Bordering belonging: A qualitative exploration of educational integration for Syrian refugees in Lebanon across perceived value and impact

BackgroundSince the outbreak of the Syrian war in 2011, close to 6 million Syrian refugees have escaped to Syria’s neighbouring countries, including Lebanon. Evidence suggests rising levels of mental health disorders among Syrian refugee populations. Yet, to the best of our knowledge, large-scale studies addressing the mental health of adult Syrian refugees in Lebanon are lacking. We examined the prevalence of depression symptoms, which represent a common and debilitating mental health disorder among Syrian refugee populations in Lebanon, along with their sociodemographic and clinical correlates.MethodsA cross-sectional survey design was conducted as part of a collaborative project-“Sijilli”- led by the Global Health Institute at the American University of Beirut (Beirut, Lebanon) across 4 informal tented settlements for refugees (Beirut, Bekaa, North, South) in Lebanon among adult Syrian refugees (≥18), over a period extending from 2018 to 2020. The survey inquired about participants’ sociodemographic and clinical characteristics, and screened participants for symptoms of depression through sequential methodology using the Patient Health Questionnaire (PHQ-2 and PHQ-9).ResultsA total of 3255 adult Syrian refugees were enrolled in the study. Of those refugees, 46.73% (n = 1521) screened positive on the PHQ-2 and were therefore eligible to complete the PHQ-9. In the entire sample (n = 3255), the prevalence of moderate to severe depression symptoms (PHQ-2 ≥ 2 and then PHQ-9 ≥ 10) was 22% (n = 706). Further analyses indicate that being ≥45 years of age (OR 1.61, 95% CI 1.13–2.30), a woman (OR 1.34, 95% CI 1.06–1.70), widowed (OR 2.88, 95% CI 1.31–6.32), reporting a neurological (OR 1.73, 95% CI 1.15–2.60) or a mental health condition (OR 3.98, 95% CI 1.76–8.97) are major risk factors for depression.ConclusionOur study suggests that an estimated one in four Syrian refugees in Lebanon shows moderate to severe depression symptoms, and our findings have important public health and clinical implications on refugee health. There is a need to enhance screening efforts, to improve access and referral to mental health services, and to improve post-migration factors among Syrian refugees in Lebanon.

Since 2019, Lebanon has experienced multiple unprecedented, interconnected crises affecting all sectors and social groups. Additionally, the country hosted the world’s highest number of Syrian refugees in 2023. While access to primary education for refugees globally has improved over the years, access to higher education remains limited, with enrolment rates significantly lower than those of their non-refugee peers. This limited access is not caused by lack of interest; rather, it stems from the de-prioritisation of higher education in international and national refugee crisis responses. Lebanon represents a complex refugee educational governance landscape, involving domestic, regional and international public and private stakeholders. This article discusses the politics surrounding higher education for Syrian refugees in Lebanon. Drawing on semi-structured interviews with six stakeholders in the educational and humanitarian network and a focus group discussion with five Syrian refugee youth, the article addresses two questions: (1) How do international and local stakeholders respond to structural, financial and political challenges in shaping the higher education response for Syrian refugees in Lebanon? and (2) How do Syrian refugee students experience and navigate the challenges of accessing higher education in Lebanon? Findings reveal that stakeholders should integrate higher education into a long-term emergency response, while accounting for the broader sociopolitical, legal and cultural environment of displacement. A holistic approach is necessary to ensure that refugee youth can pursue a socially just and transformative learning journey, wherever they reside.

Background Hepatitis B and C are life-threatening infections that can result in liver-associated complications. Lebanon is a country experiencing its worst economic and political crises to date and is considered to be of low endemicity for hepatitis B virus (HBV) and hepatitis C virus (HCV). We aimed to assess the prevalence of HBV and HCV infections among Lebanese and Syrian refugees residing in Lebanon, to describe the current situation beyond statistical scrutiny and identify risks and long-term consequences associated with neglecting these infections. Methods We extracted data on the prevalence of HBV and HCV among the Lebanese population and Syrian refugees residing in Lebanon from 2013 to 2018 and sorted them based on age and gender. We compared the prevalence of HBV and HCV among these groups to the prevalence among the Syrians remaining in Syria, after which we calculated the expected number of HBV and HCV cases in Lebanon based on the total number of registered Syrian refugees in Lebanon. We conducted an extensive literature review using MEDLINE, Google Scholar, and PubMed. Results The prevalence of HBV and HCV in Lebanon from 2013 to 2018 was 1.74% and 0.21%, respectively. 13% of HBV cases and 6% of HCV cases were associated with Syrian refugees. HBV and HCV were more prevalent among men than women for both the Lebanese population and the Syrian refugees. Among the total population, the 20-39 age group represented 40% of HBV and 30% of HCV cases. For the Syrian refugee subgroup, 57% of HBV cases and 28% of HCV cases were reported among individuals aged 20-39 years. The prevalence of HBV and HCV among the total Syrian population in Syria was 5.6% and 2.8%, which was significantly higher than the prevalence among the Syrian refugees in Lebanon for both HBV (0.003%) and HCV (0.001%). The number of HBV and HCV cases recorded among the Syrian refugees in Lebanon was significantly lower than the expected number of HBV and HCV cases. Conclusions Hepatitis B and C are neglected diseases among the Syrian refugee population in Lebanon. Continued neglect can increase the risk of chronic viral hepatitis complications and mortality, further increasing the health and economic burden in Lebanon. Urgent action is needed from the host country and the international community to achieve better surveillance, detection, and linkage to medical care in order to manage and prevent unexpected consequences.

