Syrian Refugee Patients Research Articles

Providing continuity of care for people living with noncommunicable diseases in humanitarian settings: A qualitative study of health actors' experiences in Lebanon

ObjectiveThe burden of non-communicable diseases (NCDs) is increasing among populations living in humanitarian settings. Continuity of care (CoC) involves following an individual over time and across different levels of healthcare (management, longitudinal, informational and interpersonal continuity); it is an essential component of good quality, person-centred NCD care. Providing CoC is particularly challenging in humanitarian crises where health care access may be interrupted or restricted. This paper aimed to explore health actors’ experiences of continuity of hypertension and diabetes care for Syrian refugees and vulnerable Lebanese in Lebanon. MethodsWe conducted 20 in-depth qualitative interviews with health actors, including eleven with health care providers at four urban-based health facilities supported by international humanitarian agencies that provide NCD care to Syrian refugees and vulnerable Lebanese, one representative of a governmental institution, one international delegate and seven humanitarian actors. Thematic analysis, combining inductive and deductive approaches, was guided by a conceptual framework for NCD models of care in humanitarian settings. We reported our findings against the conceptual framework's domains relating to health system inputs and intermediate goals, reflecting on their impact on the domains of CoC. FindingsExisting health system weaknesses and novel challenges (the economic crisis, COVID-19 pandemic and Beirut blast) to continuity of NCD care were identified. Health system input challenges: governance and financing (weakened governance, limited central financing, historical dependence on local NGOs for primary healthcare, a dominant private sector), health workforce (exodus of health care providers from the public system), inconsistent medicines and equipment supplies, and limited health information systems (no unified system across institutions or levels of care, lack of formal referral systems, and inconsistent facility-level data collection) contributed to limited public primary care, poorly integrated within a fragile, pluralistic health system. These factors negatively impacted the intermediate health system goals of access, standardisation and quality of NCD care for Syrian refugee and Lebanese patients, and collectively hampered the management, longitudinal, informational and interpersonal continuity of NCD care in Lebanon. ConclusionWe recommend that humanitarian actors continue the work underway with the Lebanese Ministry of Public Health to align with and strengthen health system inputs, including supporting health governance through the accreditation process, exploring new funding mechanisms, strengthening the workforce via task sharing and training, supporting the medication supply chain, improving access to facilities and service quality, and supporting the development, standardisation and interoperability of referral and information systems. In combination, these elements will support better CoC for people living with hypertension and diabetes in Lebanon.

Radiation therapy for prostate cancer in Syrian refugees: facing the need for change.

To report the utilization of radiation therapy in Syrian refugee patients with prostate cancer residing in Turkey. A multi-institutional retrospective review including 14 cancer centers in Turkey was conducted to include 137 Syrian refugee patients with prostate cancer treated with radiation therapy (RT). Toxicity data was scored using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. Noncompliance was defined as a patient missing two or more scheduled RT appointments. Advanced disease, defined as stage III or IV, was reported in 64.2% of patients while androgen deprivation therapy (ADT) was only administrated to 20% of patients. Conventionally fractionated RT with a median number of 44 fractions was delivered to all patients with curative intent (n = 61) while palliative RT (n = 76) was delivered with a median number of 10 fractions. The acute grade 3-4 toxicity rate for the entire cohort was 16%. Noncompliance rate was 42%. Most Syrian refugee prostate cancer patients presented with advanced disease however ADT was seldom used. Despite the low treatment compliance rate, conventional fractionation was used in all patients. Interventions are critically needed to improve screening and increase the use of standard-of-care treatment paradigms, including hypofractionated RT and ADT.

The effect of health literacy in explaining medication adherence among patients with hypertension: A cross-sectional study of Syrian refugees in Jordan.

