Outside Beirut, Lebanon—Israel’s plans to build an additional 1,600 settlements in East Jerusalem have revived an already catastrophic Palestinian refugee quandary. At the Chatila Refugee Camp, where I am one of six volunteers who must carefully tiptoe through piles of garbage to provide health care for refugees squashed inside rat-infested confines—this quandary is all too visible.

As a neonatal physician trained in the United States, it is a jarring process for me to practice medicine here. A cabinet with scarce medicines acts as our only pharmacy and people are utterly grateful for someone just to listen to them talk about their ailments.

The legacy of a brutal 16-year civil war and the delicate sectarian balance in Lebanon leaves Palestinian refugees in a precarious situation.

Fatoum, an 87-year-old-woman with the scars of war carved into the furrows of her face, lives alone in Chatila. She lost seven members of her family to the brutal Lebanese civil war in 1976, when Lebanese Christian Phalangist and Chamounist factions seized two major Palestinian camps, sending refugees here for safety. That was a time of anarchy, rampant with kidnappings and rapes. The siege stopped humanitarian aid, food, and water from reaching civilians. But now fierce armies have been replaced by legions of flies, swarming through the depressing structures that house hundreds of refugees under one roof.

Fatoum comes to our clinic every Saturday. “I think she sometimes comes to this clinic because she feels lonely and wants to ensure her story is never lost,” says Dr. Samer Arafat, one of the physicians. Fatoum subsists on cookies and powdered milk, which is reflected in her nutritional deficiencies. She usually arrives with multiple medical complaints and after careful examination the doctors conclude that her real ailment is grave depression. Currently, no mental-health facilities exist at Chatila. Fatoum is still disturbed by the agonizing memory of her husband dying of thirst in her arms years ago.

Memories, like people, die hard in Beirut.

• Peter Beinart & Martin Indyk: Obama and Bibi Face to Face Here in Chatila, women and children wait for hours to see a doctor, with medical complaints ranging from abdominal pain to post-traumatic stress disorder and depression. Some of the Palestinian refugees have been living in the camp since the 1948 Arab-Israeli conflict. Others arrived here after the 1967 Arab-Israeli war. A portrait of the camp, where I started volunteering recently, offers a window into the enduring struggle of refugees in the region. According to the United Nations Relief and Works Agency, 4.7 million Palestinians are refugees today; 420,000 reside in 12 refugee camps throughout Lebanon.

The camps are overcrowded and suffering from neglect and poor sanitation.

One patient lost her husband in the bloodiest atrocity of Israel’s 1982 invasion of Lebanon—the Sabra and Chatila massacres, where 1,200 civilians were slaughtered. She was a mother of three at the time, and recalls frantically searching for her husband amid the carnage. She had no option but to walk over the debris of countless foul-smelling bodies, only to discover that her husband was among the slain. To this day, she is reliant on UNRWA for health care and social services.

The legacy of a brutal 16-year civil war and the delicate sectarian balance in Lebanon leaves Palestinian refugees in a precarious situation. They are often marginalized and relegated to work as unskilled laborers, unable to progress outside the camp infrastructure. In 2007, the Lebanese Internal Security Forces attacked Nahr al-Bared, a Palestinian refugee camp in northern Lebanon, in order to rid the camp of an extremist faction, Fatah al-Islam. After sustaining intense shelling, the refugees found themselves refugees once again—this time at the hands of the Lebanese government. Nahr al-Bared was home to the largest market in northern Lebanon, so the strife dealt the refugee economy a disastrous blow. Despite promises of renovation by the Lebanese government, no major progress has been made in restoration. At a price tag of $330 million for the reconstruction effort, to date, UNRWA has only received one-third of the necessary funding.

The Palestinian refugee issue is often pushed to the bottom of the political agenda. In fact, a large sector of the Lebanese population still blames Palestinians for perpetuating the bloody Lebanese civil war that claimed more than 100,000 lives, left another 100,000 handicapped, and displaced about 900,000 from their homes, according to U.N. statistics. In addition, integration of Palestinian refugees, who comprise 10 percent of the Lebanese population, would disrupt the finely tuned Muslim-Christian balance in Lebanese society by adding a large Sunni Muslim demographic to the country’s already complex societal tapestry.

“In Lebanon, Palestinians have historically been deprived of the right to work in over 70 types of professions, including as physicians,” said Hoda Samra, UNRWA public information officer. “They are also ineligible for state social services, including health care.”

Furthermore, if Lebanon did indeed grant Palestinian refugees ample civil rights, it would lay the foundation for their permanent residency in Lebanon. Political analysts say that would absolve the Israeli government of its responsibility to adhere to the Palestinian right to return to their homeland or to offer refugees compensation, as stipulated by U.N. resolution 194. This then paves the path for further Israeli settlements, with the understanding that Lebanon, or another Arab country, would be able to sustain the absorption of the refugees created by Israeli settlement expansion. Clearly, the expansion of Israeli settlements is not without far-reaching ramifications and infinite ripples throughout the Middle East.

Israeli plans to build settlements will only make finding permanent homes for refugees more difficult. According to Peace Now, an Israeli group with expertise in Israeli settlements, there will be 8,253 proposed new homes, including the recently announced 1,600. While Prime Minister Benjamin Netanyahu acknowledged the poor timing of the announcement, there were no words to suggest that the inflammatory strategy would in any way be altered, despite Vice President Joe Biden’s strong condemnation.

The number of new Palestinian refugees to be forced deeper into the West Bank, or even into the Palestinian diaspora, is unknown; however, it is abundantly clear that Lebanon cannot, or is not willing to, absorb any more.

Either way, while heads of state puppeteer the lives of thousands of refugees and political ideologues make far-reaching prophecies on the fate of the Israeli-Palestinian conflict, women like Fatoum will continue to come to the weekly Chatila Refugee Clinic uttering, “No one is working for my interests. You are the only people here for me—you and God.”

Seema Jilani is a physician who specializes in pediatric international health care in Houston and has worked in Israel, Palestine, Sudan, Lebanon, Egypt, and the Balkans. She has been a freelance journalist for Pacifica Radio for eight years. Her radio documentary, Israel and Palestine: The Human Cost of the Occupation, was nominated for a Peabody Award.