Everything I learned during a few days in the field with a Syrian crisis response team

Informal settlement Tall Keri 001 where 20 families live on a public land owned by Tall Meayan Municipality

A few weeks after I got married, my wife signed a contract with Premiere Urgence Internationale (PUI) to take the position of field coordinator in the Akkar governorate located in the north of Lebanon. The role was to lead a base of about 60 people — a dedicated team of Lebanese nationals, as well as Palestinian, Syrian and a couple of French expatriates — working to help vulnerable communities in the region following the massive arrival of refugees.

Being a photography enthusiast, I offered to take pictures of projects for PUI while I visited her. PUI hires professional photographers from time to time for its communication, but I had the advantage of doing it for free so we came to an agreement pretty quickly.

The idea was for me to spend a couple of days in the field with the PUI local teams and to capture the work they were achieving. As I talked with the team and witnessed their work though, I realized that I had very little knowledge about everything that was happening there and that a few pictures (at least mine) could barely help describe it. So, I decided to write this post in order to complement my photography work and provide a high-level view how PUI operates there.

Pictures from my days in the field are all available here: http://alexisfogel.pixieset.com/pui-lebanon/


The current situation in the Middle East being a bit too complicated to summarize in few lines of words, I just want to provide some context regarding Lebanon and the Akkar governorate. Lebanon is a very small country — the size of the Corsica island — and hosts 5 million Lebanese citizens. On top of this you can add around 1.6 million refugees — mostly Palestinian and Syrian. During the 1948 Palestine war, Lebanon began to host Palestinian refugees and you can find around 450k Palestinian currently living in Lebanon, some born in Lebanon, to parents born in Lebanon, but very few of them being naturalized. Since the beginning of the crisis in Syria, a massive number of Syrians took shelter in Lebanon and today around one million Syrians have been registered by the United Nation High Commissioner for refugees (UNHCR). There are an estimated 300k non-registered Syrians living in Lebanon — “estimated” because the Lebanese government instructed the UN in May 2015 to stop registering refugees (a few Syrians also never registered for other reasons, such as political ones). To sum it up, around a quarter of the Lebanese population are refugees and a good chunk of them arrived since 2013 giving Lebanon more refugees per capita than any other country in the world.

A Syrian child living in the informal settlement “Chir Hmairine 026“ and playing with a wheelbarrow

Let’s focus now on the Akkar governate (Lebanon is divided in 8 governorates). Akkar is mainly a rural area and is one of the poorest in Lebanon. If you tell people in Beirut that you are going to the Akkar they will probably look at you with weird eyes and ask why (even though the Akkar is a beautiful area). Most of the Akkar population is Muslim with few Christian villages here and there and, as it is very close to Syria, people in the past were used to crossing the border for a day to do shopping, a week to visit family or a month to work. 10% of the registered Syrian refugees are now in the Akkar and for an already poor region, hosting this number of people is creating an even more precarious situation for everyone. Also, this might come as a surprise for people living in western countries but it is actually freezing in the Middle East during Winter.

My wife, Sophia, as we were walking in the snowy town of Bcharre

Premiere Urgence Internationale in the Akkar region

The main goal of PUI in the Akkar, known locally by their former name PU-AMI (Premiere Urgence Aide Medicale Internationale) is to help vulnerable populations of both refugees and also host communities. They have a staff of around 60 and are based in Halba, the biggest city in Akkar, where all the team gathers in the morning before leaving to the field. The NGO has limited private funding and most of its work in Lebanon is subsidized by organizations such as the AFD (Agence Française de Dévoloppement), the European commision or the US government. PUI’s work is guided by assessments they conduct as part of their work, data gathered by the UN and other humanitarian partners, as well as referrals from other NGOs. Projects evolve from one to another depending on the funds PUI can secure, but as I write this, there are 4 main types of actions: infrastructure, shelter, protection and health. On top of this, a dedicated team takes care of the hotline; receiving calls and visits from people seeking help and directing them to assistance adapted to their needs, be it inside or outside of PUI, in close collaboration with other partners working in Akkar. Lastly, there are also transversal teams from logistics to data management, HR, finance and security. I spent most of my time with the teams working in the field though and these are the team I will focus on.


