Article written by George Butler, a reportage illustrator, who tours around the world and paints evocative life stories. This article was published in the Guardian on the 27th of May,2014.

Earlier this year, artist George Butler spent several days in the refugees’ ‘tented settlements’ of northern Lebanon. His portraits of the people – and the often random possessions they brought with them when they fled their homes – tell their own poignant tales. Picture captions by Nick Rice

In March, I spent eight days drawing in the refugee camps or “tented settlements” as they are now called in the Bekaa valley in northern Lebanon. These settlements, medical clinics and schools are supported by Doctors of the World UK, who provide primary healthcare to tens of thousands of Syrian refugees across the country.

Having drawn in Syria several times over the last 18 months and having started a small charity delivering humanitarian aid across the border into Syria, I was aware of the conditions.

However this was very different from my last trip. There were no immediate signs of war, no tanks, no field hospitals, no walking wounded, no men in black headbands with Kalashnikovs. And yet with a million refugees now in Lebanon this was likely the most common experience of innocent people caught up in the war. Families of between eight and 12 people living in wooden-framed tents; tents in groups of five, 10, 15 and 65 on the sides of roads, in fields and next to vineyards. Often these tents were wrapped with discarded and unintentionally ironic advertising panels to keep the sun off and rain out. One featuring a Real Madrid footballer, one with female models on a catwalk and another even pictured a block of smart flats, presumably for rent, somewhere desirable – now the images were stretched around the last place on earth you would ever wish to live.

The drawings describe my seven days in the tented settlements in El-Qaa, Al-Ain and Kamed el-Loz. They show some of the people we met and the places they now live in. After listing the obvious practical things they needed for survival (water, food, medicine) going home was their biggest desire.

With passports and identification fast expiring, many of the Syrian refugees feel more trapped in Lebanon than they did under the bombs of the Syrian regime or the erratic nature of the opposition. They have few rights, no work – just the memories of a civilised, educated, clean, healthy life only three years earlier. Some told us they had been crossed off the UN refugee register, their only lifeline, unable to reapply.

It took me several days to work out how to describe these stories. Eventually, I asked some of the families if I could draw the possessions they had brought with them from Syria. I expected, of course, that these would be precious objects with sentimental value or gifts from loved ones. I was soon put straight.

In reality, these were the things they grabbed when the shelling started or when the lights went out; they were the objects left whole in the rubble of their homes, the things the kids happened to be holding or the stuff left in the car. More often than not they had no possessions at all.

It was now junk, with no useful purpose – but junk that connected them, although indirectly, to their previous life. Junk they could not throw away. The remote control for the TV, the clock, a broken lighter, an old keyring, keys for a motorbike stolen in Syria, a friend’s telephone number, a photo of a seven-year-old son left behind so he could go to school. This was the reality of it.

• These works will be shown at a private view on the 20th June in the V&A museum hosted by Doctors of the World. Doctors of the World UK provides healthcare to vulnerable people, wherever we’re needed most – in this case for the million Syrian Refugees in Lebanon.

Original article on  theguardian.com available here

More information about our programmes in Lebanon

In March, on the occasion of International Women’s Day, Amel International and MdM were pointing out that women living in Lebanon are not equal in their access to safe delivery and family planning. To raise awareness among the public as well as policy-makers and international donors on this major issue, Amel Association and MdM collect and regularly share the stories of these women.

Asma[1] is a migrant worker from Sudan. She has been living in Lebanon for the past ten years. Her story could be the story of many other vulnerable women who do not have the financial resources to access Lebanon expensive healthcare system, especially safe delivery and family planning.

Asma is 40 years old. She grew up in Khartoum, where she got married as she was only 15 year-old. She had her first child in her early twenties. She delivered by herself, without the support of any doctor. When her husband flew Sudan to work in Lebanon, she stayed alone with her little girl for several years, stuck in the middle of the severe crisis tearing her country apart. She finally managed to reach Lebanon but, with no official refugee status, she has no rights and does not get much help.

One year and a half ago, Asma gave birth in Lebanon for the third time. Paying 40,000 Lebanese pounds each month for ante-natal consultations and tests was a real challenge and she regularly could not afford it. When she was about to deliver, she went to the Lebanese hospital recommended by her gynecologist. As she could not pay for the delivery upfront, the staff of the hospital refused to let her in. She was about to give birth on the floor of the entrance when her gynecologist interfered. Her husband had then to pay 1,800 dollars for the delivery. Asma got really affected by this bitter depressing experience. She does not want to neither feel nor remember what she had to go through.

