Illness and Urban Displacement: Addressing the Needs of Refugees with Non-communicable Diseases

In collaboration with Columbia Global Centers | Amman and International Rescue Committee in Jordan, the Department of Population and Family Health at the Mailman School of Public Health at Columbia University undertook a qualitative study: “What’s happening in Syria even affects the rocks,” to explore the healthcare experiences of Syrian refugees in Jordan.

June 13, 2019

There are more than 65 million people forcibly displaced worldwide, with over 5 million Syrian refugees in Lebanon, Jordan, and Turkey as a result of ongoing conflict. This protracted crisis has had critical health implications for displaced persons. This is especially the case for the management and treatment of non-communicable diseases (NCDs) within host countries’ overburdened health care systems. While many local and international NGOs have been providing NCD services in urban, non-camp settings, health actors have become overwhelmed by the lengthy, and often costly, healthcare needs of the urban refugee population.

In collaboration with Columbia Global Centers | Amman and International Rescue Committee in Jordan, the Department of Population and Family Health at the Mailman School of Public Health at Columbia University undertook a qualitative study: “What’s happening in Syria even affects the rocks,” which provides an overview of the healthcare experience of Syrian refugees with NCDs residing in Jordan.

Although several studies have explored the NCD prevalence, utilization of services and barriers to access in the last few years, this study took place in 2018; post the dramatic shift in Jordan’s healthcare policies. It also accounts for nuances in health seeking, and utilization behaviors of urban refugees.

The study pays specific attention to urban refugees’ personal perspectives about illness, approaches to healthcare decision making, operational barriers faced with accessing care, reflections on healthcare quality, and methods for coping with challenges of healthcare access and quality.

The findings of the qualitative study indicate a deeper understanding of how health related decisions are made amidst numerous interconnected life pressures experienced by refugee communities. The study ascertains that emotional distress is a central concern and is a trigger for a non-communicable disease or its exacerbation, thus highlighting the relationship between mental and physical health, and how emotional pressures is a barrier to wellness.

Additionally, the study recognizes that service provision across all sectors – government, NGO, private – is complex, inadequate, expensive and fragmented, therefore navigating the health sector both physically and financially is burdensome for refugees receiving NCD care. It also reveals that due to the high costs incurred when accessing NCD care, participants cope by making harmful decisions that further damage their health including making risky clinical adjustments.

The study presents opportunities for better integration of government and NGO services in order to reduce the burden on both sectors and on their most vulnerable patients. It identifies strategies for addressing NCD needs among refugees in urban settings, and produces recommendations for a variety of stakeholders that respond to the health needs of displaced communities in the Middle East.

The research study is part of a joint project, Responding to Changing Health Needs in Complex Emergencies, between Columbia University Mailman School of Public Health and the Faculty of Health Sciences at the American University of Beirut. The findings of the study were presented at Columbia Global Centers | Amman on January 29, 2019 by Dr. Fouad Fouad, Assistant Professor of Public Health Practice at the American University of Beirut, and Zahirah McNatt, Senior Research Associate at Columbia University Mailman School of Public Health. The presentation aimed to foster dialogue amongst stakeholders about how to improve the accessibility and quality of NCD services for refugees in non-camp settings. The presentations were followed by breakout sessions that engage participants in a discussion on policy and practice implementation, to identify strategies for addressing NCD needs among refugees in urban settings, and produce recommendations for a variety of stakeholders that respond to the health needs of displaced communities in the Middle East.