One thing that might differentiate Lebanon from other countries where Syrian refugees fled such as Jordan, Turkey or Iraq is that there is no formal refugee camp for Syrians. The Lebanese government, which used to have camps for Palestinians, does not want to repeat history for fear that it would encourage refugees to stay longer and that it might lose control inside the camps. Camps are also criticized by many for putting refugees in a self-reliance position in which they have almost no interaction with the outside world and do not participate in the economic life. Syrian refugees seek shelter from relatives or live in rented places, either run down houses or pieces of land on which they install tents (called Informal Settlements or IS). The rent fee varies from one place to another but to give you an idea, some I have seen were around $100/year for one family to live a in a house. Some refugees work for the owners in exchange of the right to settle their tent on the land.

Grand daughter of Bashira Rachid, a Syrian refugee having a hard time providing a descent shelter to her family.

The shelter team’s job is to go in the field, assess people’s basic housing needs and provide help to get people the minimum they need to survive. Their activities are divided into two main components: covering basic needs for the tents in informal settlements and rehabilitation of occupied houses.

One important point is that PUI teams almost never complete the work by themselves. They empower families by providing subsidies or material but it is the responsibility of each family to take care of the work. This raises transparency about how the money is used and gives some freedom to the families to build and maintain their own place.

Children playing with material distributed by the PUI team — Cheikh Zannad

I was lucky enough to be present at a material distribution. PUI’s shelter team provides populations with what they call “sealing off kits” (SOK) that are raw materials to build and maintain settlements from wood to plastic or PVC sheets and small tools. Not only do they provide the material but they also teach the population how to use it so that they can make their shelter. The staff told me that refugees were actually pretty good at using the tools and from the result I could see, I tend to agree.

Al Haj, from the PUI shelter team, explaining to a woman how to use the material that was just distributed

While these distributions are managed by the PUI’s shelter team, Syrian refugees and vulnerable Lebanese are also recruited from the area and hired on a daily basis to help them do the work. This is another way PUI helps refugees: they provide work for people who are unable to get it. Most of the jobs are, indeed, forbidden to Syrian refugees and this makes their situation even more difficult. Here, also, people are hired not on their skill but based on their social and financial situations. Such workers are paid around $25 per day, agreed upon between humanitarian partners to avoid disrupting the local market.

Mahmoud, an orphan Lebanese boy making a living as a daily worker for PUI

The shelter team also helps people who rent or own places that don’t allow them to live properly (garages or unfinished houses). When beneficiaries are renting the place, PUI teams negotiate with the owner and fund improvements in exchange for a year or two of free rent for the family living there. Help depends on the original state of the place but on average this can be around $1,000. That money is used to add wooden doors, a sink, a water tank when there is no available water and concrete for the floor. Relationships with owners vary but most of them appreciate the help. Unfortunately, PUI cannot prevent them from raising the rent price after their contract is ended.

Aisha Abdullah, a 85 year old Lebanese woman hosting her Syrian daughter’s family in her precarious house

All this help is regulated and PUI teams are very careful about tracking how the money is used. When they get the agreement to fund some work, a contract is signed with both the beneficiary and also the owner plus receipts are signed when the money is distributed. Money is usually provided in three batches and families have to justify how they used the first part of the money to get the following. Here also, families have the freedom to decide who they hire and how the work is done. This is a great way to support them even though in some cases, this might lead to difficulties; especially when no one in the family is capable of organizing the work and the owner does not have the time to help. I was really moved by how involved the local PUI team was when it came to doing their best to help these people. Every time things were taking longer than they should or if they could not help a family for whatever reason, I could feel their frustration. But at the same time, regulations are critical for them to continue getting funded and help more people. Overall though, the help they provided has been a game changer for families.

Zain, a PUI field office listening to a Syrian women as she describes how bad her situation is

All my pictures on the shelter activity are here: http://alexisfogel.pixieset.com/pui-lebanon/shelter/


For any human being, especially when living in extreme conditions, having access to the right medical services is crucial. On this front, PUI teams do prevention and assessment but also support health centres so that Syrian refugees and host communities can get proper treatments. In order to provide medical services, PUI have partnered with two PHCCs (Primary Health Care Centre) in the Akkar where registered people can get treatment at a discounted rate. Depending on the PHCC, the beneficiary pays a flat fee of $2 to $3 and PUI financially support the rest: the consultation, the lab tests, and the drugs are all provided to the beneficiaries for free. The concept of a flat fee is very important as one of the main reasons why vulnerable populations don’t get to the health care center is because they don’t know how much it is going to cost them.

