Lebanon: Meeting refugees from Syria
Nicole is a finance and HR manager currently working in the Bekaa Valley in Lebanon. The project in Bekaa aims to provide healthcare to some of the thousands of refugees who have fled the war in neighbouring Syria. 
Nicole Bachtold and the MSF team
After the incredible night in our Mother and Child Centre in October, I knew I only had one month left to do everything I still wanted to before I leave, on the job and the personal side. It was a scary feeling: where did all the time go? It feels like I just arrived on here, while on the other hand I feel I’ve been here much longer with everything that has happened.


One thing I have wanted to do from the beginning is to spend a day with our social workers. They work in the informal tented settlements (ITS) in the Bekaa, and I wanted to meet the Syrian refugees there and understand more about their living conditions. Ultimately, refugees from Syria are our target patients in the clinics we run here, and it was important to me to get more insights about them. I decided this could be useful for our whole team, so my two assistants and I headed out with the social workers for a day out in the field. 


We started the day with a visit to an ITS west of Baalbeck, where our MSF community health workers held a session with the community about scabies. 



In Lebanon there are no official camps for the Syrian refugees, so there are tents scattered everywhere. This makes living conditions difficult as there is no infrastructure at all, and it also makes the follow-up difficult for our teams. 

The tents
One of the tents in the settlement. Photo: Nicole Bachtold.
Often, people have to pay rent for the piece of the land where they put their tent; prices are around 50 USD per month, so they need to be able to provide the money to pay for that. 
The water is supposed to be provided by UNHCR but with the tents being scattered all over Bekaa and Lebanon, it makes it difficult to reach everyone. 


It’s also worth noting that people are not getting officially registered as refugees anymore. That means that the official number of refugees seems stable and not very high, but the unofficial numbers are very high and still growing every day. 


Scabies is a skin infestation caused by a very tiny mite known as the Sarcoptes scabiei. These microscopic mites can live on your skin for up to two months. They reproduce on the skin’s surface and then burrow into your skin and lay eggs. This causes a very itchy, pimple-like rash to form on the skin. 
At the talk...

At an induction session. Photo: Nicole Bachtold.

Scabies is often found where people are confined in small places with low hygiene standards. It is very contagious and the mites also nest in bed linen and clothes. Amira and Satat, our community health workers had prepared boards with explanations on how to prevent and treat scabies. The people listened carefully and were asking questions, as there was already an outbreak in their settlement. They were thankful for the information and after the session, showed us around their camp. 


The people there plant and harvest tobacco leaves to earn a bit of money and you can clearly see who in the camp has more money, as their tents are bigger and better equipped than the others. Most of them arrived recently from Raqqa, a city in north Syria which is currently occupied by ISIS and thus heavily bombed. 
Inside one of the tents

Inside one of the tents. Photo: Nicole Bachtold. 

We headed towards another settlement, where our social workers Soma and Khaled went last week to provide people with the treatment for scabies, so we went to check out if it was successful or not and were received with good news, most of the scabies cases were successfully treated and the remaining ones were still under treatment. They boiled all bed linens and put them on their ‘roofs’ in the sun for three days to dry and kill the remaining mites. 


The children were following us during the visit in the camp, trying to speak some English words with us and all happy to pose for pictures :-)
Some of the children from the settlement

Children at the settlement.  Photo: Nicole Bachtold. 

It’s impressive to see how they can cope with the situation and value the small things they have. Definitely a good reminder for us, when we start complaining about small things… 


I keep on thinking about that when I’m feeling really cold now in the office or in my room, as here they don’t have heating systems. We have soubyas, which are small oven which work with heating oil but you shouldn’t leave them on during the night as they produce carbon monoxide which is not very healthy. So in the morning I wake up and I’m freezing cold and I keep on thinking, how can they cope with that, being in tents and often without soubyas? 


After this very emotional day, we headed back home full of memories. 


On the administrative side, I was very happy to achieve my Number One priority of aligning most of the salaries to have an equality in the payroll. It was a project I started working on in May and after all technical implementation of payroll in our database, we presented the project to the staff concerned at the end of October. They were really, really thankful and happy and some even started to cry and came to thank me personally for my commitment in this project. 


I worked for a long time on this project and it wasn’t always easy, but at this moment I was really happy because I knew that we had been pushing for the right thing for them and I felt useful (which isn’t always a given feeling when you spend your days in the office signing invoices and checking administrative papers)! 

We really have a great team spirit and are always there to support each other ... it feels like family

I also managed to introduce rosters to plan the workforce in a more efficient and transparent way and we’re now in the process of aligning the rest of the contracts in my last days in the Bekaa. 


Last week we did the induction course for all our new staff members last week, which meant quite some preparation time… My supervisor keeps on telling me that it’s ok not to finish everything, as Benoit, my replacement, is coming next week and will take over the ongoing tasks, but I just like to finish everything I can before I leave a job. So this means long working days and a long to-do list :-)


Benoit will still have a lot of things to work on; I know that I can’t finish everything!


It was also the last week for Marc, our doctor who works on non-communicable diseases (that’s things like diabetes, heart disease etc – illnesses that aren’t infectious and can’t be transmitted between people).  Marc and I met in April at an MSF training course in Vienna and both spent the last six months here in Bekaa. As we are both Swiss German and got along very well, it’s a very sad moment, to say goodbye… I try not to think too much about it, and it definitely helps to know that I’m leaving in a week too. 


I will miss my team here so much, the local staff, but also the international staff. We really have a great team spirit and are always there to support each other, to have fun, to go through difficult and nice moments all together. It feels like family. I guess I will have a hard time getting used to my normal life in Switzerland again. But for now, I enjoy my last week as much as I can!
Nicole with some of the children from the settlement