Vulnerability of Syrian refugees in Lebanon to COVID-19: quantitative insights

AbstractLebanon, a middle-income country with ongoing political turmoil, unstable economic situation, and a fragmented and under-resourced health system, hosts about one million Syrian refugees since 2011. While the country is currently experiencing substantial COVID-19 epidemic spread, no outbreaks have been reported yet among Syrian refugees. However, testing of this population remains limited and exposure levels are high given dire living conditions and close interaction with the host community. Here, we use quantitative insights of transmission dynamics to outline risk and contextual factors that may modulate vulnerability of Syrian refugees in Lebanon to potentially large COVID-19 epidemics.Syrian refugees live in close contact with the host community, and their living conditions are favorable for epidemic spread. We found that the high levels of crowding within Syrian refugee households and among those in informal tented settlements, the inadequate water supply and sanitation, limited use of masks, inadequate access to health care, and inadequate community awareness levels are vulnerability factors that directly impact important parameters of transmission dynamics, leading to larger epidemic scale. Poverty, stigma, and fear of legal consequences are contextual factors that further exacerbate this vulnerability. The relatively high prevalence of non-communicable diseases in this population could also affect the severity of the disease among those infected. Mathematical modeling simulations we conducted illustrated that even modest increases in transmission among Syrian refugees could result in a large increase in the incidence and cumulative total number of infections in the absence of interventions.In conclusion, while the young age structure of the Syrian refugee population might play a protective role against the scale and disease-burden severity of a potential COVID-19 epidemic, the epidemic potential due to several vulnerability factors warrants an immediate response in this population group. Local and international actors are required to mobilize and coordinate efforts to prevent the transmission of COVID-19, and to mitigate its impact amongst the vulnerable refugee populations globally.

Download Full-text

“With every passing day I feel like a candle, melting little by little.” experiences of long-term displacement amongst Syrian refugees in Shatila, Lebanon

Conflict and Health ◽

10.1186/s13031-019-0228-7 ◽

2019 ◽

Vol 13 (1) ◽

Cited By ~ 2

Author(s):

Hanadi Syam ◽

Emilie Venables ◽

Bernard Sousse ◽

Nathalie Severy ◽

Luz Saavedra ◽

...

Keyword(s):

Mental Health ◽

Social Support ◽

Gender Roles ◽

Family Dynamics ◽

Living Conditions ◽

Host Community ◽

Syrian Refugees ◽

Parental Violence ◽

Syrian Refugee

Abstract Background Long term displacement and exposure to challenging living conditions can influence family dynamics; gender roles; violence at home and in the community and mental well-being. This qualitative study explores these issues as perceived by Syrian refugees who have been living in Shatila, a Palestinian camp in South Beirut, Lebanon, for at least 2 years. Methods Twenty eight in-depth interviews with men and women were conducted between February and June 2018. Women were recipients of mental health services, and men were recruited from the local community. Interviews were conducted in Arabic, translated, transcribed, coded and analysed using thematic content analysis. Results Our results show patterns of harsh living conditions similar to those described earlier in the course of the Syrian refugee crisis. Lack of infrastructure, overcrowding, cramped rooms and violence were all reported. Participants also described a lack of social support, discrimination and harassment within the host community, as well as limited social support networks within their own Syrian refugee community. Family dynamics were affected by the increased responsibilities on men, women and children; with additional economic and employment demands on men, women assuming the roles of ‘mother and father’ and children having to work and contribute to the household. Participants discussed several types of violence, including parental violence against children and violence in the community. Violence against women was also reported. Reported mental health issues included depression, anxiety, sadness, frustration, hopelessness, self-neglect and a loss of sense of self and self-worth. Some participants expressed a wish to die. Conclusions This study describes experiences of changing gender roles, family dynamics, violence and mental health after long-term displacement in in Shatila camp, South Beirut as perceived by Syrian refugees. A lack of safety and security coupled with economic hardship rendered refugees even more susceptible to exploitation and harassment. Parental violence was the most commonly reported type of domestic violence.