Cash Plus Social and Behavioral Change Communication Approaches to Improve Food Security: Findings From Formative Research With Syrian Refugees in Lebanon

Purpose: Syrian refugees (SRs) in Lebanon are often relegated to informal camps with poor living conditions and substandard access to health care. This study examined the unique condition of urban camp-dwelling SRs in Lebanon. This population is rarely studied as they are marginalized and difficult to access. We sought to assess the prevalence of noncommunicable diseases (NCDs) and health care-seeking behaviors within this population.Methods: A randomized group of urban camp-dwelling SR participants completed a survey on disease burden, health care-seeking patterns, and attitudes toward care. A second group completed interviews regarding health care experiences. We present descriptive population and epidemiologic measures to quantify NCD burden and health care-seeking behaviors.Results: Of 101 participants, 39% reported arthritis, 25% skin infection, 24% high blood pressure, 16% chronic lung conditions, 16% eye disease, and 15% diabetes. Major themes from interviews with SRs included poor living conditions, high cost of health care services, and perceived discrimination by health care workers (HCWs). The major theme from interviews with HCWs was a perception that SRs received health care services similar to members of surrounding communities.Discussion: In this population, we found a higher prevalence of NCDs at younger ages than in the general SR population. We described perceived barriers to accessing health care, including the noteworthy finding of perceived discrimination by HCWs in a linguistically and culturally related host community. We discussed social determinants of health within the camp and refugees' ability to access health care services.

Syria: the neglected health crisis deepens

3 Introduction 4 Realities on the ground 5 The legal and political environment of Lebanese regions hosting Syrian refugees 8 Needs particularities among Syrian refugees according to geographic areas 13 Analysis of risks and challenges to aid provision in light of regional differences 14 Bibliography 16 Sam van Vliet and Guita Hourani, “Regional differences in the conditions of Syrian refugees in Lebanon”, Civil Society Knowledge Center, Lebanon Support, 23 April 2014 Published by Lebanon Support with the support of the Royal Norwegian Embassy. The views expressed in this document are solely those of the author, and do not necessarily reflect the views of Lebanon Support or the Royal Norwegian Embassy. Beirut, 23 April 2014 | Lebanon Support © 2014 all rights reserved 3 Abstract Lebanon has entered its third year as a country hosting the highest number of Syrian refugees in the region. All geographical areas with a high concentration of Syrian refugees in Lebanon share a similar protracted marginality, underdevelopment, and weak infrastructure. Syrian refugees experience different levels of legal and political conditions, security and protection, freedom of mobility, access to aid and relief services, access to labor, socio-economic conditions, and prices of goods and rent, all depending on their geographical settlements. These geographical differences are of eminent relevance that affects not only the Syrian refugees and their hosting communities, but also refugee policies and aid programs. This paper explores these variations by analyzing, first, differences among host communities and, second, by examining the dissimilarities among geographic settlements. The paper reveals that the conditions of Syrian refugees depend on the geographical areas of their settlement within Lebanon. Host-refugee relations also show a direct relationship to the variant geographical areas and their sociodemographic compositions. This paper concludes that geographical differences are of vital importance to be considered when studying the living conditions of refugees, developing policies, or designing aid programs.

