Everyone is overwhelmed. United Nations bodies are desperately trying to raise funds, the Lebanese government is seeking to maintain control and local and international charities are providing care to the refugees across the country, all seemingly unable to cope with the sheer scale of the crisis.

A country that is home to little more than 4 million people, Lebanon currently hosts 600,000 Syrians who are registered or awaiting registration with the UN, and the total number is estimated to be much higher. Among the refugee community needs are increasing, as those with savings run dry, while within the Lebanese population many previously poor people are increasingly destitute as cheap Syrian labor pushes down wages. Dealing with this is an unenviable task.

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Interactive map of Syrian refugees in Lebanon

But while the scale of the crisis and its devastating impact on Lebanon has been so vast no single organizational structure could have dealt with it in its entirety, serious questions are being raised about the way in which all bodies have responded to the crisis. The impression insiders give is that much of the response has been inadequate, myopic and badly coordinated.

A delayed reaction

Perhaps the worst case of inertia has come from the government itself. When the Syrian crisis started in early 2011, the government’s position was to remain neutral because of its close relationship with President Bashar al-Assad. There was little discussion of the crisis continuing for more than the immediate months, partly because many expected the Syrian conflict to end quickly as other uprisings in the region had. It was not until 15 months into the crisis that the Lebanese government produced its first crisis-management plan.

Even government officials say the response has not been ideal. Makram Malaeb, program manager at the Ministry of Social Affairs, admits “there was a period of time when there was a denial,” while Ramzi Naaman, lead coordinator of Lebanon’s Syria response plan, believes that the government has failed to understand how fundamentally the crisis is changing the country. As such, he says, their response has been piecemeal, with no medium-term planning. “They are not scared enough,” he told Executive.

The health sector epitomizes many of the concerns. A recent paper in the UK-based health journal The Lancet found that “pressure on domestic health systems is immense,” with hospitals struggling to cope with a sharply increased workload, even though capacity has not increased. Among the concerns are new diseases, such as the skin disease leishmaniasis — which is common in northern Syria but not in Lebanon — brought to the country by Syrian refugees, as well as a dwindling number of available beds.

Fouad Fouad, member of the Faculty of Health Sciences at the American University of Beirut and co-author of the Lancet report, believes medium-term planning could have allowed the government to use the crisis as an opportunity to invest in much-needed infrastructure. “My feeling is that with this long-term crisis, the only way to face [this] issue is to adapt the system to absorb more, or to be the kind of system that deals with such an unexpected crisis.” Instead, he says, the government has hoped the current infrastructure will be able to cope.

Fouad was in fact tasked with drawing up part of the government’s strategic planning document for dealing with the Syria crisis. Shuffling through the files in his third-floor office he produces the document, which calls for major investment in hospitals as a way to help benefit the local population as well as aid refugees. The plan, he says, was delivered at the end of 2012 but was never published. “Can you believe that this is the only copy? Well maybe they [the government] have another copy,” he says. “It’s just all papers, and documents, there’s no action plan.”

Syrians using Lebanon’s hospitals have put a strain on the country’s infrastructure

Critics of the government argue the Syria file has not been taken seriously enough. Syria has been dealt with primarily as a humanitarian crisis and thus has fallen under the remit of the Ministry of Social Affairs (MoSA) — one of the smaller ministries with historically little sway — while the Ministries of Health, Education and Interior have played smaller roles. 

There have been numerous calls for a new strategy recognizing the scale of the crisis. Ziad Sayegh, a former advisor to the Ministry of Labor, is among the leading voices for such a framework. Speaking to Executive in late June, he called for either an independent but powerful body of around a dozen expert technocrats to coordinate the government’s response to the crisis or, more radically still, an independent ministry within the government dedicated to dealing with the crisis. “We have an executive opportunity, now this is the right time,” he says. “The new prime minister along with the president should have a serious look at this proposal without going into political agendas.”

Sayegh is, of course, referring to Tammam Salam — Lebanon’s prime minister-designate. Since former Prime Minister Najib Mikati resigned his government in April, Salam has been trying to form a new government — a process unlikely to end soon. With Parliament’s term ‘temporarily’ extended by 17 months due to the deadlock over elections, the office of President Michel Sleiman is now the only fully functional part of government.

Antoine Haddad, secretary-general of the Democratic Renewal Movement, organized one of the first major conferences on the impact of the crisis on Lebanon. Haddad, who is close to the president, thinks a prolonged period without a government could force Sleiman to take matters into his own hands and reshape the response to the crisis. “The [prime minister] is more fit to [deal with] this, but I suppose that there is a possibility that we live without a government for a long period. So what shall we do? I think in this case the presidency shall have to deal with the issue.”

A shifted burden

Without a coherent political response, much of the burden for responding to the crisis has fallen on the international community. UNHCR, the UN’s refugee body, has led the response to the crisis, simultaneously coordinating the operations, implementing them and partnering with NGOs to deliver assistance. They have launched five, six-month long Regional Response Plans (RRP) in which they have appealed for funding. But they have found the sheer scale of the crisis difficult to cope with.

