Forced to sleep on the balcony during winter. Sexually harassed and dismissed. Slapped, berated, and locked inside employers' homes. These are just some of the experiences migrant domestic workers have disclosed to Doctors Without Borders/Médecins Sans Frontières (MSF) medical and mental health teams in Beirut, Lebanon.
Most patients at MSF's clinic in the northern Beirut suburb of Bourj Hammoud are migrants, drawn to the area for its affordable housing, diverse religious sites, and proximity to public transport stations. Many of the migrants chose to leave their home countries in search of a better life in Lebanon—only to find themselves trapped under the kafala (sponsorship) system, excluded from legal protections afforded to other workers and robbed of their agency. Half are domestic workers, often subjected to mistreatment and abuse in their employers' homes.
Living under the kafala system
Migrant workers come to Lebanon through the kafala system, which has been described by human rights activists and organizations as amounting to “modern-day slavery.” Under this system, many migrants are overworked and underpaid—or not paid at all—with no breaks or days off. Those who are domestic workers often face verbal and physical abuse in their employers' homes, with serious implications for their health and well-being. These workers are almost exclusively women.
Under the kafala system, sponsors often take migrants' legal documents along with their agency as humans. Migrants can be denied their right to communicate with anybody outside of the household, including their family. Leaving the house is not always possible, and they can only return to their home country if their sponsor consents.
— Beatrice
Access to health care is severely limited for migrants bound by the kafala system, which allows employers to deny workers their right to health care. Even those operating outside the system face difficulty accessing care, as they are frequently turned away from hospitals and primary health care centers for not having legal documents, or simply because they’re not Lebanese. Some avoid seeking health services altogether for fear of being turned away or deported, or because they don't have the money to pay for care. This can worsen and complicate medical conditions.
While some workers are able to find support within migrant communities, many are left homeless, without legal documents, and in need of urgent assistance. Those seeking to return home might not have the resources to arrange their paperwork or buy a plane ticket. Despite the hardships they face, some choose to stay in Lebanon because they need to feed their families, or simply because they have nowhere to go.
The dehumanization of domestic workers
When migrant workers share their stories with MSF staff, themes of racism and discrimination are prevalent. In Lebanon, the term El-Srilankiyye (Arabic for “The Sri Lankan”) has historically been used to refer to migrant domestic workers—regardless of their actual nationality—reflecting the origin of most workers arriving in the early 2000s. As migration patterns shifted, the term El-Ethiopiyye (“The Ethiopian”) became more common.
— Tigist*
These labels not only reduce individuals to their nationality but also reinforce stereotypes that people from these backgrounds are inherently domestic workers. More concerning is the implication that such work is degrading, further marginalizing people who take on these essential roles. Their mistreatment and exploitation have been normalized to the point that even the most shocking stories have become recurrent.
Migrants’ medical needs go unmet and unheard
At the MSF clinic in Bourj Hammoud, our teams are responding to migrants’ medical needs through primary health care consultations, sexual and reproductive health services, and mental health services, including psychiatric consultations. We also have been covering the cost of referrals for hospitalization in life-threatening cases, including for psychiatric emergencies.
— Martha*
“In 2024, psychiatric consultations in the Bourj Hammoud clinic doubled compared to the previous year,” said Elsa Saikali, MSF mental health supervisor. “This highlights the huge mental health needs among migrant communities. Migrant workers are often dehumanized, subjected to racism and discrimination, and exposed to physical and sexual abuse. All this has deep repercussions on their psychological well-being.”
One of the challenges migrants face in Lebanon is the language barrier, which further limits their ability to access health care as they are obliged to sign documents and communicate in Arabic to survive. But at MSF’s clinic, things are done differently.
— Makdes*
“We’re one of the rare organizations in Lebanon offering translation for migrants during mental health sessions,” said Saikali. “What makes our clinic special is the presence of community health educators for patients. They are MSF staff from the migrant communities who facilitate patient bonding, build trust, and make sure the patient is properly informed about their health status.”
But the needs of migrant communities in Lebanon span beyond medical care, and it's difficult for patients to take care of their mental health if they’re experiencing homelessness or unable to feed themselves. This is where the role of our social workers comes in.
“My job is to refer patients to services that are beyond MSF’s ability to respond to,” said Hanan Hamadi, MSF social worker at the Bourj Hammoud clinic. “The patients who come to me have the most basic needs, such as shelter, food items, and cash assistance. I refer them to other organizations offering these services.”
