Geneva/Beirut/New York - While Lebanon has absorbed tens of thousands of refugees fleeing the conflict in neighbouring Syria in recent months, many people are living in overcrowded conditions, suffering psychological distress, are fearful for their safety, and are unable to afford medical care, said the international medical humanitarian organisation Médecins Sans Frontières (MSF) in a report released today.

The MSF report, Fleeing the violence in Syria: Syrian refugees in Lebanon, details the living conditions and health of the refugees and the major challenges facing them, including access to housing, food, water, sanitation, healthcare, and security. Most refugees are settling in economically disadvantaged regions of Lebanon, placing an additional burden on already overstretched resources. Gaps are appearing in refugees’ access to medical care, particularly hospital care and treatment for chronic diseases.

“The refugees are really being tested,” said Fabio Forgione, MSF’s head of mission in Lebanon. “When they arrive, most are struggling to deal with the consequences of direct violence and loss; then they have to face the reality of not being able to go home. Many lose all hope.”

Of the 5,000 refugees interviewed by MSF, three-quarters fled Syria as a direct result of the conflict and 40 per cent have lost family members to the violence. The majority say they have not found the security they sought. Lebanon is itself unstable as a result of the Syrian crisis, evidenced by recent violent tensions in the country’s second city, Tripoli.

Feelings of hopelessness and alienation are widespread. Nine out of ten people interviewed see their future as highly precarious and do not know if they will be able to return home.

As more and more Syrians cross into Lebanon, living conditions for the refugees are deteriorating.

“There are severe overcrowding problems in Wadi Khaled in northern Lebanon and in Aarsal in Bekaa Valley, while in Tripoli, rental costs are beyond what they can afford,” said Forgione.

Most Syrian refugees in Lebanon rely on humanitarian assistance, which is now coming under threat. So far, the combined support of host communities, the government, and humanitarian organisations has averted a major health crisis. Individuals within the Lebanese community have made tremendous efforts to integrate and help the refugees, but financial constraints are limiting what they can do. Reductions in assistance could put the refugees’ health in danger, MSF warned.