As the military conflict at Nahr al Bared continues to take its toll on the thousands of Palestinian civilians displaced from the camp, Lebanese aid organisations are finding that the crisis is generating its own particular set of issues.

Fighting between Lebanese forces and the Fatah al-Islam group of al Qaeda-inspired militants has entered its fourth week. The militants are holed up in the Nahr al Bared refugee camp and have vowed to fight to the death.

Rita Hamdan, director of Popular Aid for Relief and Development (PARD), an NGO providing environmental health services to Palestinian refugees in Lebanon, has been overseeing an emergency relief operation in the nearby camp of Beddawi, where the majority of those displaced from Nahr al Bared have fled.

"The problem is with environmental health - nobody is noticing this, except us," she says.

PARD says that more than 11,000 refugees are staying in community centres, mosques and schools run by the U.N. Relief and Works Agency for Palestinian Refugees in the Near East (UNRWA), as well as with local families. As a result, conditions in Beddawi have become severely overcrowded and diseases are spreading fast.

"They have spread already - but fortunately only scabies and lice, not more serious diseases," Hadman says. "If measures are not taken, there will be diseases like diarrhoea and hepatitis."

So far, the organisation's relief effort in Beddawi has involved the installation of extra latrines and washing facilities, the establishment of a first aid tent and the distribution of hygiene kits. Other initiatives include the targeted training of young refugees, so that they can form health committees to do hygiene awareness-raising throughout the camp.

Hamdan's other main concern is that the prepared meals provided to the refugees by other charities are creating a dependency culture.

"In the first few days of any crisis, people have to be given hot food, but later they should have the means to make their own. As long as there is hot food, they are becoming dependent on it," she says.

"I don't like it. It's degrading. They are not disabled. Provide them with the food, and they will do it themselves."

Others working closely with the Palestinian community fear that the crisis is playing to some of the deeply rooted political issues that have helped create the difficult conditions in which the Palestinian refugees live.

Lebanon's troubled history has meant that the Palestinian population has periodically suffered internal displacement within the country, with the result that fears about expulsion from camps in Lebanon quickly take hold, explains Sylvia Haddad, head of Palestinian NGO the Joint Christian Committee for Social Service.

"People in Nahr Al Bared are refusing the prefab houses set up for them, fearing that they may lose the camp," she says. "It's the fear of being displaced again. This is why UNRWA set up tents. We had sixteen camps, and now there are twelve. Many feel that the crisis is a conspiracy to remove the camp, because it's a very nice place by the sea."

In a context where the Palestinian militia are often blamed for starting the 15-year civil war from which Lebanon is still recovering, she fears that advocacy work on behalf of the Palestinian community will be jeopardised by the crisis.

"I'm afraid this has set up a step backward, because not everyone will understand that this faction (Fateh al Islam) are not Palestinians. Or they will say, 'Why did the Palestinians allow them into the camps?'"

Humanitarian workers are also anticipating the challenges of the next phase of their work - helping the refugees of Nahr al Bared return home and rebuild their lives once the fighting has stopped.

"The big problem now is that Nahr al Bared has been heavily bombed, and we need to remember that it was already an area where people had nothing," says Walid Fakherddine, chief coordinator of Aid Lebanon: the Civil Campaign for Relief. "There's loads of work to be done."

He identities the installation of a new water sanitation system as one of first priorities for agencies aiming to help the refugees resume normal life. Psycho-social work for people traumatised by their recent experiences is also vital, he says - but getting funding for it will prove difficult.

"It's not like a building, where people can see what they get for their money."

In a country where all roads lead to politics, Hamdan is also anxious about who will take responsibility for providing the resources for reconstruction for members of Lebanon's most disadvantaged community.

"They will need proper shelter and proper infrastructure," she says. "Who's going to pay for it - the government or UNRWA?"

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