[1] The name was changed to preserve the privacy of the interviewee.

On Sunday 27^th April, an airstrike on the Syrian village of Qah in the Idlib region hit a school. Three people died (including two children) and eleven others were injured. Injured people have been treated in the closest hospitals. Some of these facilities are supported by MdM.

One of MdM warehouses was also hit and its entire stock – including over 450 hygiene kits – destroyed. At the moment, there is no evidence that the association was being targeted. Since October 2012, MdM has been working with Syrians in internally displaced camps in Qah, near the Turkish borders. The organisation provides Syrians with medical assistance, through nine primary healthcare centers located in the different camps of the region.

MdM strongly condemns these attacks and reiterates the imperative for all parties to the conflict to respect the rules of International Humanitarian Law and protect civilians and civilian infrastructures. In addition, the safety and security of the medical and humanitarian personnel, infrastructures and medical transportation vehicles must be guaranteed without any further delay. 

Since Monday 21^st April, one of the Syrian hospitals supported by MdM in Idlib near the Syrian-Turkish border has received nine patients presenting symptoms which could be a result of exposure to chlorine gas. According to a Syrian medical organization, which manages the hospital, which is an MdM partner, the patients presented with acute respiratory diseases.

They all come from a village just South of Idlib. One of the patients, a six-year-old child, arrived dead at the hospital while a young woman, suffering from acute respiratory distress syndrome, had to be intubated and fell into a coma. Acute respiratory distress syndrome is one of the short-term complications related to the inhalation of chlorine vapour.

For weeks, several of our medical partners in North Syria have been sharing with MdM their worries regarding possible chlorine attacks. They have been preparing their staff for such a possibility and asked their international partners to provide them with chemical protection.

MdM is in regular contact with its Syrian partners in order to assess the situation on the ground and – if appropriate – to provide adapted support. In September 2013, MdM had made available to its Syrian partners nearly 100,000 doses of atropine, an antidote for nerve gas poisoning.

Moreover, in the past weeks Aleppo has been the renewed target of intensive bombings. Between 7 and 12 April, three medical structures managed by one of MdM’s Syrian partners have been damaged during airstrikes. “Two floors of our surgery hospital have been turned to ashes”, explains one of the doctors of the Syrian medical organization.

From the beginning of the conflict, MdM has been calling on all the parties to the conflict to consider hospitals and all healthcare facilities as sanctuaries.

On April 2^nd 2014, MdM and the Ministry of Health of Palestine signed on to a project aimed at improving mental health care for children and adolescents in Nablus governorate. Over three years, MdM – through its Swiss and French sections – and the Palestinian Counseling Centre will build the capacities of health centers, schools and communities to detect manage and refer mental health disorders’ cases.

The Ministry of Health of Palestine made the development of specialized services for children and teenagers a top priority in its Second National Mental Health Strategic Plan for 2012-2014. Huge efforts are necessary as only one public structure, located in Halul, Hebron governorate, provides specialized psychological care for minors. Therefore, one of the first steps of the project will be the creation of a Community Mental Health Center for Children and Adolescents in Nablus, specialized in providing mental health services for children and teenagers. This will involve the rehabilitation and equipment of the centre as well as the recruitment and training of the centre’s staff.

Primary health care centre’s medical staff as well as schools’ counselors and social workers work with minors on a daily basis. They are in the best position to identify children suffering from mental health disorders and refer them to Nablus Community Health Centre for comprehensive psychological support. MdM and the Palestinian Counseling Centre will train and supervise them in doing so.

In 25 villages of Nablus governorate, awareness and prevention activities will be conducted in order to limit the stigma associated with mental health disorders and to inform about the mental health services available within the primary health care centers, schools and the communities. Volunteers within the communities will be trained in parental guidance and psychological first aid.

At the institutional level, mental health policies focusing on care for children and teenagers will be progressively integrated into the policies of the Ministry of Health of Palestine. The Ministry of Health of Palestine will endorse the training curriculum for primary health and Community Mental Health Center staff, as well as implement a national referral system and data collection system. The implementation of these national systems by the Ministry of Health of Palestine will be supported by MdM in Nablus Governorate. .

Half of the population living in the West Bank is under the age of 18. Palestinian children and teenager’s mental health status is particularly impacted by the level of violence, in an economically-deteriorated context. In the past 15 years, MdM teams regularly met children with psychological symptoms and social problems such as insecurity feelings, hyper vigilance, bedwetting, attention deficit hyperactivity, anxiety, low level of academic achievement or social withdrawal.