Download Full-text

The Impact of Syrian Refugee on Jordanian National Security

European Journal of Social Sciences ◽

10.26417/ejss.v2i3.p84-90 ◽

2019 ◽

Vol 2 (3) ◽

pp. 84

Author(s):

Mazen A. S. Alougili

Keyword(s):

National Security ◽

Political Stability ◽

Host Community ◽

Syrian Refugees ◽

Refugee Crisis ◽

Syrian Crisis ◽

Protracted Conflict ◽

Syrian Refugee ◽

Syrian Refugee Crisis ◽

The Impact

The protracted conflict in Syria and the deterioration in the security situation inside has brought about an unprecedented refugee crisis over the past six years, where it is estimated that over 5 million Syrian refugees have fled to neighboring countries by 2017. As one of the neighboring host communities for refugees, Jordan has entailed significant costs at the economic, social, political, and security levels. This study aims at assessing the impact of Syrian refugees on Jordan’s security, as well as the potential threats and challenges generated by the escalation of the Syrian crisis on the kingdom. Forced immigrant implications for host communities are diverse. Therefore, it should be taken into consideration the host communities’ economic, social, political, and infrastructure status when addressing those implications. The Syrian refugee crisis has placed financial, social, and institutional strains on Jordan as a host community. It is in the light of this that Syrian refugees might be considered as a threat to the socio-economic, political stability of the kingdom and most importantly internal and national security.

Download Full-text

The Impact of Syrian Refugee on Jordanian National Security

European Journal of Social Sciences ◽

10.26417/ejss-2019.v2i3-78 ◽

2019 ◽

Vol 2 (3) ◽

pp. 84

Author(s):

Mazen A. S. Alougili

Keyword(s):

National Security ◽

Political Stability ◽

Host Community ◽

Syrian Refugees ◽

Refugee Crisis ◽

Syrian Crisis ◽

Protracted Conflict ◽

Syrian Refugee ◽

Syrian Refugee Crisis ◽

The Impact

Download Full-text

Bir güvensizlik ülkesi olarak Türkiye’nin mültecileri, Suriyeliler ve Türk mülteciler

GÖÇ DERGİSİ ◽

10.33182/gd.v4i1.570 ◽

2017 ◽

Vol 4 (1) ◽

pp. 21-40 ◽

Cited By ~ 3

Author(s):

Ibrahim Sirkeci

Keyword(s):

European Union ◽

Asylum Seekers ◽

Military Coup ◽

Syrian Refugees ◽

Member States ◽

Refugee Population ◽

Syrian Crisis ◽

Syrian Refugee ◽

Generous Support ◽

The Eu

Doğu ve güney komşuları üzerinde gelen göç akınlarının ve üye ülkeler arasındaki göçlerin artışıyla Avrupa Birliği (AB) en büyük krizlerinden birini yaşamaktadır. Avrupa’daki en ana tartışma konuları arasında Avrupa’ya göçü ve AB içindeki göçü sınırlamak ve üye ülkeler arasında mülteci kotası ve külfet paylaşımına yapılan itirazlar yer aldı. Bu krizde Türkiye anahtar ülke olarak ortaya çıktı ve ülkedeki büyük Suriyeli mülteci nüfusu ve bu nüfusun Avrupa’ya gitmesini engellemesi karşılığında vaat edilen milyarlarca Avro nedeniyle tartışmaların odağında yer aldı. Suriye krizi 4,8 milyon mülteci yarattı ve 2016 yılı sonu itibariyle bunların 2,8 milyonu Türkiye’de ikamet etmekteydi. Suriyeli mültecilere karşı cömert tavrıyla Türkiye güvenli bir ülke olarak tescil edilmiş oldu. Bu, hikayenin daha karanlık bir başka yüzünü gölgelemektedir. Çünkü aynı ülkenin vatandaşları 1980 askeri darbesinden bu yana milyonu aşkın sığınma başvurusu yaptılar. Ülkenin bugünkü şartları ve yeni veriler, Türkiye’den AB’ye yönelen daha çok mülteci akını olacağını gösteriyor. ABSTRACT IN ENGLISHTurkey’s refugees, Syrians and refugees from Turkey: a country of insecurityThe European Union (EU) has faced one of its biggest crises with the rise of population inflows through its Eastern and Southern neighbours as well as movements within the Union. In 2016, the main debate that dominated Europe was on restricting migration within and into the EU along with concerns and objections to the refugee quota systems and the sharing of the burden among member states. Turkey emerged as a ‘gate keeper’ in this crisis and has since been at the centre of debates because of the large Syrian refugee population in the country and billions of Euros it was promised to prevent refugees travelling to Europe. The Syrian crisis produced over 4.8 million refugees with over 2.8 million were based in Turkey by the end of 2016. Turkey with its generous support for Syrian refugees has been confirmed as a ‘country of security’. This shadows the darker side of affairs as the very same country has also produced millions of asylum seekers since the 1980 military coup. Current circumstances and fresh evidence indicate that there will be more EU bound refugees coming through and from Turkey.

