Insights into theorizing social exclusion and inequities: A perspective from the Arab World

Abstract

Objective: To explore the influence of the global structural determinants and their pathways of action on health disparities and social exclusion, drawing on findings from research with four different population groups in an Arab context. We use a socioecological framework to categorise these determinants into levels to allow an in-depth look into their pathways of action on social exclusion and inequalities. Methods: We use findings from an ethnographic study on Palestinian and Iraqi refugees in Lebanon; a qualitative research study on women's needs for labour support in three public hospitals in Egypt, Lebanon and Syria; and counselling experiences with university scholarship recipients in Lebanon. These findings were revisited using a social exclusion lens. Results: Global forces, such as modernism, inequitable foreign policies of resettlement countries, over-medicalization of health care, modern educational systems and armed conflicts fueled by global vested interests interact to cause and exacerbate social exclusion. Palestinian refugees relate their experiences of discrimination in what is perceived to be a hostile society to policies reducing their education and employment opportunities. Delays in processing resettlement applications of Iraqi refugees and the lack of power over the choice of resettlement countries are a source of reported stress and anxiety. Over-medicalization of maternity care disrupts the traditional ways of giving birth surrounded with family through policies and practices restricting labour companionship, resulting in the isolation and silencing of women during childbirth. Scholarship students reported inadvertent exclusion from their families, societies and colleagues. Scrutiny of the findings and re-examination of the data reveals the importance of global structural determinants in explaining the patterns of exclusion reported for the population groups observed. Conclusion: Expanding the ecological framework of determinants of social exclusion at the level of wider social/structural determinants is necessary to improve our understanding of social exclusion in impoverished and war affected places around the world.

“A person who does not have money does not enter”: a qualitative study on refugee women’s experiences of respectful maternity care

“…The fear from medical procedures and from being subject to sub-standard care expressed in women’s narratives reflects the lack of accountability in the Lebanese healthcare system [ 48 ] especially when they consider they are reliant on humanitarian aid to receive healthcare because they are refugees. These systems continue to alienate and silence women, deprive them of their right to information, segregate them as refugees and isolate them from their support systems [ 49 ]. Similarly, women’s choices of their healthcare providers, type of birth and anesthetic are limited.…”

“…A recent review of women’s reports on obstetric violence in the Eastern Mediterranean region indicates that disrespect and abuse during childbirth is reported by women from all countries of the region and that socio-cultural norms related to patriarchy and the professional dominance of healthcare providers normalize these behaviors with the healthcare system [ 35 ]. Our previous work in Lebanon and Arab countries has shown that women are silenced and marginalized in the healthcare system during childbirth [ 36 ]. Given this background, we aim at understanding women’s interpretation of the meaning and experiences of “respect” and “disrespect”.…”

Behind the scenes of research ethics committee oversight: a qualitative research study with committee chairs in the Middle East and North Africa region

“…This interest in the practice of research ethics has particularly arisen due to sensitive issues, widespread vulnerability and marginalization among the region's populations (19). The MENA region has historically witnessed social turmoil, wars, impoverishment, economic recessions, and deeply rooted social injustices which continue to have adverse impacts on people's health (20). Consequently, the number of publications on war-affected populations in the region has ensued since the start of the 21st century and extending to the study of the civil uprisings in 2011 (21) and during the COVID-19 pandemic when a substantial increase in COVID-19 related research has taken place in Saudi Arabia, funded by local and international agencies (22).…”