MdM has been working in Syria since the start of the conflict, both inside the country and at its borders. We have seen for ourselves that the situation is worsening and that a “red line” has long been crossed.

Airstrikes on hospitals, violence against medical staff who assist the wounded, medical centres being used as places of torture and supply problems are all factors that have contributed towards the collapse of the Syrian health system. In such a context, operating on the wounded and providing them with post-operative care is becoming increasingly difficult. To mark the third anniversary of the outbreak of hostilities in Syria, MdM has produced a documentary “twenty-four hours inside an Aleppo hospital”, which includes photos and eye-witness accounts of Syrian doctors, nurses and volunteers who risk their lives every day providing medical care in  make-shift hospitals and health centres.

Watch the documentary on syrie.medecinsdumonde.org or have a look at our Photo Gallery

The third anniversary of the start of this conflict is an opportunity to remind those on both sides of the conflict of their obligation to respect international humanitarian law and guarantee the protection of civilians.

MdM is calling for:

• A halt to attacks on non-military targets (residential areas, schools) and for hospitals and all other care facilities to be considered sanctuaries;
• An end to the use of indiscriminate weapons prohibited  by international conventions;
• The lifting of the sieges on towns that are causing starvation among the inhabitants and preventing them from seeking medical care;
• Freedom to bring humanitarian aid into these zones and to access all patients;
• Protection and freedom of movement for all medical and humanitarian aid workers;
• Cross-border humanitarian aid access from all the surrounding countries;
• Unconditional acceptance of Syrian refugees in the neighbouring countries and protection for these refugees;
• The strengthening of security and justice measures within the camps;
• Financial support for the health systems and  NGOs in these host countries; and
• A generous European policy on entry for Syrian refugees.

On this occasion, just as it has over the last three years, MdM is reasserting the right of all individuals to receive medical assistance wherever they are and whatever the circumstances.  

Visit the site dedicated to the three years of conflict:  syrie.medecinsdumonde.org

On the occasion of International Women’s Day 2014, Amel Association and MdM point out that women living in Lebanon are not equal in their access to safe delivery and family planning.

In 2004, according to the last official report available, most births were attended by skilled medical staff and were taking place at the hospital. But since 2011 and the Syrian refugee crisis, more and more testimonies from women visiting Amel Association healthcare centers indicate they have been constrained to deliver at home. ‘I was really scared. In Syria, I always delivered at the hospital’, explained Mariam, a Syrian woman living in a tented settlement of the Bekaa Valley. In most cases, financial and geographic constraints prevented women to go to the hospital. Some families cannot afford the fees asked from them before the pregnant woman get admitted in the hospital, others cannot reach it due to lack of transportation means and distance of the structures.

Amel Association and MdM express their concern regarding delivery’s costs in Lebanon. For vulnerable women – Syrian refugees or vulnerable Lebanese – delivering at the hospital means accumulating debts and worsening an already precarious economic situation.

A complete assessment should lead to a strategic plan to ensure an affordable and qualitative access to reproductive health services. A greater effort should be put on offering family planning solutions to vulnerable women in Lebanon. While contraceptive methods are available in most healthcare facilities, women as well as men often lack awareness and proper information in order to make an informed choice.

In the coming months, Amel Association and MdM would like to raise awareness among the public as well as policy-makers and international donors on the importance of improving access to safe delivery as well as family planning for women living in Lebanon.

More information about MdM programme in Lebanon here.

More information about Amel Association here.

Humanitarian, Human Rights and Peace Groups welcome unanimous Security Council Resolution demanding unhindered humanitarian access across conflict lines and borders, urge swift implementation

A coalition of 17 international Humanitarian, Human Rights and Peace Groups welcome today’s unanimous Security Council resolution demanding safe and unhindered humanitarian access – including across conflict lines and across borders – to people in need throughout Syria.

Today’s action by the Security Council is an important step towards getting desperately needed aid to millions of Syrians, including a quarter of a million who are trapped in besieged communities. However, this resolution will only be meaningful if it results in real, substantial changes on the ground in Syria. We have been in a similar situation before. Last October, the Security Council issued a strong statement urging all parties, in particular the Syrian authorities, to facilitate safe and unhindered humanitarian access to people in need. At that time, approximately 6.8 million Syrians were in urgent need of humanitarian assistance. Now that number is 9.3 million, half of whom are children. After more than four months and a significant amount of diplomatic effort, the results on the ground have been meager and the overall humanitarian situation has deteriorated.