Poor medication adherence is a concern among patients with hypertension. However, few studies have assessed the effect of health literacy on medication adherence among refugee patients. The aim was to examine the effect of health literacy and associated factors in explaining medication adherence among Syrian refugee patients with hypertension. A cross-sectional study was used, recruiting 150 Syrian refugees with hypertension in February 2020. The Hill-Bone scale and the Health Literacy Questionnaire were used to collect data, which were analysed using descriptive and inferential statistics. Participants had low levels of medication adherence and had low mean scores in eight of nine subscales of the health literacy scale, except in the appraisal of health information subscale. Factors including patient's age, marital status, the number of medications and co-morbid diseases were significantly associated with medication adherence. Age, understanding written health information and ability to engage with healthcare providers were predictive of medication adherence. To increase medication adherence among refugee patients with hypertension, nurses need to improve patients' health literacy and understanding of health information about their disease.

Comparison of Survival Rates of Syrian Refugee Versus Turkish Pediatric Patients with Leukemia

Although survival rates are increasing in acute leukaemias today, this rate is lower in developing countries; there are very few studies conducted on this matter in refugee patients. This research aims to evaluate the survival rate in pediatric Syrian refugee patients with acute leukaemia and compare it with Turkish pediatric leukaemia patients. A total of 144 patients diagnosed with acute leukaemia were included in the study, and their files were reviewed retrospectively. Nineteen 144 patients (13%) were Syrian refugees, and 125 (87%) were Turkish patients. The median age of the Syrian refugees and Turkish patients was 6.9 years (range 1-18 years) and 7.2 years (range 2-18 years), respectively, and gender distribution was similar for both groups (p:0.32). The relapse rate and rate of patients in the high-risk leukaemia group were higher in the Syrian refugee patient group (p=0.05). The survival rates of the Syrian refugee patients at the 11th month and 23nd month of the follow-up were 87.5% and 70%, respectively. The survival rates of the Turkish patients in the 23rd month and 44th month of the follow-up were 96.6% and 85%, respectively. The survival rates of the Turkish patients were significantly higher (p<0,001). The odds ratio of mortality adjusted for being a Syrian refugee was 5.3 (with a 95% confidence interval, 1.5 to 18.3). No difference was observed between the groups regarding compliance with treatment. Survival rates of the Syrian refugee leukaemia patients were lower, and the rate of patients in the high-risk leukaemia group and the relapse rate was higher in Syrian refugee patients compared to Turkish patients.

Socioeconomic and Medical Vulnerabilities Among Syrian Refugees with Non-communicable Diseases Attending Médecins Sans Frontières Services in Irbid, Jordan

Non-communicable diseases (NCDs) are high-prevalence health problems among Syrian refugees. In 2014, Médecins Sans Frontières (MSF) identified unmet NCD care needs and began providing free-of-charge services for Syrian refugees in Irbid, Jordan. This study aimed to describe current socioeconomic and medical vulnerabilities among MSF Irbid Syrian refugee patients and their households and raise awareness of their ongoing health needs that must be addressed. A cross-sectional survey among Syrian refugees attending MSF NCD services in Irbid Governorate, Jordan was conducted by telephone interviews in January 2021 to query sociodemographic characteristics, economic situation, self-reported NCD prevalence, and Ministry of Health (MoH) policy awareness. Descriptive analysis of indicators included proportions or means presented with 95% confidence intervals. The survey included 350 patient-participants in 350 households and 2157 household members. Mean age was 28.3 years. Only 13.5% of household members had paid or self-employed work; 44% of households had no working members. Mean monthly income was 258.3 JOD (95%CI: 243.5–273.1) per household. Mean expenditures were 320.0 JOD (95%CI: 305.1–334.9). Debt was reported by 93% of households. NCD prevalence among adults was 42% (95%CI: 40–45). Hypertension was most prevalent (31.1%, 95%CI: 28.7–33.7), followed by diabetes (21.8%, 95%CI: 19.7–24.1) and cardiovascular diseases (14.4%, 95%CI: 12.6–16.4). Only 23% of interviewees were aware of subsidized MoH rates for NCD care. Twenty-nine percent stated they will not seek MoH care, mainly due to the unaffordable price. Our findings highlight increased vulnerability among MSF Irbid Syrian refugee NCD patients and their households, including: an older population; a high percentage of unemployment and reliance on cash assistance; higher proportion of households in debt and a high number of households having to resort to extreme coping mechanisms when facing a health emergency; and a higher proportion of people with multiple comorbid NCDs and physical disability. Their awareness of subsidised MoH care was low. MoH care is expected to be unaffordable for many. These people are at increased risk of morbidity and mortality. It is vital that health actors providing care for Syrian refugees take action to reduce their risk, including implementing financial support mechanisms and free healthcare.

