On 13 December 2021, the Lebanese Association for Family Health (SALAMA) hosted a closing ceremony of its Japan Trust Fund project, "Reducing maternal mortality and morbidity related to reproductive health among Syrian refugees and the Lebanese host communities in the Bekaa", at the Movenpick Hotel in Beirut. It was attended by the representatives from the Japanese Embassy in Lebanon, the Ministry of Social Affairs, the Lebanese Order of Midwives, international organizations, and civil society groups. The event celebrated many achievements, including its reach to 6,115 people with more than 102,000 sexual and reproductive health (SRH) services, through speeches, presentations, and video documentaries. It also served as an opportunity to look back on the various challenges the project faced due to the country’s political and economic crises, the COVID-19 pandemic, and the Beirut explosion. Many reiterated the further needs in the country, particularly among those in humanitarian situations. The Japanese government has been funding SALAMA's work in the Bekaa region since 2017, and this project was the second one. President of SALAMA, Dr Joseph Challita, and the executive director, Ms Lina Sabra, expressed their deep gratitude to the Government of Japan in their speeches. The representative of the Japanese embassy responded with an acknowledgement of the relevance and good outcomes of the project. Dr Joseph Challita said: "We are gathered here today to celebrate our success in implementing this project. Let us strive together, as always, to make our voices heard by leaders and decision makers who have the ability to create an environment that facilitates equal access to contraceptives and family planning services for all women and girls." Ms Lina Sabra said: "SALAMA was committed to the priorities of Japan's official development assistance ODA policy, which focuses on empowering all marginalized groups that need services and respecting the cultures of different communities... Salama focused on contributing to the achievement of Sustainable Development Goals 3, 5, and 13."  Ms Maki Yamaguchi, Embassy of Japan in Lebanon, said: "In light of the multiple crises that Lebanon is facing, it has become difficult for the Lebanese community and the Syrian refugees to access the necessary health services, hence the importance of launching successful projects."  Project documentation videos: JTF end of project report HIV success story Family planning success story Pregnant women program (Mama & Baby Kits) Dignity kits

An interview with Malak Dirani, a midwife at the Lebanese Association for Family Health (SALAMA) on the impact COVID-19 is having on the services she provides to vulnerable communities including Syrian refugees. What is your role at SALAMA? I am a midwife and trainer with the Order of Midwife in Lebanon for family planning so I provide a range of services, including: Pre-natal and post-natal care for pregnant women Gynaecological services  Providing VCT (Voluntary Counseling Test) for HIV with counseling pre and post-test Providing family planning services such as IUDs, contraceptive pills, emergency pills and condoms, as well as family planning and unsafe abortion counseling. How has your job been impacted by the outbreak of coronavirus/COVID-19?  Before the coronavirus crisis, I was conducting fields visits with social workers and volunteers once or twice a week. We would provide family planning services, gender-based violence (GBV) counseling, and providing awareness sessions on different sexual and reproductive health topics. Unfortunately, all outreach visits to field have now had to stop. Due to the current situation and the risk of spreading of COVID-19, we have been forced to reduce our activities and services, and to reduce the number of clients we can receive. For any client that does visit our clinics, they must follow the strict prevention and hygiene protocols before they enter. We also deliver small group information sessions with clients on coronavirus, what they can do to protect themselves, and advice on what to do if they have symptoms.  In the long-term, how do you think coronavirus/COVID-19 will impact sexual and reproductive health on a national and global scale? The immediate impacts of coronavirus on the communities we serve in the refugee camps are: An increased risk of malnutrition The number of unintended pregnancies will increase Communities that are living in camps are not protected from contracting COVID-19. Most tents contain at least six people, so coronavirus can very quickly spread through the camp if someone catches it  The majority of people in the camps are unemployed, so they have no way of securing even their basic needs. I think the long-term impact will be contraceptive supplies and the impact this will have on women. In Lebanon, we import all family planning methods, even condoms. Now airports are closed, those commodities are less available. Countries that produce family planning methods are some of the most affected ones by COVID-19 (such as India and China), so we will face a lack of these on a global scale, which will lead to an increase the number of unintended pregnancies and unsafe abortion. Do you have a message you’d like to share with other frontline healthcare workers who continue to deliver care during the COVID-19 pandemic? My message to healthcare workers across the world is that we are always here for people to secure their health rights. We are on the frontline, we were always the one who people trust! We are the nation's guiding light during this difficult time, so we can, with our efforts and power support patients, overcome this crisis, and save lives.

