An assessment of diabetes care in Palestinian refugee camps in Syria

Abstract

Background:Palestinian refugees have been a displaced group of people since 1948, many of whom are living in refugee camps in the Middle East. They are entitled to free health care from the United Nations Relief and Work Agency (UNRWA). They show a higher prevalence of diabetes than the population in their host countries in the Middle East. This study examined the realities of care for diabetic patients in UNRWA health clinics in Damascus, Syria. The aim was three-fold: To investigate the level of diabetes care, to probe patients’ level of general understanding of their disease and its management, and to search for areas of potential improvement.Methods:Data on patient education and care was gathered over a 1 month period from August 4, 2008 to September 4, 2008 using questionnaires and direct observation of the workflow at the clinics. Clinic-led care was observed by the study team using checklists during patient visits. All of the clinic staff and sampled patients were interviewed. The main areas of care assessed were: Patient follow-up; examination of eyes and feet; availability of medications; and patient education. A total of 154 people with diabetes were sampled from three refugee camps situated around Damascus.Results:A total of 154 patients, three doctors and seven nurses composed the sample of the study. Foot examinations were almost always neglected by health staff and eye examinations were not offered by the UNRWA clinics. Interviews with patients showed that: 67% (95% confidence intervals [CI]: 0.59-0.70) had to buy their medication at their own expense at least once due to medication shortage in the UNRWA clinics, 48% (95% CI: 0.40-0.55) displayed poor knowledge regarding the cause and exacerbating factors of diabetes, 65% (95% CI: 0.56-0.72) had not heard of insulin, and 43% (95% CI: 0.35-0.51) did not know for how long they needed to take their medications.

Treating Syrian refugees with diabetes and hypertension in Shatila refugee camp, Lebanon: Médecins Sans Frontières model of care and treatment outcomes

“…This was especially important for patients with significant financial constraints. In that sense and unlike other NCD programs targeting different refugee contexts [24–26], the MSF model of care was adapted in a way to reduce the burden of visits on the patients. For instance, the model reduced the frequency of the visits to the minimum possible, decreased their length and avoided patients having to move outside of the clinic for tests or drugs, while still achieving high quality care.…”

Access to Safe Water and Personal Hygiene Practices in the Kulandia Refugee Camp (Jerusalem)

“…Generally, Palestinian refugee camps are poor, overcrowded and lack adequate basic infrastructure. 2-4 In 1948 the United Nations established the United Nations Relief for Palestine Refugees (UNRPR) agency to address the issues pertinent to Palestinian refugees. This agency was replaced a year later with the United Nations Relief and Works Agency (UNRWA).…”

“…Palestinian refugees face a multitude of health challenges deriving from factors associated with their living conditions, including overcrowded housing, inadequate or non-existent public infrastructure, and a deeply under-resourced social infrastructure. 2 , 7 Globally, infectious diseases are a major cause of morbidity and mortality in developing countries, accounting for 43% of the total global disease burden, with acute respiratory infections and diarrheal illnesses being the most common manifestations in children. In the West Bank, the primary causes of death in infants less than one year old are infectious diseases, specifically both acute respiratory infections and diarrheal disease.…”

Systematic review on chronic non-communicable disease in disaster settings

“…Certain regions or populations were more heavily studied than others as was the case for DM where 57.6% of studies reviewed were conducted in the EMRO region. 32.4% of DM studies focused on the Palestinian (22, 29, 32, 71, 78-82, 84, 105) population alone, higher than Africa, the Americas, Western Pacific (WP), and South East Asia (SEA) combined. The high prevalence of articles conducted in the EMRO may reflect the higher prevalence of diabetes there (106).…”

“…Consideration should be given to include comparison or control groups in study design, for example individuals in neighboring regions, non-refugee counterparts, or matched sample populations not afflicted by the disease (34, 53) to be able to better assess and thus target the effects of the humanitarian crises itself on disease outcomes. Additionally, long-term cohorts and registries (105) would be ideal to better understand the diversity of diseases and contributory factors in even greater depth. Of all the studies included, none referred to the Sphere guidelines(111), WHO Noncommunicable Diseases in Emergencies brief (112), or WHO PEN package of essential NCD interventions(113) as markers for study design, which we propose be included in future research.…”