Nursing Care Experiences With Syrian Refugees in Southern Turkey: A Metaphor Analysis.

Healthcare professionals' "cultural prejudices" toward individuals' cultural beliefs, attitudes, and perceptions affect the care they provide. Their awareness of their bias is closely associated with the quality of healthcare provided. This study was designed to assess nurses' perceptions regarding providing care to Syrian refugee patients using metaphors and to evaluate their views based on these metaphors. The participants in this qualitative study consisted of 80 nurses who worked in Level 1 and Level 2 health institutions. Data were collected using an interview form prepared by the researchers. The form included descriptive characteristics of the nurses and two expressions used to determine the nurses' opinions on providing care for Syrian refugee patients. The nurses were given an incomplete sentence, which was "Providing care for a Syrian refugee patient…because…," and were asked to complete the blanks. The data were analyzed using the content analysis method. On the basis of "providing care for Syrian refugee patients," four categories of metaphors were determined: occupational awareness, health promotion, a difficult process/resistance, and providing service in vain. The participants generated 50 metaphors, with "humanity," "a baby/little child," and "a barrier" as the three most used metaphors, belonging to the "occupational awareness" and "a difficult process/resistance" categories, respectively. The metaphors of nurses regarding giving care to Syrian refugee patients were mostly concentrated in the categories of "occupational awareness" and "a difficult process/resistance." Metaphors generated by the nurses offer a powerful research tool to reveal, understand, and explain nurses' personal perceptions and to develop and support nursing care accordingly. In addition, the subject of transcultural nursing should be discussed more extensively in nursing education programs. Understanding the social context of refugees is very important during the nursing care process.

Utilization of radiation therapy and predictors of noncompliance among Syrian refugees in Turkey

BackgroundAccess to cancer care is a problem that continues to plague refugees displaced from their home countries. The turbulent political crisis in Syria, which has led to millions of refugees seeking asylum in Turkey, merits further attention. We aimed to study the rate of utilization of radiation therapy among Syrian refugees with cancer living in Turkey in an attempt to identify the contributing factors predictive of non-compliance with prescribed RT.MethodsIn this retrospective review of 14 institutional databases, Syrian refugee patients in Turkey with a cancer diagnosis from January 2015 to December 2019 who were treated with RT were identified. The demographic data, treatment compliance rates, and toxicity outcomes in these patients were surveyed. Variable predictors of noncompliance such as age, sex, diagnosis, treatment length, and toxicity were studied. The association between these variables and patient noncompliance was determined.ResultsWe identified 10,537 patients who were diagnosed with cancer during the study period, of whom 1010 (9.6%) patients were treated with RT. Breast cancer (30%) and lung cancer (14%) were the most common diagnoses with up to 68% of patients diagnosed at an advanced stage (Stage III, IV). 20% of the patients were deemed noncompliant. Treatment with concurrent chemoradiotherapy (OR 1.61, 95% CI 1.06–2.46, p = 0.023) and living in a refugee camp (OR 3.62, 95% CI 2.43–5.19, p < 0.001) were associated with noncompliance. Age, sex and treatment length were not significantly associated with noncompliance.ConclusionsNoncompliance with radiotherapy among Syrian refugees in Turkey remains an area of concern with a multitude of factors contributing to these alarming numbers. Further studies to better ascertain the finer nuances of this intricately complex problem and a global combination of efforts can pave the way to providing a solution.

