Pandemic Relief: Beirut Test-Drives Mobile Medicine for Migrants

Global fund seeks to help 5 cities, in Lebanon and elsewhere, cope with pandemic responses in local immigrant & migrant communities.

by Maria Luisa Gambale. Read more on PassBlue.

Through the early months of the Covid-19 pandemic, Beirut was spared the catastrophic caseloads that brought many cities around the world to their knees throughout the spring and early summer of 2020, but the port blast on Aug. 4 changed all that. The explosion itself killed at least 200 people, left 300,000 people homeless and destroyed medical facilities, overloading others.

In the following weeks, Lebanon experienced its first surge in Covid-19 cases, quadrupling seven-day averages in a few weeks. While these effects were felt throughout a country suffering from dramatic political and financial crises, they landed particularly hard on the refugees and migrant workers who have poured into Beirut over many years, many of them living in neglected neighborhoods close to the port.

Just over two years ago, the challenges facing cities absorbing large influxes of refugees and immigrants fueled the formation of the Mayors Migration Council (MMC), a nonprofit group dedicated to linking up city governments and international aid and interventions. Now Beirut is one of five cities benefiting from the million-dollar Global Cities Fund for Inclusive Pandemic Response, inaugurated by the council to respond to the needs of cities regarding migrants, refugees and internally displaced people during the pandemic. Thirty cities were invited to bid; 26 ultimately did. While grants will also go to cities in Colombia, Mexico, Peru and Sierra Leone, and often will be coupled with help from United Nations agencies, Beirut is the only one where a UN agency, UN-Habitat, will help manage the project.

Beirut’s winning proposal, put forward by Mayor Jamal Itani with the support of UN-Habitat, netted a relatively modest $176,000 for a mobile medical unit that will provide free Covid-19 tests and other basic medical services in underserved neighborhoods. “We concluded it’s the best project to help these vulnerable societies . . . in these stressful times,” Mayor Itani said in an email response to questions from PassBlue. The clinic will be the first unit of its kind provided by the Lebanese government.

Beirut is a logical choice for this pilot project. With a population of 6.8 million, the city hosts an estimated 1.5 million Syrian refugees and 470,000 Palestinian refugees registered by the UN, along with about 18,000 refugees from other places. Some 400,000 migrant workers (likely a dramatically low estimate) are thought to be living there now.

Covid-19 has accelerated the decline of an unstable political situation and an already devastated economy, made worse, Mayor Itani pointed out, by the pandemic and its various lockdowns — including one that was provoked by a daily high of 6,154 confirmed cases in mid-January and is just lifting. The country’s Ministry of Social Affairs estimates that more than half the population is now unemployed.

Getting to know the neighborhoods

UN-Habitat, whose main office is in Nairobi, will be a major partner on the ground. Taina Christiansen, who is head of its country program in Lebanon, said in a Zoom call, “Normally the funds would go directly to the municipality, but because of Lebanon’s [unstable] financial situation, UN-Habitat will help manage the fund.”

UN-Habitat data is central to many development projects in Beirut and vital for the medical mobile project, as Lebanon hasn’t held a population census since 1932 and has clamped down on UN Refugee Agency registration of Syrian refugees, which creates an uncertain profile of that population and its needs.

UN-Habitat’s Lebanon Neighborhood Profiles offers statistics and field research reports on vulnerable neighborhoods. Mayor Itani selected two of four neighborhoods identified in the project — Sabra and Karm El-Zeytoun — as targets for this project.

Syrian and Palestinian refugees make up 45 percent of the population in Sabra, an extension of the Shatila refugee camp, originally settled by Palestinians. Karm El-Zeytoun, adjacent to the port area and heavily affected by the August explosion, is said to be 15 percent Syrian, with an additional 22 percent of residents recorded as having unknown origins.

Access to medical care is a primary concern. While 68 percent of households reported to UN-Habitat that they had received information related to Covid-19, only half said they knew where to go if they contracted the virus. Transportation is cited as a major block, more often by women than men, and frequent lockdowns have severely cut access to medical care in refugee camps.

