Syrian Refugees In Lebanon Research Articles

Using Facebook advertising data to describe the socio-economic situation of Syrian refugees in Lebanon.

While the fighting in the Syrian civil war has mostly stopped, an estimated 5.6 million Syrians remain living in neighboring countries. Of these, an estimated 1.5 million are sheltering in Lebanon. Ongoing efforts by organizations such as UNHCR to support the refugee population are often ineffective in reaching those most in need. According to UNHCR's 2019 Vulnerability Assessment of Syrian Refugees Report (VASyR), only 44% of the Syrian refugee families eligible for multipurpose cash assistance were provided with help, as the others were not captured in the data. In this project, we are investigating the use of non-traditional data, derived from Facebook advertising data, for population level vulnerability assessment. In a nutshell, Facebook provides advertisers with an estimate of how many of its users match certain targeting criteria, e.g., how many Facebook users currently living in Beirut are "living abroad," aged 18-34, speak Arabic, and primarily use an iOS device. We evaluate the use of such audience estimates to describe the spatial variation in the socioeconomic situation of Syrian refugees across Lebanon. Using data from VASyR as ground truth, we find that iOS device usage explains 90% of the out-of-sample variance in poverty across the Lebanese governorates. However, evaluating predictions at a smaller spatial resolution also indicate limits related to sparsity, as Facebook, for privacy reasons, does not provide audience estimates for fewer than 1,000 users. Furthermore, comparing the population distribution by age and gender of Facebook users with that of the Syrian refugees from VASyR suggests an under-representation of Syrian women on the social media platform. This work adds to growing body of literature demonstrating the value of anonymous and aggregate Facebook advertising data for analysing large-scale humanitarian crises and migration events.

Ageism, an invisible social determinant of health for older Syrian refugees in Lebanon: a service providers’ perspective

BackgroundOlder refugees face particular challenges because their health and social needs are largely overlooked in humanitarian programmes, policies and research. The few studies available have shown that older refugees suffer from a high prevalence of non-communicable diseases, including mental health problems, increased social isolation and poverty, and difficulty accessing health and social services. This article aims to provide further in-depth understanding of how service providers perceive health and social challenges of older Syrian refugees living in Lebanon by focusing on (1) their health and social challenges; (2) the available and lacking services; (3) participation; and (4) policy recommendations to improve services.MethodsThis study is based on a qualitative research approach. Fifteen semi-structured interviews were conducted with health and social workers providing services to older Syrian refugees living in Lebanon. All interviews were digitally recorded, transcribed, coded and analysed using thematic analysis.ResultsStudy results clearly show that older refugees face increased marginalisation and neglect, mainly because of ageism. Ageism experienced at aid agency, family and individual levels, impacts negatively on older refugees. They have a sense of social isolation, neglect and feel they are a burden, consequently their social participation decreases, impacting negatively on their physical and mental health as well as their access to social and health care. Linked to experiences of ageism, study participants noted: (1) high prevalence rates of non-communicable diseases and mental health problems; (2) difficulties accessing care, with inadequate services to support the needs of older refugees; and (3) policy recommendations calling for an holistic approach to aid which takes into consideration the specific needs of older refugees as well as their capabilities.Concluding remarksAgeism is a key determinant of health which negatively impacts the physical, mental and social health, and wellbeing of older Syrian refugees. It pushes them to the margins of society where they are left behind by the humanitarian response, policy makers and researchers, as well as their communities and families. To mitigate this situation, this article calls for directly addressing ageism on social, service and policy levels.

