By May Haddad MD.MPH This paper was presented at 12th. Congress on Poverty and Health, Berlin, Dec. 2006- Dedicated to the people of Lebanon for their resilience, dignity and solidarity that they had shown during the Israeli invasion of Lebanon in summer 2006

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May Haddad
Turning relief into self reliance?
Tribute
To people living in Lebanon for the resilience, dignity and solidarity that they have mani-
fested during the latest Israeli war on Lebanon, July 12-Aug. 14, 2006
War on Lebanon
July 12 marks the beginning of unacceptable, extremely brutal & violent 5 weeks1
: One mil-
lion people (almost one third the population) flee their homes2
, 1184 civilians are killed &
4059 are injured3
, many children are among the victims4
, tens of massacres are reported5
,
tens of thousands homes are destroyed & damaged, 73 bridges are bombed all across the
country, tens of fuel stations are burnt, & a major breakdown occurs in the public health
infrastructure including water & sewage, power supply & generators etc. More than one
quarter of the health facilities are badly damaged & dysfunctional6
; two hospitals are de-
stroyed as well as hundreds of schools. Oil spill on more that 150 km of shore, damage not
limited to Lebanon but threatens all Mediterranean Sea. Gigantic mine fields are created with
over one million unexploded cluster bombs7
…
People living in Lebanon demonstrate solidarity & spontaneous support to each other despite
their religious, political & class differences: 735,000 people find refuge with families, schools,
and centers located in relatively safer areas in Lebanon8
. Almost everybody offers help within
1
During the campaign, Israel's Air Force flew more than 12,000 combat missions. The Navy fired
2,500 shells, and the Army fired over 100,000 shells [43]
, destroying large parts of the Lebanese
civilian infrastructure. 400 miles of roads, 73 bridges and 31 targets such as Beirut International
Airport, ports, water and sewage treatment plants, electrical facilities, 25 fuel stations, 900
commercial structures, up to 350 schools and two hospitals were destroyed, as well as some 15,000
homes. Some 130,000 more homes were damaged, Wikipedia
2
According to High Relief Commission about 130,000 people found shelter in about 760 schools, more
than half a million found shelter with families, friends, churches, mosques, etc and about 270,000 fled
Lebanon to neighboring countries (mainly Syria).
3
GOL & Higher Relief Council, Aug. 24, 2006
4
As one example, 28 of the new Qana massacre (July 30) are children
5
Many massacres happened when Israeli planes bombed people who are fleeing their homes, in-
cludes caravans that The Israeli themselves have authorized
6
WHO, Oct. 11, 2006
7
The most disturbing act was that 90% of these bombs were dropped in the last 72-hours of the
conflict when it was clear that a cease-fire was eminent (UN report)
8
230,000 person fled to neighboring countries

2. May Haddad: Turning relief into self reliance?
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his/her capacities9
. Civil society, NGOs & humanitarian agencies form platforms & coalitions
to complement each other & meet basic survival needs10
.
Lebanon witnessed a humanitarian shortcoming with departure of senior UN staff from Le-
banon & delay in emergency response (The UN response comes after two weeks of crisis
initiation). It is to note that international relief agencies (who are new to Lebanon), para-
chute into the country with different agendas without proper consultation/ coordination with
local counterparts.
My life froze…
My life froze on July 12; all activities that I have planned become irrelevant…
I am devastated with the killing, massacres, bombing & massive destruction happening. Ad-
ditionally, I fear other unseen bombs that can be masked under Relief.
Despite the need for relief, we have not been prepared for such emergency nor have we
mechanisms to coordinate the efforts of the different stakeholders. Lebanon does not have
national policies, protocols nor plans for emergency operation despite the fact that this has
not been the first catastrophe of the kind.
This implies that relief can be chaotic, unplanned & haphazard. People in charge can inflict
harm despite good intentions…
Indeed, my fear proves real…
To date, the Ministry of Environment is still unable to disperse tons of expired medicines that
have been dumped into Lebanon.
Pharmaceutical dependency is a known issue in Lebanon with over-prescription by physicians
& demand by clients. The magnitude of the issue has most likely worsened during the war in
Lebanon with the irresponsible availability of the Relief medicines & the desired demand of
clients to store more & more quantities fearing of shortages. Unfortunately, the risk & dam-
age inflicted by the pharmaceuticals that have been widely distributed is been assessed (to
note that many of these drugs lacked instructions; & when present have been in languages
that very few can read11
).
9
People would draw sign maps next to bombarded bridges to show people fleeing their towns rela-
tively safe roads, artists & educators organize workshops & sessions with children of displaced fami-
lies, people donate clothes, food to other etc.
10
Such as Samedoun, NGO platform of Saida, Civil Campaign for Relief, the Collective of NGOs in
Lebanon etc.
11
I have seen many pharmaceuticals with instructions that are unreadable to many including Italian,
Spanish & Greek. Additionally, many drugs lacked instruction papers

