A Scoping Review of the Vulnerabilities of Syrian Refugees Amid Overlapping Crises in Jordan, Lebanon, and Türkiye

BackgroundThe scarcity of evidence-based research on non-communicable diseases (NCDs) among Syrian refugees has hampered efforts to address the high burden of these diseases in host countries. The objective of this study is to examine published research on NCDs among Syrian refugees in order to inform future research, practice, programs, and policy. .MethodsUsing the scoping review framework proposed by Arksey et al., 17 different databases were searched to identify studies reporting on NCDs among Syrian refugees. The number of relevant documents found was 34, with the earliest going back to 2013—2 years after the beginning of the Syrian conflict.ResultsThe majority of these documents were descriptive in nature and only two studies addressed the effectiveness of interventions in the management of NCDs. No studies investigated the prevention of these diseases. Furthermore, only 7 studies addressed the host community and only one research article, conducted in Lebanon, included subjects from the host community. The increasing number of documents over the past 5 years illustrates a growing interest in studying NCDs among Syrian refugees. Examination of the papers showed high prevalence of NCDs among Syrian refugees as well as unmet healthcare needs.ConclusionThe findings of this review highlighted the dire need for further research on the burden of NCDs among Syrian refugees. Future studies should diversify research design to include interventions, address the host community in addition to the refugees, tackle prevention as well as treatment of NCDs, and explore strategies to enhance the resilience of the host country’s health system while ensuring quality of care for NCDs. The increasing momentum for research found in this review presents an opportunity to fill current knowledge gaps, which could result in preventing, controlling and ultimately reducing the burden of NCDs among Syrian refugees and their host communities.

Since 2011, the Syrian conflict has generated one of the largest displacement crises globally, with most Syrian refugees hosted in neighboring Middle Eastern countries. These host settings differ substantially in legal, social, settlement, and service conditions, which shapes both refugee experiences and the interpretation of mental health evidence. Protracted displacement, cumulative trauma, and post- migration adversity have contributed to a substantial burden of psychological distress, yet distress may be expressed not only through post-traumatic stress, depression, and anxiety symptoms, but also through culturally embedded experiences such as somatic complaints, grief, family disruption, role loss, stigma, uncertainty, and reduced dignity. This scoping review mapped prevalence patterns of psychological distress and associated risk and protective factors among Syrian refugees residing in Middle Eastern host countries, including Jordan, Lebanon, Turkey, Iraq, and Egypt. Following the Arksey and O’Malley framework and reported in accordance with PRISMA ScR, we searched PubMed, Web of Science Core Collection, and Scopus for peer-reviewed English language studies published between 2011 and 2025, with searches last updated in December 2025. Records were screened at title and abstract and full text stages using predefined criteria. Screening and data extraction were conducted by a single reviewer using standardized forms, with decisions and extracted data reviewed and discussed with a second author to enhance consistency. Eighteen studies met inclusion criteria, most conducted in Jordan, Lebanon, and Turkey, with fewer in Iraq and Egypt. Psychological distress was consistently substantial, most commonly reflected in elevated post-traumatic stress, depressive, and anxiety symptoms, while reported prevalence patterns varied widely by host country context, living setting, subgroup, sampling frame, and instruments or cut offs. Distress was repeatedly associated with trauma exposure and post-migration living difficulties, including economic hardship, legal insecurity, and daily stressors, whereas social connectedness and perceived support emerged as protective correlates. Findings highlight the need for scalable, culturally responsive psychosocial interventions and service models that reduce structural barriers to access, address stigma, and account for culturally embedded expressions of distress in protracted displacement settings.Systematic review registrationhttps://osf.io/vmju8/overview

