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An exploration of politicized healthcare access for Syrian and Palestinian refugees in Jordan: a question of equity
Abstract
Purpose
Refugees commonly face inequitable access to health care services in their host country. This study aimed to identify factors influence refugee access to health services and to assess perceptions of barriers to health care for different refugee groups in Jordan.
Design/methodology/approach
In-depth interviews were combined with document analysis and analyzed using thematic and framework methods.
Findings
Findings highlighted inequitable access to health services between different refugee groups. Unlike Palestinian refugees from the West Bank, Palestinian refugees from Gaza faced financial barriers to access health care as a result of citizenship status, which affected their health insurance, referrals for health care and legal right to work. Syrian refugees similarly lacked Jordanian citizenship and health insurance and mainly depended on UNHCR for health services, though some were able to acquire work permits and pay for private care.
Originality/value
This study demonstrates a need for politically and economically appropriate policies to minimize the disparity of health care access among these refugee groups.
... Uninsured patients face greater financial barriers to treatment, contributing to poorer survival rates compared to insured patients [28]. Government initiatives expanding insurance to schoolchildren and subsidizing premiums have reduced but not eliminated health insurance disparities, especially across geographic regions [29]. ...
This narrative review explores the multifaceted barriers hindering access to quality cancer care in Jordan. A literature-based narrative review was undertaken to explore the current identified barriers to cancer care in Jordan. Four databases were searched using relevant keywords to identify key insights on barriers and proposed solutions. Key challenges and potential solutions were identified based on evidence from studies, reports, and initiatives. Medical services and infrastructure exhibit centralized disparities, impacting rural and underserved areas. Human resources shortages, geopolitical instability, and quality management issues pose significant challenges. Public awareness campaigns face hurdles in addressing the tobacco epidemic and late-stage diagnosis. Socioeconomic disparities, particularly in health insurance and urban–rural divides, further compound barriers. Refugees encounter distinct challenges, including late-stage diagnosis, financial barriers, and psychological distress. Despite multiple challenges, Jordan presents a model for regional development and health equity. This study not only contributes to improving cancer care in Jordan but also offers a roadmap for policymakers, healthcare practitioners, and researchers in similar contexts globally. Government initiatives, financial aspects, and proposed policy measures are examined as potential solutions. Recommendations include coordinated prevention strategies, enhanced screening uptake, training programs, the equitable distribution of facilities, and policy directives aligned with global commitments. The role of digital technologies, telemedicine, and community engagement models is emphasized.
... In line with the broader literature, which argues that cash transfers need to meet a certain income threshold to meaningfully support pathways out of poverty [48,49], our findings indicate that the transfer amounts received by Syrian refugees in Jordan are between 2 and 4 times greater than that received by vulnerable Palestinians under the Palestinian National Cash Transfer Programme [26,50]. While our findings indicate that the transfer amounts in Jordan help support survival needs but are too low to adequately tackle young people's physical and mental health challenges, the comparative lens employed in this article sheds light on the politics of aid, including declining support for refugees in situations of protracted crises [51,52]-of which Palestine refugees are an emblematic case [53][54][55]. ...
Sustainable Development Goals (SDGs) 1 and 2 aim to eradicate poverty and hunger in all their forms. However, the onset of the Covid-19 pandemic and subsequent lockdowns has disrupted progress toward achieving these goals. Despite considerable attention to the effects of the pandemic on poverty and food insecurity, there has been much less attention to the experiences of forcibly displaced adolescents during Covid-19 lockdown measures. This article addresses this evidence lacuna by drawing on mixed-methods data collected through phone-based surveys (n = 4,319) and in-depth qualitative interviews (n = 191) carried out in 2020 with adolescents (aged 12–19 years) from host and refugee communities in Jordan and Palestine. We also examine whether social protection has been able to mitigate the worst effects of food and economic insecurity on adolescents from host and refugee communities. Descriptive and inferential analysis of the quantitative data was conducted using Stata 16. The qualitative interviews were recorded, transcribed, and thematically coded using MAXQDA 12 software. We found that a significant proportion of adolescents experienced reduced diet diversity and food insecurity during the Covid-19 lockdown in autumn 2020 in both Jordan and Palestine. Adolescents with the worst economic and food security outcomes also had poorer self-reported physical health, lower resiliency scores, and higher levels of anxiety and depression. In Palestine, social protection measures contributed less to mitigating the negative consequences of the pandemic, whereas in Jordan—largely due to higher transfer amounts—social protection was more significant in mitigating these negative health and well-being consequences. Priority actions for getting adolescent-related SDGs back on track include scaling up emergency-responsive and age- and gender-sensitive social protection, especially for the most disadvantaged young people, including adolescents with disabilities, married girls, adolescents out of school, and young people from refugee households living in host communities, where packages of support are typically more disparate.