Outpatient use patterns and experiences among diabetic and hypertensive patients in fragile settings: a cross-sectional study from Lebanon

ObjectivesAssess and describe the health service use and delivery patterns for non-communicable disease (NCD) services in two contrasting fragility contexts and by other principal equity-related characteristics including gender, nationality and...

The Spectrum of Beta-Thalassemia Mutations in Syrian Refugees and Turkish Citizens.

Introduction and objectivesNeighboring the border between Turkey and Syria, Sanliurfa is one of the Turkish provinces with the highest number of Syrian refugees in our country. We aimed to find out the spectrum of beta-globin gene mutations in adult Turkish citizens and Syrian refugees with beta-thalassemia major.ResultsOf the participants, 35 patients (70%) were Turkish citizens and 15 patients (30%) were Syrian. The most common mutation in Turkish patients was found to be IVS-I-110 (G>A) with a frequency of 28.8%, followed by IVS-I-6 (T>C) with a frequency of 15.5%. Other common mutations were IVS-I-1 (G>A) and codon 39 (C>T) with frequencies of 11.1%. These four mutations accounted for 65.5% of all mutations in the Turkish cohort. The most common mutations in Syrian refugee patients were IVS-I-1 (G>A), IVS-II-1 (G>A), IVS-I-5 (G>C), and codon 5 (-CT), all with a frequency of 15.7%, accounting for 62.8% of all mutations in the Syrian patients. In the analysis, codon 5 (-CT) mutation (15.7% vs 0%, p=0.023) was found significantly higher in Syrian refugees compared to Turkish citizens.Discussion and conclusionsA wide spectrum of mutations was detected in beta-thalassemia major patients living in the Sanliurfa region. Mutational profiles in Turkish and Syrian patients were found to be significantly different from each other. Because marriages between Syrian refugees and Turkish citizens are increasing in our region, the genetic findings and the mutational profiles in Turkish and Syrian patients obtained in this study are thought to become useful for future prenatal molecular diagnostic tests.

Retrospective analysis of Syrian refugee patients admitted to a hospital adult emergency service

Introduction: Due to wars and political changes, large-scale migration can occur from countries. Millions of people leave their places of residence and take refuge in other countries and affect the sociological, economic and health systems of the country they go to. Methods: Syrians under temporary protection, who applied to Sakarya University Training and Research Hospital adult emergency room between 01/03/2018-31/12/2019, were examined retrospectively. Thus, it was aimed to examine the effect of Syrian refugees on emergency services. Results: A total of 4310 Syrian patient applications are made, of which 2710 are male and 1600 are female. 3607 (83.7%) of the patients applied to the green outpatient clinic, 175 of the patients (4.1%) are forensic cases. 151 (86.3%) of forensic cases belong to male Syrian patients. Most of the patients are young adults, the average patient age is 30.8 ± 10.71 and the median age is 28. Conclusion: It was concluded that Syrians mostly apply to the green clinic in the adult emergency department, male and young patients apply more, forensic cases occupy a small proportion among these applications, and generally non-emergency cases use the emergency service. Refugees can be informed about applying to primary health care in non-emergency situations and organizing health infrastructure in this direction can reduce the emergency service workload.

The Impact of War-Related Stress on Coronary Artery Disease Severity in War Survivors: A SYNTAX Study.

Background: Due to the strong relationship between stress and heart disease, particularly acute myocardial infarction (MI), this study investigated the complexity of coronary artery disease (CAD) among Syrian refugee patients referred to Jordan University Hospital and its relation to war-related stressors. Methods: This is a retrospective study that utilized the SYNTAX I score in order to evaluate all Syrian refugees that underwent coronary artery catheterization at Jordan University Hospital during the period between May of 2014 and December of 2017. Results: There was a significant association between war-related stressors and high SYNTAX score (SX score), thus indicating a higher complexity of CAD in Syrian war survivors with higher stress scores. The strongest war-related correlation was observed with crossing green-lines, in which Syrian refugee patients who had crossed such lines had significantly higher SYNTAX scores. Regression analysis demonstrated that war stressors were positive predictors of increased SYNTAX scores even when adjusted for conventional CAD risk factors. Surprisingly, none of the CAD risk factors were significantly associated with SYNTAX score. Conclusion: Our findings suggest that exposure to multiple war-related stressors may increase the complexity and severity of CAD in Syrian war survivors. Thus, special attention, efforts, and resources should be allocated to screen for such vulnerable patients in order to provide them with the appropriate healthcare.