“Older people tend to be invisible”: a qualitative study exploring the needs and inclusion of older Syrian refugees in the context of compounding crises in host country, Lebanon

BackgroundOlder Syrian refugees in Lebanon are a marginalized population with under-recognized health needs. The inclusivity of this population within the humanitarian response is poorly understood. This study aims to identify the unique needs of older Syrian refugees in the context of recent concurrent crises in Lebanon, and explore the extent to which they are being met and prioritized by local and international aid agencies.MethodsWe conducted in-depth interviews with a snowball sample of 26 stakeholders from 11 organizations operating in the health, nutrition, and water, sanitation, and hygiene sectors. Data analysis followed principles of thematic analysis.ResultsConcurrent political, economic, and public health crises in host country promoted income insecurity among older refugees and increased dependency on younger relatives, leading to food insecurity, neglect, and poor health outcomes, including the sequelae of untreated non-communicable diseases. Mental illness was perceived to be exacerbated by Covid-19 related challenges, including social isolation, uncertainty about the future, and additionally due to feelings of guilt related to economic dependence and fundamental exclusion from labor force participation. Despite their vulnerability, older refugees are overlooked by the humanitarian response, which may be related to a lack of data. Pervasive medication shortages in the setting of the economic collapse, as well as inaccessible physical environments and competing interests were all identified as major barriers to care.ConclusionsOlder Syrian refugees in Lebanon experience dual vulnerability that is acutely exacerbated in the setting of concurrent crises. Sociopolitical, economic, and cultural barriers promote social exclusion and may confer an increased risk of income and food insecurity in this population, with significant implications for health. Humanitarian aid agencies operating in the context of fragmented, under-resourced health systems are currently unable to sufficiently address multi-faceted needs of this community. We recommend moving away from a donor-dependent model of aid by allocating resources toward strengthening inclusive national health systems that emphasize preventative care. We further call for age-disaggregation of routine data and normalization of data sharing among stakeholders in the academic and public health sectors in order to develop evidence-based initiatives that can meet the needs of this under-served community.

Worlds of Pain: A process evaluation of the Caregiver Support Intervention with Syrian refugees in Lebanon

This paper reports on a process evaluation conducted as part of a randomized controlled trial of the Caregiver Support Intervention (CSI), a nine-session preventive group psychosocial intervention, with Syrian refugees in Lebanon (n ​= ​480, 240 families). Fifteen focus group discussions (FGDs) were conducted with 122 CSI participants (51% of participants in the intervention arm of the trial), including 63 female and 59 male caregivers. We analyzed the focus group data to explore the mechanism of impact of the CSI on caregiver wellbeing and parenting. We also examine the impact of multiple adversities on the results of the trial, which was conducted in a context of widespread social unrest, a severe economic crisis, and the COVID-19 pandemic. Despite these adversities, participants described improvements in their psychological wellbeing and parenting as a result of the CSI. Changes in parenting include a reduction in harsh parenting and an increase in warm and responsive parenting. Findings suggest a pathway from the mindfulness practices and anger management techniques taught in the CSI, to improved caregiver wellbeing, to positive changes in parenting. Participants described becoming less angry and more patient, as well as better able to lower their arousal before responding to conflictual situations with their children. Increased knowledge of positive parenting also contributed to changes in parenting. About half of focus group participants reported a marked attenuation of effects following the intervention, which they attributed primarily to the high stress generated by the combination of the economic crisis and the pandemic. We examine specific ways in which the focus group findings diverge from the trial results, and consider the limitations of standalone psychosocial interventions in contexts of extreme adversity.

Development of a Prediction Model for the Management of Noncommunicable Diseases Among Older Syrian Refugees Amidst the COVID-19 Pandemic in Lebanon

