With clashes between government forces and rebels in Damascus and Aleppo, tens of thousands of Syrians are fleeing to neighboring countries like Lebanon. Many are in need of medical care, but treatment is expensive.
Conflict is escalating in Syria as the uprising enters its 18th month. The United Nations (UN) estimates that some 30,000 Syrians have ended up as refugees in Lebanon. Wadi Khaled, a valley at the border in northern Lebanon, is one of the preferred areas Syrian refugees cross illegally into Lebanon. Most cross at night and with the help of cross-border smugglers. They arrive in need of food, water and shelter.
But a good number of them, some 2,000 according to the UN, come in need of urgent medical care. Many, like Amar Idriss, were injured by government ammunition used during protests.
"I was shot in both legs," Idriss said, resting on a hospital bed in the northern Lebanese city of Tripoli. "I was at a protest and they started shooting at us. All I saw were bullets flying: the government security services shooting at us."
Wounded protestors shun hospitals in Syria
Idriss lies with one of his legs in a cast and scratches and bruises across his body. Like most of the wounded refugees arriving in Lebanon, he refused to seek care at a hospital back in Syria. He says that these days, hospitals in Syria are riddled with Syrian government agents, looking for wounded protestors.
"They'd kill us," he said. "You go in bleeding, you come out dead."
After he was shot in June, Idriss says he was sneaked across the Syrian-Lebanese border through a secret route used by the Free Syrian Army.
Lebanese border towns like Arsal, on the northern border with Syria were once sleepy, marginal outposts. These days they are the center of the action. The number of wounded Syrians showing up at towns like Arsal has steadily climbed since the beginning of the uprising. Waiting on the Lebanese side of the border is a clutch of NGOs and the Red Cross.
"We have a special team, special equipment to do the triage," said Georges Kettaneh, director of Disaster Management at the Lebanese Red Cross. "We are transporting the cases and also we are giving blood donations."
But back when the uprising started, there was no such response along the border. Initially, an informal network of safe houses and improvised clinics developed, staffed mostly by refugee Syrian medics. They provided refugees wounded in the conflict with essential medical care. But pretty soon, this situation had to change because the safe houses were less than adequate both in terms of sanitation, and security.
Safe houses were no longer safe
"It became known that the safe houses contained injured Syrians, so they became exposed to the factions in Lebanon that support the Syrian regime," said Abu Raed, director of the refugee-led organization, the Syrian Higher Commission for Relief in Lebanon.
As a result, healthcare for Syrian refugees in Lebanon has moved, over the past eight months, from these safe houses into mainstream Lebanese hospitals like this one in Tripoli, where Idriss is being treated. The trade-off for this improved set-up is that Syrian medics, like surgeon Abu Jawad, can no longer treat their compatriots. By law, they are forbidden from working as doctors in Lebanon without taking medical equivalency exams. Jawad was a surgeon back home in Syria, but here in Lebanon, he is more of an administrator than a doctor.
"My work here is limited to overseeing our own Syrian injured patients," Jawad said on a ward in the government hospital in Tripoli, where Idriss is being treated. "The patients are sent from the border area and we greet them, we take them into surgery and sometimes I sit in on surgeries because of the experience I gained doing surgery in Syria."
The medical response in Lebanon has been improving for Syrians, but is also expensive, and therefore hard to sustain. The trouble now is that no one knows how long the uprising will continue - or how long the injured refugees will keep coming.
"The challenge is we have to see the capacity of the hospitals and finances to cover these people in hospitals," said Kattaneh of the Lebanese Red Cross. "If it continues for a very long time, then who is going to cover it?"