... In Jordan, Syrian refugees are allowed to work, with a majority of them working on a valid work permit and living on a government-issued residence permit [3,4]. In addition, most of the Syrian refugees in Jordan have access to education and health services, which are mainly offered by the UNHCR [5]. However, competing resources often fail to meet the complex health needs of this vulnerable group [2]. ...
(1) Background: War and displacement are well-known predictors of negative mental health outcomes among affected populations. This is especially relevant for refugees of war, particularly women, who often repress their mental health needs due to family responsibilities, social stigma, and/or cultural pressures. In this study, we compared the mental health status of urban Syrian refugee women (n = 139) with local Jordanian women (n = 160). (2) Methods: Psychometrically validated Afghan Symptom Checklist (ASC), Perceived Stress Scale (PSS), and Self-Report Questionnaire (SRQ) examined psychological distress, perceived stress, and mental health, respectively. (3) Results: According to independent t-tests, Syrian refugee women scored higher than Jordanian women on the ASC [mean score (SD): 60.79 (16.67) vs. 53.71 (17.80), p < 0.001], PSS [mean score (SD): 31.59 (8.45) vs. 26.94 (7.37), p < 0.001], and SRQ [mean score (SD): 11.82 (4.30) vs. 10.21 (4.72), p = 0.002]. Interestingly, both Syrian refugee and Jordanian women scored higher than the clinical cutoff in the SRQ. Regression analyses indicated that more educated women were less likely to score high on the SRQ (β = −0.143, p = 0.019), particularly in the anxiety and somatic symptoms subscale (β = −0.133, p = 0.021), and were less likely to exhibit symptoms of ruminative sadness (β = −0.138, p = 0.027). Employed women were more likely to exhibit high coping ability than unemployed women (β = 0.144, p = 0.012). (4) Conclusions: Syrian refugee women scored higher than Jordanian women in all used mental health scales. Access to mental health services and enhancing educational opportunities would help mitigate perceived stress and may enhance stress-coping abilities.
Aim
This systematic review explores the impact of the Syrian refugee crisis on public health and healthcare services in Jordan, identifying key challenges in access, assessing resource strain, and proposing solutions to enhance service delivery.
Background
The ongoing Syrian refugee crisis, which started in 2011, has severely impacted healthcare provision in Jordan. With over a million refugees, healthcare professionals and organizations face new demographic challenges that need immediate and long‐term attention. This situation places significant strain on the Jordanian healthcare system, raising concerns about its ability to effectively provide services to both refugees and residents.
Methods
This systematic review used electronic databases such as PubMed, CINAHL, and Scopus, focusing solely on articles published from 2018 to 2024 in adherence to PRISMA guidelines, which guided the sourcing, selection, and analysis of relevant studies. Of the 70 extracted papers, 19 relevant studies were identified, providing a range of insights into emerging healthcare issues in Jordan.
Results
Refugees faced major challenges accessing healthcare services due to factors such as cost, systems, and policies. It became clear that chronic disease management and mental health services are two significant areas where gaps in service provision were evident.
Discussion
The influx of Syrian refugees has significantly affected nurses, resulting in increased workloads, emotional stress, and burnout. The themes identified by the researcher were the endurance of demands and heightened burnout.
Conclusions
Policy changes and increased funding are essential for enhancing the health sector. Integrating refugees into the national health system ensures resources are available for both refugees and the local population, which is crucial for sustainable public health.
Implications for nursing and health policy
The Syrian refugee crisis has strained nurses in Jordan, increasing workloads, stress, and burnout. Expanding the workforce, specialized training, and mental health support are essential. Strengthening preventive care and involving community health workers can improve outcomes and ease system strain, ensuring quality care for refugees and locals.
For most of its existence, Jordan has been island of relative stability and peace in a region beset by conflict. For this reason it has been a major refugee-hosting country since its creation as a state. Migrants and refugees have entered the country fleeing war, seeking employment and medical care and for religious pilgrimage. The large- scale refugee presence has fundamentally altered Jordan’s demographic composition, and its relations with Western as well as regional states. While its early history includes policies of remarkable openness and assimilation towards Arab migrants, over time Jordan has moved towards a more restrictive stance towards its refugee residents (De Bel-Air, 2007).
This research report offers an extensive overview of the current situation of refugees in Jordan and their impact on the country.
