Refugee Health Program, Global Health Institute, American University of Beirut, Beirut, Lebanon.
Hariri School of Nursing, American University of Beirut, Beirut, Lebanon.
PLoS One. 2020 Dec 2;15(12):e0242421. doi: 10.1371/journal.pone.0242421. eCollection 2020.
Lebanon has approximately one million Syrian refugees (SR) registered with the United Nations High Commission on Refugees (UNHCR) and an unknown number of unregistered SR, who cannot benefit from formal assistance. This study aimed to examine the livelihoods, coping strategies, and access to healthcare among SR based on registration status and accompanying formal assistance. A mixed-method approach with more emphasis on the qualitative design was adopted. A purposive convenient sampling approach was used to recruit SR from informal tented settlements (ITS) in the Beqaa region in Lebanon. Data collection included 19 focus group discussions (FGDs) that were conducted with participants, who were further divided into three groups: registered refugees with assistance, registered without assistance and unregistered. Twelve in-depth interviews were conducted with key informants from humanitarian organizations. All interviews and FGDs were audio recorded, transcribed, and thematically analyzed. SR were highly dependent on formal assistance when received, albeit being insufficient. Regardless of registration status, refugees resorted to informal livelihood strategies, including informal employment, child labor, early marriage, and accruing debt. Poor living conditions and food insecurity were reported among all SR. Limited healthcare access and high out-of-pocket costs led to limited use of antenatal care services, prioritizing life-threatening conditions, and resorting to alternative sources of healthcare. Severity of these conditions and their adverse health consequences were especially pronounced among unregistered refugees. Our findings shed light on the economic and health disparities among marginalized SR, with the lack of registration and formal assistance increasing their vulnerability. More tailored and sustainable humanitarian programs are needed to target the most vulnerable and hard-to-reach groups.
黎巴嫩约有 100 万叙利亚难民（SR）在联合国难民署（UNHCR）登记，还有数量不明的未登记 SR，他们无法获得正式援助。本研究旨在根据登记状况和伴随的正式援助，考察 SR 的生计、应对策略和获得医疗保健的情况。本研究采用了一种混合方法，更侧重于定性设计。采用了目的性便利抽样方法，从黎巴嫩贝卡地区的非正规帐篷定居点（ITS）招募 SR。数据收集包括 19 次焦点小组讨论（FGD），参与者进一步分为三组：有援助的登记难民、有登记但无援助的难民和未登记的难民。还对来自人道主义组织的 12 名关键信息提供者进行了 12 次深入访谈。所有访谈和 FGD 均进行了录音、转录和主题分析。尽管援助不足，但 SR 在获得援助时高度依赖正式援助。无论登记状况如何，难民都采取了非正式的生计策略，包括非正规就业、童工、早婚和借贷。所有 SR 都报告了生活条件差和粮食不安全的情况。医疗保健机会有限，自付费用高，导致产前保健服务的使用有限，优先考虑危及生命的情况，并求助于替代医疗来源。这些情况的严重程度及其对健康的不利后果在未登记的难民中尤为明显。我们的研究结果揭示了边缘化 SR 之间的经济和健康差距，缺乏登记和正式援助增加了他们的脆弱性。需要制定更有针对性和可持续的人道主义方案，以针对最脆弱和难以接触的群体。
