LL12 million hospital bill – the agency’s standard policy with all cases that meet their criteria – while a local charity provided some additional aid and Ahmad himself gathered what he could from friends, neighbors and family to reach 90 percent of the owed amount.

“We said, ‘Bless us, she has nobody, respect the dead so we can bury her.’ He [Dr. Farhat] said, ‘No, absolutely not,’” Ahmad told The Daily Star.

Ahmad was able to secure the money through more donations from friends the day after the phone call and was then able to bury his aunt.

The Daily Star spoke with Farhat, and while he confirmed that it was indeed his voice that was recorded he refuted that he made many of the statements in the phone call.

“I was speaking to one of my employees, it’s rude for him to be recording a private conversation,” Farhat said. “This is a private hospital; I don’t have anyone supporting me. I tried to help the patient, she died, may God have mercy on her.”

He argued that he takes in many Syrian refugees while most hospitals turn them away.

“We hear what was said in that recording all the time,” Mohammad, a community outreach volunteer in Tripoli who also asked not to use his real name, told The Daily Star. “It could be even worse than that.”

Mohammad, who himself is a refugee from Homs, explained that many Syrians have difficulty securing the remaining 25 percent of hospital bills which the UNHCR does not cover.

According to their website, the UNHCR is currently $1.6 billion short of its 2015 funding requirement for Lebanon. This shortfall in funding has forced the U.N. body to only provide targeted assistance for life-saving operations, child birth and care for newborns.

Treatment for cancer, eye problems and any kind of car accident is not covered. Mohammad, for instance, lost a chunk of his arm in a rocket blast, but the procedure to rectify it is not covered by the UNHCR.

Aid agencies in the north have reported cases of hospitals withholding corpses and newborn babies from families until they cover the remaining 25 percent that they owe. The most common tactic employed, however, is withholding patients’ ID cards until they settle their bills.

A source at the Tripoli Governmental Hospital said this was a regular practice which the hospital employed for both refugees and Lebanese citizens.

The Health Ministry did not respond to The Daily Star’s request for comment.

Refugees without proper identification that shows their status in the country face arrest at checkpoints and could potentially be prevented from working if a job requires travel. This produces a vicious circle in which the refugees cannot work to earn the money necessary to pay their bill.

Shamekh, a Syrian refugee whose family is in Tripoli but works in Beirut, knows this all too well. His wife gave birth prematurely and his newborn son was hospitalized for two months before dying. The hospital would not release his son until he provided his ID as insurance. Since he needed it for work they took his sister’s instead.

“She can’t leave the house now, she has to stay inside or else she might get arrested,” he told The Daily Star. “I only make LL20,000 a day, how am I supposed to make rent and save for the bill.”

Another issue many Syrians aren’t accustomed to is Lebanon’s highly privatized health care system, as all health care was provided by the state in Syria. Up until the Lebanese government installed strict entry requirements for Syrians at the borders, many Syrians chose to brave returning to war-torn areas to get treated for free as opposed to struggling to meet payments in Lebanon.

According to an Amnesty International report from 2014 on refugees’ access to health care in Lebanon, 11 percent of refugees returned to Syria specifically for medical reasons last year.

Lebanon’s health care system has long been expensive and is also difficult to access for Lebanese citizens.

According to the Amnesty report, 86 percent of hospital beds are privately owned, making treatment expensive, while a National Survey of Household Living Conditions in 2007 found that over half of Lebanese do not have medical insurance, meaning the financially strained state must cover their costs.

The arrival of more than 1.1 million refugees into Lebanon from Syria has pushed this system to the very brink.

In March, the Association of Private Hospitals urged international donors to increase their funding of UNHCR so that more refugees could meet their payments. They estimated that securing hospitalization for 1.5 million refugees living in “squalid conditions” would cost $600 million per year and only 5 percent of that is available.

Mohammad, however, feels that Lebanon must first address the issues its own citizens face with health care before refugees can expect better treatment.

“There’s no solution to this problem. They have to find a solution for the Lebanese citizens first. I’m a foreigner in this country.”