Fieldwork opportunities and challenges in Palestinian refugee camps in the West Bank, occupied Palestinian territory, and in Jordan: lessons learned from a Palestinian adolescent reproductive health cross-sectional study

Abstract

BackgroundPalestinian refugee camps have lasted for more than 70 years. Generally the residents are poor and the camps are crowded and politically unstable, with a range of social, cultural, and economic constraints. Studying the adolescent reproductive health of girls in refugee camps is crucial yet challenging, primarily because of its sensitive nature. We use experiences from a cross-sectional study of Palestinian adolescent reproductive health to discuss methodological challenges and opportunities for researching this subject in the context of refugee camps. MethodsWe completed a household survey in Palestinian refugee camps in the West Bank (19 camps) and Jordan (ten camps) from June to September, 2019. Data from 2949 adolescent girls aged 15–18 years (1443 from the West Bank and 1506 from Jordan) were collected in relation to menarche and menstruation, mental health, and nutrition. A fingerprick haemoglobin test for anaemia was conducted among participating girls. Data were collected by women fieldworkers using electronic tablets. Written consent was obtained from girls and their mothers or a female caregiver for both the survey and the blood tests. Consent to enter the household was obtained first, then consent from girls. FindingsResponse rates at the household level were 3573 (87%) of 4103 and 3210 (74%) of 4314 for the West Bank and Jordan, respectively, and for girls were 1443 (95%) of 1522 and 1506 (99%) of 1526 for the West Bank and Jordan, respectively. This seemed to suggest a higher level of trust and willingness to participate in the West Bank compared with Jordan at the household level, although this seemed almost no problem for the girls as long as their caregivers had agreed. During data collection, we encountered fieldwork challenges at political, social, cultural, and structural levels. When recruiting participants, fieldworkers used a random-walk procedure, as it was hard for them to track their route in the narrow, unstructured, and unidentified camp roads and alleyways, which caused delays and disruption to the process. Crowded households posed an ethical challenge in securing girls’ privacy, particularly in more conservative Jordan. Furthermore, we encountered resistance to fingerprick blood tests owing to fear of contamination, particularly in the more politically unstable camps in the West Bank. The political situation also affected fieldwork in the West Bank by limiting working hours owing to road closures and Israeli army incursions. Despite this, fieldworkers were able to develop a good rapport with participants, especially when the fieldworkers themselves were camp dwellers. Engagement and involvement with local organisations was essential for research teams to gain the trust of families and girls, enabling valuable and credible data collection. InterpretationWhen conducting studies in Palestinian refugee camps, especially on sensitive issues, it is crucial to know the camp well, obtain assistance from local organisations to acquaint and familiarise the population with the research, and to use trained fieldworkers from the local community. Finally, and most importantly, it is essential to be flexible and to have contingency plans that include extra time, personnel, and resources that may be needed to overcome unforeseen circumstances. FundingInternational Development Research Centre (IDRC), Ottawa, Canada.