Host country responses to non-communicable diseases amongst Syrian refugees: a review

Abstract

BackgroundSince the beginning of the Syrian conflict in 2011, Jordan, Lebanon and Turkey have hosted large refugee populations, with a high pre-conflict burden of non-communicable diseases (NCDs).ObjectivesWe aimed to describe the ways in which these three host country health systems have provided NCD services to Syrian refugees over time, and to highlight the successes and challenges they encountered.MethodsWe conducted a descriptive review of the academic and grey literature, published between March 2011 and March 2017, using PubMed and Google searches complemented with documents provided by relevant stakeholders.ResultsForty-one articles and reports met our search criteria. Despite the scarcity of systematic population-level data, these documents highlight the high burden of reported NCDs among Syrian refugees, especially amongst older adults. The three host countries utilized different approaches to the design, delivery and financing of NCD services for these refugees. In Jordan and Lebanon, Ministries of Health and the United Nations High Commissioner for Refugees (UNHCR) coordinate a diverse group of health care providers to deliver health services to Syrian refugees at a subsidized cost. In Turkey, however, services are provided solely by the Disaster and Emergency Management Presidency (AFAD), a Turkish governmental agency, with no cost to patients for primary or secondary care. Access to NCD services varied both within and between countries, with no data available from Turkey. The cost of NCD treatment is the primary barrier to accessing healthcare, with high out-of-pocket payments required for medications and secondary and tertiary care services, despite the availability of free or subsidized primary health services. Financial impediments led refugees to adopt coping strategies, including returning to Syria to seek treatment, with associated frequent treatment interruptions. These gaps were compounded by health system related barriers such as complex referral systems, lack of effective guidance on navigating the health system, limited health facility capacity and suboptimal NCD health education.ConclusionAs funding shortages for refugee services continue, innovative service delivery models are needed to create responsive and sustainable solutions to the NCD burden among refugees in host countries.Electronic supplementary materialThe online version of this article (10.1186/s13031-019-0192-2) contains supplementary material, which is available to authorized users.

Protocol for a Randomized Controlled Trial: Peer to Peer Group Problem Management Plus (PM+) for Adult Syrian Refugees in Turkey

“…Syrians in Turkey have free access to mental health services in public hospitals and migrant health centres [27]. However, due to numerous barriers such as lack of knowledge on available mental health services or (self-)stigma, the use of mental health services is low among Syrian refugees [28,40].…”

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

“…The daily stressors, financial precarity, the myriad barriers to accessing care experienced by Syrian refugee NCD patients in Jordan and the potentially harmful decisions they make as a result of stretched finances have been well documented in our own and others' studies [43,[55][56][57][58]. The free care provided by MSF goes some way to alleviating the NCD-related financial burden affecting their current cohort.…”

Cardiovascular Disease among Syrian refugees: a descriptive study of patients in two Médecins Sans Frontières clinics in northern Lebanon

“…As the global burden increases, medical humanitarian organisations, such as Médecins sans Frontières (MSF), are increasingly faced with patients needing care for NCDs, including those with ASCVD. While there is growing evidence on the burden and gaps in access to care for NCDs in humanitarian crisis settings, very little has been published on the cost effective management of NCDs in general, and still less on the management of ASCVD, in humanitarian settings [11][12][13][14][15]. This is a significant gap, especially given that limited evidence shows that crises may actually increase CVD mortality, morbidity and risk factors [12,[16][17][18].…”

“…The Lebanese Ministry of Public Health (MoPH) and UNHCR coordinate a complex group of providers to serve Syrian refugees, and UNHCR-registered refugees can access a network of primary care centres [15]. However, they are required to make subsidised co-payments for consultations, medications and referrals for hospital treatment; accessibility varies between areas; and access to hospital-based services is very limited [15,26].…”

“…The Lebanese Ministry of Public Health (MoPH) and UNHCR coordinate a complex group of providers to serve Syrian refugees, and UNHCR-registered refugees can access a network of primary care centres [15]. However, they are required to make subsidised co-payments for consultations, medications and referrals for hospital treatment; accessibility varies between areas; and access to hospital-based services is very limited [15,26]. Registration of Syrian refugees by UNHCR was suspended in May 2015, following Lebanese government instruction, and unregistered refugees are limited to attending facilities funded by private donors or humanitarian organisations, such as MSF [15,27].…”