BEIRUT: We’ve been in Haifa Hospital for precisely seven minutes before the power cuts out. The clock on the wall by the reception booth sits proudly between a picture of Yasser Arafat and a plastic sign showing a Kalashnikov rifle struck through with livid red lines. No guns. This is a hospital, after all. “Electricity is one of our biggest problems,†says Dr Alim al-Ahmed. “You’ve lived in Beirut [where shortages lead to roving power cuts], so you know the problems we have. Here, those problems are ten times worse.†Haifa Hospital is where Palestinian refugees in Lebanon go if they are sick. At least those who can afford to be sick. Situated in the heart of Bourj al-Barajneh – a camp where an estimated 20,000 refugees survive in a single square kilometer of south Beirut – the Hospital has 30 beds and six full-time doctors. In the next 30 minutes the power goes out a further six times. Each time the two head trauma surgeons, sitting languidly in their air-conditioned office, halt their paperwork for the briefest of moments and resume with eyes squinted. Dr. Suzie Millar, Head of A&E at INOVA Fairfax Hospital in Washington, on a Middle East tour to raise awareness on ward hygiene, heard about Haifa’s power cuts and has brought provisions. She rummages in her backpack, pulls out two headlamps with elasticated straps and hands them to the white-coated doctors. As the surgeons play with the lights, shining faint yellow beams onto the back of their hands, Dr Millar explains what the equipment will be used for. “They’ll use these for operating when the power cuts out,†she says, as if exasperated by the prospect. “Back in DC we have $10,000 LED lights for operations. Something like these would never be used for anything, except maybe going camping.†After being guided through the hospital’s three floors, it becomes clear that Dr Millar’s comments were not said in disparagement. Since this one building has to provide medical care for the more than 50,000 Palestinian refugees living in Beirut, it is something not short of a miracle that any operations take place here at all. The facility is funded entirely by the Palestinian Liberation Organization, which saw fierce conflict with both Israeli and South Lebanese armies during Lebanon’s fifteen years of bloody civil war and still operates within the country’s camps. Ahmad Iskander, from the Palestine State Embassy, explains how it handles any hospital’s most challenging operation: finance. “If a woman comes to us and needs attention, we know she cannot afford it. The cost of a bed is 125,000 LL ($75) a night and that’s without drugs or treatment. “We will ask her for what she has, make some inquiries and we will get her the money.†She will be helped because she is Palestinian. The same treatment doesn’t apply outside the country’s 14 official camps. Lebanon has an estimated 420,000 Palestinian refugees in its midst, yet healthcare is a luxury about which the majority cannot dream. Hoda El-Turk, spokeswoman for the United Nations Relief and Works Agency for Palestinian Refugees in the Near East (UNRWA) explains how 51 doctors, 119 nurses and 163 paramedics have to administer care to nearly half a million people – the vast majority of whom belong to the lowest socio-economic group most likely to require medical attention. “Tertiary care is very expensive. The patient’s contribution ranges from 30% to 70% with an average of 45%,†says El-Turk. “This is a real burden on refugees, especially if the head of the family is affected. The main complaints of the community relate to the cost of hospitalization at this level.†These challenges faced by refugees aren’t going away. In fact, they’re increasing. Dr. Ichlas is in charge of Haifa’s maternity unit. Trained in Russia, she has the frizzy bob and sturdy gait of a Siberian matrushka. She says a team comprising her and two midwives delivers about 50 babies a month. Dr. Ichlas explains that although UNWRA runs regional maternity clinics for consultations and antenatal care, up to 30 percent of Palestinian births are done at home. On the way out of the ward, there is a tiny, jaundiced baby stretched out in an incubator as if sunbathing under the UV lamp. Although she can’t be more than two days old, her ears are pieced with aquamarine and gold studs. The nurse, coming to check on the girl, strikes up a Marlboro Light before readjusting the light. Dr. Ahmed shows visitors around the A&E department, made up of three rooms and as many beds. “We have antibiotics, analgesics, anticoagulants. We have no chemotherapy treatment because we don’t treat cancer patients,†he says, rattling off more forms of simple treatment that are too expensive to administer. The hospital sees an average of 10 serious trauma cases a week. Often, Haifa’s facilities are woefully inadequate for the treatment required. “There is no such thing as an average day, a patient can come at any time, although mostly at night,†says Dr Ahmed. “Most commonly we have cardiac patients. We also see injuries sustained in quarrels, gun-shots and stab wounds, especially at the weekend.†The survival rate for trauma victims is respectable, and Dr Ahmed talks with deep pride about some of his more successful cases. “Once we had a patient with an injury to their arm. We thought we were going to have to amputate it, but our orthopedic surgeon managed to save it and get blood flow back to the arm. “[The patient] now has full use of it.†Passing along a ward with brightly painted walls in primary colors, each room is filled with a patient and apparently half their extended family. There is an old man in his underwear reclining on a busted sofa-bed with a drip in his arm and a cigarette in his mouth. Dr Millar, despite being evidently appalled by the place’s sanitation, has nothing but admiration for Haifa’s physicians. “These people are working without even the most basic of equipment. They don’t even have a CAT scan and for trauma surgeons that is unbelievable. “In the States, anyone with anything suspect gets sent upstairs [for a CAT scan]. Here, they have no idea what’s happened until they open them up.†In an upstairs trauma surgery theater, a brand-new ventilator sits forlornly in the corner, packaging still loosely draped over its monitor. Dr Ahmed explains why it isn’t operative. “Unfortunately, no one knows how to use it.†It’s a story that applies to thousands of displaced peoples in Lebanon. As Palestinian refugees, these doctors in particular are barred from working anywhere in Lebanon, except at Haifa. All of them have trained in Europe, Russia or the Middle East, and are easily as qualified as US or British medical staff. That they are outstanding physicians goes unacknowledged by circumstance. They work with what little they have, saving lives when they can, but more often watching patients die because they lack access to facilities a mile way that would see them saved. “These are first-world doctors, working in third-world conditions, in a country with first-world facilities,†says Dr Millar. Social and educational difficulties contribute to the exasperation of Haifa’s doctors. Dr Ahmed explains how cases of suspected violence are commonplace, often leading to badly injured women refusing medical treatment for fear of spousal retribution. “Yes. It is common,†he sighs. “We also see suicide attempts very often, mainly from young females. They have problems with their families and they see this as the only way out. We deal with these cases and then send the patients out for [therapy].†Dr Ahmed speaks on all things medical with measured passion, still approaching every case with a clinical zeal and a determination not to let limited resources circumscribe his medical skill. Some cases, he concedes, bring him to the verge of despair. His mood deepens as he tells of one woman’s death. “Once there was a female patient, about 20 years old, with a fractured skull. I asked her about the cause [of the injury]. She wanted to light a cigarette and used a gun. Apparently it looked like a lighter, but it was a real gun. The bullet entered through her nose. She died in the hospital.†Outside the maternity unit, on the way back into the camp’s squalid alleyways, a man sits, barely fitting on his garden-furniture chair, head buried in his huge hands. A nurse in baby pink scrubs emerges from theater and removes her facemask to reveal a beaming smile. The man – big as a bear, strong and ruddy – crumples into tears of joy. BM