Download Full-text

Access to healthcare and self-rated health among refugees in transit and after arrival in Norway

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.828 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

J Haj-Younes ◽

E Strømme ◽

W Hasha ◽

J Igland ◽

E Abildsnes ◽

...

Keyword(s):

Health Care ◽

Host Country ◽

Access To Health Care ◽

Negative Impact ◽

Minority Group ◽

Access To Healthcare ◽

Syrian Refugees ◽

Self Rated Health ◽

Perceived Access ◽

In Transit

Abstract Background Lack of basic infrastructure and poor provision of health services in conflict settings and during flight can have a negative impact on health. The overall health status of refugees seems to improve after arrival at a safe destination. This may be related to a safer environment and better access to health care services, but prior studies on this topic are limited. This study aims to assess self-perceived access to healthcare and its relationship with self-rated health (SRH) among refugees in transit and when settled in a host country. Methods We used data from the CHART study (Changing Health and health care needs Along the Syrian Refugees' Trajectories to Norway), which includes a cohort of 353 Syrian refugees who were contacted in 2017-2018 in Lebanon while waiting for relocation, and one year after their arrival to Norway. Information on self-perceived access to healthcare and its association with SRH was analyzed separately at each time-point. Data analysis was performed with STATA using logistic regression adjusting for age, gender, ethnicity and years of education and presented as adjusted odds ratios (AOR) with 95% CI. Results Fifteen percent reported good access to healthcare and 62% reported good SRH in Lebanon vs. 91% and 77% respectively, in Norway. Measures in Lebanon showed no association between access to healthcare and good SRH (AOR: 1.2 (0.6-2.2)), and men reported worse access to healthcare than women (AOR: 0.5 (0.3-1.0). In Norway, access to healthcare was strongly associated with good SRH (AOR: 4.7 (2.1-10.7) and was negatively associated with belonging to one specific minority group (AOR: 0.1 (0.0-0.3)). Conclusions Both SRH and perceived access to care improved from being in transit to being settled in Norway, the latter substantially more. There was a significant association between access to healthcare and good SRH after the refugees' arrival to a safe host country but not in transit. Key messages Refugee’s self-reported health and access to healthcare seem to improve shortly after arrival to a host country. To ensure that the UN’S Sustainable Development Goals concerning health equity are reached, refugees’ access to healthcare in transit and its impact on overall health needs to be addressed.

