"How Will I Take Her to Have Her Vaccinated?": Threats to Healthcare Access Among Syrian Refugees in Lebanon

Background and purpose: Health leaders charge that our global community has failed the people of Syria through our inability to accurately grasp the reality of the crisis, and the failure of our systems of care to adequately meet the needs of Syrian refugees. The 1.5 million Syrians who have fled to Lebanon face a host of injustices, including lasting trauma, economic precarity, food insecurity, and crowded and unsafe living conditions. We know these challenges contribute to increased risk of communicable diseases like polio and tuberculosis, problems effectively managing non-communicable diseases, and barriers to preventive and primary care. Within this troubling picture, the need for appropriate healthcare for Syrian refugees in Lebanon remains largely unmet, due to cost, a highly fragmented and privatized system, and legal and practical debates about refugee status and associated rights related Syrians who have fled into Lebanon. The result is a troubling picture of inequality and disparities around health, which has important implications for public health and social work.

Methods: In this IRB approved study, we gathered data using collaborative family interviews, drawing and mapmaking, neighborhood walks, and GPS-tracked activity logging with 351 individuals within 46 families who had fled Syria for Lebanon. We coded data line by line and used a constant comparison method of qualitative analysis to create, refine, and group themes.

Results: The most influential barriers for families seeking medical care was the high cost of care and the mistrust they felt in the system, which was made worse by the political insecurity they experience with regards to their refugee status and therefore their ability to claim their right to accessible and affordable care. Most families had profound crises around legal documentation and refugee status, and concomitant fear and restrictions to their mobility. Travel to obtain quality and affordable care was thus a significant barrier for families. Finally, compared to the previous system in their home country of Syria, Lebanon’s system is highly fragmented and privatized, with religious or political parties delivering about 40% of healthcare. Syrian families had trouble understanding and entering into this complex, costly, highly partisan health system.

Conclusions and Implications: Our findings highlight the inequities created by barriers vulnerable populations face within highly privatized, costly, and factional healthcare systems. In so doing, our findings support the argument that universal healthcare delivered via strong, nonpartisan, coordinated public systems is a critical element of reducing disparities around healthcare access, and is particularly crucial for vulnerable populations during economic or humanitarian crises. This work also highlights how important it is to coordinate care and have multiple entry points within communities settings. Relatedly, our study draws into sharp relief how models of strong coordination of care ought to be situated within comprehensive emergency plans that address the realities of health and humanitarian crises at hand. Finally, as social work research, practice, and advocacy attends to understanding and alleviating barriers surrounding refugee healthcare, we must not lose sight of the factors that underlie this massive crisis, particularly the political violence that created it.