Abstract PS7-73: Late presentation and suboptimal treatment of breast cancer among Syrian refugees. A call for systematic international action

Abstract Introduction: The Syrian crisis, started in 2011, has had a profound impact on the entire region. Jordan, a low-middle income country with limited resources is ranked first in the region in relation to the number of refugees hosted. The latest national census reported over a million Syrian refugee in the country. Lack of sufficient funding, from either the host country or international refugee aid organizations, may lead to suboptimal treatment of cancer patients. The total number of Syrian cancer patients registered at King Hussein Cancer Center (KHCC) hospital-based cancer registry was 510 patients. Local and regional funds covered the treatment of almost two thirds of these patients. In this study, we report on patterns of presentation and management of Syrian patients with breast cancer treated and followed at our institution. Patients and methods: This is a retrospective data collection of Syrian refugees who presented to our institution with a diagnosis of breast cancer from January 2011 to December 2019. Adult patients aged 18 year or older with pathologically-confirmed diagnosis of breast cancer were required to have at least one medical encounter. Data was collected from the electronic medical records for eligible patients. Management was compared against our approved clinical practice guidelines (CPG). Results: During the study period, a total of 147 adult Syrian refugee patients with breast cancer had at least one medical encounter at our institution. All were females and median age (range) at diagnosis was 47 (21-84) years. Thirty-four (23.1%) patients did not complete the work up and missed subsequent visits and will be excluded from analysis. The remaining 113 patient had biopsy proven invasive (n=110) or ductal carcinoma in situ (n=3) and continued their treatment and follow up; 39 (34.5%) had early stage disease, 48 (42.5%) locally advanced and 26 (23.0%) presented with metastatic disease. Estrogen receptors (ER) were positive in 75 (66.4%) patients while 63 (55.8%) had positive progesterone receptor (PR). HER2 positive disease was documented in 31 (27.4%) while 18 (15.9%) patients had triple negative disease. Eighty (70.8%) patients underwent surgery, 60 (75.0%) were at KHCC. The median time from first encounter to surgery for those who underwent upfront surgery was 2 months. Breast conserving surgery (BCS) was done for 27 (45.0%). However, only 11 (35.4%) of the 31 patients eligible for breast reconstruction underwent such procedure. Adjuvant radiation was given to 49 (77.7%) of 63 candidate patients and some were delayed. Systemic treatment with chemotherapy was given to 103 patients; as neoadjuvant (n=37, 35.9%), adjuvant (n=45, 43.7%) and palliative (n= 21, 20.4%). Among the 31 patients with HER2-positive disease, only 11 (35.5%) patients received it. Additionally, only 3 (30.0%) of 10 patients who were candidates for CDK4/6 inhibitors received it. Genetic Testing and counselling were also suboptimal, only 8 (12.3%) of 65 candidate patients underwent genetic testing. Across all needed treatment, 37 (32.7%) patients had significant deviations when judged against our institutional CPGs. Conclusions: Syrian refugees with breast cancer had late presentation and more advanced-stage disease. They are more likely to receive delayed and suboptimal surgeries, genetic counseling and systemic therapy highlighting the urgent need for international systematic approach for cancer care among such unprivileged population. Citation Format: Hikmat Abdel-Razeq, Faris Tamimi, Maryam El-Atrash, Baha' Sharaf, Razan Mansour, Rawan Mustafa. Late presentation and suboptimal treatment of breast cancer among Syrian refugees. A call for systematic international action [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-73.

Epidemiologic Study of Syrian Refugees Underwent Surgery Due to Fracture in a Tertiary Reference Hospital in Turkey.

