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

Abstract

Since the uprising in Syria in March 2011, over 4.3 million Syrians have fled to neighboring countries. Over a million have sought refuge in Lebanon, constituting almost a quarter of the Lebanese population and becoming the largest refugee population per capita in the world. With inequitable health coverage being a longstanding problem in Lebanon, Syrian refugee women's health, and specifically their sexual and reproductive health, is disproportionately affected. An increase in gender-based violence and early marriage, a lack of access to emergency obstetric care, limited access to contraception, forced cesarean sections, and high cost of healthcare services, all contribute to poor sexual and reproductive health. In this commentary, we conceptualize violence against Syrian refugee women using the ecological model, exploring the intersections of discrimination based on ethnicity, gender, and socioeconomic status, while critiquing interventions that focus solely on the intrapersonal level and ignore the role of microsystemic, exosystemic, and macrosystemic factors of negative influence. These social determinants of health supersede the individual realm of health behavior, and hinder women in taking decisions about their sexual and reproductive health.

Health inequities faced by Ethiopian migrant domestic workers in Lebanon

“…Syrian refugee women (Yasmine and Moughalian 2016) in Lebanon, who also face lack of access to emergency obstetric care, limited access to contraception, forced caesarean sections, and high cost of healthcare services. However, both these groups of women are in a relatively advantaged position compared to MDWs, as their pregnancy is not considered illegitimate, and Syrian women are supported by the UNHCR for up to 75% of their hospital bills.…”

A Qualitative Analysis of Knowledge, Attitudes, and Perceptions of Family Planning Among Syrian Refugees in Lebanon

“…Our results identify multiple policy-level barriers that impede Syrian refugees' access to FP services in Lebanon, and according to the above framework, addressing such policies is important for improving SRH services [36]. Participants in this qualitative study noted economic hardships for refugees in Lebanon, which is highly relevant since cost is an important barrier to contraceptive use [20,29,37,38]. In Lebanon, patients must pay a portion of the health care fees out-of-pocket [39], and with Lebanon's relatively expensive health care system along with UNHCR's reduced subsidization of health services [40], the required fees are prohibitive for some individuals.…”

“…Despite increased efforts to provide information on FP and SRH, few girls are able to attend programs because they are often not allowed to leave home without an accompanying male adult [27,28]. Even when Syrian girls and women do access services, they often perceive that they are judged and mistreated [29] as well as viewed negatively by Lebanese health care providers [8]. Misinformation about harmful side effects as well as banning of contraception by husbands and family members were identified as barriers to FP uptake in pre-conflict Syria and continue to be cited by some refugees after displacement [25][26][27].…”

Engaging Men to Support the Resilience of Syrian Refugee Children and Youth in Lebanon

“…As a protective strategy, Syrian refugees have resorted to early marriage of their daughters in order to help protect them from sexual harassment and risk of sexual abuse or to help with financial security (Hassan et al, 2015;Yasmine & Moughalian, 2016). Although this practice was common in Syria before, early marriage is believed to be happening at higher rates due to the belief that marriage offers increased protection (Cherri, Rodriguez-Llanes, & Guha-Sapir, 2017).…”

“…Child marriage in Syria would also typically happen within communities where families knew each other and protective social connections were well established. In displacement, families are marrying young girls to men with whom there is no pre-established connection, who may have a significant age gap, or who have multiple wives, increasing the risk of DV and IPV (Boswall & Akash, 2015;Cherri et al, 2017;Mourtada, Schlecht, & DeJong, 2017;Wells, Steel, Hassan, & Lawsin, 2016;Yasmine & Moughalian, 2016). Early marriage has other negative consequences for young girls.…”