The people of Syria cannot afford a recurrence of that disappointment. They cannot afford for this resolution to be disregarded. The UN Security Council has displayed unprecedented unity on this issue. Council members must now show the same unity in ensuring the full and swift implementation of their demands.

Getting aid to all those in need in Syria in the midst of an ongoing conflict is a complex and dangerous challenge. But the test of whether this resolution is being implemented is fairly simple, and requires real progress by all parties, in the next 30 days, on five central points at a minimum:

1. Lifting of sieges on populated areas and ensuring all people in besieged communities have safe and unhindered access to humanitarian aid;

2. Opening of border crossings from neighbouring countries for deliveries of life-saving aid by both the UN and NGOs;

3. Stream-lined procedures for approving humanitarian aid convoys and prompt approval of requests for convoys to travel to hard-to-reach areas;

4. Cessation of attacks on schools and hospitals and the demilitarization of these facilities, as well as the facilitation of free passage for all medical personnel and equipment;

5. Cessation of indiscriminate use of explosive weapons in populated areas, and any methods of warfare which do not respect the obligation under international humanitarian law to distinguish between civilian populations and combatants.

The Security Council’s resolution is a diplomatic breakthrough; it is not yet a humanitarian breakthrough. This will require the swift translation of the Council’s strong, shared words into meaningful action. For the sake of more than 9 million suffering Syrians, we call on all parties to act immediately on the Security Council’s demands and we call on Security Council members to be firm in ensuring the rapid implementation of the resolution. Saturday, February 22, 2014

STATEMENT ATTRIBUTABLE TO THE UNDERSIGNED ORGANIZATIONS:

Center for Victims of Torture

Center for Civilians in Conflict

Christian Aid

Conectas Human Rights

Global Center for the Responsibility to Protect

Human Rights Watch

International Rescue Committee

Islamic Relief Worldwide

Médecins du Monde

Norwegian Refugee Council

Pax Christi International

People in Need

Save the Children

Solidarités International

Syrian American Medical Society

Tearfund

World Vision International

As the Olympic Games open in Sochi, humanitarian, human rights and peace groups demand the right of access to besieged communities in Syria. 

To the Foreign Ministers of UN Security Council Member States:

As the world comes together in Sochi to open the Olympic Games, Syrians are living under siege. In the spirit of the ancient tradition of an Olympic truce, echoed by the United Nations Secretary-General in January, we call on the UN Security Council to put an end to these inhumane and illegal methods of war by supporting a Resolution demanding full and unimpeded humanitarian access to all areas of Syria.

As the Winter Olympics open, Syria must be opened to life-saving humanitarian aid.

Words cannot convey the horror and suffering that Syrians are enduring on a daily basis: 9 million people, approaching half of Syria’s pre-war population, have fled their homes; 6.5 million are internally displaced; 40 percent of hospitals have been totally destroyed and 2 million children have been forced out of school. At least 110,000 people have been killed in the conflict, according to a recent report by the Oxford Research Group[1].

While these numbers are staggering, they do not begin to tell the whole story.

In some parts of Syria, civilians are being held hostage in their own cities. The UN estimates that at least 242,000 people are being subjected to this medieval method of war, which violates international humanitarian law. After more than a year under siege, people in these areas are running out of food and medicine. Children and women are facing acute malnutrition and, in some cases, starving to death because food and medical aid has been prevented from coming in and people from getting out. In so-called ‘hard to reach’ areas, another 3 million people eke out a desperate existence where shelling of civilians, shifting front lines, targeting of humanitarian workers and bureaucratic restrictions on aid delivery mean Syrian civilians in acute need are unable to access basic goods and services.

In a Presidential Statement on October 2, 2013, the UN Security Council unanimously agreed to specific steps that all parties to the conflict must take to comply with their obligations under international humanitarian law to facilitate aid. More than 4 months later, and despite ongoing negotiations that have marginally eased access to Yarmouk and may allow for partial access to Homs, it is clear that the October statement is being largely ignored by the parties.

As the world unites to celebrate the spirit of the Olympic Games, we call on all members of the Security Council to support a binding Resolution demanding that all parties to the conflict guarantee safe, full and unhindered delivery of humanitarian assistance to populations in need in all areas of Syria. The Resolution should incorporate all elements of October’s presidential statement and go further.

It must also:

• create a mechanism for monitoring and reporting on any party blocking access, including monitoring impediments to aid delivered directly from neighbouring countries;
• demand immediate access for humanitarian convoys to all besieged areas;
• demand humanitarian pauses in the fighting to allow life-saving food and medicine to be delivered to people in areas most severely affected by the fighting, and for civilians to move safely to other areas if they wish; and
• request the UN to support impartial humanitarian organizations that are delivering aid into Syria across borders.