AimThis study aims to analyze the spectrum, management, and outcome of Syrian refugees’ fracture over four-year period, highlighting challenges in management and follow-up.MethodsThis was a retrospective review of Syrian refugee patients operated for fractures at our centre from January 2015 to January 2019. The patients were evaluated for age, gender, mechanism of injury, location and type of fracture, presence of accompanying injuries, surgical technique, complications, mortality and morbidity. The comparison of complications and postop outpatient clinic controls between Turkish citizens and Syrian refugees were also evaluated.ResultsThe study included a total of 455 patients comprising 281 adults (202 males, 79 females) with a mean (SD) age of 41.1 (19.3) years and 174 children with a mean age of 8.8 (4.9) years. The trauma mechanism was most commonly fall in both adult and pediatric patients (86.6% / 73.5%). Whilst lower limb fractures were more common in adults (73.7%), upper limb fractures were more common in children (63.4%). The presence of accompanying trauma was determined in 21 (7.5%) adults and 10 (5.7%) children. Multiple fractures were determined in 12 (4.3%) adults and eight (4.6%) children. Plate fixation (PF) was most used in 137 (48.8%) adult patients and K-wire augmentation was used in 75 (43.1%) pediatric patients. Out of the 455 patients, 41 (14.6%) adults and 13 (7.3%) children developed complications. Whilst three adult patients were died during follow-up, no deaths were recorded in the pediatric patients. Complication rate was 54/455 in Syrian refugees and 32/455 in citizens. It was observed that the complication was significantly higher in immigrants (p: 0.017). Sixty-five (14.2%) Syrian immigrants did not come to the outpatient clinic control at all or once, while this rate was 29/455 (6.3%) for Turkish citizens (p = 0.012).ConclusionInadequate living conditions and lack of communication faced by refugees reduce the rate of patient follow-up and negatively affect the results of orthopedic trauma.

Views and experiences of family physicians about Syrian refugee patients in Turkey: a qualitative research.

The aim of this study was to describe the attitudes, views and solution proposals of family physicians (FPs) about primary healthcare problems of Syrian refugee patients. This study would be the very first study for Turkey that evaluates the attitudes, views and solution proposals of FPs about primary healthcare problems of Syrian refugee patients. Following the anti-regime demonstrations that started in March 2011, the developments in Syria created one of the biggest humanitarian crises in the world and the largest number of asylum seekers continue to be hosted in Turkey. There are some studies evaluating asylum seekers' access to healthcare services in Europe, and the common result is that refugees have free access to primary healthcare services in most countries; however, they face many obstacles when accessing primary healthcare services. While there are studies in the literature evaluating the situation of access to primary healthcare services from the perspective of asylum seekers; there are few studies evaluating the opinions/views of FPs. A qualitative methodology informed by the grounded theory was used to guide the research. A total of 20 FPs were interviewed face to face through semi-structured interviews, using 12 questions about their lived experience and views caring of refugee population. Interviews were analysed thematically. The following themes were revealed: Benefiting from Primary Health Care Services, Benefiting from Rights, Differences Between the Approach/Attitudes of Turkish Citizens and Refugees, Barriers to Healthcare Delivery, Training Needs of Physicians, Solution proposals. FPs reported that there is a need for support in primary care and a need for training them and refugees in this regard and they specified refugee healthcare centres are the best healthcare centres for refugees; however, the number of these and provided services should be increased.

