The British press is fixated on the highly politicised issue of small boat crossings across the Channel. ‘Refugee crises’ are painted as sudden, volatile scenarios, describing people moving across borders, land, and sea. Little is printed about how, for the majority of the world’s forcibly displaced peoples (over 100 million, by May 2022), their situations are marked by physical stasis. On average, displacement lasts twenty years for a refugee, and over ten years for IDPs (internally displaced persons, who have remained within their country of origin). These statistics come alive in the Beqaa valley in Lebanon, where I have spent the past month volunteering with Syrian refugees. Speaking with the women who attend our charity’s centre in Saadnayel, we’ve chatted about our families and communities, the people we share our spaces with. Many women tell us that they’ve lived in their homes informal tent settlements scattered across the region since 2012, when the Syrian Civil War began.

The physical stasis that these conversations reveal, too often overlooked by national press, contrasts with the precarity and unpredictability of basic assistance. Since 2019, Lebanon has been in economic collapse, characterised by a halving of the country’s GDP, hyperinflation, electricity cuts, and an estimated 80% of its population under the poverty line. Such instability has made external funding for refugees’ healthcare increasingly limited. Both before and during the crisis, Syrian refugees have been obliged to pay for hospital visits themselves, or to rely upon a loose network of medical NGOs whose assistance can be haphazard and patchy. My friend, volunteering here as a nurse, comes out of each first aid lesson with a report of the different illnesses the female attendees have asked her about. She answers questions case by case, but for more serious issues she refers them to a medical NGO which holds free mobile health clinics around Saadnayel, although pinpointing when they will appear is more of an art than a science.

My friend comes out of each first aid lesson with a report of the different illnesses women have asked her about

Handling this institutional disorganisation has been a source of frustration for our team, but as time passes, I’ve started to wonder whether it is a symptom of deeper flaws within international refugee health assistance. Policymakers and organisations have, for some time, considered ‘refugee self-reliance’ as a key pillar of a ’sustainable solution to refugee situations’. In searching for these durable solutions to displacement, an economic approach is usually adopted, finding ways to optimise refugees’ integration into labour markets, alongside inclusion into local communities. Yet this focus on self-reliance should go further; alongside economic ventures, it is crucial that refugees are also empowered with health literacy, to create stability in increasingly unpredictable and precarious health contexts.

‘We have a lot of misconceptions like applying toothpaste to burns and coffee to wounds’

We take our own health literacy for granted. This ‘capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions’, as defined by the NIH, is far from universal. At TheHealthImpact, the charity I am volunteering with, attendees at our classes learn about first aid, such as CPR, as well as how to deal with less severe injuries such as cuts and fractures. Khadijah*, from Idlib in Syria, confirmed the importance of these lessons “because we have a lot of misconceptions like applying toothpaste to burns and coffee to wounds”. Teaching how to treat these minor injuries is particularly important as it prevents infection, and thus long referrals to expensive hospitals or free (but unpredictable) clinics.

This grassroots initiative has proved remarkably effective at spreading information about health through Saadnayel. In one year, the charity has reached over 600 students, benefitting more than 3,504 people, as the classes’ attendees – predominantly women – are equipped to look after their own families’ health. In turn they teach their friends and family, or refer them to the charity’s centre. Additionally, the free provision of first aid and hygiene goods costs significantly less than pharmacist or hospital services, as ten dollars includes enough supplies for one family, for a month.

Most significantly, such community-centred approaches foster the ‘health and dignity’ of local refugee populations, in a way that is stable and self-empowering. Back in 2020, I wrote about the looming impact of COVID-19 in refugee camps across the Aegean Islands in Greece. Two years later, I’m struck by how poor health infrastructure persists among refugee populations, like in Lebanon. I don’t mean to compare and contrast the different health conditions of refugees across the world: to call certain situations inherently ‘worse’ or ‘better’ than the other is a mistake, because each health situation is far from what we take for granted. I intend only to point out their commonalities. Most have unstable access to proper healthcare, either due to limited personnel, or the prohibitive cost of accessing education. While I still urge the mending of funding gaps in healthcare provision, health literacy offers a ground-up approach for certain immediate needs (as echoed by a WHO report).

As people remain in circumstances of protracted displacement year after year with limited improvement in living situations, we must also consider a deeper shift towards refugees’ self-reliance, self-empowerment, and dignity. They are people with agency, not simply passive masses to be reported on, or to be helped in haphazard ways. The difficulties of protracted displacement will persist, as will unpredictability in healthcare scenarios. But where one positive kind of ‘stasis’ and stability can thrive is within refugees’ own education and community knowledge.

Names with an asterisk * have been anonymised for safety.