Abstract
With over 500,000 Syrian refugee children in Lebanon, we undertook this study to assess unmet child health needs and health service utilization among Syrian refugees and affected host communities in Lebanon with the aim of informing humanitarian programming. A cross-sectional survey of Syrian refugees and host communities in Lebanon was conducted using a two-stage cluster survey design with probability proportional to size sampling. The questionnaire focused on access to health services, including a module on care seeking for children. The care seeking rate was 74.2 % among refugee and 89.0 % among host community households with a child less than 18 years seeking medical care the last time it was needed. Refugee households most often sought care in primary health care centers (52.7 %), followed by pharmacies (22.2 %) and private clinics (17.8 %), whereas host community households most often sought care in private clinics (47.6 %) and primary health care centers (23.2 %). Among child care seekers, 95.2 % of refugee and 94.6 % of host community children were prescribed medication during the most recent visit, of which 92.7 and 97.3 %, respectively, obtained the medication. Overall, 66.0 % of refugee and 75.9 % of host community households reported out-of-pocket expenditures for either the consultation or prescribed medications at the most recent visit (refugee mean US$30.4; host community mean US$56.0). Care seeking was significantly lower among refugees than the host community. Out-of-pocket payments were considerable for both groups, the majority of which were for medication, and cost was the primary barrier to both care seeking and attaining medications.
Highlights
The influx of refugees fleeing war in Syria since early 2011 is illustrative of a growing trend in forced displacement towards settlement in urban areas and middle-income countries (Spiegel et al 2010; Gutierres and Spiegel 2012)
Care seeking was higher in the host community where 87.3 % of households reported medical attention was sought the last time a child needed care as compared to 79.4 % of Syrian refugee households (p < 0.001); there were no significant differences in the care seeking rate by region in either population (p = 0.616 and p = 0.412, respectively)
Care seeking for Syrian refugee children was significantly lower than for Lebanese children in affected Lebanese host communities
Summary
The influx of refugees fleeing war in Syria since early 2011 is illustrative of a growing trend in forced displacement towards settlement in urban areas and middle-income countries (Spiegel et al 2010; Gutierres and Spiegel 2012). In the Syrian refugee context, children under the age of five account for 17.7 % of the refugee population and those under age 17 account for approximately half (51.5 %) of the population (UNHCR 2015c). This distribution poses even greater challenges to host countries given that mortality causes and disease burdens of displaced populations are often similar to populations with high child mortality rates. In light of the ongoing crisis in Syria and ever-growing challenges in meeting the unique health needs of refugees in host countries, we undertook this study to assess the access to and utilization of health services among Syrian refugee children in non-camp settings in Lebanon. With over 500,000 Syrian refugee children in Lebanon, we undertook this study to assess unmet child health needs and health service utilization among Syrian refugees and affected host communities in Lebanon with the aim of informing humanitarian programming
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