“To die is better for me”, social suffering among Syrian refugees at a noncommunicable disease clinic in Jordan: a qualitative study

Abstract

Background: The conflict in Syria has required humanitarian agencies to implement primary-level services for noncommunicable diseases (NCDs) in Jordan, given the high NCD burden amongst Syrian refugees; and to integrate mental health and psychosocial support into NCD services given their comorbidity and treatment interactions. However, no studies have explored the mental health needs of Syrian NCD patients. This paper aims to examine the interaction between physical and mental health of patients with NCDs at a Médecins Sans Frontières (MSF) clinic in Irbid, Jordan, in the context of social suffering. Methods: This qualitative study involved sixteen semi-structured interviews with Syrian refugee and Jordanian patients and two focus groups with Syrian refugees attending MSF's NCD services in Irbid, and eighteen semistructured interviews with MSF clinical, managerial and administrative staff. These were conducted by research staff in August 2017 in Irbid, Amman and via Skype. Thematic analysis was used. Results: Respondents describe immense suffering and clearly perceived the interconnectedness of their physical wellbeing, mental health and social circumstances, in keeping with Kleinman's theory of social suffering. There was a 'disconnect' between staff and patients' perceptions of the potential role of the NCD and mental health service in alleviating this suffering. Possible explanations identified included respondent's low expectations of the ability of the service to impact on the root causes of their suffering, normalisation of distress, the prevailing biomedical view of mental ill-health among national clinicians and patients, and humanitarian actors' own cultural standpoints. Conclusion: Syrian and Jordanian NCD patients recognise the psychological dimensions of their illness but may not utilize clinic-based humanitarian mental health and psychosocial support services. Humanitarian agencies must engage with NCD patients to elicit their needs and design culturally relevant services.

Integrating community health volunteers into non-communicable disease management among Syrian refugees in Jordan: a causal loop analysis

“…Individuals interviewed ► Community health professor from the Jordan University of Science and Technology (1) ► Syrian refugee patients (one male and 1 female) ► International Rescue Committee staff (7) Including community health volunteers (CHVs) (one male, 1 female Jordan and were aware of the motivations and goals for this work. Community perspectives as well as the perspectives of CHVs who had practised in target communities, often for years, were prioritised in order to fully consider the limitations of current programming and the ways in which future programming might meet identified gaps in care.…”

“…4 Prolonged displacement and a high burden of non-communicable diseases (NCDs) require that primary care predominantly delivered by non-governmental organisations (NGOs) be optimised to prevent severe morbidity and mortality. [5][6][7][8][9] Syrian refugees in Jordan access healthcare in fragmented ways. In camp settings,…”

Barriers to Accessing Mental Health Services among Syrian Refugees in Ankara

“…The main barriers to access mental health care reported in the refugee literature are language problems [3,5,28,29] and lack of knowledge about where and how to get access to mental health services [24,25,30], which were our main ndings as well. The language barrier was especially important: many refugees said they would go to the hospital if they knew there was a translator or an Arabic-speaking doctor/psychologist at the premises.…”

Beliefs About Causes and Cures of Prolonged Grief Disorder Among Arab and Sub-Saharan African Refugees

“…These numbers are about three times higher than the numbers from representative samples of bereaved Westerners after mostly non-violent loss [e.g., ( 10 )]. However, the percentage of those refugees who receive adequate support for their mental-health problems is generally low ( 11 , 12 ) and refugees are less likely to seek or be referred to mental health services ( 13 – 15 ). Given the prevalence of PGD, the high number of refugees in Western countries, and the general treatment gap, there seems to be a need to adapt grief-focused treatments to refugees' specific needs.…”