Older Syrian refugees have a high burden of noncommunicable diseases (NCDs) and economic vulnerability. To develop and internally validate a predictive model to estimate inability to manage NCDs in older Syrian refugees, and to describe barriers to NCD medication adherence. This nested prognostic cross-sectional study was conducted through telephone surveys between September 2020 and January 2021. All households in Lebanon with Syrian refugees aged 50 years or older and who received humanitarian assistance from a nongovernmental organization were invited to participate. Refugees who self-reported having chronic respiratory disease (CRD), diabetes, history of cardiovascular disease (CVD), or hypertension were included in the analysis. Data were analyzed from November 2021 to March 2022. The main outcome was self-reported inability to manage any NCD (including CRD, CVD, diabetes, or hypertension). Predictors of inability to manage any NCD were assessed using logistic regression models. The model was internally validated using bootstrapping techniques, which gave an estimate of optimism. The optimism-adjusted discrimination is presented using the C statistic, and calibration of the model is presented using calibration slope (C slope). Of 3322 older Syrian refugees, 1893 individuals (median [IQR] age, 59 [54-65] years; 1089 [57.5%] women) reported having at least 1 NCD, among whom 351 (10.6% overall; 18.6% of those with ≥1 NCD) had CRD, 781 (23.7% overall; 41.4% of those with ≥1 NCD) had diabetes, 794 (24.1% overall; 42.2% of those with ≥1 NCD) had history of CVD, and 1388 (42.3% overall; 73.6% of those with ≥1 NCD) had hypertension. Among individuals with NCDs, 387 participants (20.4%) were unable to manage at least 1 of their NCDs. Predictors for inability to manage NCDs were age, nonreceipt of cash assistance, household water insecurity, household food insecurity, and having multiple chronic diseases, with an adjusted C statistic of 0.650 (95% CI, 0.620-0.676) and C slope of 0.871 (95% CI, 0.729-1.023). The prevalence of nonadherence to medication was 9.2%, and the main reasons for nonadherence were unaffordability of medication (40.8%; 95% CI, 33.4%-48.5%) and the belief that they no longer required the medication after feeling better (22.4%; 95% CI, 16.4%-29.3%). In this cross-sectional study, the predictors of inability to manage NCDs among older Syrian refugees in Lebanon were mainly related to financial barriers. Context-appropriate assistance is required to overcome financial barriers and enable equitable access to medication and health care.

Developing a sexual and reproductive health educational intervention for adolescent Syrian refugee girls: Challenges and lessons learned.

In Lebanon, a country with the highest per capita refugee population in the world, roughly one in four persons is forcibly displaced. Early marriage is highly prevalent among Syrian refugees in Lebanon and qualitative studies suggest an unmet need for sexual and reproductive health (SRH) information and services in this community. Adolescent Syrian refugee girls in Lebanon are a vulnerable population at risk of negative SRH outcomes related to early sexual debut, which occurs primarily in the context of early marriage. Despite this need, cultural norms and gender roles generally restrict adolescent girls' access to SRH resources. To address this need for comprehensive sexuality education, our team developed a novel, rights-based, peer-led, adolescent SRH educational curriculum that is specific to the context of Syrian displacement in Lebanon. This curriculum was developed to be administered as part of Project Amenah, a community-based, multi-component intervention that aims to reduce early marriage and improve SRH among adolescent Syrian refugee girls displaced in Lebanon. The curriculum, which features eight discreet age-appropriate units, is based on extensive formative work conducted in this community, as well as adaptations of early marriage programs implemented in low-resource settings elsewhere. Topics covered include, but are not limited to, gender and human rights, communication, negotiation and decision-making, reproductive anatomy, puberty and menstruation, sexually transmitted infections, family planning and modern contraception, and adolescent pregnancy. We encountered several challenges when developing this curriculum, including those related to community acceptability, varying levels of literacy levels among participants, and limited engagement with married adolescents, who may experience mobility restrictions that preclude their participation. We recommend that investigators developing adolescent SRH interventions in similar settings utilize a behavior-determinant-intervention logic model to guide their study design, elucidate community priorities and capacity by conducting preliminary qualitative work and assembling a community advisory board, and follow a peer-led model, which has shown to be effective for adolescent SRH interventions.

