"We are deeply concerned about families, many with lots of small children, who were already living in extreme poverty and who have now lost their homes or been displaced," said Fatma Odaymat, a health officer with the United Nations Children's Fund (UNICEF).

Officials in Tripoli 90 kilometres (56 miles) north of Beirut estimate that some 20,000 people were directly or indirectly affected by the fighting which pitted Sunni Muslims in the Bab al-Tebbaneh neighbourhood against members of the Alawite community in nearby Jabal Mohsen.

Alawites are an off-shoot of Shiite Islam.

"Most of these people have lost their livelihoods since they worked at small jobs and were paid by the day," Mervat al-Hoz, a member of Tripoli's municipal council, told AFP. "They are now living in total misery."

She said 236 homes were destroyed by the clashes which first erupted in May and which left 23 people dead and more than 100 wounded.

Some 800 families have been displaced, among them 260 Sunni families who have sought refuge in schools in the city.

Alawite families have mostly fled to Syria or to villages in the Akkar region north of Tripoli where relief agencies are scrambling to provide them with hygiene kits, food and medication.

Cases of measles and mumps have already been reported, prompting officials to organise a vaccination campaign to prevent any outbreak of disease.

"What worries us is what is going to happen to these people when schools reopen in a month's time," Odaymat said. "Many of them have lost everything.

"This is a region where the drop-out rate in schools was already at 55 percent," she added. "How will these kids approach the new school year?"

In one school in Tripoli, several families were crammed into classrooms with many having to sleep on mattresses in hallways. Stifling summer temperatures, which usually reach 35 degrees Celsius (95 Farenheit), add to their woes.

"It is unbearable living here," said Mukhlisa Khaled al-Sayyed, 70, fighting back tears. "This is the first time in my life I've been reduced to this.

"I would rather die than have to rely on a handout."

She said she and her family fled their Bab al-Tebbaneh home after it was shelled. They slept along the shore for two days before seeking shelter in one of nine schools that were opened for those made homeless by the fighting.

"There are 10 of us living in a room," lamented Nimr Hamad, a father of five.

"We are Muslim and our customs do not allow us to mix like this with strangers," he added. Under Muslim tradition men and women who are not related are not allowed to share quarters.

"When these people left their homes they took nothing with them," said Hoz. "Some of them even asked us for 1,000 Lebanese pounds (less than a dollar) to enable them to find transport and check on their homes."

She said an emergency committee had been set up along with a 24-hour hotline to provide assistance.

In the most recent bout of violence last Saturday, nine people were killed and about 50 wounded.

"Since then there have been small clashes every day and we are crossing our fingers that the situation will not escalate," Odaymat said. "But local officials are not optimistic that this will end any time soon."

Bab al-Tebbaneh is a stronghold of the anti-Syrian parliamentary majority while the inhabitants of Jabal Mohsen mainly support the Syrian-backed opposition led by the powerful Shiite Muslim group Hezbollah. -AFP