Abstract
BackgroundSince the beginning of the Syrian conflict in 2011, Jordan, Lebanon and Turkey have hosted large refugee populations, with a high pre-conflict burden of non-communicable diseases (NCDs).ObjectivesWe aimed to describe the ways in which these three host country health systems have provided NCD services to Syrian refugees over time, and to highlight the successes and challenges they encountered.MethodsWe conducted a descriptive review of the academic and grey literature, published between March 2011 and March 2017, using PubMed and Google searches complemented with documents provided by relevant stakeholders.ResultsForty-one articles and reports met our search criteria. Despite the scarcity of systematic population-level data, these documents highlight the high burden of reported NCDs among Syrian refugees, especially amongst older adults. The three host countries utilized different approaches to the design, delivery and financing of NCD services for these refugees. In Jordan and Lebanon, Ministries of Health and the United Nations High Commissioner for Refugees (UNHCR) coordinate a diverse group of health care providers to deliver health services to Syrian refugees at a subsidized cost. In Turkey, however, services are provided solely by the Disaster and Emergency Management Presidency (AFAD), a Turkish governmental agency, with no cost to patients for primary or secondary care. Access to NCD services varied both within and between countries, with no data available from Turkey. The cost of NCD treatment is the primary barrier to accessing healthcare, with high out-of-pocket payments required for medications and secondary and tertiary care services, despite the availability of free or subsidized primary health services. Financial impediments led refugees to adopt coping strategies, including returning to Syria to seek treatment, with associated frequent treatment interruptions. These gaps were compounded by health system related barriers such as complex referral systems, lack of effective guidance on navigating the health system, limited health facility capacity and suboptimal NCD health education.ConclusionAs funding shortages for refugee services continue, innovative service delivery models are needed to create responsive and sustainable solutions to the NCD burden among refugees in host countries.
Highlights
The influx of Syrian refugees has placed significant pressures on existing services within hosting countries, on health and education. The responses to this complex emergency has differed by host country; while Jordan and Turkey established refugee camp infrastructure, Lebanon did not, with refugees living either in host communities, or in informal tented settlements where access to essential services such as shelter, food, sanitation, and health care is not officially established
We reviewed the current landscape in terms of: 1) Non-communicable disease (NCD) burden; 2) NCD service provision; 3) access to NCD services and medications; and 4) barriers and facilitators to accessing NCD care by Syrian refugees
To our knowledge, this review is the first to explore both the burden of NCDs amongst displaced Syrians living in Jordan, Lebanon and Turkey and the diverse health system responses
Summary
Forcible displacement is increasing globally, affecting an estimated 68.5 million people in 2017 [1]. One in six people in Lebanon is a refugee – the highest proportion of refugees to host population in the world. In Jordan, 1 of every 14 people is a refugee, whereas Turkey hosts 3.5 million people, the largest absolute number of refugees in the world [3]. The influx of Syrian refugees has placed significant pressures on existing services within hosting countries, on health and education. The responses to this complex emergency has differed by host country; while Jordan and Turkey established refugee camp infrastructure, Lebanon did not, with refugees living either in host communities, or in informal tented settlements where access to essential services such as shelter, food, sanitation, and health care is not officially established. Since the beginning of the Syrian conflict in 2011, Jordan, Lebanon and Turkey have hosted large refugee populations, with a high pre-conflict burden of non-communicable diseases (NCDs)
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