Semistructured in-depth interviews are commonly used in qualitative research and are the most frequent qualitative data source in health services research. This method typically consists of a dialogue between researcher and participant, guided by a flexible interview protocol and supplemented by follow-up questions, probes and comments. The method allows the researcher to collect open-ended data, to explore participant thoughts, feelings and beliefs about a particular topic and to delve deeply into personal and sometimes sensitive issues. The purpose of this article was to identify and describe the essential skills to designing and conducting semistructured interviews in family medicine and primary care research settings. We reviewed the literature on semistructured interviewing to identify key skills and components for using this method in family medicine and primary care research settings. Overall, semistructured interviewing requires both a relational focus and practice in the skills of facilitation. Skills include: (1) determining the purpose and scope of the study; (2) identifying participants; (3) considering ethical issues; (4) planning logistical aspects; (5) developing the interview guide; (6) establishing trust and rapport; (7) conducting the interview; (8) memoing and reflection; (9) analysing the data; (10) demonstrating the trustworthiness of the research; and (11) presenting findings in a paper or report. Semistructured interviews provide an effective and feasible research method for family physicians to conduct in primary care research settings. Researchers using semistructured interviews for data collection should take on a relational focus and consider the skills of interviewing to ensure quality. Semistructured interviewing can be a powerful tool for family physicians, primary care providers and other health services researchers to use to understand the thoughts, beliefs and experiences of individuals. Despite the utility, semistructured interviews can be intimidating and challenging for researchers not familiar with qualitative approaches. In order to elucidate this method, we provide practical guidance for researchers, including novice researchers and those with few resources, to use semistructured interviewing as a data collection strategy. We provide recommendations for the essential steps to follow in order to best implement semistructured interviews in family medicine and primary care research settings.
Background
Greece constitutes a main point of entry for the EU but also a final destination for a large number of immigrants. The present research aims to illuminate the relationship of Albanian immigrants with the public health system in Greece. Cross sectional study of 167 Albanian immigrants who referred to the emergency department (ED) of a tertiary general hospital. The average age of the study population was 38.96 years (SD: ± 12.53), with 62.1% being familiar with health services. 54.9% referred to the ED for chronic problems. 41.9% were dissatisfied regarding the level of care provided; Albanian citizenship was thought to be the main reason (40%). Despite the majority of Albanian immigrants being familiar with health services in Northern Greece, there seems to be a misuse of the emergency department for chronic problems. A good proportion of immigrants believe their foreign citizenship prevents them from better healthcare.
Objective
Access to healthcare is an important part of the (re)settlement process for Syrian refugees in Canada. There is growing concern about the healthcare needs of the 54,560 Syrian refugees who were admitted to Canada by May 2018, 80% of whom are women and children. We explored the healthcare needs of newcomer Syrian women, their experiences in accessing and using health services, and the factors and conditions that shape whether and how they access and utilize health services in the Greater Toronto Area (GTA).
Method
This community-based qualitative descriptive interpretive study was informed by Yang & Hwang (2016) health service utilization framework. Focus group discussions were held with 58 Syrian newcomer women in the GTA. These discussions were conducted in Arabic, audio-recorded with participants’ consent, translated into English and transcribed, and analyzed using thematic analysis.
Results
Participants’ health concerns included chronic, long-term conditions as well as new and emerging issues. Initial health insurance and coverage were enabling factors to access to services, while language and social disconnection were barriers. Other factors, such as beliefs about naturopathic medicine, settlement in suburban areas with limited public transportation, and lack of linguistically, culturally, and gender-appropriate services negatively affected access to and use of healthcare services.
Conclusion
Responding to the healthcare needs of Syrian newcomer women in a timely and comprehensive manner requires coordinated, multi-sector initiatives that can address the financial, social, and structural barriers to their access and use of services.
Background: Syrian refugees in Jordan are currently facing difficulties in accessing adequate healthcare.
Aims: This study looked at the health conditions and barriers to accessing healthcare in Syrian refugees settled in Jordan.
Methods: Pubmed, CINAHL and Google Scholar were searched for published cross-sectional studies on the health status of Syrian refugees, specifically the prevalence of chronic diseases, communicable diseases, physical impairments, emotional and mental health problems, and barriers to health care. The terms searched were: Syrian refugee, health access barriers, health access, chronic diseases, communicable diseases/infectious diseases, physical impairment and mental health. The prevalence and 95% confidence intervals (CI) were calculated.
Results: The literature search yielded 265 articles, of which 8 were eligible for inclusion. The prevalence of the conditions assessed were: chronic diseases, 29% (95% CI: 0.190–0.429); communicable diseases, 42.9% (95% CI: 0.184–0.713); emotional and mental health problems, 32.9% (95% CI: 0.191–0.504); physical impairment, 14.4% (95% CI: 0.056–0.322). Financial issues were the greatest barrier to accessing health care for 66% (95% CI: 0.449–0.823%).