Download Full-text

ROLE OF REINFECTION IN TRANSMISSION DYNAMICS OF COVID-19: A SEMI-ANALYTICAL APPROACH USING DIFFERENTIAL TRANSFORM METHOD

MALAYSIAN JOURNAL OF COMPUTING ◽

10.24191/mjoc.v6i1.9814 ◽

2021 ◽

Vol 6 (1) ◽

pp. 745

Author(s):

Opeyemi Odetunde ◽

Jibril Lawal ◽

Ally Yeketi Ayinla

Keyword(s):

Treatment Strategies ◽

Differential Transform Method ◽

Host Community ◽

Transmission Dynamics ◽

Transform Method ◽

Social Distancing ◽

Linear System Of Equations ◽

Differential Transform ◽

Non Linear System

Reinfection of a recovered individual either as a result of relapse or new contact no doubt poses a major threat to the eradication of an infection within the host community. In this work, the role of re-infection in the transmission dynamics of COVID-19 was considered and analysed using the semi-analytical tool Differential Transform Method (DTM). COVID-19 (also known as Coronavirus) has shut down the economy of the world since it became a global pandemic. A mathematical model was constructed with consideration of multiple pathways of infection transmission, the treatment strategies and policies adopted (social distancing, wearing of face mask and so on) to limit the spread of the infection globally. The non-linear system of equations governing the model was solved using DTM and the resulting series solution was compared with the standard numeric Runge-Kutta order 4 (RK4). It was discovered that re-integration of a recovered individual into the susceptible community without observing the prevention guidelines such as social distancing, washing of hands and proper sanitizing could increase the spread of the infection since the recovered individuals are not guaranteed of immunity against the infection after recovery. The study concluded that families of recovered patients must ensure adequate preventive measure while integrating their recovered loved ones back to their midst.

Download Full-text

Impact of restricting access to health care services on Syrian refugees in Jordan: evidence from cross-sectional surveys

International Journal of Human Rights in Healthcare ◽

10.1108/ijhrh-08-2020-0068 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Ibraheem Khaled Abu Siam ◽

María Rubio Gómez

Keyword(s):

Health Care ◽

Health Care Access ◽

Access To Health Care ◽

Health Care Services ◽

Health Care Cost ◽

Syrian Refugees ◽

Cross Sectional ◽

Content Type ◽

Care Access ◽

Care Services

Purpose Access to health-care services for refugees are always impacted by many factors and strongly associated with population profile, nature of crisis and capacities of hosing countries. Throughout refugee’s crisis, the Jordanian Government has adopted several healthcare access policies to meet the health needs of Syrian refugees while maintaining the stability of the health-care system. The adopted health-care provision policies ranged from enabling to restricting and from affordable to unaffordable. The purpose of this paper is to identify the influence of restricted level of access to essential health services among Syrian refugees in Jordan. Design/methodology/approach This paper used findings of a cross-sectional surveys conducted over urban Syrian refugees in Jordan in 2017 and 2018 over two different health-care access policies. The first were inclusive and affordable, whereas the other considered very restricting policy owing to high inflation in health-care cost. Access indicators from four main thematic areas were selected including maternal health, family planning, child health and monthly access of household. A comparison between both years’ access indicators was conducted to understand access barriers and its impact. Findings The comparison between findings of both surveys shows a sudden shift in health-care access and utilization behaviors with increased barriers level thus increased health vulnerabilities. Additionally, the finding during implementation of restricted access policy proves the tendency among some refugees groups to adopt negative adaptation strategies to reduce health-care cost. The participants shifted to use a fragmented health-care, reduced or delayed care seeking and use drugs irrationally weather by self-medication or reduce drug intake. Originality/value Understanding access barriers to health services and its negative short-term and long-term impact on refugees’ health status as well as the extended risks to the host communities will help states that hosting refugees building rational access policy to protect whole community and save public health gains during and post crisis. Additionally, it will support donors to better mobilize resources according to the needs while the humanitarian actors and service providers will better contribute to the public health stability during refugee’s crisis.

