FINAL DRAFT -December 31, 2010
American University of Beirut
Citation: Chaaban, J., Ghattas, H., Habib, R., Hanafi, S., Sahyoun, N., Salti, N., Seyfert, K., Naamani, N. (2010), “Socio-Economic Survey of Palestinian Refugees in Lebanon”, Report published by the American University of Beirut (AUB) and the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA).
The fact that living conditions for most Palestine Refugees living in Lebanon are precarious, as this report shows, is widely observed, commented on and may hardly need restating. Why then this report? In fact, this is the first study to evaluate poverty among refugees in Lebanon in an academically sound and comprehensive way, and to suggest a poverty reduction strategy that is evidence-based. Commissioned by the United Nations Relief and Works Agency (UNRWA), this report profiles the socio-economic conditions and estimates the incidence of poverty among Palestine Refugees in Lebanon and links it to demographic, health, food security and other socio-economic markers. This report is based on a nationally representative household survey, covering over 2,600 households, interviewed face-to-face in late July and early August 2010 by a team of 60 data collectors supervised by the American University of Beirut (AUB). Households in camps as well as in gatherings were interviewed, in a total of 32 localities. To the best of our knowledge this is the first survey of this scale and geographical coverage in over 10 years.
The ambition of this report is not merely informative. It aims to guide UNRWA policy and develop policy recommendations based on data gathered through the household survey. Thus the added value of the present report, as compared to previous work on the same topic, stems from the scale of data it analyses and the scope of its ambition as directing and informing UNRWA policymaking in the country.
This report takes a multi-dimensional approach to poverty, taking it to be more than just the lack of income or assets but to include a household or individual’s education, health, food security and other indicators. This approach is justified by the observation that in order to take advantage of their innate capabilities to participate productively in society, individuals require a certain degree of security and care in non-economic domains such as health or food security. The report has therefore been written by a multi-disciplinary expert team of AUB academics in the fields of Community Nutrition, Public Health, Sociology, Nutritional Epidemiology, and Applied Economics and Poverty Targeting.
Social Exclusion of Palestinian Refugees in Lebanon: An Overview
The Palestinian presence in Lebanon dates from the Nakba in 1948, the community is best described as one of protracted (long term) refugees rather than refugees fleeing from recent conflict. Despite their longstanding presence in Lebanon Palestine refugees remain excluded from key aspects of social, political and economic life in the country. Indeed they are barred from owning property or practicing in more than 30 professions, among which all liberal professions. Recent changes in labor regulations have yet done little to change this. In contrast Palestine refugees residing in Syria and Jordan can work in all professions and own property. In addition the Lebanese army controls access to Palestine refugee camps, restricting refugees’ mobility.
This social exclusion physically extends to camps, the space inhabited by about two thirds of Palestine refugees. Camps are enclaves outside the authority of the Lebanese state. However, the surface area of the camps has not increased with population and many have become cramped shantytowns, offering little privacy to residents and exposing them to health hazards. Within camps UNRWA provides housing, water, and electricity. These services do not extend to gatherings and camp surroundings, mostly also inhabited by Palestinians, and which suffer from irregular waste disposal and water and electricity supply, which officially are the responsibility of the Lebanese Government. UNRWA also provides education, health care services as well as some additional welfare services to Palestinians living in camps as well as gatherings. Although a total of 46 Arab organizations and 20 foreign NGOs assist Palestine refugees in Lebanon, the volume and scope of their assistance pales in comparison to services delivered by UNRWA.
While Palestinians demand inclusion in the labor and real estate markets as well as free movement, political inclusion and governance of the refugee community is a more contested topic. Neither Palestinians nor Lebanese want the complete assimilation, or Tawteen of refugees into the Lebanese State. The ideal case scenario would be one where ‘citizen-refugees’ enjoy civil and economic rights as well as the right to space and mobility, all the while contributing through their consumption and taxes to the Lebanese economy as a whole, until their final settlement with right to return.
Never was a census taken of Palestine refugees living in Lebanon. Only UNRWA’s registration system gives some data but is inaccurate given the massive emigration of Palestinians. This survey allows for the first time to estimate accurately the total number of refugees living in Lebanon. Of the 425,000 refugees registered with UNRWA since 1948, only 260,000-280,000 currently reside in Lebanon. About a quarter live in Tyre, Saida and Beirut areas, one fifth in the North and 4% in the Beqaa. More than half of the refugee population live in camps (62%) as compared to 38% living in gatherings, mainly in camp vicinity.
Based on the household survey results, 53% of refugees are women and the Palestine refugee population is young, with an average age of 30 years, and half of the population is younger than 25 year-old. The average household size is 4.5 members, compared to 4.2 for Lebanese households.