Conclusions: The health challenges of Syrian refugees are not just about chronic and acute diseases, injuries, or shortage of health resources or health disparities. It is a health burden that has become an economic, political and social crisis for the Jordanian government and its people, and measures and support to help Jordan continue to provide for refugees are needed.
Pharmaceutical sector of Syrian Arab Republic before the war was characterized by bold and successful development since the late 1980s. With the beginning of war in the country back in March 2011, momentum has changed significantly. Traumatism, communicable diseases related to morbidity and mortality as well as wound infections became particularly hot public health concern. This relates not only to the direct victims of military conflict but also to the displaced civilians, refugees, and ordinary citizens alike. Evolving legislative framework in Syria since 1980s tolerated dispensing of antibiotics without appropriate prescription. Such practice led to spreading of antibiotic resistance among the local bacteria frequently causing both community-acquired and nosocomial infections. Laboratory findings of resistant bacteria strains among the Syrian refugees in some European countries serve as evidence of concern spreading far beyond Middle East. Practice of self-diagnosis and self-medication with antibiotics by patients themselves and restraint to pharmacist advice is widespread. A number of recommendations is presented to stakeholders to compact antibiotic resistance after the peace is established in the country. The successful implementation of such recommendations is the way to preserve shrinking golden reserve of highly potent antibiotics as it is the last defense line against resistant bacterial strains causing severe life—threatening infections.
The civil war in Syria has caused a mass influx of Syrian refugees into other countries throughout the region and beyond. Jordan has received a large share of Syrian refugees, currently totaling to the alarming number of 1.2 mln people. Addressing the need of Syrian refugees has drained the resources of Jordanian government and has had its substantial impact on Jordanian society overall. In an effort to better understand the humanitarian, political, economic, sociocultural and environmental challenges to Jordan and its government, this study has developed a comprehensive analytical framework. The comprehensive analytical framework has been developed based on the system thinking approach and the systematic review of gray literature and peer-reviewed articles. This framework provides a better capacity to discover the potential consequences of a massive refugee influx and covers the vital factors based on the realistic criteria regarding the burden of refugees on the formulation of policies. The analytical framework is applied to Jordan as the receiving state since the influx of Syrian refugees into Jordan in 2011 to 2015 and it potentially could be used as a comparative analytical tool for other receiving states.
Background:
This review aims to explore the healthcare needs and access to healthcare services among Syrian refugees in Jordan. Furthermore, it identifies possible ways of responding to such needs within the framework of the structural challenges faced in this particular context.
Methods:
Through qualitative techniques, this study systematically reviewed nine articles identified in academic and international organizations' databases. Six articles are from scholarly sources, while three are published reports or commentary articles; thus, there are variations in methodological rigour. An analysis of the articles was performed based on the Critical Appraisal Skills Programme check tool to systematically assess the trustworthiness, relevance and results of the included papers.
Results:
The overall access to healthcare is relatively good for most registered Syrian refugees. However, some groups lack access due to financial and structural barriers, such as not possessing the appropriate civil documentation and/or not having the means to pay out-of-pocket expenses to access adequate services. A key challenge relates to access of inpatient care. Accessing care for non-communicable/chronic diseases requires not only legal documentation but also long-term access and continuity of care in an already overburdened health care system.
Conclusion:
The healthcare needs of the refugee, as well as the host population in Jordan, cannot be adequately met without the international society acknowledging a collective responsibility, including a financial commitment. One effort that could solve a major structural problem for those not able to access healthcare is increased flexibility in regards to documentation.
Background:
Since 2015, Europe has been facing an unprecedented arrival of refugees and migrants: more than one million people entered via land and sea routes. During their travels, refugees and migrants often face harsh conditions, forced detention, and violence in transit countries. However, there is a lack of epidemiological quantitative evidence on their experiences and the mental health problems they face during their displacement. We aimed to document the types of violence experienced by migrants and refugees during their journey and while settled in Greece, and to measure the prevalence of anxiety disorders and access to legal information and procedures.
Methods:
We conducted a cross-sectional population-based quantitative survey combined with an explanatory qualitative study in eight sites (representing the range of settlements) in Greece during winter 2016/17. The survey consisted of a structured questionnaire on experience of violence and an interviewer-administered anxiety disorder screening tool (Refugee Health Screener).
Results:
In total, 1293 refugees were included, of whom 728 were Syrians (41.3% females) of median age 18 years (interquartile range 7-30). Depending on the site, between 31% and 77.5% reported having experienced at least one violent event in Syria, 24.8-57.5% during the journey to Greece, and 5-8% in their Greek settlement. Over 75% (up to 92%) of respondents ≥15 years screened positive for anxiety disorder, which warranted referral for mental health evaluation, which was only accepted by 69-82% of participants. Access to legal information and assistance about asylum procedures were considered poor to non-existent for the majority, and the uncertainty of their status exacerbated their anxiety.