Syrian women receive aid packages from one of many NGOs working on the situation

In January this year, they launched RRP4 based on an estimated 300,000 refugees coming by the end of June. By mid-February that number had been surpassed, but they had only raised 48 percent of the desired funding. As such, many assistance programs had to be scaled back dramatically. “We have to make difficult choices every day in terms of who we assist and how much assistance we can give,” Joelle Eid, information officer at UNHCR, says.

While the funding crisis is acute, questions have also been raised about UNHCR’s role. Historically, the body was not as heavily involved in Lebanon as the Palestinian relief agency UNRWA. UNHCR has thus grown rapidly, from just 50 staff in 2011 to 400 currently, and questions are being raised about its capacity.

Olivier Beucher, head of the Danish Refugee Council in Lebanon and the chair of the body that represents the top international NGOs in the country, believes the UN agency is overloaded. “Too much is demanded or required from UNHCR… Now with the size of the crisis in Lebanon, the caseload is so high that they can’t do this,” he says. Beucher suggested that there are a range of other ways in which the system could be organized, including a cluster-style system where different agencies take on different key sector coordination roles, working in closer conjunction with the government and NGOs.

Making difficult choices for the future

As it becomes increasingly clear that the crisis will continue to affect Lebanon for years to come, those in the field are concluding that a medium-term plan is necessary. The principle of aid targeting perhaps provides an example of how a lack of strategic planning early in the process can encumber the response later on.

In theory, targeting aid is the right thing to do. With a refugee crisis of this severity and funding shortages, it is not possible to provide quality care to everyone. As such, aid agencies should provide support to the most vulnerable. “Either you reduce the assistance, or you don’t deliver assistance to everybody. And we do believe that the combination of both is and was needed a long time ago,” Beucher says.

The current plan is to target aid in three particular areas: food vouchers, hygiene kits, and baby kits, starting in September. The aim is to reduce the amount of people receiving these services in order to support the most needy. But Beucher believes that poor planning has made it difficult to differentiate those who are more in need than others. 

Normally, in order to make needs-based assessments, he says, aid agencies would visit “every set of families [that register] to make sure that people are not lying [about their needs].” This is most easily done when families first register, but the UN has merely recorded the “bio data” — basic information about the families.

As such, Beucher says, there is little chance that the targeting can now be accurate. “Our worry is that the UNHCR will do the targeting on its own based on the criteria that they gathered, but this will have a big error in the selection… [then] they will ask the NGOs to verify that these people are vulnerable, and we know we will find a lot of people that are not as vulnerable as they mention, and they will need to be excluded from the assistance. And this is where you have conflict with the refugee families,” he says. 

Beucher believes this could endanger his field workers as they will be forced to tell refugees they are no longer entitled to, for example, food vouchers. A key way to avoid this is a major communication push to let refugees know. For a program due to launch in September, the UN is perhaps running a little late. UNHCR’s Eid told Executive in mid-July that the “criteria [for who is eligible for targeted assistance] has not yet been set”, but that they hoped to finalize the terms of targeting by the beginning of August. This will leave the body with a month to communicate the new policy to the huge refugee community.

Eid admits problems in the past with communication but says they are being resolved. “This time we are devising a strategy whereby we would communicate to refugees the changes that are expected to happen,” she said.

Better communication

If the UN has struggled to communicate with the refugees, then coordination with the government and NGOs is also sub-optimal. Insiders talk of communication breaking down between different bodies, meaning they are often duplicating work or failing to share information. UNHCR’s Eid denied these claims, saying, “I have not heard of these rumors.”

“Unfortunately the coordination is [poor] on many levels. You need to have a strong strategy for collaboration. I know that several UN agencies working here, but there’s no one plan for all. And many big international organizations don’t talk to UN agencies,” AUB’s Fouad says.

In recent months, however, there have been a few positive signs that the entities are starting to work together better. In June the UN launched its fifth RRP calling for funding from international donors. For the first time, the government was a partner in the bid, with $450 million of the $1.7 billion appeal aimed to support government projects. This, Eid says, was a major step toward improving the response plan.

Similarly, in recent weeks the government established a trust fund with the World Bank. While the size of the fund is still being confirmed, Naaman said the basic plan is that it “is under the government’s responsibility, along with an international partner that is concerned in the issue, so they will be doing a sort of supervision so that everything is [transparent].” In June the acting government released a new plan for dealing with the crisis. Despite the lack of details, it promises that they are tackling the matter in a more serious manner.

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Interactive map of Syrian refugees in Lebanon

However, unless there is a new government, there is little hope that the response to the crisis will markedly improve. Without a carefully orchestrated national strategy, the refugee crisis is likely to remain in the hands of the overstretched UNHCR — making essential medium-term planning less likely.

Note: This article originally said Beucher proposed a cluster system