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Additionally tobacco & cigarettes donations have been included in the relief items. The mag-
nitude of the issue is under study12
.
Promoting & disseminating infant milk formulas goes on unchecked for weeks after the initia-
tion of the crisis without noting its’ hazardous impact on breastfeeding; it is to be noted that
multi-national milk companies hook mothers to using infant formula during its’ distribution
through relief 13
. Aid workers immediately handle the formula to the displaced mother who
thinks that her milk has turned bad because of the war & related tension or has experienced
a decrease in its’ flow; without counseling or advise that the mother can & should continue
giving her child the best, her own milk14
. Mass distribution of infant formula has been re-
ported15
. Sarcastically, the GOL & respective UN agencies succeeded in issuing a joint state-
ment in mid. Oct. after the damage has been incurred…
Relief agencies can create dependencies. Families, who initially have been reluctant to re-
ceive aid, request it as a right over time.
Turning relief into self reliance?
Minimizing the potential long term damage of relief & maximizing its’ short term benefits has
been an issue to many of us involved in community health actions during the war in Leba-
non.
With the delay in action (or its’ absence at a policy level), many of us developed strategies
that are people centered…
Here is a synopsis from one experience16
:
12
Researchers from Public Health Department at AUB have recently paid attention to the issue
13
The consequences of these in decreasing breastfeeding together with the low availability of clean
water contribute to increased incidence of diarrhea
14
Many organizations were reported to be involved in infant formula distribution to all mothers under
their catchment’s area. The magnitude of this distribution is not fully clear, although HRC was one of
the main agencies involved in this, and the consequences of such activity is not clear. Such practice,
in addition to the stress caused by the war, may have affected infant feeding practices. Thus, the
incidences of breastfeeding may have decreased and the low availability of clean water may have
contributed to an increase in the incidence of diarrhea, UNICEF report, Distribution of infant formula
during the Lebanon Crisis, 2006
15
UNICEF report, Distribution of infant formula during the Lebanon Crisis, 2006
16
Emergency response: Mother & Child Health, implemented by ANERA in partnership with IRAP,
Najdeh, Palestinian Women Humanitarian Organization, Amel, Jaber, & LFPA, July-Oct. 06. This inter-
vention succeeded in reaching out to over 15000 mothers & their young children through dissemina-
tion of under three kits & mothers kits & providing educational sessions whereby mothers learn practi-
cal skills such as home based oral rehydration mix & other.