Download Full-text

British newspapers’ stance towards the Syrian refugee crisis: An appraisal model study

Discourse & Society ◽

10.1177/0957926518801079 ◽

2018 ◽

Vol 30 (1) ◽

pp. 64-84 ◽

Cited By ~ 2

Author(s):

Fatemeh Tavassoli ◽

Alireza Jalilifar ◽

Peter RR White

Keyword(s):

Terrorist Attacks ◽

Syrian Refugees ◽

Refugee Crisis ◽

Policy Changes ◽

Syrian Refugee ◽

Model Study ◽

Political Orientations ◽

The Right ◽

Syrian Refugee Crisis ◽

The Guardian

This study investigates the representations of the Syrian refugee crisis in commentary articles published in two British newspapers with different political orientations, The Guardian and The Telegraph. The study draws on the appraisal model as a linguistic tool to analyse the attitudinal language of the articles indicative of the stances adopted by the newspapers. Such stances have the potential to position the readers to positively view the refugees and accept them into their homeland labelled as the welcoming stance, or otherwise reject them labelled as unwelcoming. The selected 20 articles belong to September 2015 and March 2016, the beginning and end of a 6-month period during which important policy changes were made by the leading countries in the wake of 2015 terrorist attacks. The findings indicate that the left-leaning The Guardian adopts a dominantly welcoming stance towards the Syrian refugees and consistently maintains this welcoming stance after 6 months of chaos across Europe. The right-leaning The Telegraph, however, shows a more unwelcoming stance and becomes even more unwelcoming after 6 months.

Download Full-text

Prevalence of Depression Symptoms and Associated Sociodemographic and Clinical Correlates Among Syrian Refugees in Lebanon

10.21203/rs.3.rs-62968/v1 ◽

2020 ◽

Author(s):

Hady Naal ◽

Dana Nabulsi ◽

Nour El Arnaout ◽

Lina Abdouni ◽

Hani Dimassi ◽

...

Keyword(s):

Mental Health ◽

Large Scale ◽

Severe Depression ◽

Depression Symptoms ◽

Syrian Refugees ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Clinical Correlates ◽

Syrian Refugee ◽

Prevalence Of Depression

Abstract Background: Since the outbreak of the Syrian war in 2011, close to 6 million Syrian refugees have escaped to Syria’s neighbouring countries, including Lebanon. Evidence suggests rising levels of mental health disorders among Syrian refugee populations. Yet, to the best of our knowledge, large-scale studies addressing the mental health of adult Syrian refugees in Lebanon are lacking. Aims: We examined the prevalence of depression symptoms, which represent a common and debilitating mental health disorder among Syrian refugee populations in Lebanon, along with their sociodemographic and clinical correlates.Methods: A cross-sectional survey design was conducted as part of a collaborative project-“Sijilli”- led by the Global Health Institute at the American University of Beirut (Beirut, Lebanon) across 4 informal tented settlements for refugees (Beirut, Bekaa, North, South) in Lebanon among adult Syrian refugees (≥18), over a period extending from 2018 to 2020. The survey inquired about participants’ sociodemographic and clinical characteristics, and screened participants for symptoms of depression through sequential methodology using the Patient Health Questionnaire (PHQ-2 and PHQ-9). Results: A total of 3255 adult Syrian refugees were enrolled in the study. Of those refugees, only 51.6% (n=1678) screened positive on the PHQ-2 and were therefore eligible to complete the PHQ-9. The PHQ-9 analysis revealed high prevalence (25%) of moderate to severe depression in the total sample, suggestive of high probability for major depression disorder (MDD). Further analyses indicate that being ≥45 years of age (OR 1.70, 95% CI 1.22-2.36), a woman (OR 1.35, 95% CI 1.07-1.69), divorced/separated (OR 3.32, 95% CI 1.57-7.01), reporting a neurological (OR 1.77, 95% CI 1.20-2.61) or a mental health condition (OR 5.30, 95% CI 2.40-11.66) are major risk factors for MDD.Conclusion: Our study suggests that one in four Syrian refugees in Lebanon have probable MDD, and our findings have important public health and clinical implications on refugee health. There is a need to enhance screening efforts, to improve access and referral to mental health services, and to improve post-migration factors among Syrian refugees in Lebanon.

Download Full-text