Abstract
Due to its geographical proximity to the Syrian conflict and the occupied territories, Lebanon has experienced an influx of refugees in recent times. Palestinian refugees are an identified key vulnerable population, with displaced communities increasingly experiencing camp insecurity, vulnerability to drug use and related health harms. A qualitative study consisting of in-depth interviews and focus group discussions (FGDs) was undertaken as part of a regional exercise investigating Palestinian community experiences of substance and drug use in refugee camps. Thematic analysis triangulated the perspectives of 11 professional stakeholders representing United Nations, human rights and non-governmental organizations (NGOs), and eight Palestinian community members. Emerging themes centered on the interplay between socio-economic instability, lack of law enforcement and camp governance contributing to concerning levels of familial, drug and camp violence, trafficking and availability of drugs. Transactional sex and the exploitation of women and children in drug dealing, diversification toward drug manufacture and dealing of drugs with the outside community were described. There is a lack of harm reduction and rehabilitation supports for those in need. This study highlights the complexities in tackling drug dealing and related criminal activity within refugee camps and humanitarian settings, and the vulnerabilities of those living within to harmful drug use.
Highlights
The Middle East and North Africa (MENA) region and its ongoing instability and humanitarian crisis in a number of countries, along with the migration and displacement of populations pose multiple challenges for health systems, especially in issues related to HIV and drug use response programs
Interview and focus group discussions (FGDs) guides consisted of questions around perceptions of the changing and current situation regarding substance use, abuse and dependence in the camps; common substances used and the factors contributing to substance use and abuse; impact on families living in the camps; thoughts and opinions regarding potential interventions to address youth and children’s vulnerability to substance use; identified harm reduction, community or psycho-social supports for communities and families affected by the issue; and the impact of COVID-19 on the situation overall
Seven themes emerged from the data analysis: Poverty and unemployment; Hopelessness and drug related coping; Inner and outer camp aspects of lawlessness; Drug availability, user and dealer networks; Impacts of COVID-19 on drugs and drug use; Drug related violence and exploitation of the vulnerable; and Imperatives for community support
Summary
The Middle East and North Africa (MENA) region and its ongoing instability and humanitarian crisis in a number of countries, along with the migration and displacement of populations pose multiple challenges for health systems, especially in issues related to HIV and drug use response programs. While Lebanon has been classified as a drug transit country, routine surveillance of epidemiological variables such as the rates of substance use disorder, drug-related blood borne viral (BBV) transmission ( HIV and hepatitis), and treatment uptake is lacking (Global Initiative against Transnational Organized Crime, 2017; MENAHRA, 2021; Van Hout & Wells, 2016). Available data suggests that general population rates of HIV, hepatitis B and C prevalence in Lebanon are low, but are reported to be rising in refugee populations, and are concentrated among those engaged in drug and sexual risk behaviors (MENAHRA, 2021; WHO-EMRO, 2016)
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