BackgroundMore than 5.5 million Syrian refugees have fled violence and settled in mostly urban environments in neighboring countries. The Middle East and North Africa (MENA) region accounts for 6% of the global population but 25% of the population are ‘of concern’ to the UN Refugee Agency. In addition to large amounts of forced migration, the region is also undergoing an epidemiologic transition towards a heavier burden of noncommunicable diseases (NCDs), which in 2018 accounted for 74% of all deaths in the region. To address NCD needs globally, a myriad of policies and interventions have been implemented in low-income stable country settings. However, little is known about which policies and interventions are currently being implemented or are best suited for refugee hosting countries across the Middle East and North Africa.MethodsA scoping review of peer-reviewed literature was conducted to identify policies and interventions implemented in the Middle East and North Africa to address the needs of urban refugees with noncommunicable diseases.ResultsThis scoping review identified 11 studies from Jordan, Lebanon, Iran, West Bank, Gaza and Syria. These studies addressed three foci of extant work, (1) innovative financing for expensive treatments, (2) improvements to access and quality of treatment and, (3) efforts to prevent new diagnoses and secondary complications. All interventions targeted refugee populations including Palestinians, Sudanese, Syrians, Afghans and Iraqis.DiscussionThe scoping review highlighted five key findings. First, very few studies focused on the prevention of noncommunicable diseases among displaced populations. Second, several interventions made use of health information technologies, including electronic medical records and mHealth applications for patients. Third, the vast majority of publications were solely focused on tackling NCDs through primary care efforts. Fourth, the literature was very sparse in regard to national policy development, and instead favored interventions by NGOs and UN agencies. Last, the perspectives of refugees were notably absent.ConclusionOpportunities exist to prioritize prevention efforts, scale up eHealth interventions, expand access to secondary and tertiary services, address the scarcity of research on national policy, and incorporate the perspectives of affected persons in the broader discourse.

BackgroundThis study presents a descriptive synthesis of Kurdistan Region of Iraq’s (KRI) primary care system, which is undergoing comprehensive primary care reforms within the context of a cross-cutting structural economic adjustment program and protracted security, humanitarian, economic and political crises.MethodsThe descriptive analysis used a framework operationalizing Starfield’s classic primary care model for health services research. A scoping review was performed using relevant sources, and expert consultations were conducted for completing and validating data.ResultsThe descriptive analysis presents a complex narrative of a primary care system undergoing classical developmental processes of transitioning middle-income countries. The system is simultaneously under tremendous pressure to adapt to the continuously changing, complex and resource-intensive needs of sub-populations exhibiting varying morbidity patterns, within the context of protracted security, humanitarian, economic, and political crises. Despite exhibiting significant resilience in the face of the ongoing crises, the continued influx of IDPs and Syrian refugees, coupled with extremely limited resources and weak governance at policy, organizational and clinical levels threaten the sustainability of KRI’s public primary care system. Diverse trajectories to the strengthening and development of primary care are underway by local and international actors, notably the World Bank, RAND Corporation, UN organizations and USAID, focusing on varying imperatives related to the protracted humanitarian and economic crises.ConclusionsThe convergence, interaction and outcomes of the diverse initiatives and policy approaches in relation to the development of KRI’s primary care system are complex and highly uncertain. A common vision of primary care is required to align resources, initiatives and policies, and to enable synergy between all local and international actors involved in the developmental and humanitarian response. Further research that integrates the knowledge synthesized in this article, and enables actors in KRI to learn from their own experiences and efforts, along with those of other jurisdictions, would be invaluable towards the ongoing development of primary care.

Objective: The aim of this scoping review was to explore what is known about the health seeking behaviors among Syrian refugee women within hospital and community settings. The objectives were to explore health seeking behaviors of Syrian refugee women and highlight specific issues that are important to Syrian refugee women related to seeking for health care. In addition, to uncover potential obstacles/barriers that face Syrian refugee women while seeking for health care.Methods: Arksey and O’Malley (2005) framework for scoping review was utilized to guide the review process and to explore health seeking behaviors of Syrian refugee women. Various databases such as, Academic Search Complete, CINAHL, PubMed, Scopus, PsycINFO, Science direct and SocINDEX were utilized in the review. The search strategy consisted of broad queries, in the title, abstract, full texts and keyword fields. The search included studies published from 2011 on, that is, from the time the Syrian conflict started (March 2011) and were limited to those in the English language. Thematic analysis was undertaken to synthesize extracted data.Results: A total of 19 studies were selected for this review. The data from this review were organized along two thematic categories (accessibility of health care services) and (awareness of health care needs and available health care services). Accessibility of health care services was the most frequently reported theme throughout this area of the literature and is most often include (financial barriers, language barriers, availability of culturally and gender appropriate health services). Awareness of health care needs and available health care services was the second commonly encountered theme within the area of Syrian refugee’s women health seeking behaviors.Conclusions: Having available and accessible health care services for Syrian refugee women in host countries is a fundamental human right that can enhance Syrian refugee women health, wellbeing and quality of life. An awareness of the potential health seeking behaviors, obstacles/barriers and challenges that facing Syrian refugee women may help to promote their accessibility to health services and consequently improve their health and wellbeing. Practitioners can use this review findings to inform future policy, education and developments in practice. Further research is required to develop and evaluate initiatives that target the identified barriers and help Syrian refugee women to fulfil their unmet health care needs.

