"We Are Living from a Lack of Death": An Exploration of the Mental Health Needs of Syrian Refugee Women in Lebanon

Background and Purpose: Since the beginning of the Syrian refugee crisis in 2011, an estimated 1.5 million Syrian refugees have resettled in Lebanon, making it the country with the highest number of refugees per capita. Syrian refugees in Lebanon have faced numerous vulnerabilities, in part due to lack of government protection. These challenges were further exacerbated in recent years as the country has faced a series of crises starting in 2019, including the October 17 Revolution, the COVID-19 pandemic, the Beirut Port Explosion, and an economic crisis described by the World Bank as one of the world’s worst in the past 150 years. Syrian refugees have been disproportionately impacted by these crises, and 9 out of 10 Syrian refugees in Lebanon now live in extreme poverty, according to the United Nations High Commissioner for Refugees.

These events have impacted the mental health of the Syrian refugee community, particularly women. However, limited research exists on the wellbeing of refugees experiencing large scale crises in their resettlement contexts that can be used to inform the development of effective and culturally appropriate mental health and psychosocial support (MHPSS) services. This study addresses this gap by exploring the experiences of Syrian refugee women in Lebanon - starting with their migration journeys and ending with the aforementioned crises - and the impact these experiences have had on their mental health and wellbeing.

Methods: Semi-structured interviews that lasted between 45 and 90 minutes were conducted with 20 Syrian refugee women with an average age of 37 that have been residing in Beirut since before 2019. Participants were recruited via phone calls through two local refugee-serving nonprofits. The interviews were conducted in the local Arabic dialects and transcribed verbatim. The transcripts were then translated to English and coded thematically using NVivo based on a phenomenological hermeneutic approach.

Results: Participants struggled with multiple cumulative stressors, such as a lack of safety and stability, discriminatory treatment, undesired shifts in family dynamics, and an inability to secure basic needs for themselves and their children. This manifested in a variety of changes in their physical and mental health. They acknowledged commonalities between their difficult experiences in Lebanon and Syria and that this compounded their stress levels. Themes in participants’ responses revealed that gender differentially impacted their experiences integrating into Lebanon. Finally, they described complicated relationships with the concepts of “home” and “hope.” Despite the challenges discussed, participants emphasized religion and a sense of community as sources of resilience.

Conclusions and Implications: These results indicate that Syrian refugee women in Lebanon are exposed to unique cumulative and systemic forms of trauma. In order to be more effective and culturally appropriate, MHPSS services should consider their history of trauma exposure, relationships with their families and communities, and the important role of faith and spirituality. Community level mental health services should also be more holistic in their approaches and account for and alleviate socioeconomic stressors to enable Syrian refugee women to plan for a future that is guided by their self-determined goals and dreams.