Many Palestinian workers are discouraged from working: 56% of refugees are jobless and only 37% of the working age population is employed. The Palestinian refugee labor force reaches 120,000, of which 53,000 are working. Joblessness among refugees has a strong gender dimension: Only 13% of women are employed compared to 65% of men. Those with a job are often in low status, casual and precarious employment. Our survey shows that 21% of employed refugees work in seasonal employment, and only 7% of those employed have a contract. Very few have a second job (3%) indicating the scarcity of even low quality employment. Most refugees have low qualifications: 6% of the Palestinian labor force has university training, compared to 20% for the Lebanese labor force.
Though employment differs little across regions, quality of employment does. The share of those employed in low status elementary occupations is highest in Tyre while the share of high status professionals and senior officials is highest in the North. Nearly a quarter of workers in Tyre are employed in the agricultural sector and 87% of all agricultural workers live in Tyre. People working in elementary occupations or the agricultural sector are more likely to belong to the working poor than those working in other professions.
Survey results show that education can help refugees secure more and better jobs. A refugee with a vocational or university degree is more likely to be employed than one holding a Brevet (official diploma qualifying entry into secondary) or lower. Moreover, of those with a university degree, 70% work as professionals or associated professionals, while those with a Brevet or less work mainly in crafts and elementary occupations. Employment rates for women who attended further education are also higher. Half of women with a university degree work and 43% of those with a vocational degree do.
Yet refugees till face many challenges in their educational attainment. Survey results show that 8% of those between 7 and 15 years old were not at school in 2010. In addition to this, two thirds of Palestinians above the age of 15 do not have Brevet, compared to a Lebanese rate of 50%. Only 50% of youths in Secondary school age (16-18 years old) are enrolled in education. Half of those live in the South, though attendance varies significantly within regions. Education is central to improving livelihoods among refugees, as household heads with Brevet or more are less likely to have poor or food insecure households. As for higher education, only 13% of refugees older than 18 have the Baccalaureate or higher, compared to 17% for the Lebanese population.
Conceptul Approach: Three Ways to Measure Poverty
The main purpose of this report is to assess poverty. There are three main methods to estimate poverty. The most frequently used concept is money metric and assumes that the differences in individual welfare can be summarized by differences in income and expenditure. However, if used for policy targeting, there is a strong incentive for beneficiaries to give untruthful answers. A second, alternative approach is to measure poverty using observable income and expenditure correlates, such as physical assets of the households, which can be less easily misrepresented. However, these may be inaccurate since based on correlates rather than actual observation. Asset-based indicators sufficiently identify people that have been living in poverty for a long time, but they do not capture well short term changes in households’ material circumstances.
Money metric and asset based approaches to poverty have been criticized for focusing on the economic status of a household or individual and ignoring enabling assets (or capabilities) such as basic education, health, access to water, sanitation and electricity, which support or prevent an individual’s participation in social and economic life to the best of his or her capabilities. Hence, multi-dimensional measures have been proposed, such as, most famously the Human Development Index.
The present report assesses poverty along five dimensions: namely economic status, housing, health, food security and education. According to this framework, a Palestinian household is considered to be poor if its members are unemployed or in infrequent, unstable employment, live in bad housing conditions, are of poor health, suffer food insecurity and have had only few years of official schooling. Not all, but most of these characteristics define a poor Palestinian household. A major criticism of composite poverty indicators is that they tend to underestimate poverty when compared to money metric indicators. All three of the above methods are developed in the report.
2627 households were randomly selected from all camps and many gatherings across Lebanon. A questionnaire was designed covering the five poverty dimensions under assessment, namely economic status, housing, health, food security and education. Questionnaires were administered by UNRWA social workers who had been trained in interview techniques by AUB. The research design was approved as ethical by AUB’s Institutional Review Board and data collection took place in early August 2010.
Poverty Profile of Palestine Refugees in Lebanon
Money Metric Poverty
The money metric poverty line used in this report represents a person’s minimum daily needs in monetary terms. The poverty line stands at US$ 6 a day, which allows to cover basic food and non-food requirements (such as rent, transport, utilities etc.) of an adult Palestine refugee. This poverty line is based on that used by the Lebanese household survey in 2004 and by UNRWA in 2008, adjusted for inflation. Two thirds of Palestine refugees are poor, which equates to an estimated 160,000 individuals. The poverty rate is higher in camps than in gatherings, nearly three quarters of camp residents are poor while slightly more than half of gathering residents are poor.