Conclusions:
This survey, conducted during a mass refugee crisis in a European Community country, provides important data on experiences in different refugee settings and reports the high levels of violence experienced by Syrian refugees during their journeys, the high prevalence of anxiety disorders, and the shortcomings of the international protective response.
Migrant deaths en route to the European Union are by no means new. Yet the level and intensity of recent tragedies is unprecedented: More than 5000 deaths were recorded in 2016, demanding swift action on the part of EU Member States.
Dr Vicki Squire (PaIS, Warwick), together with an international and multidisciplinary team of Co-Investigators including Dr Dallal Stevens (Warwick Law School), Professor Nick Vaughan-Williams (PAIS, Warwick), Dr Angeliki Dimitriadi (ELIAMEP, Athens), and Dr Maria Pisani (Malta), have been awarded an ESRC Urgency Grant (150K) for the project entitled 'Crossing the Mediterranean Sea by boat: Mapping and documenting migratory journeys and experiences'.
The project produces a timely and robust evidence base as grounds for informing policy interventions developed under emergency conditions across the Mediterranean. It does so by assessing the impact of such interventions on those that they affect most directly: migrants or refugees themselves. The project undertakes such an assessment by engaging the journeys and experiences of people migrating, asking:
What are the impacts of policy interventions on migratory journeys and experiences across the Mediterranean?
How do refugees and migrants negotiate complex and entwined migratory and regulatory dynamics?
In what ways can a European policy agenda be re-shaped to address concerns such as migrant deaths at sea more effectively?
In its first phase (autumn 2015), the project focuses on three EU island arrival points in Greece, Italy and Malta . Phase 2 (spring/summer 2016) diversifies sites along key routes, to include Athens, Berlin, Istanbul and Rome. Qualitative interview data, both textual and visual, is produced through an interdisciplinary participatory research approach. The project contributes: an interdisciplinary perspective on the legal and social implications of policy interventions in the region; a comparative perspective on migratory routes and methods of travel across the Mediterranean; a qualitative analysis of the journeys and experiences of refugees and migrants; and methodological insights into participatory research under challenging conditions.
Jordan's last population census gave the total population of the country as 9,531,712 in November 2015, 2,918,125 (31 per cent) of whom were foreign nationals. If accurate, these numbers indicate that Jordan is a major migrant-receiving country. Jordan has the highest refugee-to-population ratio and the country is also now the top refugee hosting country in absolute numbers. Indeed, it hosted more than 2.7 million registered refugees as of September 2016; of whom 2.1 million persons of Palestinian descent registered with the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) who have lived in the country for decades; and 664,100 refugees under UNHCR's mandate including Syrians and Iraqis. Besides, Jordan is a migrant-sending country too: an estimated 10 percent of Jordan's nationals (700 to 800,000) are expatriated abroad, most of them to the Gulf States.
Background
The 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.
Methods
A 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.
Results
Care-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 US4.2).
Conclusions
Despite 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.
Background:
In Tak province, Thailand migrants and refugees from Myanmar navigate a pluralistic healthcare system to seek Tuberculosis (TB) care from a variety of government and non-governmental providers. This multi-methods qualitative study examined access to TB, TB/HIV and multidrug-resistant tuberculosis (MDR-TB) treatment with an emphasis on barriers to care and enabling factors.
Methods:
In the summer and fall of 2014, we conducted 12 key informant interviews with public health officials and TB treatment providers. We also conducted 11 focus group discussions with migrants and refugees who were receiving TB, TB/HIV and MDR-TB treatment in Tak province as well as non-TB patients. We analyzed these data through thematic analysis using both predetermined and emergent codes. As a second step in the qualitative analysis, we explored the barriers and enabling factors separately for migrants and refugees.
Results:
We found that refugees face fewer barriers to accessing TB treatment than migrants. For both migrants and refugees, legal status plays an important intermediary role in influencing the population's ability to access care and eligibility for treatment. Our results suggest that there is a large geographical catchment area for migrants who seek TB treatment in Tak province that extends beyond provincial boundaries. Migrant participants described their ability to seek care as linked to the financial and non-financial resources required to travel and undergo treatment. Patients identified language of health services, availability of free or low cost services, and psychosocial support as important health system characteristics that affect accessibility.
Conclusion:
Access to TB treatment for migrants and refugees occurs at the interface of health system accessibility, population ability and legal status. In Tak province, migrant patients draw upon their social networks and financial resources to navigate a pathway to treatment. We revised a conceptual framework for access to healthcare to incorporate legal status and the cyclical pathways through which migrants access TB treatment in this region. We recommend that organizations continue to collaborate to provide supportive services that help migrants to access and continue TB treatment.