عوامل الشخصية الخمسة لدى النازحين السوريين والفلسطينيين المقيمين في المخيمات اللبنانيةTHE FIVE BIG FACTORS OF PERSONALITY AMONG ISPLACED SYRIANS AND PALESTINIANS REFUGEES LIVING IN LEBANON

Syrian refugees in Lebanon are a major challenge at the social, economic and psychological levels, in addition to the issue of the Palestinian refugees in Lebanon in the wake of the Naksaa of 1948. The main hypothesis of this study is that the difficult circumstances experienced by the displaced may affect their personality traits. The sample consisted of 430 individuals, (n=204) Syrian refugees and (n=226) Palestinian refugees of both sexes. All the members of the sample responded to the Arabic Inventory of the Five Big Personality Factors. The inventory enjoys good to high alpha coefficients in both samples, and was administered by 15 social specialists during February and March 2022. The findings revealed statistically significant differences in neuroticism in both the Syrian and the Palestinian samples. Women’s mean scores were higher, while there were no statistically significant differences between the sexes on any of the other personality factors. Upon comparing the Syrian and the Palestinian samples on the personality factors, one statistically significant difference appeared in the neuroticism factor, where the Syrian mean scores were higher than those of the Palestinians, including the sexes. Calculating the correlation coefficients among the five factors, it was shown that the correlations in the Palestinian sample of both sexes were twice that of the Syrian sample of both sexes (10 to 5 statistically significant correlations). By conducting a factorial analysis of the correlations between the personality factors, two factors were extracted from the Syrian sample, labelled “Balanced Personality” and “Neuroticism vs. Extraversion”. In the sample of Palestine, one bipolar factor was extracted labeled “Stable personality vs Extraversion” Upon comparison with an Egyptian sample that lives in a stable environment, the factors of extraversion, conscientiousness in both the Syrian and the Palestinian samples were found to increase, which enables them to adapt to the current circumstances.

The short-lived effects of unconditional cash transfers to refugees

We study two year-long unconditional cash-based assistance programs for Syrian refugees in Lebanon, and show that they improve consumption, child well-being, food security, and reduce livelihood coping. Despite high transfer values, we find no evidence of lasting effects at six months after either program ends. Households spend transfers on basic needs and take children out of work and re-enroll them in school. Beneficiaries increase cash savings and their stock of durable goods, but liquidate and spend these assets during or soon after the beneficiary period. The results are similar for longer assistance periods and across transfer modalities.

When coping strategies become a way of life: a gendered analysis of Syrian refugees in Lebanon

ABSTRACT Using a field survey in informal Syrian refugee camps in Lebanon, this paper analyses refugee coping strategies and demonstrates how severe strategies become a way of life. It addresses how each refugee’s strategic choices are determined by an environment that is conceptualized via four dimensions of displacement: the civil host community, national and international policy, and humanitarian aid, in addition to individual characteristics such as gender. The findings show that the gender of the household head influences the severity of coping strategies, both directly and indirectly. The likelihood of using child labour and reducing the number of daily meals is higher for female-headed households. To categorise coping strategies among refugees, a new framework is proposed based on three categorisations: survival strategies, enhancing strategies and improving strategies.

Syrian Refugees In Lebanon: “New Community” In Lebanon’s Confessional Political System

The paper analyzes the Syrian refugee crisis in neighboring countries, mostly in Lebanon. Syria’s neighborhood hosts currently about 5.5 million forcibly displaced Syrians who have fled the crisis since its onset in 2011. More than 3.4 million Syrians are registered in Turkey and around 2 million in Lebanon, Jordan, Iraq and Egypt (World Bank 2016). According to the UNHCR (2017), the small Lebanese state hosts today around 1.5 million registered Syrians, making it the country with the highest number of refugees per capita (Yasmin 2022). How has Lebanon’s political system dealt with the Syrian refugee issue and how have Syrian refugees – a new “non-core group”(Harris 2012) in Lebanon’s society – interacted with the state’s confessional configuration of power? How has Lebanon’s political system framed and accommodated an external “minority” in the context of a refugee-producing conflict and how has the political discourse constructed the issue of large-scale displacement? The conflict in Syria between the government of Bashar al-Assad and various other forces, which started in the spring of 2011, continues to cause displacement within the country and across the region. At the end of 2018, Syrians continued to be the largest forcibly displaced population, with 13.0 million people living in displacement, including 6,654,000 refugees, 6,184,000 internally displaced people (IDPs) and 140,000 asylum seekers (Ferris, Kiris ci, Shaikh 2013; UN OCHA 2016).