BackgroundTurkey hosts the world’s largest community of Syrians displaced by the conflict. The Minimum Initial Service Package (MISP) is a coordinated set of priority reproductive health services. There is not any scoping review assessing the RH situation of Syrian refugees in Turkey within the framework of the MISP objectives. The objectives of this review is to identify the situation of sexual and reproductive health (SRH) among Syrian refugee women in Turkey, and document the health services provided for them in terms of the components of MISP. We hoped to show evidence of gaps and help guide future research to focus on priority areas to improve the range, quality, and access to SRH services and to recommend public health interventions.MethodThe literature search was conducted in Turkish and English. Multiple electronic databases (Turkish Medline, Google Scholar, PubMed, Web of Science, Medline, Cochrane Database of Systematic Reviews, EBSCOHost, CINAHL, and Embase) were searched from January 2011 to May 2018. References published in the peer-reviewed literature, the grey-literature, and on websites were eligible for inclusion if they had conducted research on one or more of the following SRH topics specifically for Syrian women in Turkey: maternal and neonatal health/antenatal care, HIV and sexually transmitted infections, use of contraceptives, sexual violence, and services delivery and accessibility. References were excluded if any of the following criteria were relevant: not specific to Syrian women refugees in Turkey. Firstly, the titles and abstracts of the articles that were found were examined to determine if they met the eligibility criteria. Secondly, if the abstracts and titles met one or more of the eligibility criteria, the full text of the articles have been examined. Finally, standard forms were prepared and used to summarize the articles narratively. The results of the screening were recorded in Excel spreadsheets for comparison, and any disagreements among the researchers were resolved by consensus. The studies were grouped according to the MISP objectives.ResultsA total of 24 publications were eligible for inclusion in the review. Consanguineous marriage rate was 56%. The rate of marriage under age 18 were very high. Mean age at first marriage was found to be between 18 and 20. The rate of antenatal care was inadequate. The rate of using a modern contraceptive method was 24% among married and all age groups of Syrian women. The rates of unmet family planning needs were about 35%. Among patients admitted to gynecology outpatient clinics, about half of the applicants were reported to have abnormal vaginal discharge. The reported rates of sexual violence were about 8%. Only 20% of Syrian women had regular gynecological visits.ConclusionOverall, we conclude that early marriage, low modern contraceptive use, unmet need for contraception, sexual and gender-based violence are the major SRH issues reported. There is a need for further studies to identify the barriers limiting service uptake as well as to document successful practices. Long term strategies to improve the SRH status of Syrian refugee women should be developed with participation of all stakeholders. This review is significant in terms of that it is the first scoping review assessing the RH situation of Syrian refugees in Turkey within the framework of the MISP objectives. Based on the data of this review, relevant policy makers should consider to improve the SRH status of Syrian women refugees in Turkey.