Background:
Lebanon, a small Middle Eastern country facing constant political and national unity challenges with a population of approximately 300,000 Palestinian and Iraqi refugees, has welcomed more than 1.2 million Office of the United Nations Commissioner for Refugees (UNHCR)-registered Syrian refugees since 2012. The Government of Lebanon considers individuals who crossed Lebanese-Syrian borders since 2011 as "displaced", emphasizing its long-standing position that Lebanon is not a state for refugees, refusing to establish camps, and adopting a policy paper to reduce their numbers in October 2014. Humanitarian response to the Syrian influx to Lebanon has been constantly assembling with the UNHCR as the main acting body and the Lebanon Crisis Response Plan as the latest plan for 2016.
Methods:
Review of secondary data from gray literature and reports focusing on the influx of Syrian refugees to Lebanon by visiting databases covering humanitarian response in complex emergencies. Limitations include obtaining majority of the data from gray literature and changing statistics due to the instability of the situation.
Results:
The influx of Syrian refugees to Lebanon, an already weak and vulnerable state, has negatively impacted life in Lebanon on different levels including increasing demographics, regressing economy, exhausting social services, complicating politics, and decreasing security as well as worsened the life of displaced Syrians themselves.
Conclusion:
Displaced Syrians and Lebanese people share aggravating hardships of a mutual and precarious crisis resulting from the Syrian influx to Lebanon. Although a lot of response has been initiated, both populations still lack much of their basic needs due to lack of funding and nonsustainable program initiatives. The two major recommendations for future interventions are to ensure continuous and effective monitoring and sustainability in order to alleviate current and future suffering in Lebanon.
Introduction:
The influx of Syrian refugees into Jordan presents an immense burden to the Jordanian health system, particularly in treating chronic health conditions. This study was undertaken to assess utilization of health services for chronic health conditions among Syrian refugees in non-camp settings.
Methods:
A survey of Syrian refugees in Jordan was undertaken in June 2014 to characterize health seeking behaviors and issues related to accessing care for hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, and arthritis. A cluster design with probability proportional to size sampling was used to attain a nationally representative sample of 1550 non-camp Syrian refugee households.
Results:
Of 1363 cases with a chronic health condition diagnosis, 84.7% had received care in Jordan. Public facilities faced a heavy burden serving over half (53.9%) of care-seekers; the remainder received care in the private (29.6%) and NGO/charity (16.6%) sectors. Individuals with non-communicable diseases (NCDs) in the central region of Jordan and with arthritis had the lowest rates of care-seeking when compared to other regions and conditions. Overall, 31.6% of care-seekers had an out-of-pocket payment for the most recent care-seeking event which averaged 18.8 USD (median = 0 USD), excluding cost of medications.
Discussion:
Forced displacement presents major challenges to those with NCDs, which have the potential to seriously impact both the quality of life and life expectancy amongst refugees. NCD patterns among Syrian refugees indicate the importance of continuing support to public sector services in Jordan to adequately meet expanding needs and ensure appropriate prevention and control of priority NCDs.
The aims of this study were to identify the most needed health care services, accessibility of various health care services, and barriers to access as perceived by a group of Syrian refugees living in non-camp settings in Jordan and to compare accessibility among different groups. The study was conducted in the Amman, Irbid, Karak, and Maan governorates of Jordan. This is a cross-sectional, analytical, observational study using convenience and snowball sampling for data collection. A structured questionnaire was included in an ongoing needs assessment of a Jordanian nongovernment organization in April 2014, with a total of 196 surveys conducted. In addition to the prevalent acute and communicable diseases, chronic diseases and dental problems were common. Preventive and primary health care were more accessible than advanced services. Structural and financial barriers hindered access. The specific survey location and governorate were associated with a difference in reported access. Registration status, health provider, duration, and out-of-pocket payment did not affect accessibility. The capacities of health facilities at different levels should be increased. Enhanced information sharing among health providers can improve identification of needs and gaps.
Policies and procedures govern organizations whether they are private or public, for-profit or not-for-profit. Review of such policies and procedures are done periodically to ensure optimum efficiency within the organization. Framework analysis is a qualitative method that is aptly suited for applied policy research. Framework analysis is better adapted to research that has specific questions, a limited time frame, a pre-designed sample and a priori issues. In the analysis, data is sifted, charted and sorted in accordance with key issues and themes using five steps: familiarization; identifying a thematic framework; indexing; charting; and mapping and interpretation. Framework analysis provides an excellent tool to assess policies and procedures from the very people that they affect.