For our Women in Leadership series, we interviewed Lina Sabra, the Executive Director of the Lebanese Association for Family Health (SALAMA).  How did you get into sexual and reproductive health and rights (SRHR)? I started working on sexual reproductive rights and women’s health issues when I was doing my MA in Sociology at a Lebanese university. I attended a conference by the Lebanese Family Planning Association when I was 20, and then became more involved in these issues.  After that, I became a  youth volunteer at the  Lebanon Family Planning Association. I was then elected as the Arab World Region (AWR) Youth Representative for the Governing Council from 2003 till 2004. Even my family are now interested in SRHR. When my 12 year old niece had an assignment in about researching NGOs, she decided to focus on SALAMA’s mission, vision, and objectives. What was it like growing up in Lebanon when it came to SRHR? I grew up in a rural area in the Bekaa. In these areas, sexual reproductive health is not talked about, even in schools. We didn’t have sexual education, only biology lessons teaching us about reproduction but not sexual education. We still don’t have these lessons in the curriculum – the first time I heard about sexual education was at university. When it comes to SRHR what does Lebanon need to focus on? In providing comprehensive sexual education so that children can go through their school lives being educated in a healthy and informed way regarding these issues. We should also focus on raising awareness for women and girls, but also men, because sexual reproductive issues include them, as well as religious leaders, decision makers etc. most of whom are still men. Besides, sexual reproductive health issues affect everyone.  How have the issues around SRHR changed? There is greater awareness of SRHR now that women and girls have greater access to education. There’s been a decrease in infant mortality and increase in awareness as more women are now working and engaged in the labour force. The average age that girls are getting married has also gone up and Lebanon is working on laws to improve this further. These issues are no longer taboo. Now people are aware of family planning and they are accessing it more than before.  Advocating SRHR is hard in Lebanon because we have a lot of challenges: religious leaders, political parties etc. who try to impose their views. That’s why we need to work as a coalition of NGOs and networks together to bring about effective change. Recently Lebanon has seen women get elected in parliament and become ministers and they are working on these issues and will hopefully help NGOs to raise awareness and push for change. Different NGOs, organizations and networks are currently working on changing/updating laws and policies related to early marriage, domestic violence, people living with HIV rights, and marital rape. SALAMA is planning to work on the laws and policies related to sexual harassment at workplace.  What taboos do people still face? People living with HIV/AIDS face social stigma and discrimination. Divorced women, young women and women who have abortions also face stigma and discrimination. Also, having an alternative sexual orientation is still not fully accepted in Lebanon.  A key reason for these taboos is because the laws are related to religion. We cannot talk about changing anything unless we change the mind of the religious leaders. Many of the existing laws and policies regarding sexual and reproductive health/right need to be updated or changed. For example, abortion is still unlawful here unless it’s considered to endanger the woman’s life.  Also, there is no law or policies to prevent sexual harassment in the workplace. Thus, people especially women and girls do not report any case in order to not be blamed themselves or stigmatized or fired.    What is SALAMA doing for International Women’s day?  Every year for International Women’s Day and Mother’s Day we conduct a campaign in Arabic called ‘Your wellbeing is our aim’. During the campaign, we provide services and medication for free and provide transportation for refugees for free. An outreach team brings them to the clinic from camps and they can then have increased access to our services. This happens every March at SALAMA’s SDP in Zahleh-Bekaa governorate.