Too many Syrians are dying because they cannot access life-saving aid. The Security Council must turn this Olympic moment of international solidarity into action on behalf of the Syrian people. It must adopt a Resolution demanding full and unimpeded humanitarian access across Syria to save lives now.

Signatories:

Action by Christians for the Abolition of Torture (ACAT) (France)

Arab Program for Human Rights Activists (MENA)

arche noVa e.V. (Germany)

Broederlijk Delen/Pax Christi Flanders (Belgium)

Catholic Committee Against Hunger And For Development (France)

Center for Victims of Torture (USA)

Christian Aid (UK)

Commonwealth Human Rights Initiative (India)

Conectas Human Rights (Brazil)

Egyptian Initiative for Personal Rights (EIPR) (Egypt)

Euro-Mediterranean Human Rights Network (REMDH) (France)

Fellowship of Reconciliation USA

The Friends Committee on National Legislation (USA)

Human Appeal (UK)

Human Rights First (USA)

Human Rights Information & Training Center (Yemen)

Human Rights Watch (USA)

International Alert (UK)

The International Federation for Human Rights (FIDH) (France)

International Rescue Committee (USA)

Islamic Relief UK

Islamic Relief USA

Kontras (Indonesia)

Médecins Du Monde (France)

medico international (Germany)

Middle East and North Africa Partnership for Armed Conflict Prevention (MENA)

Non-violence Network in the Arab Countries (MENA)

Norwegian Refugee Council (Norway)

Open Society Foundations (USA)

PAX (The Netherlands)

Pax Christi International

People in Need (Czech Republic)

Permanent Peace Movement (Lebanon)

Physicians for Human Rights (USA)

Solidarites International (France)

Syrian American Medical Society (SAMS) (USA)

Tearfund (UK)

Médecins du Monde resumes its psychosocial activities in six schools of Nablus governorate.

As the second semester of the school year starts, Médecins du Monde-France (MdM) resumes its psychosocial activities for children ages 6-12 in the schools of As-Sawya, Duma and Al-Luban Ash-Sharqiya, Nablus governorate, in partnership with the Ministry of Education through the School counseling department of the Directorate of Education-South Nablus. Living in poor and isolated villages and frequently exposed to violence from settlers and Israeli Security Forces, these children need an open, safe and confidential space to express their feelings.

Nablus governorate is the governorate most affected by settler’s related violence in the West Bank: in 2013, the Office for the Coordination of Humanitarian Affairs (OCHA) reported 119 incidents there. Fifty-nine Palestinians, including seventeen children, have been injured in such incidents. Incidents also happened in schools. Last October, the Jalud Mixed Secondary school was attacked by 30 settlers while 192 students were attending classes. 25% of them have been so scared by the attack that they have not been able to go back to school in the following days. In response to this emergency situation, school counselors provided the students with mental health support.

Drawing on their 15-year experience on the ground, MdM teams uncovered the highly negative impact that such violence has on the mental health status of Palestinian children. MdM psychologists and social workers regularly meet children with psychological symptoms and social problems such as insecurity feelings, hypervigilance, bedwetting, attention deficit hyperactivity, anxiety, low level of academic achievement or social withdrawal.

During the first semester of the school year 2013-2014, 3,200 children in fifteen different schools benefitted from MdM psychosocial activities. “Through drawing, role playing, music and traditional games, we work with the children on social interaction, communication skills, conflict resolution and self-esteem. Our aim is for them to reach psychological balance”, explained Shaheera, MdM social worker conducting sessions with the children. Following the activities, changes have been noticed in children’s behavior. “Interaction and children’s participation in my classes have increased”, said a teacher at Duma Mix School.

Concerns expressed by children during the sessions encourage MdM teams to remain vigilant regarding their psychological state. Close collaboration between school counselors and MdM teams is essential to support children adequately. During the sessions, MdM social workers can identify children with specific psychosocial needs. They refer them to school counselors who provide individual and group counseling services to the children. If needed, children can be referred to the Community Mental Health Center.

To ensure a better follow-up of children suffering from mental health disorders, MdM also works to strengthen the mental health services for children and adolescents, in partnership with Médecins du Monde-Switzerland and the Palestinian Councelling Center. Recurring themes in children’s drawings, such as imprisonment or soldiers’ attacks, clearly show the need to support these children on the long run.

MdM team members in Nablus are available on request for interviews or visits of MdM psychosocial activities in the schools.