Syrian beneficiary visiting a gynaecologist at the Irshad medical center in Berqayel village

Additionally, PUI supports the cost of running the centre and provides training to the staff. It also takes care of stocking, ordering and delivering the right medication to the PHCC while overseeing how they are prescribed and helping PHCCs staff to manage stock.

Last but not least, the PUI staff organizes sessions at PHCCs to bring awareness to health issues and basic hygiene. These are special times during which people can ask questions about health issues and learn how to prevent them.

Health session led by Mohamed Ali from the PUI health team at the Irshad medical center

Formerly, PUI had mobile health units that provided basic treatment directly in the settlements, but they stopped, as part of their initiative, to give support, but not make beneficiaries more dependent on them than what they are already. They still have a crucial outreach activity though, travelling from one informal settlement to another and meeting with the communities. The outreach team has one nurse, one midwife and social workers who are in the field 4 days a week. Its role is to be a local resource when it comes to health. The team creates relationships with families, finds people that act as local points of contact, so that it has a way to communicate with the settlements, and transmits information in both directions. This is how the organization lets people know about PHCCs’ flat fees and educational sessions.

The midwife and the nurse do basic health assessments of people there. Thanks to this, they are able to follow up with the communities and make sure everyone gets the medication they are supposed to receive. Here also, the health professionals encourage the population to visit PHCCs when required; explaining how the process works and why this care is important. In addition, they organize focus group sessions once a month at each location to discuss with pregnant women what they experience and answer questions about pregnancy, risks, breastfeeding and so on. I had the chance to be present in one of these sessions and I have to admit that even though I could not understand anything they were saying, the atmosphere was joyful and I could see that there is no taboo in these discussions.

Ismail, father of 9, suffering from hyper blood pressure and getting helping from the PUI health team

As with PHCCs, the heatlh team members also takes the opportunity of their visits to organize sessions to teach the dos and don’ts of basic hygiene to reduce the risk of sickness. I missed a “wash your hands day” that happened a couple of weeks before my visit, on which they explained why dirty hands could lead to disease and infection.

Eid (7) and Khalid (6), playing with garbage. Neither of them has been attending school since their family fled Syria in 2011.

I was astonished to see how close the PUI staff members are to beneficiaries. They know each other well and there seems to be a real trust relationship between families and staff. Now, from my experience, people living in Informal Settlements are very welcoming to anyone. Even if you are here only to take pictures, leaving without drinking a (very sugary and tasty) tea is out of the question. And no matter their condition, most of faces looking at you will attach a smile to them.

PUI social worker Nabile with Abeer, a refugee living in the Chir Hmairine 008 Informal Settlement

All my pictures on the health activity are here: https://alexisfogel.pixieset.com/pui-lebanon/health/

Infrastructure: Education (rehabilitation of schools) & Water Supply networks

The Akkar being a very poor region of Lebanon, some areas are missing critical facilities such as access to water or proper schools. This impacts the lives of everyone, whether they are Syrian refugees or Lebanese citizens. PUI has a team taking care of these types of massive projects to improve these situations.

Khaled, Syrian Daily worker covering the need his 7 person family and milk for his 8 month son thanks to his work with PUI

In these cases, PUI takes care of everything from the assessment to the studies to the implementation. The project I had the opportunity to shoot was done in Borj el Arab, a city for which PUI is building a water supply network with a 400-cubic meter capacity reservoir that would connect houses and provide them with water. This is a $2 million project that started July 2015 and will continue into 2017. These projects are critical for Lebanon and one can consider them as a global benefit to the country brought by the current situation and this probably helps the tolerance toward refugees in the country. And this is even more important considering that tensions rise between the Lebanese population and refugees as labor and rental markets are disrupted by the number of incoming refugees.

Here again, PUI employs a workforce with their “cash for work” initiatives as a way to help Syrian refugees and vulnerable Lebanese residents support their families.

