The Lebanese Center for Human Rights (CLDH) is a local non-profit, non-partisan Lebanese human rights organization in Beirut that was established by the Franco-Lebanese Movement SOLIDA (Support for Lebanese Detained Arbitrarily) in 2006. SOLIDA has been active since 1996 in the struggle against arbitrary detention, enforced disappearance and the impunity of those perpetrating gross human violations.

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May 21, 2012

The Daily Star - Ain al-Hilweh deals with psychological impact of camp violence, May 21 2012

By Stephen Dockery
AIN AL-HILWEH, Lebanon: During the height of one feud in the Ain al-Hilweh Palestinian refugee camp months ago, a bomb targeting fighters was discovered under a house. The bomb was defused; no harm done.But not quite. The family that lived in the building the bomb was planted under could not stop thinking about what could have been.
Francois Kazour, a psychiatrist who works with Medecins Sans Frontieres, the only mental health provider in the camp, is treating the husband and wife for sleeping problems, and he expects their child may eventually need some type of treatment as well.
A long string of armed clashes and assassinations has shaken Ain al-Hilweh over the past several years, leaving several dead and many more wounded. Here in the largest Palestinian camp, factionalism and periodic communal fighting in the camp are taking a toll in other ways as well; mental health issues like post-traumatic stress disorder and acute stress syndrome, seen rarely in other camps, are being diagnosed in noteworthy numbers.
Mental health professionals say they can break down Ain al-Hilweh’s mental health diagnoses into two categories: Cases like depression and anxiety related to overcrowding and unemployment seen in many of the region’s poor refugee camps, and those cases directly related to living in a constant fear of violence.
“It’s a very difficult camp and a unique community,” Kazour says.
Unique to Ain al-Hilweh, the armed leadership struggles of the ’70s and ’80s remain simmering. Split-offs of the Fatah Palestinian faction, Islamist organizations and other groups who have set up shop in the relative lawless environs vie for power in the 1-square-kilometer camp that houses around 50,000 people.
Along the camp’s narrow, unmaintained streets, the signs of instability are not hidden. Young and old gunmen sit in shade and at checkpoints holding weathered rifles. Near one mechanic’s shop, a man shakes a battered AK-47 to punctuate his arguments.
Those guns take their toll on the militia fighters and the people.
One man was struck by a bullet after being caught between gunfire in the camp’s narrow streets. Weeks later he came to a camp hospital looking for help. He couldn’t stop thinking that he was going to die.
Kazour diagnosed him with acute stress disorder and prescribed medication for his condition.
“There were clashes between military factions in the camp and several weeks afterward we had acute stress disorder and PTSD cases directly related to the clash,” explains Kazour “It can be an acute feeling days or weeks after military clashes.”
Mental health treatment in the camp generally divides along two lines: Psychiatry treatment like Kazour offers that involves the prescription of drugs by doctors, and more hands-on treatment from psychologists that involves therapy extended over long periods of time.
Psychologist Manal Kassem helps families and individuals work through mental health issues through discussion and therapeutic exercises.
Kassem says many cases she sees are made worse by just how tight security is. The level of militia security in the camp and Lebanese Army security outside make Ain al-Hilweh feel like sealed off area, she says. Kassem says it’s healthier for residents if they can have interaction with their surroundings.
That tight security has a broad range of impacts on people.
Kassem says some people have developed phobias of police because of their limited range of movement; others have experienced so much violence that a loud noise sends them into a panic.
“It relates to what they have passed through all these years,” Kassem says.
The closed camp is also causing a resurgence in the traditional practice of marrying first cousins due to the difficulty of finding spouses, she says. Kassem says that can create a broad range of genetically derived psychological problems.
In a largely poor, largely unemployed diaspora community, the toils of living in a crowded refugee camp for decades is stress enough.
“Of course security and stability plays a very important role and increases, maybe, the prevalence of depression and anxiety, but at the same time the first cause of these kinds of disorders is socio-economic status,” says Rola Sharkieh, a coordinator for MSF in the camp.
The camp’s unusual politics have constantly presented a challenge to the operation of clinics, from the people who need treatment to the support needed to launch mental health operations in the first place.
MSF officials met with over 20 political and religious parties, a number of which only exist in the Ain al-Hilweh camp, before opening operations to make sure their new services were welcomed.
Since they opened a year ago the response has been significant. They have reached out with house visits and information sessions, and so far over 200 people have sought aid at the camp, including men, women, spouses and even militia fighters.
“People were calling for this service,” she says.

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