Perspectives of Frontline Professionals on Palestinian Children Living with Sibling and Parental Drug Use in the UNRWA Camps, Jordan

Abstract

Context: The occupied Palestinian territories (oPt) consists of the non-contiguous West Bank including East Jerusalem and the Gaza Strip. It is densely populated within these confines, and has a unique socio-economic context characterized by political and economic tensions . Around 2.2 million Palestinians are displaced and living in the ten UNRWA refugee camps in Jordan. Palestinian communities are exposed to a double burden of disease caused by the severe economic, social and health consequences of Israeli occupation and resultant displacement. Exposure to political violence, economic hardship, fragmentation of Palestinian families, unemployment, trauma and community stress underpin a reported rise in drug abuse. . Method: A qualitative study using focus groups ( n =3) with a convenience sample of health care and educational professionals was conducted in two UNRWA camps ( Al-Zarka, Al-Wehdat ) in Jordan. Guided discussions explored the experiences of these professionals in working with Palestinian families and children affected by substance/drug use and drug use disorder in the home. Data were analysed using thematic analysis (TA). Results: Five themes emerged from the TA. These were: 1)Access to drugs was perceived to be relatively easy in the camps; 2) Attitudes towards drugs appear to have desensitised, yet stigma persists; 3) Families of drug users are affected by fear, social and economic poverty, with significant physical and psychological cost to children; 4) Powered by Editorial Manager® and ProduXion Manager® from Aries Systems CorporationCauses of substance/drug use in Palestinian communities living in Jordanian UNRWA camps is multifactorial; 5) Solutions are multi-faceted and indicative of the need for prevention and support for those at risk, and affected . Conclusions: Threats to UNRWA from the current political climate and the reducing investment in services may exacerbate this public health and security issue. For an evidence based approach to have credibility in the camp communities, there is a need for accurate, factual information, along with robust epidemiological data, relating to the extent, characteristics and harms associated with drug use.

Understanding and Responding to Substance Use and Abuse in the Palestinian Refugee Camps in Lebanon Prior to and During COVID-19 Times

“…We adopted a critical realist approach (Bhaskar, 1975 ) which focused on understanding and not merely describing social reality of substance and drug-related activity in the camps, in order to yield insights and to support the generation of community-led responses addressing the issues affecting the camp communities. This qualitative study consisting of in-depth interviews and focus group discussions (FGDs) was undertaken in Lebanon as part of a regional exercise investigating Palestinian community experiences of substance and drug use in refugee camps (Al-Afifi et al, 2019 ; Van Hout et al, 2019 ; Wazaify et al, 2020 ). The design of the data collection instruments was based on extant harm reduction and research expertise of the MENAHRA team in the field, on a systematic review of literature (Van Hout et al, 2019 ), and on extant published studies using the same methodology and with Palestinian refugees undertaken by the last author in the West Bank and Gaza, and Jordan (Al-Afifi et al, 2019 ; Wazaify et al, 2020 ).…”

Public health imperatives in countering drug related health threats and vulnerabilities in contemporary Palestinian refugee camps

“…are generally denied full rights to political, economic and societal integration (employment, property ownership), are restricted access to public education, public health care and social services, and consequently experience acute socio-economic deprivation ( Habib et al., 2012 ; Kitamura et al., 2018 ). Further to the political insecurity, complicated by the impending angst around the ‘right to return’, Palestinian refugee communities in the drug transit and drug production countries of Lebanon, Jordan, Syria, West Bank and Gaza are reported to increasingly experience camp insecurity and drug related health threats and vulnerabilities ( Thabet & Dajani, 2012 ; UNRWA/UNICEF, 2018 ; Massad et al., 2016 ; Al-Afifi et al., 2019 ; Damiri, 2019 ; Syam et al., 2019 ; Van Hout et al., 2019 ; Wazaify et al., 2020 ). These conditions inside camps, along with tensions with the outside or host communities collectively increase their risk of substance use and high-risk drug use ( Afifi et al., 2019 ; Anera, 2019 ).…”

“…Limited access to safety and justice, lack of governance and infiltration by radical Islamist groups and criminal networks in some camps has played a vital role in the targeting of youth by drug dealers, the spread of drug abuse, trafficking and violence ( Damiri et al., 2018 ; UNHCR, 2016 ; Yamout et al., 2012 ). Young disenfranchised Palestinian refugees, particularly males, and those living with the trauma of displacement and conflict, are extremely vulnerable to drug related risk behaviours including exploitation in drug trafficking by cross border criminal networks ( Al-Afifi et al., 2019 ; Al-ghzawi et al., 2014 ; Elbedour et al., 2007 ; Van Hout et al., 2019 ; Wazaify et al., 2020 ). Internal efforts by Palestinian communities, NGOs, and CSOs strive to counteract this threat to communal existence and safety in the refugee camps.…”

“…In contrast, whilst both Syria and Jordan note PWID as a key population in their National AIDS planning, there is no operationalization of harm reduction in Syria, and whilst NSP was provided on a small scale in Jordan, there has been a decline in the important of some health programmes, particularly the national AIDs programme, with domestic resources are currently diverted to refugee support initiatives. Community groups continue to report concern around the hidden nature of drug use, the stigmatising treatment of drug users as criminals by law enforcement, and lack of harm reduction and drug treatment provision accessible near to the camps ( Al-Afifi et al., 2019 ; Glick et al., 2018 ; MENAHRA, 2020 ; Van Hout et al., 2019 ; Wazaify et al., 2020 ). Efforts are also reported to be coming from within, for example in Lebanon where in 2014, a group of young people living in Burj Barajneh camp converted an old prison building into a drug rehabilitation centre.…”

“…Efforts are also reported to be coming from within, for example in Lebanon where in 2014, a group of young people living in Burj Barajneh camp converted an old prison building into a drug rehabilitation centre. The lack of policy driven by evidence is underpinned by camp security and governance aspects which hamper efforts to collect routine surveillance data, resulting in lack of informed policy ( MENAHRA, 2020 ; Wazaify et al., 2020 ).…”