PUI daily worker building a water network for the city of Borj El Arab

In all the pictures, you can see PUI workers wearing their PUI clothes with their logo on them (former logo, actually, as this is the one of PU AMI). The reason is not only to promote the NGO but mostly for security reasons. As PUI starts to be well known in the region, it is important that people know the workers are with PUI. Even I was wearing a PUI coat while I was shooting pictures (and yes, I wore it proudly). It was funny to see how the locals were stopping by to look at the work in progress, sometimes offering fruits to workers. I can tell that despite how hard their work is, the job is easier with a short tea break offered by a nearby family.

Zafer, A PUI field worker providing the project with his incredible vitality

All my pictures on the infrastructure activity are here: http://alexisfogel.pixieset.com/pui-lebanon/infrastructure/

Protection / Education / Psychosocial support

It is very hard for Syrian refugees to find work in Lebanon as Lebanese companies can only employ up to 10% foreigners and many jobs are forbidden to them. On the other hand, the rising prices for basic services have put the Lebanese population in a very unstable situation. PUI’s protection team has a program to help the most vulnerable populations in order to prevent them from using negative coping mechanisms such as child labor or prostitution. These are called Emergency Cash Assistance and are available as a one-time help to around 200 families in order to get them back on their feet and working on longer term solutions. I do not have photographs to share of this because I did not have the occasion to follow the team on this type of activity.

The protection team also does important work with school, as a crisis such as the current one — when it comes on top of an already difficult situation — can have a dramatic impact on children.

Malaak, 12 years old, always smiling despite the difficult economic and social situation

The protection team’s mission is to help children in the Akkar to grow in a better environment. PUI’s infrastructure team has already done a great job rehabilitating schools, and the protection team is taking over to organize multiple activities directly with children and also with parents and teachers to inform them on: how to encourage positive discipline? How to make children feel safe? What is important for a child development? All these (and a lot more) are themes that are addressed in collaboration with the people that impact children’s life on a day to day basis. And this brings results. As I was there, the team interviewed two mothers from Sheik Zanad who testified how psychosocial programs provided by the PUI team had a tremendous impact on their children, who are now among the first students in their respective classes.

Elham explaining how awareness sessions helped her being a better mother for her son Walid

Another impressive event that I was able to witness is called the “Open days”. This happens on Fridays when there is no school and PUI invites children from the area to gather and play together. The time I witnessed, they welcomed around 150 children from the Knaisseh village, split into 3 groups depending on their age. The smallest children were in the courtyard of the school while the other groups were in the surrounding streets. This is a very delicate time for the PUI team, as they are in charge of many children and they need to keep control of everything. For this, they work with local volunteers that they train to be organizers for the different activities (here, also helping them learn and giving them a bit of money). The activities are not chosen randomly and they all have a purpose to help children learn to trust each other, to feel safe and to work as a team. They get children to create a safe zone by holding hands and they play a game in which one child is blindfolded and has to be guided by another child to complete a task.

Six to eight year old children building a safe circle during an Open days session organized by PUI in Knaisseh

During these activities, the team also tries to detect kids with potential issues that they could help: violent behavior, isolation, the PUI team takes note of signs that would lead them to a stronger assessment later on. Depending on the topic, they can then either help the child, themselves, or they would refer the child to another NGO, such as “Save The Chidren” which specializes in these types of issues. All referrals done by PUI teams across all sectors are centralized by the hotline team, which has a strong knowledge about the services provided by local and international NGOs in the area.

Afaf, a PUI team leader, taking special care of an isolated child during an Open days session in Knaisseh

All my pictures on the protection activity are here: https://alexisfogel.pixieset.com/pui-lebanon/protection/

Going further

These few days in the field with the PUI teams have been instructive and even though I just scratched the surface, I am glad to have a somewhat better view on what my wife is working on days and nights. I also take this opportunity to thank her for this incredible knowledge she has brought to me — I could not be prouder of her work. I am convinced that the action of PUI in the Akkar has a tremendous impact on the region and I am grateful to the PUI team in Akkar that took the time to explain to me everything I wrote here. Now there is a lot more to learn and I can only encourage you to read any content you can find on the topic. And if you want to contribute, here is a link to the PUI donation page, I give you my word that they’ll make good use of it: https://www.premiere-urgence.org/en/make-a-donation/.

Special thanks to David Rostan from Dashlane who proof-read all this.