Poverty has also been estimated at the extreme spectrum of poverty. An extreme poverty threshold of US$ 2.17 allows purchasing enough food to satisfy the daily basic food needs of an adult Palestine refugee. 6.6% of Palestine refugees spend less than the monetary equivalent necessary to cover their basic daily food needs. This amounts to 16,000 individuals. The extreme poverty rate in camps (7.9%) is almost twice of that observed in gatherings (4.2%).
The high poverty rate reflects overall low income, as proxied by expenditure, among Palestine Refugees. Indeed most refugees exist around the poverty line, and shocks may easily push households into poverty. Within our dataset no household reported spending more than US$600. Saida and Tyre gather more than 81% of all extremely poor refugees, and a third of all poor live in Tyre. Though gatherings have generally lower poverty rates than camps, some gatherings in Tyre, such as Jal el Bahr or Qasmieyeh, have very high poverty rates, exceeding those of most camps. Considering that many Palestine refugees in Tyre work in agriculture and elementary professions, this indicates that these very poor gatherings are communities of agricultural labourers.
There are twice as many poor among Palestine refugees and occurrence of extreme poverty is four times higher as compared with the Lebanese population. Geographically, poverty rates among Palestinians are higher than those of their Lebanese neighbors; this differential is particularly strong in the Central Lebanon Area where poverty rates among Lebanese are less than half of those among Palestinians. A notable exception is the North where poverty rates among Lebanese and Palestinians are comparable. Indeed the distribution of poverty among Palestinians is inverse to that of the Lebanese, with higher poverty rates in the South as compared to the North. Although the North has suffered from a recent crisis in the Nahr El Bared Camp, the results do not show a significant effect; this can be explained by the many ongoing emergency projects taking place in that region. Survey evidence also shows that employment has a low impact on reducing overall poverty, but it has a significant impact on reducing extreme poverty, which drops from 9.3% to 5.1% when the household head’s status changes from unemployed to employed. This is due to the precarious and low-pay nature of jobs that Palestine refugees typically hold in Lebanon.
To complement money metric poverty rates, a Deprivation Index based on components of welfare was developed. The components included: good health, food security, adequate education, access to stable employment, decent housing, and ownership of essential household assets. The Deprivation Index shows that 40% of Palestine Refugees living in Lebanon are deprived. This indicator correlates closely with money metric measures of poverty analyzed above. These results indicate that securing good health, food security, an adequate education, access to stable employment, decent housing, and the possession of essential household assets are an integral component of any long-term poverty reduction strategy for the Palestinian refugees in Lebanon.
Characteristics of Poverty
Poverty is higher among children and adolescents (6-19). Overall poverty increases with the number of children and the family size. However, extreme poverty decreases with the number of children in the family. This is due to the contribution of young family members to the livelihoods of the poor family, often through child labor. All households that have a disabled household head (9% of the refugee population) are classified as extremely poor. Poverty is also significantly higher when the household head has low education (primary and below). Poverty incidence drops to 60.5% when the household head has an above primary educational attainment, and extreme poverty is almost divided by two.
Consistent with the multi-dimensional approach adopted in this report, we included an analysis of food security among Palestine Refugees. Food security is not understood to mean over-all food availability, but the ability of people to satisfy their nutritional needs through means available to them, that is to say earnings from work, welfare transfers or own production. Food security includes food quantity as well as quality indicators. Malnutrition, overweight as well as micronutrient deficiencies can be different manifestations of food insecurity.
Two thirds of Palestine refugees report dissatisfaction with their diet, more than half (58%) are vulnerable to food insecurity, a third are mildly food insecure, more than a quarter (28%) are moderately food insecure and 15% report severe food insecurity. Factors affecting food insecurity are similar to those affecting poverty. Camp residents are more likely to suffer from food insecurity than Palestine refugees living in gatherings. Regionally residents in the North are less likely to suffer food insecurity than residents in other areas, especially Tyre. Indeed two thirds of the food insecure live in the South (Tyre and Saida). Interestingly, Palestine refugees living in the Bekaa are most likely to experience severe food insecurity.
If the head of household has the Brevet this reduces the likelihood of food insecurity for the household. Employment only slightly reduces the likelihood of a household experiencing food insecurity, while occupational status, an indicator for quality of employment, has a more important impact on the likelihood of experiencing food insecurity. As was the case for extreme poverty, female-headed households are more likely to experience severe food insecurity. These observations, relating to education, employment and female-headed households, indicate that food insecurity and poverty vary with similar socio-economic markers. Indeed poverty and food insecurity are significantly correlated and most poor and extreme poor also experience some degree of food insecurity.