Syrian Refugees In Lebanon: “New Community” In Lebanon’s Confessional Political System

The paper analyzes the Syrian refugee crisis in neighboring countries, mostly in Lebanon. Syria’s neighborhood hosts currently about 5.5 million forcibly displaced Syrians who have fled the crisis since its onset in 2011. More than 3.4 million Syrians are registered in Turkey and around 2 million in Lebanon, Jordan, Iraq and Egypt (World Bank 2016). According to the UNHCR (2017), the small Lebanese state hosts today around 1.5 million registered Syrians, making it the country with the highest number of refugees per capita (Yasmin 2022). How has Lebanon’s political system dealt with the Syrian refugee issue and how have Syrian refugees – a new “non-core group”(Harris 2012) in Lebanon’s society – interacted with the state’s confessional configuration of power? How has Lebanon’s political system framed and accommodated an external “minority” in the context of a refugee-producing conflict and how has the political discourse constructed the issue of large-scale displacement? The conflict in Syria between the government of Bashar al-Assad and various other forces, which started in the spring of 2011, continues to cause displacement within the country and across the region. At the end of 2018, Syrians continued to be the largest forcibly displaced population, with 13.0 million people living in displacement, including 6,654,000 refugees, 6,184,000 internally displaced people (IDPs) and 140,000 asylum seekers (Ferris, Kiris ci, Shaikh 2013; UN OCHA 2016).

Supporting parenting among Syrian refugees in Lebanon: a randomized controlled trial of the caregiver support intervention.

Parenting interventions in humanitarian settings have prioritized the acquisition of parenting knowledge and skills, while overlooking the adverse effects of stress and distress on parenting-a key mediator of refugee children's mental health. We evaluated the effectiveness of the Caregiver Support Intervention (CSI), which emphasizes caregiver wellbeing together with training in positive parenting. We conducted a two-arm randomized controlled trial of the CSI with Syrian refugees in Lebanon, with an intent-to-treat design, from September 2019-December 2020. A total of 480 caregivers from 240 families were randomized to the CSI or a waitlist control group (1:1). Retention from baseline to endline was 93%. Data on parenting and caregiver psychological wellbeing were collected at baseline, endline, and three-month follow-up. Prospective trial registration: ISRCTN22321773. We did not find a significant change on overall parenting skills at endline (primary outcome endpoint) (d = .11, p = .126) or at follow-up (Cohen's d = .15, p = .054). We did find a significant effect on overall parenting skills among participants receiving the full intervention-the sub-sample not interrupted by (COVID-19) (d = 0.25, p < .05). The CSI showed beneficial effects in the full sample at endline and follow-up on harsh parenting (d = -.17, p < .05; d = .19, p < .05), parenting knowledge (d = .63, p < .001; d = .50, p < .001), and caregiver distress (d = -.33, p < .001; d = .23, p < .01). We found no effects on parental warmth and responsiveness, psychosocial wellbeing, stress, or stress management. Changes in caregiver wellbeing partially mediated the impact of the CSI on harsh parenting, accounting for 37% of the reduction in harsh parenting. The CSI reduced harsh parenting and caregiver distress, and demonstrated the value of addressing caregiver wellbeing as a pathway to strengthening parenting in adversity. These effects were achieved despite a pandemic-related lockdown that impacted implementation, a severe economic crisis, and widespread social unrest. Replication under less extreme conditions may more accurately demonstrate the intervention's full potential.

Effects of a WHO-guided digital health intervention for depression in Syrian refugees in Lebanon: A randomized controlled trial.