War adds another challenge for migrants in Lebanon
The recent Israeli bombardment of Lebanon exacerbated many migrants' socio-economic challenges. Many have disclosed to MSF teams that they were abandoned in war-affected areas, left on the streets or locked inside the homes of employers who fled for safety.
During the two-month war, migrant community leaders helped MSF teams reach those most in need of assistance in overcrowded shelters and apartments, where we donated essential relief items and delivered medical care through a mobile clinic.
— Makdes*
Other programs run by local and international organizations helping migrants have dwindled over the years—some only operating for limited periods of time, leaving gaps in migrants' resources once closed.
“It is getting increasingly difficult to refer our patients to other organizations offering assistance to migrants in Lebanon,” said Hamadi. “This is due to the scarce funding allocated to programs supporting migrants and the defunding or closure of others. This is not a recent issue, as it’s been happening for a while.”
One of the biggest challenges MSF teams in Lebanon are facing is referring patients for hospitalization, including for psychiatric emergencies. Organizations with scarce funding might have to stop covering hospitalization for migrants. If these organizations scale down this support, MSF alone would not be able to cover the gap alone, and many people’s needs will go unmet.
*Names have been changed
In their own words
Stories of domestic workers in Lebanon
Beatrice
When Beatrice shared her story with MSF, the sound of Israeli forces' reconnaissance drones was triggering memories of the day she broke both ankles trying to flee her employer's home.
It was October 6, 2024, and Lebanon was under intense Israeli bombardment. Beatrice was cleaning the house when she saw a bomb hit a nearby building. She instinctively tried to flee, but her employer had locked her inside—so she jumped from the balcony, leaving her in need of urgent care.
"My friends called an organization to see if they can support me with the treatment, Beatrice said. "That organization along with MSF covered my surgery, medication, and the two-month recovery period.”
Makdes
Makdes* and her family were saving up money to start a project in Ethiopia. She knew people working in Lebanon, so she decided to take the same journey in hopes to earn enough money to support her family.
The first family she lived with in Lebanon made her work under impossible conditions. “In my culture, you have to be offered food to eat,” said Makdes. “But they never cared or even asked if I’ve eaten.” Before and after each family meal, Makdes had to clean on an empty stomach. “I would wait until everyone was asleep to sneak some bread or an orange. I was living on scraps.”
In her last three days working in that home, she was bedridden with exhaustion. Her employer locked her inside her room, accusing her of simply not wanting to work. Later, she was taken back to the agency that had brought her to Lebanon. The agency sent her to another family's home, where the situation was even more difficult—slapped and yelled at by an employer who scared her for fun.
Martha
Originally from the Tigray region in Ethiopia, Martha* moved to the capital, Addis Ababa, to provide for her family, working in a hotel during the day and studying management at night.
One day she lost her job, so she decided to go to Lebanon. Soon after she arrived, her employer sent her to live with their elderly parents and their caregiver. For the three months she lived in that house, the caregiver sexually harassed her, but no one believed her. Even after she recorded a video of the harassment, the perpetrator was not held accountable and her experience was dismissed. She was then sent to live in her employer’s house along with other migrant workers.
“My employer would yell at me if I asked her for anything or asked her a question,” said Martha. “She mistreated me, often delaying paying me my salary. She did not believe I was experiencing sexual harassment. She did not even believe me when I told I her I was sick.”
Ahmet
Ahmet* arrived in Lebanon from Bangladesh eight years ago, with travel papers arranged by an agency back home. Two people picked her up from the airport in Beirut, claiming that they’d apply for residency for her, but ended up running away with all her money.
That’s when the reality hit her: Without a visa to live or work in Lebanon, she would need a sponsor who she'd probably have to live with, and unable to choose the type of work that suited her. The promise of a better life in Lebanon quickly vanished.
Ahmet started taking odd jobs where she could find them, mainly ironing and dishwashing. Her husband later joined her in Lebanon and found a job at a hotel. Around a year ago, however, he was arrested for not having a valid work permit. He spent four months in jail before being deported to Bangladesh.
Tigist
When Tigist* was just 14 years old, she migrated from Ethiopia hoping to support her family. She spent five years working in a restaurant in Sudan before migrating to Lebanon so she could make more money.
At 19, she spent four months living in a family's home where she had to work many hours through hunger and thirst. Only then would she be given a small amount of food and water—but forced to eat quickly so she could get back to work.
Years years later, she fell in love with a Sudanese man and married him. She had hoped for a companion and support system, but instead, her husband abused her, beating and mistreating her on a regular basis before finally kicking her and their son out of the house. The two became homeless.
