Experiences of Cultural Differences, Discrimination, and Healthcare Access of Displaced Syrians (DS) in Lebanon: A Qualitative Study

Abstract

The study aims to examine cultural differences and discrimination as difficulties encountered by DS when using the Lebanese healthcare system, and to evaluate the equity of DS access to health services in Lebanon. This is a qualitative study using in-depth semi-structured interviews with DS and Lebanese healthcare professionals. The participants were selected by visiting two hospitals, one public Primary Healthcare Center, and three PHCs managed by Non-Governmental Organizations. The recruitment of participants was based on reasoned and targeted sampling. Thematic analysis was performed to identify common themes in participants’ experiences of DS in accessing Lebanese healthcare. Twenty interviews took place with directors of health facilities (n = 5), health professionals (n = 9), and DS (n = 6) in six different Lebanese healthcare institutions. The results showed barriers of access to care related to transportation and financial issues. Healthcare services provided to the DS appear to be of poor quality due to inequitable access to the health system, attributable to the discriminatory behavior of healthcare providers. Among the several factors contributing to the presence of discrimination in the Lebanese healthcare system, the persisting fragility of the healthcare system—facing a humanitarian crisis—emerged as the major driver of such unequal treatment. The number of DS in Lebanon is roughly equal to a quarter of its citizens; there is an urging need to restore the Lebanese health system to ensure the equitable provision of health services for DS and appropriate working conditions for health professionals.

Healthcare bias and health inequalities towards displaced Syrians in Lebanon: a qualitative study

“…On the other hand, the findings of the study, which also aligns with the results of the exploratory study (August 2020) ( 31 ), show that healthcare bias is manifested in aggressive and racist communication and the adoption of segregated attitudes toward DS patients. In this context, HCP may act either consciously or unconsciously in an oppressive manner during their interactions with DS, as indicated in the literature.…”

“…The causes of healthcare bias toward DS in Lebanon largely described in this study complement the results of the exploratory study conducted in August 2020 ( 31 ). The particularities of the Lebanese context relate to a history of political conflicts between the two countries as well as the current economic and political crisis in Lebanon that has made resources rare and strained the health system.…”

“…Moser and Korstjens (2017) ( 34 ) estimate that small groups of six participants allow more time to express their points of view and give detailed information. The exploratory study conducted in August 2020 ( 31 ) revealed that group interviews provide relevant insights based on shared experiences.…”

“…These areas were chosen as they are familiar to us through our contacts and (1) because hospitals and primary care facilities there are close to DS refugee camps in Bekaa and North Lebanon. (2) The exploratory study conducted prior to this study (August 2020) (31) was also carried out in these provinces, though with different participants.…”

“…The results indicated that multiple challenges have jeopardized DS health and welfare. Healthcare services provided to DS perceived to be of poor quality due to inequitable access to the health system and the discriminatory behavior of healthcare providers ( 31 ). Following the identification of the problem of healthcare biases experienced by DS, the research questions were expanded as follows:…”