Guidelines for determining nonprobabilistic sample sizes are virtually nonexistent. Purposive samples are the most commonly used form of nonprobabilistic sampling, and their size typically relies on the concept of “saturation,” or the point at which no new information or themes are observed in the data. Although the idea of saturation is helpful at the conceptual level, it provides little practical guidance for estimating sample sizes, prior to data collection, necessary for conducting quality research. Using data from a study involving sixty in-depth interviews with women in two West African countries, the authors systematically document the degree of data saturation and variability over the course of thematic analysis. They operationalize saturation and make evidence-based recommendations regarding nonprobabilistic sample sizes for interviews. Based on the data set, they found that saturation occurred within the first twelve interviews, although basic elements for metathemes were present as early as six interviews. Variability within the data followed similar patterns.
This is the first in a series of three articlesIn the past decade, qualitative methods have become more commonplace in areas such as health services research and health technology assessment, and there has been a corresponding rise in the reporting of qualitative research studies in medical and related journals.1 Interest in these methods and their wider exposure in health research has led to necessary scrutiny of qualitative research. Researchers from other traditions are increasingly concerned to understand qualitative methods and, most importantly, to examine the claims researchers make about the findings obtained from these methods.The status of all forms of research depends on the quality of the methods used. In qualitative research, concern about assessing quality has manifested itself recently in the proliferation of guidelines for doing and judging qualitative work.2–5 Users and funders of research have had an important role in developing these guidelines as they become increasingly familiar with qualitative methods, but require some means of assessing their quality and of distinguishing “good” and “poor” quality research. However, the issue of “quality” in qualitative research is part of a much larger and contested debate about the nature of the knowledge produced by qualitative research, whether its quality can legitimately be judged, and, if so, how. This paper cannot do full justice to this wider epistemological debate. Rather it outlines two views of how qualitative methods might be judged and argues that qualitative research can be assessed according to two broad criteria: validity and relevance.
Summary points
Qualitative methods are now widely used and increasingly accepted in health research, but quality in qualitative research is a mystery to many health services researchers
There is considerable debate over the nature of the knowledge produced by such methods and how such research should be judged
Antirealists argue …
Qualitative methods are now widely used and increasingly accepted in health research, but quality in qualitative research is a mystery to many health services researchers. There is considerable debate over the nature of the knowledge produced by such methods and how such research should be judged. Antirealists argue that qualitative and quantitative research are very different and that it is not possible to judge qualitative research by using conventional criteria such as reliability, validity, and generalisability. Quality in qualitative research can be assessed with the same broad concepts of validity and relevance used for quantitative research, but these need to be operationalised differently to take into account the distinctive goals of qualitative research.
Facilitating access is concerned with helping people to command appropriate health care resources in order to preserve or improve their health. Access is a complex concept and at least four aspects require evaluation. If services are available and there is an adequate supply of services, then the opportunity to obtain health care exists, and a population may 'have access' to services. The extent to which a population 'gains access' also depends on financial, organisational and social or cultural barriers that limit the utilisation of services. Thus access measured in terms of utilisation is dependent on the affordability, physical accessibility and acceptability of services and not merely adequacy of supply. Services available must be relevant and effective if the population is to 'gain access to satisfactory health outcomes'. The availability of services, and barriers to access, have to be considered in the context of the differing perspectives, health needs and material and cultural settings of diverse groups in society. Equity of access may be measured in terms of the availability, utilisation or outcomes of services. Both horizontal and vertical dimensions of equity require consideration.
Purpose
The purpose of this paper is to explore how Palestinian refugee families in Malaysia cope with the challenges they face during their transitional destination. These families have recently fled from conflict zones in various Arab countries and moved to Malaysia where they registered in the office of the United Nations High Commissioner for Refugees (UNHCR) in Kuala Lumpur, waiting for resettlement in a third country.
Design/methodology/approach
The paper utilizes the qualitative research approach, drawing descriptive analysis (thematic analysis technique) of data collected by semi-structured, in-depth interviews with 30 Palestinian families. For sample selection, the author used purposive sampling and employed the Snowball technique to select the families who have experienced refuge life for the second time. Then the sample was equally divided into three groups to include ten families moving from Iraq, Syria and the Gaza Strip. The interviews were conducted with the head of the families who varied in terms of gender and age composition. The study involved 9 female participants and 21 males. They are all Muslims and aged between 24 and 80 years old. In terms of educational background, all of the participants are literate with formal school education, diploma or tertiary education.
Findings
The study shows that refugee families adopt four main ways of coping commonly used to improve the quality of their life during their transition in Malaysia. They turn to religion and spirituality, keep in touch with relatives and friends in the diaspora and conflict zones, develop a positive image about their present situation by comparing it to worse living conditions of others living in conflict zones and plan to migrate to Europe to hold a European passport which will give them the opportunity to visit their original country, Palestine.