Timeline

Funds were processed in January but hiring staff and buying supplies could take another couple of months. The city hopes to roll out the mobile unit by April, and then it will have to build trust in the various communities. “We expect to do 15–20 tests per day at the beginning, until [more] people are encouraged to engage,” Christiansen of UN-Habitat said, “with testing increasing slowly after the first couple of months.”

Citizen groups will be key to community acceptance, and appropriate ones are still being identified. The city is adopting a Municipal Social Cell (MSC), also overseen by UN-Habitat, to work with groups in vulnerable neighborhoods to identify challenges, gather and analyze data and propose solutions to the city government. “You could even say that we hope that the MSC will be the voice of those underserved and often left behind,” Christiansen said.

Currently composed of two social workers and one community organizer, the Social Cell will measure how well the mobile clinic works, including community receptiveness and satisfaction. “You can build a new school,” Christiansen noted, “but if it’s not used, that’s a failure.”

Mayor Itani acknowledged issues with migrant acceptance and said that the Social Cell aims to build positive interaction. “The Social Cell will have the responsibility to find solutions to these problems,” he said, “and to cooperate with the existing NGOs [nongovernmental organizations] in those geographical areas, who will help in bridging the gap.”

Model for a displaced future

According to the UN, more than 56 percent of the world’s population lives in cities, and that is expected to increase to 68 percent in 30 years. More than 95 percent of Covid-19 cases currently around the globe are occurring in urban areas. And the vast majority of the 272 million people displaced globally from their homes end up in cities. Cities attract at least 60 percent of refugees and 81 percent of internally displaced persons, as well as many migrant workers.

In 2018, 150 mayors from around the world, led by the Mayors Migration Council’s 10-mayor leadership board, took ownership of commitments made by UN member states with the Global Compact on Safe, Orderly and Regular Migration, the first UN agreement to address international migration in all its dimensions, and the Global Compact on Refugees, which seeks to bolster local government support for host communities and refugees alike. (The United States, under the Trump administration, declined to adopt both voluntary pacts.)

The next step for the council was to find money to make things happen. “When the pandemic hit,” said Samer Saliba, manager of the council fund, “the mayors in MMC saw that their constituents were acutely affected.” They raised an initial $1 million from the Open Society Foundations, George Soros’s philanthropy. “But at the same time,” Saliba added, “it was important to us to put out a call to action for international organizations focused on migration displacement issues to fund 22 cities total by 2022.”

The goal is to bypass national governments and bring direct assistance to city governments, which have the closest knowledge of constituents’ needs, and build community trust in municipalities and the assistance that city governments can provide. This is particularly challenging in a country where trust in national government is low and despair is prevalent. Mayor Itani — with backing throughout his political career from former Prime Minister Rafik Hariri and now his son Saad Hariri — is part of a system that is deeply mistrusted, in increasingly loud terms, by the Lebanese people.

Yet cities must reach people who desperately need help. “Local authorities have been putting out fires around the world,” Christiansen said. “So, empowering them to do it better is the wisest way forward.”

Challenges ahead

Testing and cautionary measures remain critical around the world in stemming the pandemic but emphasis has been shifting to vaccinations. The first doses arrived in Lebanon on Feb. 14, but only 60,000 doses have reportedly come so far, and getting more has been and will be a struggle. According to Human Rights Watch, even with the 2.73 million doses obtained through the Covax facility (the vaccine-buying consortium for the world’s poorest countries, co-led by the World Health Organization), the country has mapped out only enough doses to immunize half of the population, despite Health Minister Hamad Hassan’s claim that 80 percent of the population will be vaccinated by the end of the year.

The World Bank is financing much of Lebanon’s vaccination campaign, with a commitment of $34 million for two million doses. To help ensure its investment, the bank has contracted with the International Federation of the Red Cross and the Red Crescent Societies to act as a monitoring agency. But those arrangement were briefly in peril after lawmakers were exposed jumping a line that was supposed to be strictly enforced and, AP reported, the World Bank threatened to withdraw its commitment.

At the same time, the nationalist hashtag #LebaneseFirst started appearing on Twitter last month, proof that immigrants, refugees and migrant workers in Lebanon will continue to bear at least some of the brunt of Lebanese citizens fed up with the government and the pandemic and facing down vaccination shortage with angry trepidation.