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It is becoming obvious to us: The scale of the crisis is incredibly huge; most of the agencies
adopt traditional approach in distributing food items & non-food items; with minimal atten-
tion to the inherent resources of people themselves. “We do it for them…when we can… and
with what we have” has been a mainstream approach in relief delivery.
We decide to pay attention on the needs of mothers, infant & young children as we know of
their vulnerability & that other are not paying attention. We also decide to build on the as-
sets & to enhance partnership with mothers themselves.
We challenge Relief as an opportunity to build the capacity of relief /community workers to
understand better the health issues & develop skills of community health activists…
We challenge Relief as a time to reach mothers with doable actions that they can do to pro-
tect/promote health.
We challenge Relief by creating opportunities for change within structures, attitudes & prac-
tices.
Providing commodities that are useful, safe & culturally sensitive & that mothers & young
children need has not been a straight-forward task. It means that we need to continuously
reflect on our actions, examine the truth of our criteria & modify17
. It also implies that we
need to undo the damage of multinational companies & the impact of media in promoting
expensive & un-essential commodities & brand names. We discover in the process that
community workers themselves are un-sensitized & that there is a need to develop with
them critical thinking that helps them examine the impact of every relief commodity on
mothers & children. In addition to carry on the same process with mothers themselves…
We also discover in the way, that relief can be an experience that helps us realize real
needs; & that we can succeed in transforming relief into development, by simply paying at-
tention to what we do & how we do it.
We also realize that with minimal capacity building efforts, we can succeed in empowering
community workers & mothers. We note that interactive, participatory & hands on learning
process is effective in enhancing our capacities as community health activists & that of
mothers.
We are to examine our working principles that guide our work.
We list: cooperation, partnerships, building on assets, reflect & improve sensitivity to values
& traditions, hope, seeking better life, caring, love & respect.
17
As an example, when we have decided to include thermometers in the under three kits based on
feedback that mothers provided, we have been faced by new dilemmas; the available mercury ther-
mometer in the market can be unsafe to distribute & we are better off replacing them with digital
thermometers that proved to be non-existent i in the market.

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The following are actions that help us maintain achievements18
:
We are to establish platforms for continued communications, networking, sharing & learning
new skills among each other in a similar spirit to this experience
Developing & disseminating a production on our experience in learning helps us refresh our
information, adapt/apply contents to our community actions & provides a reference to help
other peers learn
We are to continue supporting mothers & children through many interactive approaches
We have developed best practice list of doable actions that mothers can do. We can use
such lists to plan our activities/interventions
We are to continue recruiting youth (both male & female) & volunteers (include moth-
ers/housewives themselves) in community actions & enforce their vital role in wider cover-
age & outreach
We are to integrate children in our community actions both as activists and as beneficiaries.
Doctors & nurses are to be addressed with an update of scientific health information particu
larly in infant nutrition & breastfeeding
Delivery/Birth facilities are to be updated with best practices to support breastfeeding.
All primary health care clinics within the reach of our structures are to be encouraged to ad-
vocate best practices that mothers can do & create supportive environments to promote
breastfeeding
We need to actively work in identifying/researching inexpensive /affordable /useful alterna-
tives to medicine, processed & canned food, infant food etc.
We are to explore creative approaches in our work, we can organize festive activities such as
health festivals/campaigns & present skills through entertaining & engaging skits, theater &
games. We can also utilize special events/dates to conduct entertainment education happen-
ings etc.
Developing/disseminating appropriate publications targeting mothers & community members
& engaging mothers themselves in developing learning materials are useful approaches.
18
Summary of Reflect & Improve Process that engaged over 150 decision maker & community work-
ers from 7 partner NGOs working in emergency mother & child health intervention during the crisis in
Lebanon (paper by May Haddad, Putting the element together, Towards Effective Actions in Commu-
nity Health, Nov. 06)

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NGOs are called upon to enhance cooperation among each other towards better health,
wider coverage & better outreach
We are to enhance networking among each other & among local groups & communities.
And finally, to conclude; as one community worker said:
‫ه‬ ‫ك‬ ‫ي‬ ‫إ‬‫ه‬ ‫ك‬ ‫ي‬ ‫إ‬......‫ﻥ‬ ‫و‬ ‫آ‬ ‫ﺡ‬ ‫ون‬ ‫ا‬‫ﻥ‬ ‫و‬ ‫آ‬ ‫ﺡ‬ ‫ون‬ ‫ا‬
......
Haddad, May
People’s Health Movement Libanon
Kontakt:
Mail: may_haddad@hotmail.com