As dawn breaks over the Bekaa Valley in Lebanon, Fatima Ibrahim, her two boys and three girls start to stir. They live in a tent in one of the many makeshift Syrian refugee settlements that pockmark the countryside.

Lebanon is home to a million Syrian refugees, more than any other nation. And Bekaa is home to 400,000 of those, more than anywhere else in the country.

The 41-year-old Fatima is thinking of breakfast too. “My biggest worry is how to feed my children,” she said. Fatima doesn’t have any food this morning, so she goes to a neighbour and brings back a little plate of olives, some bread and tea.

“We’re like one big family looking out for each other,” she said. “The children always ask for more food, just like normal kids, but I can’t provide them with anything more.”

Life is expensive for Syrian refugees in Lebanon. There are no official refugee camps so they must pay rent for the land their tents are pitched on, plus electricity, water and somebody to take away the refuse. It’s about $1300 a year for a one room tent like Fatima’s.

Caritas provides new arrivals with a starter kit of stoves, bedding, blankets and food parcels and sometimes cash for rent. But with the crisis now into its third year, the refugees are struggling.

“We diversified our activities,” said Najla Chahda, Director of the Caritas Lebanon Migrant Centre. “The focus is less on distributions and more on providing for life skills so they can find work.”

Some of the women head off to the fields nearby. Bekaa is farming country and there is day work like picking and cleaning vegetables. Men are busy too in the camp, digging better drainage to improve the hygiene.

Yet with such a large number of people, most of the refugees have no income. “When the vegetable supplier comes, I will get food on credit. The only way to survive is through debt,” said Fatima.

On top of Fatima’s regular costs, there are the healthcare expenses for her 12-year-old son Mohammed. He lost an arm when a shell hit nearby his grandparents in Idlib, Syria.

A Caritas mobile medical clinic nearby is open in the morning for patients, providing basic treatment for the Syrian refugees.

Among them is Khairiya, a mother of four girls and a new baby boy. The girls are sick. Their camp lies next to a river which is clogged with rubbish. There are lots of flies and it is dusty.

The baby has reflux. He was born in a nearby hospital but has spent every day since in the camp.

She is happy to have a boy after four girls, partly because her greatest concern is the safety of the girls. “I keep them inside the tent all day,” she said. “You hear stories that girls are being abused.”

If her husband has found work as a day labourer, they might have lunch. If not, they won’t. “In Syria, there was bombs and hunger. In Lebanon, there is just hunger,” said one of her friends.

Her daughters don’t go to school, though one of the biggest successes Caritas has had is getting Syrian refugee children into a second shift in Lebanese schools. Caritas provides transport, school bags and books, and helps register the children in classes.

“Ensuring 60,000 children are able to attend school is a big achievement,” said Chahda.

Nisrayeh is one mother whose children are benefiting from the Caritas programme. They live in a half-finished building with 60 other families.

“Sending my children to school has been so important. I’d rather go hungry than have them lose out,” she said. “The schools have treated the children really well. They have been very welcoming.”

Nisrayeh is trying to make life as normal as possible for her kids. “I work hard to make things nice,” she said. “But they see the truth.”

One of the disappointments has been that the television the families shared broke, meaning her 12-year-old son couldn’t watch the World Cup.

It might come as a surprise that there are so many televisions and satellite dishes in the camps, but they’re seen as a crucial link to home.

“Every two or three hours, there is a news flash from Syria,” said Rasha, another Syrian refugee who lives in an abandoned shopping mall in the north of the country. “People are obsessed with news from Syria.”

It’s part of the trauma that they have been through playing out. The refugees avoid their present reality and are caught up with what’s happening at home.

“It gets to you, the noise, the children, the lack of privacy. It’s like being trapped in mental asylum or a jail,” she said.

Rasha prepares the evening meal. “It’ll be either green beans with lemon or green beans without lemon,” she said. Then they’ll go to bed. Each night she cries herself to sleep thinking of the parents she left behind in Syria.

As the sunsets in Bekaa, Khairiya will try to sleep too, exhausted, in the tent she shares with six others. But it’s not the baby crying with colic that keeps her away, but worry for the next day. They’ve been refugees in Lebanon for three years now.

“Life here doesn’t get worse,” she said. “It doesn’t get any better either. We just want to go home.”

Patrick Nicholson is communications director for Caritas Internationalis. He filed this report on recent trip to Lebanon.