Are refugees applying to child and adolescent psychiatry departments only to obtain a disability report? The experience of a department in a Turkish city on the Syrian border

Aim: Children and adolescents are the most affected by wars. They are also at higher risk for psychiatric disorders. However, as in all disadvantaged groups, the reasons for applying to psychiatry departments in refugees may differ from the local population. So we aimed to investigate reasons for applying to psychiatry department, the sociodemographic characteristics, presence of psychopathologies, prescriptions and treatment compliance of child and adolescent Syrian refugees.Materials and Methods: This research comprises an outpatient clinical sample of 400 refugee patients. The data was obtained by retrospectively examining the records of Syrian refugee patients aged between 0 and 18 years old who applied to Mardin State Hospital Child and Adolescent Psychiatry Department between May 2018 and May 2019. The sociodemographic characteristics of the cases, their psychiatric diagnoses according to DSM-5, medicines, and their continuation to psychiatric controls were evaluated.Results: 59% (235) applied to the department for treatment of psychiatric symptoms and 41% (165) applied to obtain a disability report. The mean age of refugees included in the study was 8.1 ± 4.7, out of which 231 were boys (58%) and 169 were girls (42%). The two most common diagnoses were Intellectual Disabilities: n=46 (19%) and Trauma and Stressor Related Disorders: n=39 (17%). Only 27% of patients showed compliance with the offered treatment. The most used medications were antipsychotics (41.17%) and antidepressants (38.16%).Conclusion: In our sample psychopathology rates were high and treatment compliance was low. In addition, the application rate for the disability report was quite high. As a result protective and therapeutic strategies should be implemented to address these issues and awareness should be increased for psychiatric disorders.

\u201cTo die is better for me\u201d, social suffering among Syrian refugees at a noncommunicable disease clinic in Jordan: a qualitative study

BackgroundThe conflict in Syria has required humanitarian agencies to implement primary-level services for non-communicable diseases (NCDs) in Jordan, given the high NCD burden amongst Syrian refugees; and to integrate mental health and psychosocial support into NCD services given their comorbidity and treatment interactions. However, no studies have explored the mental health needs of Syrian NCD patients. This paper aims to examine the interaction between physical and mental health of patients with NCDs at a Médecins Sans Frontières (MSF) clinic in Irbid, Jordan, in the context of social suffering.MethodsThis qualitative study involved sixteen semi-structured interviews with Syrian refugee and Jordanian patients and two focus groups with Syrian refugees attending MSF’s NCD services in Irbid, and eighteen semi-structured interviews with MSF clinical, managerial and administrative staff. These were conducted by research staff in August 2017 in Irbid, Amman and via Skype. Thematic analysis was used.ResultsRespondents describe immense suffering and clearly perceived the interconnectedness of their physical wellbeing, mental health and social circumstances, in keeping with Kleinman’s theory of social suffering. There was a ‘disconnect’ between staff and patients’ perceptions of the potential role of the NCD and mental health service in alleviating this suffering. Possible explanations identified included respondent’s low expectations of the ability of the service to impact on the root causes of their suffering, normalisation of distress, the prevailing biomedical view of mental ill-health among national clinicians and patients, and humanitarian actors’ own cultural standpoints.ConclusionSyrian and Jordanian NCD patients recognise the psychological dimensions of their illness but may not utilize clinic-based humanitarian mental health and psychosocial support services. Humanitarian agencies must engage with NCD patients to elicit their needs and design culturally relevant services.

The Impact of Middle Eastern Crisis on Cleft Care: Evaluation of Demographic and Perioperative Data in Syrian Refugees With Cleft Lip and Palate.

The cleft lip and palate (CL/P) define a heterogeneous group of congenital deformities, which are morphologically highly diverse, with a complex and multifactorial etiology. Affected children may experience social problems due to negative effects on speech, hearing, facial appearance, as well as negative psychological effects on the parents. In 2011, after the civil war began in Syria, a great wave of immigration began to Turkey and other neighboring countries. Refugees may not be able to receive optimal health care because of cultural differences, socioeconomic status, language problems, and psychosocial problems. To increase awareness about this issue, the authors investigated the demographic, perioperative, and post-operative data of Syrian refugee patients with CL/P who were admitted to our cleft center between January 2016 and May 2019. Sixty-eight refugees with CL/P were detected as the result of the screening. Unlike the protocol the authors follow in our center, cleft lip repair was performed at an average of 7.6 months and cleft palate repair was performed at an average of 28.7 months of age. The rate of fistula was found 26.2%.The civil war in Syria has caused the repair of the patients with cleft lip and palate at a later age, hampered the follow-up and treatment, and caused more complications. Considering the demographic, social, economic and cultural characteristics of the patients, it was demonstrated that the necessary health precautions and infrastructure should be provided on the pillar of plastic surgery.

