Securing medical care in Lebanon

The small town of Al Mohammara, located in the north of the country about 15 kilometres northwest of Tripoli, once had 2,300 inhabitants. Due to an influx of people from the surrounding villages, it has now grown to about 7,000 people. Since 2011, 8,000 refugees from Syria have also arrived. In addition, it is located in the immediate vicinity of Nahr El-Bared - the largest Palestinian refugee camp in the country with approximately 36,000 people. This alone poses major challenges to the provision of public services, which have been dramatically exacerbated by a multiple economic crisis for a good two and a half years.

Triggered by chronic political instability, mismanagement, corruption and a misguided central bank policy, Lebanon is currently experiencing the worst economic crisis in its history. Due to a lack of foreign exchange reserves, the fixed exchange rate to the US dollar could no longer be maintained in September 2019. Within two years, the Lebanese lira lost over 90 per cent of its value against the US dollar. Average monthly incomes, which were the equivalent of about 1,000 US dollars before the crisis, are now no longer worth 100 US dollars. At the same time, the country had to mitigate the consequences of the COVID-19 pandemic. Lockdowns further exacerbated the recession and tourism failed to materialise in this country blessed by beautiful beaches. Russia's war of aggression finally collapsed the economy. Lebanon previously imported large quantities of its wheat needs from Ukraine. Even those who could still afford the rising prices were at times unable to find bread in the shops due to the lack of wheat. Due to scarce foreign currency reserves, oil imports have also been greatly reduced and electricity is only available by the hour. There is also a lack of medicines, and since 2021 there have been cholera cases in the country for the first time in about 50 years.

According to the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA), Al Mohammara is considered one of the most vulnerable cities in Lebanon, lacking local infrastructure to provide basic services to citizens. The need to establish a health centre was also prioritised through several studies and focus group discussions conducted by United Nations Children's Fund (UNICEF), United Nations Development Programme (UNDP) and others.

As a result, the Al Mohammara municipality initiated the construction of a two-storey health centre. But due to the economic crisis, there was suddenly a lack of funds to continue work on the second floor of the building. Through the "TAHIL Facility for Stabilisation and Development", which was established jointly by KfW Entwicklungsbank and the Norwegian Refugee Council (NRC) to support Syrian refugees in Lebanon, funds were acquired and at least the current completion of the exterior of the centre was secured.

Since 2018, there has been a town twinning between Al Mohammara and Opfenbach in the Allgäu region of Germany, which was established with the help of the Initiative "Municipal Know-how for the Middle East" of Service Agency Communities in One world (SKEW). As a result of talks, consultations and workshops held between the municipality of Opfenbach and the municipality of Al Mohammara, it was agreed to support the municipality of Al Mohammara in the construction, equipment, and operation of the health centre. For this purpose, a local specialist was financed through SKEW’s “Expert Fund for Municipal Partnerships Worldwide”, also to improve coordination between the partner cities and local NGOs.

Ramia Assaad was recruited in July 2022. She is the perfect person for the job. Not only is she a certified national surveyor with accreditation in Canada, but she has also been responsible for accrediting health centres to international standards for the Lebanese Ministry of Health for the past ten years.

To finance the facility, especially the medical equipment, funds from SKEW's programme “Partnership Projects for Sustainable Local Development (Nakopa)” were applied for. No easy task for Christian Renn, responsible project manager in the Opfenbach municipal administration. In addition to coordination between the parties involved on the German side - KfW, SKEW and Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ )- and various technical financial requirements, calculations had to be adjusted several times due to the dynamic economic situation.

A visit to the project participants in Opfenbach in September 2022 gave Ramia Assaad a boost for her work, and not only from a technical point of view: " Personally, I learned a lot from them during this journey. The sense of humanity, commitment and professionalism was impressive. They supported me during my work, encouraged me and listened to my concerns. My visit to Opfenbach gave me empowerment, everyone was showing sympathy and were very generous in their hospitality. Even though I come from different background, different religion, and different clothes, they treated me with respect and dignity. During my stay in Opfenbach we visited many administrative, educational, health and other institutions... I gained a lot of knowledge and made sure to pass on the good impression I had to my country. It was good to know that things can work, and that a well-designed and organized system can improve the well-being of individuals."

Now that the Nakopa project funds have been approved and the completion of the building is nearing, it is time to begin the final spurt of the final phase, where there are still a number of tasks for Ramia Assaad to complete in parallel:

• Reviewing and approving the tenders for the interiors,
• Purchasing and installing the equipment and furniture,
• Starting the recruitment process for the health centre staff,
• Training and orienting the newly hired staff,
• Updating the financial plan,
• Installing medical and financial software
• Public relations in the community about the health centre and the services offered,
• Preparing for the opening ceremony.

If everything goes according to plan despite the difficult circumstances, the opening will take place in mid-2024. As the need is great, even a partial opening for simpler examinations and medication dispensing in part of the building at an earlier date is currently being considered.
Once the primary care centre is ready, it will be the largest accredited primary care medical centre in the governorate, covering 1,000 square metres. It will then have a laboratory, radiology, physiotherapy, paediatric consultation, a treatment room for pregnant women and for gynaecology, an immunisation room, an emergency room and a mental health room. There will be a room for breastfeeding mothers and a child-friendly area. In a special isolation unit infectious disease such as COVID-19, cholera and measles will be treated.
Without the personal, financial, organisational, and technical support of the city of Opfenbach, the project would be nowhere near where it is now, says Ramia Assaad. "Together with our partner, we hope to bring our project to a good end and write new chapters in our partnership. This partnership is more than a programme, it is not only about communities in solidarity, but about connected people."