Background Humanitarian actors and host-countries in the Middle East and North Africa region are challenged with meeting the health needs of Syrian refugees and adjusting the response to contemporary humanitarian conditions – urban-based refugees, stressed host-country health systems and high NCD prevalence. Although several studies have explored NCD prevalence, utilization of services and barriers to access, these analyses took place prior to dramatic shifts in Jordanian health policy and did not account for nuances in health seeking and utilization behaviors or operational barriers. Accordingly, we aimed to understand the depth and nuances of Syrian refugees’ experiences accessing NCD services in urban and semi-urban settings in Jordan. Methods A qualitative study was conducted to explore the healthcare experiences of Syrian refugees in Jordan. The study team conducted 68 in-depth interviews with Syrian refugees in urban and semi-urban locations in central and northern Jordan. Results The findings indicated four themes key to understanding the healthcare experience: (1) emotional distress is a central concern and is frequently highlighted as the trigger for a non-communicable disease or its exacerbation; (2) service provision across all sectors – government, NGO, private – is complex, inadequate, expensive and fragmented, making engagement with the health sector physically and financially burdensome; (3) given financial constraints, participants make harmful decisions that further damage their health in order to reduce financial burdens, and (4) host-community members actively exhibit solidarity with their refugee neighbors and specifically do so during emergency health episodes. The findings from this study can be used to inform program design for forcibly displaced persons with NCDs and identify points of entry for effective interventions. Conclusions Opportunities exist for humanitarian and host-country actors to provide more comprehensive NCD services and to improve the relevance and the quality of care provided to Syrian refugees in Jordan. Global and national funding will need to align with front-line realities and foster better coordination of services between host-country health systems, private actors and non-governmental organizations.

Since 2011, the war in Syria has resulted in the displacement of 12.2 million people. Over 5.6 million have fled Syria to seek asylum in neighbouring countries, while 6.6 million have been internally displaced. Family separation, with significant psychological, social and economic implications, is a key concern for those who flee violence and cross international borders. This qualitative study sought to understand the causes of separation among Syrian families in Jordan and the obstacles to family reunification. Semi-structured, in-depth interviews were conducted with 85 Syrian refugee families identified as having separated family members. We present critical moments during migration when family separation occurs: (1) while fleeing Syria, (2) while residing in Jordan and (3) pre-existing separation due to work or travel that was exacerbated by the conflict. We also highlight the factors that perpetuate separation among families, preventing or delaying them from reuniting. These findings may help to inform more humane family-reunification practices as well as identify future research and learning needs.

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