An Analysis of Orthopedic Surgical Services Provided to Syrian Refugees in a Health Center Away from the Syria District

Background: The Arab Spring, a wave of demonstrations and protests that hadtaken place in the Arab world since December 18, 2010, had also affected Syria. Thenumber of Syrian refugees who have migrated to Turkey is over 3.5 million.Objective: The aim of this study was to evaluate the demography, clinical featuresand invoice amounts of Syrian refugee patients who were operated in an orthopedicand traumatology clinic of a healthcare institution far from the Syria district region.Materials and Methods: For this purpose, 329 Syrian patients who underwentsurgery in the field of orthopedics and Traumatology between June 2011 and 2018were enrolled in the study. The records of Syrian refugees have been retrospectivelyexamined.Results: Male applicants (76.3%) were more than females (23.7%).%). It was observedthat the highest number of applications were in the field of microsurgery (21.3%),followed by trauma (20.7%) and pediatric orthopedics (14.6%), respectively. Includingthe non-emergency trauma patients, 90% of the patients underwent elective surgerieswhile 10% underwent emergency surgeries. It was determined that the average invoiceamount was 4987 TL (min: 207 TL, max: 87541 TL) and the highest cost was in thefield of vertebral surgery (average 19384 TL). The rate of emergency applications hasshown a significant increase in 2016 and later (2016-2017-2018) compared to 2015 andbefore .Conclusion : The main Syrian refugees patient profile of the health centers far fromthe war zone is composed of elective cases and their costs.Key words: Health Services Accessibility–Hospital Costs–Orthopedic Procedures–Refugees–Syria

Prevalence of Stunting in Syrian Refugee Children With Cleft Lip and/or Cleft Palate in Time of Crisis: A Call for Intervention.

Our study aims to compare the prevalence of stunted growth in Syrian refugee children with cleft lip and/or palate (CL±CP) to other children with CL±CP of similar socioeconomic status. A retrospective medical chart review. Center for Cleft and Craniofacial Surgery at a tertiary care hospital in Lebanon in the period between January 2013 and May 2019. One hundred three Syrian refugee children and 70 Lebanese children <18 years of low socioeconomic status who have CL, CP, or both. These patients underwent cleft repair surgeries at our center. Stunted growth measured by calculating the height-for-age z-score (HAZ). Using a confidence interval of 95%, the prevalence of stunting is significantly higher among Syrian refugees (P < .003). The prevalence of stunting and age of presentation were positively correlated (P < .02). There was no difference in stunting between patients with CP and CL (P < .746). There was no difference in stunting between genders. The majority of Syrian refugee patients with CL±CP fall on the malnourished side of the nutritional spectrum as reflected by the high percentage of stunting as well as a mean of -1 for the HAZ.

Syrian Refugees and Their Impact on Health Service Delivery in the Pediatric Hematology/Oncology Clinics Across Canada

This study examined the impact of Syrian refugees on 1 area of the Canadian health care sector. We predicted that pediatric hematology clinics across Canada would see a spike in their Syrian refugee patient population in proportion to their recent migration and, as a result, an increase in perceived workload. Data on the number of refugee patients, types of diseases, and perceived workload were gathered from hematology clinics across Canada using a clinical survey (Supplemental Digital Content 1, http://links.lww.com/JPHO/A315). The results showed that Ontario had the most Syrian refugee patients, followed by the Quebec, Western Canadian, and Atlantic regions. The results also showed that perceived workload ranged from "no increase" (4 programs) to "minimal increase" <25% (1 program), "moderate increase" 25% to 75% (4 programs), and "significant increase" >75% (3 programs, 2 of which had no transfusion-dependent thalassemia patients before the immigration).