Abstract
BackgroundHumanitarian actors and host-countries in the Middle East and North Africa region are challenged with meeting the health needs of Syrian refugees and adjusting the response to contemporary humanitarian conditions – urban-based refugees, stressed host-country health systems and high NCD prevalence. Although several studies have explored NCD prevalence, utilization of services and barriers to access, these analyses took place prior to dramatic shifts in Jordanian health policy and did not account for nuances in health seeking and utilization behaviors or operational barriers. Accordingly, we aimed to understand the depth and nuances of Syrian refugees’ experiences accessing NCD services in urban and semi-urban settings in Jordan.MethodsA qualitative study was conducted to explore the healthcare experiences of Syrian refugees in Jordan. The study team conducted 68 in-depth interviews with Syrian refugees in urban and semi-urban locations in central and northern Jordan.ResultsThe findings indicated four themes key to understanding the healthcare experience: (1) emotional distress is a central concern and is frequently highlighted as the trigger for a non-communicable disease or its exacerbation; (2) service provision across all sectors – government, NGO, private – is complex, inadequate, expensive and fragmented, making engagement with the health sector physically and financially burdensome; (3) given financial constraints, participants make harmful decisions that further damage their health in order to reduce financial burdens, and (4) host-community members actively exhibit solidarity with their refugee neighbors and specifically do so during emergency health episodes. The findings from this study can be used to inform program design for forcibly displaced persons with NCDs and identify points of entry for effective interventions.ConclusionsOpportunities exist for humanitarian and host-country actors to provide more comprehensive NCD services and to improve the relevance and the quality of care provided to Syrian refugees in Jordan. Global and national funding will need to align with front-line realities and foster better coordination of services between host-country health systems, private actors and non-governmental organizations.
Highlights
Humanitarian actors and host-countries in the Middle East and North Africa region are challenged with meeting the health needs of Syrian refugees and adjusting the response to contemporary humanitarian conditions – urban-based refugees, stressed host-country health systems and high Noncommunicable disease (NCD) prevalence
The Sustainable Development Goals (SDGs) put forth a vision of universal health coverage (UHC); and the commitment to “leave no one behind” calls us to consider the health concerns of the most marginalized, including refugees residing in low-and-middle income countries (LMICs) [1,2,3]
Interviews were conducted with 68 respondents (Table 1), all of whom were Syrian refugees between the ages of 18–59, residing in and around three governorates (Irbid, Mafraq, Amman) in northern and central Jordan. 50% of the respondents were women, 48.5% had diabetes, 72.1% had hypertension and 19.1% had asthma. 92.6% had comorbid conditions including, but not limited to epilepsy, gout, kidney disease, cancer, heart disease, stroke, umbilical hernia, depression, obsessive compulsive disorder, thyroid disease and hypercholesterolemia. 27.9% had disc disorders, due to injury or degenerative disc disease. 97% of participants visited 3 or more facilities in order to access primary care, secondary care, laboratory testing and medications. 41.2% of participants visited 5 or more facilities in order to access the above services
Summary
Humanitarian actors and host-countries in the Middle East and North Africa region are challenged with meeting the health needs of Syrian refugees and adjusting the response to contemporary humanitarian conditions – urban-based refugees, stressed host-country health systems and high NCD prevalence. The forced migration of Syrians has been the primary example of difficulties faced when providing healthcare services to refugees, living in LMICs under challenging conditions, including growing numbers of refugees in urban settings, the enormous demands on host-country health systems and the demographic transition towards non-communicable diseases (NCDs) [4,5,6]. The majority of refugees have settled in urban settings in Jordan, Lebanon and Turkey and face access challenges that differ from the campbased experience [6,7,8] This population, like others across the Middle East and North Africa (MENA), has a high prevalence of NCDs, ranging from 9 to 50% [5]. In an attempt to meet the needs of this refugee population, a variety of interventions have been undertaken in the MENA region including, disease management algorithms, electronic medical records and the expansion of essential drug lists to include medications for NCDs [12, 13]
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