BackgroundMost displaced people with mental disorders in low- and middle-income countries do not receive effective care, and their access to care has deteriorated during the Coronavirus Disease 2019 (COVID-19) pandemic. Digital mental health interventions are scalable when digital access is adequate, and they can be safely delivered during the COVID-19 pandemic. We examined whether a new WHO-guided digital mental health intervention, Step-by-Step, in which participants were supported by a nonspecialist helper, was effective in reducing depression among displaced people in Lebanon.Methods and findingsWe conducted a single-blind, 2-arm pragmatic randomized clinical trial, comparing guided Step-by-Step with enhanced care as usual (ECAU) among displaced Syrians suffering from depression and impaired functioning in Lebanon. Primary outcomes were depression (Patient Health Questionnaire, PHQ-9) and impaired functioning (WHO Disability Assessment Schedule-12, WHODAS) at posttreatment. Secondary outcomes included subjective well-being, anxiety, post-traumatic stress, and self-described problems. A total of 569 displaced people from Syria with depression (PHQ-9 ≥ 10) and impaired functioning (WHODAS > 16) were randomized to Step-by-Step (N = 283; lost to follow-up: N = 167) or ECAU (N = 286; lost to follow-up: 133). Participants were considered to be lost to follow-up when they did not fill in the outcome measures at posttest or follow-up. Recruitment started on December 9, 2019 and was completed on July 9, 2020. The last follow-up assessments were collected in December 2020. The study team had access to the online platform, where they could see treatment arm assignment for each participant. All questionnaires were completed by participants online. Intention-to-treat (ITT) analyses showed intervention effects on depression (standardized mean differences [SMDs]: 0.48; 95% CI: 0.26; 0.70; p < 0.001), impaired functioning (SMD: 0.35; 95% CI: 0.14; 0.56; p < 0.001), post-traumatic stress (SMD: 0.36; 95% CI: 0.16; 0.56; p < 0.001), anxiety (SMD: 0.46; 95% CI: 0.24; 0.68; p < 0.001), subjective well-being (SMD: 0.47; 95% CI: 0.26; 0.68; p < 0.001), and self-identified personal problems (SMD: 0.49; 95% CI 0.28; 0.70; p < 0.001). Significant effects on all outcomes were maintained at 3 months follow-up. During the trial, one serious adverse event occurred, unrelated to the intervention. The main limitation of the current trial is the high dropout rate.ConclusionsIn this study, we found that a guided, digital intervention was effective in reducing depression in displaced people in Lebanon. The guided WHO Step-by-Step intervention we examined should be made available to communities of displaced people that have digital access.Trial registrationClinicalTrials.gov NCT03720769.

Implementation of fixed-dose combination therapy for secondary prevention of atherosclerotic cardiovascular disease among Syrian refugees in Lebanon: a qualitative evaluation

BackgroundWe report findings of a qualitative evaluation of fixed-dose combination therapy for patients with established atherosclerotic cardiovascular disease (ASCVD) attending Médecins Sans Frontières (MSF) clinics in Lebanon. Cardiovascular disease is a leading cause of death and disability worldwide, and humanitarian actors are increasingly faced with the challenge of providing care for chronic diseases such as ASCVD in settings where health systems are disrupted. Secondary prevention strategies, involving 3–5 medications, are known to be effective for patients at risk of heart attack or stroke, but supply and adherence are challenging in humanitarian settings. Fixed dose combination therapy, combining two or more medications in one tablet, may be a strategy to address this.MethodsThe evaluation was nested within a prospective mixed-methods study in which eligible ASCVD patients were followed for 1 year during (i) 6 months of usual care then (ii) 6 months of fixed dose combination (FDC) therapy. After 1 year, we conducted in-depth interviews with a purposive sample of patients, MSF staff and external stakeholders. Interviews focused on acceptability and sustainability of the fixed dose therapy intervention. Interview data were analysed thematically, informed by thea Theoretical Framework of Acceptability. Additional attention was paid to non-typical cases in order to test and strengthen analysis.ResultsPatients and health care providers were positive about the FDC intervention. For patients, acceptability was related to ease of treatment and trust in MSF staff, while, for staff, it was related to perceived improvements in adherence, having a good understanding of the medication and its use, and fitting well with their priorities for patient’s wellbeing. External stakeholders were less familiar with FDC therapy. While external clinicals expressed concerns about treatment inflexibility, non-clinician stakeholder interviews suggested that cost-effectiveness would have a major influence on FDC therapy acceptability. Sustainability was tied to the future role of MSF care provision and coherence with the local health system.ConclusionsFor patients and clinic staff, FDC was an acceptable treatment approach for secondary prevention of ASCVD disease in two MSF clinics in Lebanon. Sustainability is more complex and calls for better alignment of care with public systems.

