The State of the World's Refugees

Guterres, António; Spiegel, Paul

doi:10.1001/2012.jama.10161

Cited by 50 publications

(20 citation statements)

References 4 publications

(4 reference statements)

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“…The example from UNHCR that convinced Iran to undertake a health insurance scheme that would provide over one million Afghan refugees with a level of access to secondary and tertiary care that is similar to that of an “average” Iranian, is an important one that can bring the idea of universal health coverage to be applied to displaced populations [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Syrian refugees in Lebanon: the search for universal health coverage

2016

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The crisis in Syria has forced more than 4 million people to find refuge outside Syria. In Lebanon, in 2015, the refugee population represented 30 % of the total population. International health assistance has been provided to refugee populations in Lebanon. However, the current humanitarian system has also contributed to increase fragmentation of the Lebanese health system. Ensuring universal health coverage to vulnerable Lebanese, Syrian and Palestinian refugees will require in Lebanon to redistribute the key functions and responsibilities of the Ministry of Health and its partners to generate more coherence and efficiency.

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Section: Discussionmentioning

confidence: 99%

Syrian refugees in Lebanon: the search for universal health coverage

2016

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“…As the number of refugees has increased there have also been shifts towards middle-income settings with older post-demographic transition structures and an epidemiological shift away from communicable diseases that have historically characterized refugee populations [ 1 , 2 ]. Traditional camp-based assistance models have been adapted to better support refugees in urban environments; in 2009, UNHCR adapted its policy on refugees in urban settings to involve integration of refugees into existing host country systems for health, education, and other basic needs [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and care-seeking for chronic diseases among Syrian refugees in Jordan

et al. 2015

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BackgroundThere are currently more people displaced by conflict than at any time since World War II. The profile of displaced populations has evolved with displacement increasingly occurring in urban and middle-income settings. Consequently, an epidemiological shift away from communicable diseases that have historically characterized refugee populations has occurred. The high prevalence of non-communicable diseases (NCDs) poses a challenge to in terms of provision of appropriate secondary and tertiary services, continuity of care, access to medications, and costs. In light of the increasing burden of NCDs faced by refugees, we undertook this study to characterize the prevalence of NCDs and better understand issues related to care-seeking for NCDs among Syrian refugees in non-camp settings in Jordan.MethodsA cross-sectional survey of 1550 refugees was conducted using a multi-stage cluster design with probability proportional to size sampling to obtain a nationally representative sample of Syrian refugees outside of camps. To obtain information on chronic conditions, respondents were asked a series of questions about hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and arthritis. Differences by care-seeking for these conditions were examined using chi-square and t-test methods and characteristics of interest were included in the adjusted logistic regression model.ResultsAmong adults, hypertension prevalence was the highest (9.7 %, CI: 8.8–10.6), followed by arthritis (6.8 %, CI: 5.9–7.6), diabetes (5.3 %, CI: 4.6–6.0), chronic respiratory diseases (3.1 %, CI: 2.4–3.8), and cardiovascular disease (3.7 %, CI: 3.2, 4.3). Of the 1363 NCD cases, 84.7 % (CI: 81.6–87.3) received care in Jordan; of the five NCDs assessed, arthritis cases had the lowest rates of care seeking at 65 %, (CI:0–88, p = 0.005). Individuals from households in which the head completed post-secondary and primary education, respectively, had 89 % (CI: 22–98) and 88 % (CI: 13–98) lower odds of seeking care than those with no education (p = 0.028 and p = 0.037, respectively). Refugees in North Jordan were most likely to seek care for their condition; refugees in Central Jordan had 68 % (CI: 1–90) lower odds of care-seeking than those in the North (p = 0.047).ConclusionMore than half of Syrian refugee households in Jordan reported a member with a NCD. A significant minority did not receive care, citing cost as the primary barrier. As funding limitations persist, identifying the means to maintain and improve access to NCD care for Syrian refugees in Jordan is essential.

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“…Crises in recent decades have seen a shift in displaced populations settling in more non-camp settings in middle-income countries [ 1 ]. The protracted extent of many of these situations necessitates health responses focused on greater integration of refugees into host country systems rather than the establishment of parallel systems of refugee assistance [ 2 – 4 ]. The changing nature of displacement also carries implications for equitable prioritization and provision of health care and other services for refugees.…”

Section: Introductionmentioning

confidence: 99%

Health service access and utilization among Syrian refugees in Jordan

Doocy

Lyles

Akhu‐Zaheya

et al. 2016

Int J Equity Health

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BackgroundThe influx of Syrian refugees into Jordan presents an immense burden to the Jordanian health system. Changing lifestyles and aging populations are shifting the global disease burden towards increased non-infectious diseases including chronic conditions, co-morbidities, and injuries which are more complicated and costly to manage. The strain placed on health systems threatens the ability to ensure the health needs of both refugees and host country populations are adequately addressed. In light of the increasing challenges facing host governments and humanitarian actors to meet health needs of Syrian refugees and affected host communities, this study was undertaken to assess utilization of health services among Syrian refugees in non-camp settings.MethodsA survey of Syrian refugees in Jordan was undertaken in June 2014 to characterize health seeking behaviors and issues related to accessing care. A cluster design with probability proportional to size sampling was used to attain a nationally representative sample of 1550 non-camp Syrian refugee households. Differences in household characteristics by geographic region, facility type, and sector utilized were examined using chi-square and t-test methods.ResultsCare-seeking was high with 86.1 % of households reporting an adult sought medical care the last time it was needed. Approximately half (51.5 %) of services were sought from public sector facilities, 38.7 % in private facilities, and 9.8 % in charity/NGO facilities. Among adult care seekers, 87.4 % were prescribed medication during the most recent visit, 89.8 % of which obtained the medication. Overall, 51.8 % of households reported out-of-pocket expenditures for the consultation or medications at the most recent visit (mean US$39.9, median US$4.2).ConclusionsDespite high levels of care-seeking, cost was an important barrier to health service access for Syrian refugees in Jordan. The cessation of free access to health care since the time of the survey is likely to have worsened health equity for refugees. Dependence of refugees on the public facilities for primary and specialist care has placed a great burden on the Jordanian health system. To improve accessibility and affordability of health services in an equitable manner for both refugees and Jordanian host communities, strategies that should be considered going forward include shifting resources for non-communicable diseases and other traditional hospital services to the primary level and creating strong health promotion programs emphasizing prevention and self-care are strategies.

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The State of the World's Refugees

Cited by 50 publications

References 4 publications

Syrian refugees in Lebanon: the search for universal health coverage

Syrian refugees in Lebanon: the search for universal health coverage

Prevalence and care-seeking for chronic diseases among Syrian refugees in Jordan

Health service access and utilization among Syrian refugees in Jordan

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