Originality/value
The paper tackles the Palestinian refugee family life and explores their real-life stories and experiences during transition in Malaysia. It provides them with an opportunity to speak up their suffering and reveal the various strategies they adopt to cope with life challenges. Besides, the result of the study will be a fruitful addition to the corpus of sociological knowledge as well as an important contribution to the families that stay in transition in different societies around the world.
Resilience is increasingly recognised as a key process mitigating the impact of shocks and stressors on functioning. The literature on individual and community resilience is being extended to address characteristics of resilient service delivery systems in contexts of adversity. The validity and utility of a capacity-oriented resilience framework (including absorption, adaptation and transformation) is examined with respect to the functioning of United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) health systems in Lebanon and Jordan in the context of the Syrian crisis. We completed 62 semi-structured interviews (30 in Lebanon in November–December 2016, and 32 in Jordan in January 2017) with professionals at primary care, area, and country management levels. Participants reflected on changes in population health status and health service delivery during the Syrian crisis, notably with respect to the influx of refugees from Syria. Interviews were analysed through inductive thematic analysis and used to critically interrogate health systems resilience against a pro-capacities framework. We find that UNRWA systems in Lebanon and Jordan were broadly resilient, deploying diverse strategies to address health challenges and friction between host and refugee populations. Absorptive capacity was evidenced by successful accommodation of increased patient numbers across most service areas. Adaptive capacities were reflected in broadening of collaboration and reconfiguration of staff roles to enhance service delivery. Transformative capacities were demonstrated in the revision of the service packages provided. While manifest as technical capacities, these clearly drew upon solidarity and commitment linked to the political context of the Palestinian experience. The study adds to the limited literature on health system and organizational resilience and indicates that capacity-oriented framings of resilience are valuable in extracting generalizable lessons for health systems facing adversity. The proposed resilience framework promises to guide strategies for sustained care delivery in these contexts.
Background
Jordan hosts more Palestine refugees than any country in the world. Conditions under which people in a community live influence their health-related quality of life (HRQOL).
Purpose
The purpose of this descriptive, comparative cross-sectional study was to compare HRQOL of Palestine refugees in Jordan who live inside camps with those who live outside camps.
Method
Participants, recruited from inside the Baqa’a camp (n = 86) and the surrounding Abu Nsair community (n = 91), completed the World Health Organization Quality of Life Brief Questionnaire.
Discussion
There were disparities in education and social relations and environment HRQOL related to income and residency, but not gender, among refugees.
Conclusions
Refugees living inside camps, particularly if poorer, fared worse than refugees living outside camps. Enhanced programs and policies may be needed to improve HRQOL, education and socioeconomics for camp refugees. Nursing’s perspective on refugee health could make an important contribution to humanitarian efforts and health diplomacy.
The Syrian Conflict generated forced immigration from northern Syria to southeastern Turkey. Arrival of refugees resembles a natural experiment, which offers good opportunities to study the economic impact of immigration. I study three main outcomes: labor markets, consumer prices, and housing rents. I document moderate employment losses among native informal workers, which suggests that they are partly substituted by refugees. Prices of the items produced in informal labor intensive sectors declined due to labor cost advantages generated by refugee inflows. Finally, refugee inflows increased the rents of higher quality housing units, while there is no effect on lower quality units.
In a qualitative framework, research based on interviews often seeks to penetrate social life beyond appearance and manifest meanings. This requires the researcher to be immersed in the research field, to establish continuing, fruitful relationships with respondents and through theoretical contemplation to address the research problem in depth. Therefore a small number of cases (less than 20, say) will facilitate the researcher’s close association with the respondents, and enhance the validity of fine-grained, in-depth inquiry in naturalistic settings. Epistemologically prior to these considerations, however, is the explanatory status of such research. From a realist standpoint, here concept formation through induction and analysis aims to clarify the nature of some specific situations in the social world, to discover what features there are in them and to account, however partially, for those features being as they are. Since such a research project scrutinizes the dynamic qualities of a situation (rather than elucidating the proportionate relationships among its constituents), the issue of sample size - as well as representativeness - has little bearing on the project’s basic logic. This article presents this argument in detail, with an example drawn from a study of persons with a past history of cancer diagnosis and treatment.
To present an overview of how documents can be incorporated as key sources of data in qualitative nursing research.
Analysis of the nature of documents and the distinctive features of any research strategy to analyze documents.
Many different strategies can be used in the analysis of documentary sources that are relevant to nursing practice. A systematic approach to the analysis of these textual resources, using one or several of the analytic strategies described here, can support and advance nursing scholarship.
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