Status and Barriers to Noncommunicable Disease Care among Syrian Refugees in Lebanon: The Refugee Perspective Restricted; Files Only

Abstract

Background: Protracted displacements – like those arising from the conflict in Syria — compromise refugee populations’ access to therapeutic, diagnostic, and other healthcare services, especially for noncommunicable diseases (NCDs). The objective of this study was to understand the status and barriers of NCD care for Syrian refugees in Lebanon from their perspective – an often-neglected viewpoint.

Methods: Using the WHO’s Health Systems Strengthening framework, a socio-ecological model

was created to better understand the status and barriers to NCD care in Lebanon for this refugee population. Based on this framework, a quantitative survey was administered to 213 Syrian refugees living in 10 informal settlements in Lebanon who suffer from a NCD themselves or have an affected family member.

Results: Hypertension was the most reported NCD among participants at 42.2%. Heart disease was the most reported NCD among participant families at 19.9%. Of all participants, 70.4% reported receiving no healthcare coverage. In terms of availability, over 80% of respondents stated they struggle to get medications and tests for their family members. Due to affordability, 92.5% of respondents noted that the cost of care and medications is burdensome for their families. Regarding accessibility, 75% conveyed that finding transportation to the health center was difficult. In terms of accommodation and patient-centeredness, 95% felt that healthcare staff considered their values when making recommendations. While communication and respect were well received in terms of quality, between 60 and 70% of respondents raised issues of timeliness. Trust in services and satisfaction was highly rated with 70% satisfied with the care they received for their NCDs in terms of quality,

Conclusions: Overall, the survey indicates that there is high trust in services and satisfaction and adequate levels of accommodation and patient-centeredness. However, financing and service delivery pose significant barriers to NCD care for families at the health system level. At the refugee level, transportation and income barriers exacerbate these health system level problems. Newer issues about poor treatment by medical staff were also raised. Overall, these concerns reflected by the survey highlight the need for more robust investments into health system strengthening programs and higher governance and policy changes.

Table of Contents

CHAPTER I: LITERATURE REVIEW ................................................................................................. 1

1.1 BACKGROUND ON THE SYRIAN REFUGEE CRISIS IN LEBANON .............................................. 1

1.2 STATUS OF HEALTHCARE IN LEBANON.................................................................................. 2

1.3 MANAGEMENT OF NCDS IN PROTRACTED CRISIS ..................................................................3

1.4 NCD STATUS FOR SYRIAN REFUGEES IN LEBANON ................................................................4

CHAPTER II: MANUSCRIPT .............................................................................................................6

2.1 INTRODUCTION ....................................................................................................................6

2.2 METHODS .............................................................................................................................7

2.3 RESULTS ..............................................................................................................................11

2.4 DISCUSSION ........................................................................................................................17

2.5 LIMITATIONS/STRENGTHS ...................................................................................................22

CHAPTER III: CONCLUSION............................................................................................................24

BIBLIOGRAPHY .............................................................................................................................26

TABLES AND FIGURES ...................................................................................................................29

APPENDIX.....................................................................................................................................42 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology Health Sciences, Public Health
Keyword	Refugee Health Lebanon Noncommunicable Disease Syrian Refugee
Committee Chair / Thesis Advisor	Dr. Rami Yacoub, Emory University
Committee Members	Dr. Ghada Farhat, Emory University

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