IntroductionArmed conflict may influence the size and scope of research in Arab countries. We aimed to assess the impact of the 2011 Syrian conflict on health articles about Syria published in indexed journals.MethodsWe conducted a scoping review on Syrian health-related articles using seven electronic databases. We included clinical, biomedical, public health, or health system topics published between 1991 and 2017. We excluded animal studies and studies conducted on Syrian refugees. We used descriptive and social network analyses to assess the differences in rates, types, topics of articles, and authorship before and after 2011, the start of the Syrian conflict.ResultsOf 1138 articles, 826 (72.6%) were published after 2011. Articles published after 2011 were less likely to be primary research; had a greater proportion reporting on mental health (4.6% vs. 10.0%), accidents and injuries (2.3% vs. 18.8%), and conflict and health (1.7% vs. 7.8%) (all p < 0.05); and a lower proportion reporting on child and maternal health (8.1 to 3.6%, p = 0.019). The proportion of research articles reporting no funding increased from 1.1 to 14.6% (p < 0.01). While international collaborations increased over time, the number of articles with no authors affiliated to Syrian institutions overtook those with at least one author affiliation to a Syrian institution for the first time in 2015.ConclusionTo our knowledge, this is the first study to examine the impact of armed conflict on health scholarship in Syria. The Syrian conflict was associated with a change in the rates, types, and topics of the health-related articles, and authors’ affiliations. Our findings have implications for the prioritization of research funding, development of inclusive research collaborations, and promoting the ethics of conducting research in complex humanitarian settings.

IPT: From Humble Origins as ‘High Contact Therapy’ to International Adoption

Armed conflict leads to increased risk of emotional distress among children and adolescents, and increased exposure to significant daily stressors such as poverty and community and family violence. Unfortunately, these increased risks usually occur in the context of largely unavailable mental health services. There is growing empirical support that evidence-based treatment techniques can be adapted and delivered by non-specialists with high fidelity and effectiveness. However, in order to improve feasibility, applicability, and outcomes, appropriate cultural and contextual adaptation is essential when delivering in different settings and cultures. This paper reports the adaptation process conducted on a new World Health Organization psychological intervention—Early Adolescent Skills for Emotions (EASE)—for use in the north of Lebanon. Lebanon is a middle-income country that hosts the largest number of refugees per capita globally. We conducted: i) a scoping review of literature on mental health in Lebanon, with a focus on Syrian refugees; ii) a rapid qualitative assessment with adolescents, caregivers, community members, and health professionals; iii) cognitive interviews regarding the applicability of EASE materials; iv) a psychologist review to reach optimal and consistent Arabic translation of key terms; v) “mock sessions” of the intervention with field staff and clinical psychology experts; vi) gathering feedback from the Training of Trainers workshop, and subsequent implementation of practice sessions; and vii) gathering feedback from the Training of Facilitators workshop, and subsequent implementation of practice sessions. Several changes were implemented to the materials—some were Lebanon-specific cultural adaptations, while others were incorporated into original materials as they were considered relevant for all contexts of adversity. Overall, our experience with adaptation of the EASE program in Lebanon is promising and indicates the acceptability and feasibility of a brief, non-specialist delivered intervention for adolescents and caregivers. The study informs the wider field of global mental health in terms of opportunities and challenges of adapting and implementing low-intensity psychological interventions in settings of low resources and high adversity.

Maternal outcomes and access to maternal healthcare services among migrant, refugees and forced displaced women in the Middle East and North Africa: A systematic scoping review.

Adequate nutrition plays a vital role in maintaining women’s health and ensuring the healthy growth and development of infants and children. However, during emergencies and displacement, multiple factors can disrupt adequate maternal and child nutrition. The aim of this study was to explore the available literature reporting the prevalence and associated risk factors of undernutrition among displaced pregnant and lactating women. This review follows the PRISMA guidelines for Scoping Reviews. An electronic search was conducted in the PubMed, Web of Science, and Google Scholar databases. The Emergency Nutrition Network and ReliefWeb websites were also explored for grey literature. The prevalence of wasting among pregnant and lactating women varied widely, reaching 77% in Tigray internally displaced person (IDP) camps. The underweight prevalence ranged from 9.3% in a Nigerian IDP camp to 26.7% in a refugee camp in Bangladesh. Anemia was common, affecting up to 44.7% of pregnant Syrian refugees in Jordan. Maternal age, family size, childbirth interval, family income, and lack of education were the main factors associated with undernutrition among displaced pregnant and lactating women. Acknowledging the burden of undernutrition and identifying the most frequent risk factors, should inform the development of relevant nutrition interventions in different displacement settings.