Hepatitis B and C: Neglected Infectious Diseases among Syrian Refugees in Lebanon

Hepatitis B and C are life-threatening infections that can result in liver-associated complications. Lebanon is a country experiencing its worst economic and political crises to date and is considered to be of low endemicity for hepatitis B virus (HBV) and hepatitis C virus (HCV).

The association between long-distance migration and PTSD prevalence in Syrian refugees

BackgroundRefugees are forced migrants but there is a large variation in the distance that refugees cover and there is a paucity in the evidence of how this may affect refugees’ health and health care needs. Objective: We investigated the association between long-distance migration and post-traumatic stress disorder (PTSD), a serious psychiatric disorder associated with deteriorating mental and somatic health.MethodsIncluded from 2016–2019 were adult Syrian refugees in Lebanon and Denmark that arrived up to 12 months prior to inclusion. PTSD was assessed using the Harvard Trauma Questionnaire and the estimate of association was obtained by multiply imputing missing data and adjusting for confounding by propensity score-weighting with covariates age, sex, socioeconomic status, trauma experience and general mental well-being, reporting the bootstrap 95-percentile confidence interval (95% CI). Additionally, a number of sensitivity analyses were performed.ResultsIncluded were 599 participants in Lebanon (mean age 35 years old, 73% being female) and 133 participants in Denmark (mean age 30 years old, 47% being female). After multiply imputing missing data and propensity score-weighted adjustment for confounding, migration to Denmark instead of Lebanon was associated with an increase in PTSD prevalence of 9 percentage point (95% CI [-1; 19] percentage point).ConclusionsLong-distance migration may be associated with an increase in PTSD prevalence in refugees. The migration could be an important factor to consider when assessing refugees’ and asylum seekers’ health. Practitioners should consider “long-distance migration” in refugee health screenings and in particular when assessing the risk of post-traumatic stress disorder. Future research should be designed to ultimately lead to studies of relevant interventions to lower the risk of post-traumatic stress disorder in refugees.

Breastfeeding and complementary feeding in fragile settings: the case of Syrian refugees and their host communities in North Lebanon

