Assessment of reproductive health and violence against women among displaced Syrians in Lebanon

Abstract

BackgroundThe current conflict in Syria continues to displace thousands to neighboring countries, including Lebanon. Information is needed to provide adequate health and related services particularly to women in this displaced population.MethodsWe conducted a needs assessment in Lebanon (June-August 2012), administering a cross-sectional survey in six health clinics. Information was collected on reproductive and general health status, conflict violence, stress, and help-seeking behaviors of displaced Syrian women. Bivariate and multivariate analyses were conducted to examine associations between exposure to conflict violence, stress, and reproductive health outcomes.ResultsWe interviewed 452 Syrian refugee women ages 18–45 who had been in Lebanon for an average of 5.1 (± 3.7) months. Reported gynecologic conditions were common, including: menstrual irregularity, 53.5%; severe pelvic pain, 51.6%; and reproductive tract infections, 53.3%. Among the pregnancy subset (n = 74), 39.5% of currently pregnant women experienced complications and 36.8% of those who completed pregnancies experienced delivery/abortion complications. Adverse birth outcomes included: low birthweight, 10.5%; preterm delivery, 26.5%; and infant mortality, 2.9%. Of women who experienced conflict-related violence (30.8%) and non-partner sexual violence (3.1%), the majority did not seek medical care (64.6%). Conflict violence and stress score was significantly associated with reported gynecologic conditions, and stress score was found to mediate the relationship between exposure to conflict violence and self-rated health.ConclusionsThis study contributes to the understanding of experience of conflict violence among women, stress, and reproductive health needs. Findings demonstrate the need for better targeting of reproductive health services in refugee settings, as well as referral to psychosocial services for survivors of violence.

Systemic violence against Syrian refugee women and the myth of effective intrapersonal interventions

“…Examples include high cost, distance and transport, fear of mistreatment by aid workers or healthcare providers, security concerns, shame, unavailability of a female doctor, and insufficient provision of services. 9 Based on our observations, the situation of Syrian refugees in Lebanon highly resembles that of those in the Zaatari refugee camp in Jordan, where women report multiple barriers to seeking healthcare, which in any case is perceived to be of poor quality. These barriers include long waiting lines, disrespect by healthcare providers, particularly towards women, lack of female doctors, lack of medication, cost of medication, and an unclear referral system.…”

“…7 Meanwhile, as Syrian refugees struggle to pay healthcare bills, hospitals in Lebanon have resorted to aggressive methods such as withholding corpses, holding newborns hostage, or confiscating personal IDs as a measure to enforce payment of the remaining 25% from refugees. 8 Syrian refugee women are disproportionately affected by the situation in Lebanon, due to the increase in GBV (particularly intimate partner violence (IPV), early marriage, transactional sex, sexual assaults), as well as lack of access to emergency obstetric care, limited access to contraception, 9,10 forced cesarean sections, 3 and the high cost of healthcare services. These factors lead to fewer antenatal care (ANC) visits, delayed family planning, and all round poorer reproductive health.…”

“…9 Effectively, privacy is reduced and anxiety enhanced, while women's health decisions become matters decided by residing family members as well as spouses. Trying to cope and fulfill traditional gender roles, women prioritize the needs of their husbands and children instead of their own health.…”

“…These factors lead to fewer antenatal care (ANC) visits, delayed family planning, and all round poorer reproductive health. 9 Women are also at risk of stress-related mental disorders due to war, trauma, and displacement. Harassment and rape continue to take place in refugee camps, and early marriage is seen as a means of keeping daughters safe and protecting them from poverty.…”

Testimony, Memory and Solidarity across National Borders: Paul Ricoeur and Transnational Feminism

“…Specifically, the poor conditions of the Syrian refugees lead to many women reporting health problems related to nerve issues, depression, unusual pain and fatigue, repeated vomiting and migraines. 38 Most did not seek gynecological care, unless they were pregnant, due to shame and fear of stigmatization. Ricoeur's narrative hospitality is both sensitive to the specificity of the conditions these women and girls have experienced and can provide a method for working through the resulting stress and trauma of these conditions.…”