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

Khalifeh, Riwa; D’Hoore, William; Saliba, Christiane; Salameh, Pascale; Dauvrin, Marie

doi:10.3389/fpubh.2023.1273916

Cited by 2 publications

References 52 publications

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Legal residency status and its relationship with health indicators among Syrian refugees in Lebanon: a nested cross-sectional study

Ragi,

Ghattas,

Zeid

et al. 2024

Preprint

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Background: Failure to possess or renew legal residency permits increases the burden on a vulnerable refugee population. It risks detention or deportation, and hinders access to basic services including healthcare. This study aimed to examined the association between legal residency status and health of Syrian refugees living in Lebanon. Methods: Data were from two independent nested cross-sectional studies collected in 2022 through telephone surveys. In the first study, all Syrian refugees aged 50 years or older from households that received humanitarian assistance were invited to participate. The second included all adult Syrian refugees residing in a suburb of Beirut. The exposure was self-reported possession of a legal residency permit in Lebanon. The self-reported health outcomes were mental health status, COVID-19 vaccine uptake, and access to the needed healthcare services. Separate adjusted logistic regression models examined the association between lacking a legal residency permit and each health outcome. Results: The first sample included 3357 participants (median age 58 years (IQR:54-64), 47% female), of whom 85% reported lacking a legal residency permit. The second sample included 730 participants (median age 34 years (IQR:26-42), 49% female), of whom 79% lacked a legal residency permit. In both studies, lacking a legal residency permit increased the odds of having poor mental health [adjusted odds ratio (aOR):1.62 (95%CI:1.2-2.2); aOR:1.62 (95%CI:1.01-2.60)], and decreased the odds of COVID-19 vaccine uptake [aOR:0.64 (95%CI:0.53-0.78); aOR:0.51 (95%CI:0.32-0.81)]. In the sub-sample who needed primary healthcare, lacking a legal residency permit decreased the odds of access to primary healthcare in the second study only (aOR:0.37 (95%CI:0.17-0.84)). Conclusions: The majority of Syrian refugees from these two samples reported lacking a legal residency permit in Lebanon. This was associated with poor mental health and lower uptake of COVID-19 vaccination, potentially originating from fear of detention or deportation. These findings call for urgent action to support access to legal documentation for refugees in Lebanon.

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Legal residency status and its relationship with health indicators among Syrian refugees in Lebanon: a nested cross-sectional study

Ragi,

Ghattas,

Zeid

et al. 2024

Preprint

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Development of prediction models of COVID-19 vaccine uptake among Lebanese and Syrians in a district of Beirut, Lebanon: a population-based study

Ragi,

Ghattas,

Shamas

et al. 2024

bmjph

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IntroductionVaccines are essential to prevent infection and reduce the morbidity of infectious diseases. Previous evidence has shown that migrants and refugees are particularly vulnerable to exclusion and discrimination, and low COVID-19 vaccine intention and uptake were observed among refugees globally. This study aimed to develop and internally validate prediction models of COVID-19 vaccine uptake by nationality.MethodsThis is a nested prognostic population-based cross-sectional analysis. Data were collected between June and October 2022 in Sin-El-Fil, a district of Beirut, Lebanon. The study population included a random sample of Lebanese adults and all Syrian adults residing in areas of low socioeconomic status. Data were collected through a telephone survey. The main outcome was the uptake of at least one dose of the COVID-19 vaccine. Predictors of COVID-19 vaccine uptake were assessed using the Least Absolute Shrinkage and Selection Operator regression for Lebanese and Syrian nationalities in separate models.ResultsOf 2028 participants, 79% were Lebanese, 18% Syrians and 3% of other nationalities. COVID-19 vaccination uptake was higher among Lebanese (85% (95% CI 82% to 86%) compared to Syrians (47% (95% CI 43% to 51%)) (p<0.001); adjusted OR 6.2 (95% CI 4.9 to 7.7). Predictors of uptake of one or more COVID-19 vaccine doses for Lebanese were older age, presence of an older adult in the household, higher education, greater asset-based wealth index, private healthcare coverage, feeling susceptible to COVID-19, belief in the safety and efficacy of vaccines and previous receipt of the influenza vaccine. For Syrians, predictors were older age, male sex, completing school or higher education, receipt of cash assistance, presence of chronic illness, belief in the safety and efficacy of vaccines, previous receipt of the influenza vaccine and possession of a legal residency permit in Lebanon.ConclusionsThese findings indicate barriers to vaccine uptake among Syrian refugees and migrants, including legal residency status. These findings call for urgent action to enable equitable access to vaccines by raising awareness about the importance of vaccination and the targeting of migrant and refugee populations through vaccination campaigns.

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

Cited by 2 publications

References 52 publications

Legal residency status and its relationship with health indicators among Syrian refugees in Lebanon: a nested cross-sectional study

Legal residency status and its relationship with health indicators among Syrian refugees in Lebanon: a nested cross-sectional study

Development of prediction models of COVID-19 vaccine uptake among Lebanese and Syrians in a district of Beirut, Lebanon: a population-based study

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