“I wish for death,” says Umm Khattab*, a Syrian refugee who has called a flimsy tent along the northeast border of Lebanon home for years. “We live in constant anxiety and terror. Death has become more merciful than living here.”

Her words capture the stark reality faced by tens of thousands of refugees in Hermel, Qaa, and Arsal, Lebanon, where makeshift camps of tarps and scraps dot the arid landscape. These frail shelters offer little protection against the harsh elements and even less against the rising tide of anti-refugee sentiment in Lebanon. Refugees, crammed into inadequate spaces with dirt floors and no heating, grapple daily with the fear of security checkpoints and local tensions.

“Fear keeps my family of 10 crammed together in the tent all day,” says Wael*, who has hypertension and diabetes. “We never leave the tent after 6 p.m., as that is when the curfew on Syrians is imposed. The children never go out, and they face bullying from the local children.”

Wael has been a patient at the Médecins Sans Frontières (MSF) clinic in Hermel for a few years now, receiving vital medication for his chronic conditions. But recent measures have made access to lifesaving care increasingly difficult for refugees.

Since April, Lebanon has intensified raids and security measures to address the issue of unregistered individuals. As a result, Syrian patients seeking healthcare at MSF clinics in the Baalbek-Hermel governorate face growing barriers due to fears and restrictions on their freedom of movement. For many refugees in the governorate, the decision to seek medical help is now fraught with fear. One such example is Wael, who must cross a checkpoint to get to the MSF clinic in Hermel.

“I always feel anxious when I have an appointment at the MSF clinic,” confides Wael. “I fear the security checkpoints. My appointment was on 20 May, but I was afraid to go out because of a security campaign in the area, so I decided not to go. The fear causes my blood sugar to rise, and I worry I won’t have the means to lower it.”

During these security campaigns, Syrians with expired papers are often captured at checkpoints and forcibly deported back to Syria, usually without the chance to contact their families in Lebanon.

Other patients with chronic disease have resorted to rationing or abandoning medication altogether out of fear of leaving their tent to get them. A few miles away in neighbouring Qaa, Amer*, also living with hypertension, had completely run out of his medication in April.

“I ran out of medicine and don’t have the means or courage to go for a refill,” says Amer. “I have nightmares of being chased by the authorities. I do not dare cross the checkpoint and be taken away from my family perhaps forever.”

“I suffer from high blood pressure,” says Talal* from the floor of his battered tent in Arsal. “I started taking medication two months ago because of a rapid heartbeat, and my blood pressure regularly spikes above the normal range.”

The only way Talal was able to traverse the mountainous landscape of Arsal to get his medication was by riding a battered motorbike that was recently confiscated. A recent countrywide crackdown on unregistered vehicles in Lebanon has caused many Syrians to lose their motorcycles—which often serve as their only means of transport after the economic crisis.

“It was our only means to take care of our needs,” laments Talal. “If I want to go buy food for my family or get my medical consultation and medication from your clinic, I will need to rent a motorbike or a tuk-tuk, which is cheaper than a car but still too expensive for us.”

MSF has been present in the Baalbek-Hermel governorate, in the northeast of the country, since 2010. For over a decade, we have been providing free-of-charge medical services including paediatrics, sexual and reproductive healthcare, treatment for non-communicable diseases, vaccinations against preventable diseases, and mental health support for refugees and the local community alike. Currently, MSF teams run a clinic in Arsal and another in Hermel, as well as supporting access to advanced healthcare through partner hospitals. Yet, even amidst this beacon of assistance, missed medical appointments soar as fear tightens its grip on the refugee community.

Two tents down from Amer’s shelter lives Umm Omar*, who delivered her baby at home less than a month ago. Umm Omar’s memory of the night her water broke unexpectedly is hazy, but she recalls clearly how the community’s fear of crossing army checkpoints kept her confined to the tent’s dirt floor, battling the pains of labour without anaesthesia.

“I was screaming in the dead of night, and no one could take me to a clinic,” says Umm Omar as she swaddles her newborn. “They called for a fellow refugee here whose mother was a midwife. She thankfully delivered my baby by memory of the practice. But I still can’t leave the camp to get him a birth certificate.”

As Lebanon strains under its fifth year of severe economic crisis, Syrian refugees face more intolerance in the country. The economic hardship, compounded by fear of movement, has forced refugees into an impossible choice between their safety and their health. Even lower on the list of priorities for refugees is their mental health.

“We live in constant anxiety and terror. I can't even sleep due to these security campaigns and my fear for my children,” says Umm Khattab, who has been suffering breakdowns since her son was deported in late 2023. “Our children's hearts race with fear and anxiety during these campaigns, and we only hear the phrase, ‘Here they come!’ I try to comfort my children, but inside I am more afraid than they are.”

“After several years of displacement, some Syrian refugees have developed further psychological symptoms,” says Amani Al Mashaqba, MSF’s mental health activity manager in Baalbek-Hermel. “High psychological distress is present in the refugees because of repeated crisis events. Changes in behaviour related to exposure to traumatic events have been reported by our mental health patients in both adults and children. People are tired. They feel insecure, depressed, and down.”

The Syrian war, which began in 2011, led to widespread destruction and violence, displacing millions of people to neighbouring countries. The ongoing instability has left Syria unsafe, making it challenging for many to return to their homeland. Vulnerable communities’ access to healthcare in northern Lebanon should not be hindered by fear or intimidation. Patients should not have to choose between their safety and seeking medical help.