Dr. Suzan Bartels is a co-author of the report ‘Running Out of Time – Survival of Syrian Refugee Children in Lebanon’ that was published by FXB center last January. She is board certified in Emergency Medicine in both the U.S. and Canada and is currently an attending physician at Beth Israel Deaconess Medical Center as well an Assistant Professor at Harvard Medical School. As co-appointed faculty at the Harvard Humanitarian Initiative and a Visiting Scientist at the FXB center, Dr. Bartels is actively involved in international projects and public health research, primarily in conflict and disaster affected areas, with the aim of improving the science and practice of delivering humanitarian aid.
This interview was conducted by Zeina Ali Siam, second year Master’s student at the Harvard School of Public Health.
Q: Could you please provide an overview of the research you conducted in Lebanon and its purpose?
A: The project was initiated and funded by the FXB Center For Health and Human Rights at Harvard School of Public Health. My colleague, Kathleen Hamill, and I were in Lebanon for roughly 10 days at the end of November. We wanted to focus on the status of refugee children, specifically on adolescent issues including early marriage, forced labor and sexual exploitation.
We conducted 64 interviews, 34 of which where with Syrian families, and 14 with local and international staff working with humanitarian aid organizations including the UN. We spent a lot of time in Beirut where many of the NGO meetings took place. We also met with refugees in the suburbs of Beirut and Tripoli, as well as in the Bekaa valley. We further interviewed Lebanese host families and Lebanese community members including religious leaders, physicians and healthcare providers.
Q: What are the most important conclusions you have got out of your investigation?
A: Early marriage was one of the concerning issues. Families were marrying girls early for protection- though they never clearly expressed from whom or from what the girls needed protection. People also explained that early marriages were happening because of their dire economic situation– having the girl marry meant one fewer mouth to feed. Child labor is the second issue. Agriculture is the main industry employing children in Bekaa Valley, particularly in the harvest of potatoes. Children worked long days and under harsh conditions. A third concern was the lack of educational opportunities for Syrian children, which was partially caused by overcrowding of the Lebanese schools as well as high school fees. We also heard some comments about sexual exploitation. Although we didn’t directly visualize sexual exploitation, several sources independently reported that it was occurring among Syrian refugee communities.
Q: Did anything that particularly struck you during your experience?
A: What was really striking was the lack of refugee camps. There are no formal settlements for Syrian refugees in Lebanon! A million refugees are dispersed throughout the country. And this raises several challenges in the provision of humanitarian aid and services. It is very hard to locate and provide care for these scattered refugees, some of whom are constantly on the move in their struggle to survive.
Another thing that struck me was the profound sense of isolation among the Syrian refugees. Many of our questions were general, framed as, “What is happening in your neighborhood and in your community?” And typical replies were: ‘We don’t talk to anybody,’ and ‘We don’t know what is happening with other families because we don’t spend time with them.’ The refugees are living in real isolation – they keep their children inside all day in overcrowded apartments or tents and the children have no toys, no books, and no opportunities to go to school.
When asked why they keep their children inside all day, some Syrian families responded that they avoid going out because when they do, their children see Lebanese kids going to and from school, or getting sweets, and they get upset because they are not able to go to school or have treats. To prevent these emotionally difficult situations, the children are kept inside their homes. I have worked in other refugee settings and this sense of isolation is unusual. I believe that a sense of community is important for resilience and for surviving whatever life you have as a refugee, so this isolation among Syrian refugees is probably not a positive thing.
Q: As you express here, the situation is very harsh for these children. The Syrian conflict is but growing more complex over time, so there is no turning back–at least in the short term. What do you think is the way to improve the wellbeing of these children and adolescents?
A: I would emphasize two things: education and meeting the basic needs of the Syrian families. With regards to education, Lebanon is taking some steps to address this issue like creating double school shifts – often with Lebanese students attending in the morning and Syrian students attending in the afternoon. When there is an opportunity for affordable schooling, fewer children will be sent out to work and fewer girls are likely to be married at a young age. The second thing that I would emphasize is meeting the basic needs of the refugees, such as food, adequate shelter and access to medical care, so that families do not feel that they have to marry their daughters and send their children to work.
Q: Any final messages you would like to send?
A: The humanitarian and international communities are struggling to mount an appropriate response to the Syrian crisis. But this is most likely going to be a protracted conflict and much more will be needed in the future, including more advanced and strategic planning, more funding and an improved means of ensuring that the basic needs of refugees are met.