Abstract
Lebanon has approximately one million Syrian refugees (SR) registered with the United Nations High Commission on Refugees (UNHCR) and an unknown number of unregistered SR, who cannot benefit from formal assistance. This study aimed to examine the livelihoods, coping strategies, and access to healthcare among SR based on registration status and accompanying formal assistance. A mixed-method approach with more emphasis on the qualitative design was adopted. A purposive convenient sampling approach was used to recruit SR from informal tented settlements (ITS) in the Beqaa region in Lebanon. Data collection included 19 focus group discussions (FGDs) that were conducted with participants, who were further divided into three groups: registered refugees with assistance, registered without assistance and unregistered. Twelve in-depth interviews were conducted with key informants from humanitarian organizations. All interviews and FGDs were audio recorded, transcribed, and thematically analyzed. SR were highly dependent on formal assistance when received, albeit being insufficient. Regardless of registration status, refugees resorted to informal livelihood strategies, including informal employment, child labor, early marriage, and accruing debt. Poor living conditions and food insecurity were reported among all SR. Limited healthcare access and high out-of-pocket costs led to limited use of antenatal care services, prioritizing life-threatening conditions, and resorting to alternative sources of healthcare. Severity of these conditions and their adverse health consequences were especially pronounced among unregistered refugees. Our findings shed light on the economic and health disparities among marginalized SR, with the lack of registration and formal assistance increasing their vulnerability. More tailored and sustainable humanitarian programs are needed to target the most vulnerable and hard-to-reach groups.
Highlights
Today, the Syrian conflict remains one the largest humanitarian disasters, resulting in massive destruction, loss of lives, and the displacement of over 5 million individuals seeking refuge in neighboring countries, mainly Jordan, Lebanon and Turkey [1]
A total of 122 Syrian refugees participated in 19 focus group discussions (FGDs) within the present study, and there was a total of 40 men and 82 women participants
The study findings highlight the high dependency of Syrian refugees in the Beqaa region on formal assistance, when received based on their registration status, albeit being insufficient
Summary
The Syrian conflict remains one the largest humanitarian disasters, resulting in massive destruction, loss of lives, and the displacement of over 5 million individuals seeking refuge in neighboring countries, mainly Jordan, Lebanon and Turkey [1]. Lebanon has been a host country for refugees who have fled wars and persecution in their home countries, including refugees from Palestine with the 1948 Palestinian exodus, from Iraq post the Persian-Gulf war in the 1990s and the 2003 invasion, as well as forcibly displaced individuals from Syria with the onset of the war in 2011 [5,6,7]. As of July 2020, the Government of Lebanon (GoL) estimated that the country hosts close to 1.5 million Syrian forcibly displaced individuals (refugees), of which around one million were either registered or recorded with the United Nations High Commissioner for Refugees (UNHCR) [8]. Paper on Unregistered Syrian Refugees in Lebanon 2014. Ammar W, Kdouh O, Hammoud R, Hamadeh R, Harb H, Ammar Z, et al Health system resilience: Lebanon and the Syrian refugee crisis.
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