Medical assistance is at risk for thousands of Syrians fleeing into Lebanon who are living in overcrowded conditions, suffering psychological distress and unable to afford medical care, according to a new survey from charity Medecins Sans Frontieres(MSF).

At least 60,000 Syrian refugees have fled to Lebanon to escape fighting in their country since conflict broke out almost 18 months ago, according to UNHCR, the U.N. refugee agency.

“Most Syrian refugees in Lebanon are reliant on humanitarian assistance, but this is now coming under threat,” according to the report by MSF, also known as Doctors Without Borders.

Refugees are having difficulty gaining access to housing, food, water and sanitation, and nine out of 10 interviewed see their future as highly precarious, it said.

Almost half of 5,000 refugees from 889 families interviewed by MSF were in need of medication to treat such chronic diseases as asthma, diabetes, hypertension and cardiovascular diseases, the survey said, but 18.7 percent are not receiving it.