Syrian refugees in Lebanon have totaled 125,000, according to UN figures, 200,000 according to government estimates (Photo: Reuters)
In a report entitled "Misery beyond the war zone," Doctors Without Borders/Médecins Sans Frontières (MSF) gave the results of a survey carried out in the southern Lebanese city of Sidon, the eastern Bekaa Valley and the northern city of Tripoli, where its teams are providing free medical care.
Syrian refugees, as well as Palestinian refugees and Lebanese nationals fleeing the embattled country, have "profound humanitarian needs that are not being met" said MSF, whose report covered registration issues and access to medical care and lodging.
More than 50 percent of those interviewed, whether officially registered as refugees or not, were housed in substandard structures with little to no protection from the elements and the rest were struggling to pay rent after losing their livelihoods.
More than half could not afford treatment for chronic diseases, and nearly one-third had to suspend treatment because of high costs.
A major problem is the drawn-out registration period, which can last several months in Lebanon, where the Syrian refugees are scattered throughout the country and not housed in camps as in other countries in the region.
Many refugees told MSF they had not registered because they lacked information on how and where to do so or the registration points were too far away.
"Others worried that they did not have proper legal papers and would be therefore sent back to Syria," it said.
While waiting for registration, the newcomers are not entitled to any aid and are expected to pay 100 percent of their health care costs, MSF director general Bruno Jochum told reporters in Geneva.
"When you're talking about families who have left everything behind in a war zone... it's not acceptable that they sometimes have to wait weeks or months before receiving the first assistance" he said.
The MSF said 41 percent of the refugees it interviewed were not registered, and that nearly two-thirds of unregistered refugees and Lebanese returnees received no assistance whatsoever from any non-governmental groups.
"Access to assistance should be disconnected from the registration process," Jochum said, calling on Beirut and the UN's refugee agency (UNHCR) to immediately change the policy.
Even after registration, the Lebanese government and the UNHCR have determined that refugees still need to foot 15 percent of their medical bills, in what Jochum described as a political decision to ensure refugees are not seen as receiving more benefits than vulnerable Lebanese.
He described "many cases of patients with acute medical conditions who are turned away because they can't put the required sums of money on the table."
"These are people in an extremely vulnerable situation, and we believe that asking a financial fee is not adapted to their situation," he said.
According to UNHCR, more than 172,000 Syrian refugees are registered in Lebanon, 88,582 others are being processed, while another 50,000 are estimated to be in the country without attempting to formally register.
To speed up the registration process, "we definitely believe that reception centres at the border or collective shelters should be put in place rapidly," Jochum said.
While refraining from calling for Lebanon to set up full-scale camps like the ones in Turkey, Jordan, Egypt and Iraq -- which together are housing nearly 500,000 Syrians -- he stressed that "having a scattered refugee population... makes the assistance more complicated."
A critical change since a last MSF survey in June was that the number of refugees hosted by Lebanese families had plummeted.