BackgroundAdequate breastfeeding and complementary feeding practices are paramount in fragile situations where access to food and healthcare is limited. The objectives of this study are to examine breastfeeding and complementary feeding practices among Syrian refugees and their Lebanese host communities and to investigate the correlates of exclusive breastfeeding (EBF) at four and 6 months in these communities.MethodsUsing two-stage stratified sampling, a cross-sectional survey was conducted in Akkar, a region with a high density of Syrian refugees in Lebanon, between April and November 2019. In one-to-one interviews, mothers of children (6–24 months) completed a questionnaire including specific questions about breastfeeding and complementary feeding practices, a 24-h recall, and socio-demographic characteristics for 189 Syrian refugees and 182 Lebanese host community households. Descriptive statistics, simple and multiple logistic regression were used in data analysis.ResultsAmong breastfeeding practices, ever-breastfeeding was most prevalent (90%), followed by early initiation of breastfeeding (64.8%), EBF at four (49.6%), and six (36%) months. One in four children was introduced to solids before 6 months of age, and less than a third was given iron-fortified baby cereals as the first complementary foods. Only 24.4% and 9.2% of children met the minimum dietary diversity and minimum acceptable diet requirements, respectively. Compared to children of the Lebanese host communities, those of Syrian refugees had higher rates of EBF at four and 6 months as well as continued breastfeeding at 1 year, whereas only 17.9% of Syrian refugees’ children met minimum dietary diversity compared to 30.9% of Lebanese host community children (p < 0.05). Among refugees, education and spouse’s employment status were associated with higher odds of EBF at 4 months. As for Lebanese households, female children were less likely to be exclusively breastfed at 4 months and 6 months, while a natural delivery increased the odds of EBF at 6 months.ConclusionBreastfeeding and complementary feeding practices are suboptimal among children of Syrian refugees and their Lebanese host communities in North Lebanon. There is a need for intervention strategies to tackle gaps in services and assistance delivery programs to enhance infant and young child feeding practices among both communities.

Identity Politics and Syrian Refugees in Lebanon: Implications for Higher Education

Identities and identity politics play a significant role in the lives of Syrian refugees in Lebanon. Using empirical qualitative research with focus groups as the primary research method, this article is a critical investigation into the ways in which Syrian refugees in Lebanon are simultaneously politicized through their everyday lived experiences yet depoliticized through humanitarian policy and practice. In particular, the article explores how the politicization/depoliticization dichotomy impacts Syrian refugees’ access to and experiences within higher education opportunities made available for them in Lebanon. The article argues that humanitarianism’s inattentiveness to intersectional identities and social hierarchies of power has often resulted in physical and psychological educational exclusions and reinforced existing inequalities and fissures/divisions between different groups of refugees. In this way, higher education for refugees has often fallen short of its potential to transform lives.

Mistreatment at work and musculoskeletal pain in male and female working Syrian refugee children

Since the Syrian war in 2011, Syrian refugees in Lebanon have continued to experience socioeconomic deprivation, resorting many families to child labour as a form of survival. Adopting a gender-sensitive analysis, this study explores the relationship between psychosocial adversities and musculoskeletal pain among male and female Syrian refugee children in Lebanon, using data from a cross-sectional survey of working Syrian refugee children between 8 and 18 years in informal tented settlements in the Bekaa Valley of Lebanon. The majority of working children (4090) worked in agriculture (75.8%). Of the children who experienced musculoskeletal pain, 27.4% worked despite severe pain, three-quarters of the children worked under time pressure, over a third (37.4%) were physically abused at work, and the majority (95.8%) had a good relationship with their co-workers. Logistic regression models revealed a significant association between exposure to psychosocial stressors at work and musculoskeletal pain among male and female children. Practitioner summary: This study is the first to obtain direct testimony on musculoskeletal pain and psychosocial risk factors, among Syrian refugee children in Lebanon. Using a gender-sensitive analysis, the survey results demonstrated associations between exposure to psychosocial stressors and musculoskeletal pain among male/female Syrian refugee children enduring strenuous working conditions.

The Syrian Refugees in Lebanon

The Syrian crisis has caused one of the greatest episodes of forced displacement since World War II and some of the densest refugee-hosting situations in modern history. Lebanon has hosted more than 1 million Syrian refugees. This article is based on a large multisectoral survey of Syrian refugees’ households in Bekaa, conducted by the Union of Relief and Development Associations (URDA) in the period 2016–17 with a total of 1614 households and 6199 individuals. It assesses the socio-economic and living conditions of this representative sample (i.e., the location of refugees and housing conditions, the legal status of refugees, family expenditure, shelter, displacement, education, work, health, child health including child marriage). Among many vulnerabilities experienced by Syrian refugees, we identify three salient domains of precariousness, which are education, health, and early marriage. A particular analysis covers the differential analysis between camp dwellers versus urban ones, and the conviviality of the former compared with the latter.