Manifestations of food insecurity in the diet include very low fresh food intake, as fresh fruit intake is remarkable low in the population as a whole: More than half of Palestinian refugees consume fruit less than once per day, and 46.5% of severely food insecure households consume fruit less than once per week. Other fresh foods, in particular meat, chicken and dairy intakes are also affected by food insecurity. These were also the most frequently cited foods households were unable to afford. Thus food insecure Palestine households suffer from low quality diets.
It is highly likely that approximately one third of the population are not meeting their micronutrient requirements. It is well known that micronutrient deficiencies cause stunting, poor cognitive and psychomotor development of children, putting the refugee population in Lebanon at considerable health risks. Moreover, survey evidence shows that 57% eat sweets and 68% consume sweetened drinks frequently. This is also worrying as food insecurity coupled with a diet high in sugar or fat and low in micronutrients increases the burden of chronic diseases (especially diabetes and cardiovascular diseases).
A third of the Palestine refugee population is estimated to have chronic illness and 4% a functional disability. Hypertension is particularly prevalent, which is cause for concern considering changing eating habits outlined above. This strongly affects poverty. All households with a disabled head of household live in extreme poverty. A quarter of refugee households had an acute illness in the past six months; a third of these had the flu or common cold or other respiratory tract illnesses. 20% had an acute gastro-intestinal tract illness. Acute illnesses pose a particular risk for the Palestine refugee population, most of which live around the poverty line, since they often lead to extra-ordinary expenses and periods out of work. Considering that 95% of the population are without insurance and most of them in precarious employment, they are unlikely to receive indemnities or sick leaves, thus a case of acute illness may push a household into poverty.
As for mental health, 21% stated that they experienced depression, anxiety or distress. Men reported better self-rated health scores than women. In general, women report a higher incidence of chronic and psychological disorders and lower self-rated health scores, while men are more likely to suffer functional disability. This is consistent with the international literature.
Similar to poverty and food security indicators, the North also reported the best health ratings, including self-reported health. The Central Lebanon Area reported the highest incidence of chronic and psychological problems, while the Bekaa reports a very high incidence of acute illnesses. Self-rated health shows little geographical variation.
UNRWA is the most frequently used health care provider: a third of patients with an acute illness visit an UNRWA health clinic, while a quarter consult with a private doctor and 10% visit the Palestinian Red Crescent. Unsurprisingly, average out of pocket health care expenditure is highest for hospitalisation. Households with a hospitalised family member spent on average US$614 over the last 6 months. Those with a doctor’s visits due to disability spent US$262, households with an acutely ill family member not requiring hospitalisation spent US$ 164 and those with a chronic illness case US$137. Indeed the share of household expenditure on health jumps from 3% to 13% when a family member is chronically ill or disabled.
Housing and Living Conditions
Poor quality housing continues to be a problem in communities where most Palestinian refugees live in Lebanon. 40% of households have water leaking through their roof or walls, and 8% of households live in shelters where the roof and/or walls are made from corrugated iron, wood or asbestos. Restrictions on the living space have resulted in almost 8% of households reporting living in overcrowded conditions (more than three people live in one room). Bad housing is concentrated in the South, particularly Rashidiyeh and Ain el Helweh camps and gatherings throughout Tyre region. 9% of households in the survey reported having no water heater or fridge, compared to 3% among Lebanese households.
Weight of the Palestinian Presence in Lebanon
This study highlights how Palestine refugees in Lebanon are currently enduring harsh living conditions, mostly due to the widespread social exclusion they experience in the country. Yet their presence in Lebanon, although contested by a significant portion of the Lebanese population, imposes virtually no burden on the host country. In fact, refugees have very few alternatives to UNRWA in terms of securing their livelihoods and basic needs. At present, the survey shows that only 13% receive direct financial or in kind support other than that provided by UNRWA, and many of these are infrequent and irregular. UNRWA is also the main health care and education provider, with a network exceeding 100 schools and health care centers throughout the country. This heavy reliance on mostly free UNRWA services puts the organization in front of a difficult task, namely how to ensure decent living conditions for refugees and at the same time keep efficiency and cost-effectiveness during implementation. If UNRWA was not present in Lebanon, overall poverty among refugees would increase by 14%, and extreme poverty would be multiplied by three.
Moreover, we estimate that Palestinian refugees in Lebanon spend about 340 million US$ per year,a considerable contribution to the local economy, especially rural areas where most Palestinians live and work. Moreover, the jobs Palestinians typically take can be seen as complimentary to those taken by the Lebanese, as Palestinians residing in the country have a different skill set and thus would not pose a threat to the local job seekers. This argument should be key in further convincing the Lebanese authorities to lift labor market restrictions on Palestinians.