Introduction: The Syrian conflict has displaced approximately 1.5 million people to Lebanon. In this setting of forced displacement, child marriage, insecurity, and limited access to sexual and reproductive health services can lead to increased rates of adolescent pregnancy, which have been linked to exacerbated maternal morbidity and mortality. Family planning can help to delay childbirth, increase time between pregnancies, and empower women to make their own reproductive health choices. To date, there is limited research on the knowledge of, and attitudes towards, family planning among Syrian refugees in Lebanon.Objective: Identify knowledge, attitudes, and perceptions towards family planning among Syrian refugees with the overarching goal of informing response strategies to improve sexual and reproductive health for displaced Syrian families in Lebanon.Methods: A thematic qualitative analysis of focus group discussions conducted in Lebanon in January 2017 by the ABAAD Resource Center for Gender Equality. The sample of 99 participants included Syrian women, girls and men.Results: While contraceptive use was generally deemed acceptable by women and girls, husbands’ and mother-inlaws’ attitudes towards fertility influenced their decisions about its use in practice. Additionally, reliable family planning services and sexual and reproductive health education were perceived as seldom available to Syrian refugees in Lebanon. Participants suggested that family planning awareness programs were needed for both parents and girls.Discussion: Changes at the policy, service, community, and individual levels are required to increase knowledge regarding and access to family planning services for Syrian refugees in Lebanon. In the interim, non governmental organizations may play a role in providing educational and supportive services for displaced Syrian girls and women.

Deliveries can be complicated by many factors, especially if women are not well followed up. Syrian refugees, for the last decade, have had to go through unbearable circumstances, which have affected their health. This is evident in the pregnancy data when we look at the delivery methods and outcomes. The caesarian section (C-section) rate among Syrians before the civil war was as per the WHO recommendation; this rate, however, changed enormously for the Syrian refugees in Lebanon.This study aims to determine the C-section rate among Syrian refugees in Lebanon, identify contributing factors, and compare it to pre-war Syrian rates. This retrospective study featuring a sample size of 2183 women was conducted in a government hospital, where refugees are hospitalized under the coverage of the United Nations High Commissioner for Refugees ( UNHCR). The studied variables includethe mode of delivery, maternal age, parity, day of the week, maternal hospital stay, gestational age, sex of the baby, and weight of the baby. The C-section rate increased dramatically after the displacement of the refugees to Lebanon. This increase, however, is significantly lower than the rate among the Lebanese population. The main variables associated with an elevated C-section rate were maternal age (p-value <0.0001), day of the week (p-value <0.0001), gestational age (p-value <0.0001), and male babies (p-value = 0.024). Furthermore, C-section was associated with a longer hospital stay. The C-section rate among Syrian refugees in Lebanon increased dramatically compared to the C-section rate in the Syrian population before the war. This increase is double the optimal rate recommended by the WHO.

In this study, we aimed to explore the prevalence and determinants of common mental health disorders (CMHDs, posttraumatic stress disorder [PTSD], depression, and anxiety) in Syrian refugees in Lebanon. Specifically, we examined how the associations between cultural adversities (discrimination, unemployment, and separation from family) and CMHDs are modified by levels of religiosity and sex. Between March and June 2017, a cross-sectional study was conducted targeting adult Arab Syrian refugees residing in Beirut and Southern Lebanon. Eligibility criteria comprised being a United Nations High Commissioner for Refugees-registered Syrian refugee residing in Lebanon, 18 years and older, and having no history of mental disorder or physical disability. A total of 191 refugees agreed to participate and complete a battery of six questionnaires. Exposures were measured using a sociodemographic questionnaire, the Postmigration Living Difficulties Checklist, the Harvard Trauma Questionnaire, and the Belief into Action Scale, while outcomes were measured using the Posttraumatic Stress Disorder Checklist for DSM-5 and the Depression and Anxiety Scale-21 Items. Half (50.3%) of our sample had high PTSD risk, 73.8% had high depression risk, and 73.8% had high anxiety risk. Stratified analysis revealed religiosity and sex to be effect modifiers of the associations between cultural adversities and CMHDs. Specifically, cultural adversities were only significantly associated with CMHDs in the low religiosity stratum and males. Only unemployment was a significant risk factor for PTSD in both males (OR = 4.53, 95% CI [1.44, 14.27]) and females (OR = 2.77, 95% CI [1.14, 6.74]). Religiosity and sex are effect modifiers of the associations between cultural adversities and CMHDs. Religious and spiritual interventions in mental health care should be adopted in refugee settings. Moreover, there is an urgent need for capacity-building initiatives addressing social determinants of mental health among Syrian refugees in Lebanon. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

This chapter analyzes the nature of the Syrian refugee influx in Lebanon and the social, political, security and economic ramifications. The particular nature of Syrian refugees in Lebanon and the unique relations of their hosting country with the country they fled from have contributed to a relative coping of Syrian refugees in Lebanon. The highest percentage of Syrian refugees in the Middle East has found refuge in Lebanon. The chapter explores which factors have contributed to a mitigation of tensions in Lebanon with regards to the Syrian refugee crisis and to what extent these factors are able to diffuse tensions for more time to come. Prior to the Syrian refugee crisis, the main groups of conflict-related refugee groups in Lebanon were Palestinians and Iraqis, with smaller numbers of other nationalities such as from Sudan. The fine line between voluntary economic migration and involuntary conflict-related refugees is highly contested in the current context of Syrians coming to Lebanon.

Identities and identity politics play a significant role in the lives of Syrian refugees in Lebanon. Using empirical qualitative research with focus groups as the primary research method, this article is a critical investigation into the ways in which Syrian refugees in Lebanon are simultaneously politicized through their everyday lived experiences yet depoliticized through humanitarian policy and practice. In particular, the article explores how the politicization/depoliticization dichotomy impacts Syrian refugees’ access to and experiences within higher education opportunities made available for them in Lebanon. The article argues that humanitarianism’s inattentiveness to intersectional identities and social hierarchies of power has often resulted in physical and psychological educational exclusions and reinforced existing inequalities and fissures/divisions between different groups of refugees. In this way, higher education for refugees has often fallen short of its potential to transform lives.

Refugees are highly vulnerable to mental health disorders and head injuries. The primary aim of this study is to examine the impact of posttraumatic stress disorder (PTSD) and head injury on reactive and appetitive aggression in adult Syrian refugees in Lebanon. A cross-sectional study was conducted targeting adult Arab United Nations High Commissioner for Refugees-registered Syrian refugees residing in Beirut and southern regions of Lebanon. Eligible refugees completed a battery of questionnaires including the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition, the Trauma Events and Head Injury sections of the Harvard Trauma Questionnaire, the Buss-Perry Aggression Questionnaire, and the Appetitive Aggression Scale. A total of 191 Syrian refugees participated in the study: 62.83% were females, and the mean age was 31.01 years (SD = 10.98). The severity of PTSD (adjusted B = 0.18, 95% CI [0.05, 0.31], p = .006), having experienced at least one head injury trauma event (adjusted B = 10.20, 95% CI [1.61, 18.79], p = .020), and the severity of somatic symptoms (adjusted B = 0.71, 95% CI [0.23, 1.20], p = .004) were significant risk factors of reactive aggression. As for appetitive aggression, males (females adjusted OR [aOR] = 0.06, 95% CI [0.02, 0.18], p < .001), younger individuals (aOR = 0.95, 95% CI [0.91, 0.99], p = .024), and higher severity of somatic symptoms (aOR = 1.20, 95% CI [1.09, 1.32], p < .001) were significant risk factors. PTSD and head injury are independent risk factors for reactive aggression but not appetitive aggression in Syrian refugees in Lebanon, while the severity of somatic symptoms is an independent risk factor for both reactive and appetitive aggression. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

BackgroundNavigating health systems in host countries can be a challenge for refugees, particularly in a multi-provider system such as Lebanon. Syrian refugees in Lebanon face a high burden of Non-Communicable Diseases (NCDs) including diabetes mellitus. Evidence on how refugees navigate the health system is essential to improve provision of NCD services. We conducted a qualitative study amongst Syrian diabetes patients visiting Médecins Sans Frontières (MSF) clinics in one urban and one rural setting in Lebanon to explore factors influencing choice of and pathways to diabetes care.MethodsIn-depth interviews were conducted with male and female adult participants with DM type 1 or type 2 who were receiving treatment at MSF clinics. Participants were recruited using convenience sampling. Interviews were conducted in Arabic and directly transcribed and translated into English. Data were coded in NVivo and analyzed using an inductive thematic approach.ResultsA total of 29 in-depth interviews were conducted with 13 men and 16 women. Knowledge and understanding of diabetes management differed among participants. Syrian refugees in Lebanon gathered information about health services for diabetes largely from social networks of family and peers rather than through formal means. Pathways to care included different combinations of providers such as clinics, pharmacists and informal providers.ConclusionsSyrian refugees with diabetes in Lebanon face considerable challenges in navigating the health care system due to their vulnerable status and limited knowledge of the host country systems. To ensure access to care for diabetes, efforts need to be made to support patients’ orientation in the Lebanese health system.

Education is a basic need in the lives of Syrian refugees in Lebanon and teachers, specifically, play a critical role in the quality of education these children receive. Their experiences provide a critical view of the reality of refugee education in Lebanon. The present study examines the challenges teachers face when teaching Syrian refugee children in Lebanon. The research adopts a phenomenological approach, using in-depth interviews with teachers of Syrian refugee students in a public school in Beirut. Participants discussed psychological and academic needs of students, effectiveness of current methods, lack of parental support, their perceptions of the students, cultural and gender roles, personal experiences and beliefs, as well as teachers’ roles.