“Older people tend to be invisible”: a qualitative study exploring the needs and inclusion of older Syrian refugees in the context of compounding crises in host country, Lebanon

Abstract

Background Older Syrian refugees in Lebanon are a marginalized population with under-recognized health needs. The inclusivity of this population within the humanitarian response is poorly understood. This study aims to identify the unique needs of older Syrian refugees in the context of recent concurrent crises in Lebanon, and explore the extent to which they are being met and prioritized by local and international aid agencies. Methods We conducted in-depth interviews with a snowball sample of 26 stakeholders from 11 organizations operating in the health, nutrition, and water, sanitation, and hygiene sectors. Data analysis followed principles of thematic analysis. Results Concurrent political, economic, and public health crises in host country promoted income insecurity among older refugees and increased dependency on younger relatives, leading to food insecurity, neglect, and poor health outcomes, including the sequelae of untreated non-communicable diseases. Mental illness was perceived to be exacerbated by Covid-19 related challenges, including social isolation, uncertainty about the future, and additionally due to feelings of guilt related to economic dependence and fundamental exclusion from labor force participation. Despite their vulnerability, older refugees are overlooked by the humanitarian response, which may be related to a lack of data. Pervasive medication shortages in the setting of the economic collapse, as well as inaccessible physical environments and competing interests were all identified as major barriers to care. Conclusions Older Syrian refugees in Lebanon experience dual vulnerability that is acutely exacerbated in the setting of concurrent crises. Sociopolitical, economic, and cultural barriers promote social exclusion and may confer an increased risk of income and food insecurity in this population, with significant implications for health. Humanitarian aid agencies operating in the context of fragmented, under-resourced health systems are currently unable to sufficiently address multi-faceted needs of this community. We recommend moving away from a donor-dependent model of aid by allocating resources toward strengthening inclusive national health systems that emphasize preventative care. We further call for age-disaggregation of routine data and normalization of data sharing among stakeholders in the academic and public health sectors in order to develop evidence-based initiatives that can meet the needs of this under-served community.

By the numbers and in their own words: A mixed methods study of unmet needs and humanitarian inclusion of older Syrian refugees in Lebanon

“…Access to healthcare in Lebanon is faced with cost barriers for both Lebanese and Syrians with costs of services, medications, and transportation hindering access to care [17, 33, 43–45]. Findings in this sector are consistent with other studies on older refugees in Lebanon [23, 25, 26, 46] and Jordan [27], which show the high burden of NCDs and difficulties in accessing healthcare. In Ukraine, older refugees were also found to suffer from a high burden of NCDs [47], and around 34% are in urgent need of chronic medication [48].…”

“…While multiple studies have been conducted with older Syrian refugees (OSRs) in Lebanon [14,[23][24][25][26], and other neighboring countries [27][28][29][30], an extensive needs assessment with a focus on their reports and perceptions of inclusion is missing. This study guided by a human-rights lens is looking at a population with a myriad of intersecting vulnerabilities to emphasize its right to access humanitarian assistance.…”

Strengthening Family Bonds and Promoting Rural Development: The Impact of Universal Social Pensions in Tanzania

“…As individuals age, their economic needs tend to become more challenging to fulfill, especially for those engaged in informal employment sectors where financial stability may be precarious (Nomaguchi & Milkie, 2020). Moreover, advancing age often brings with it a host of health-related issues, further exacerbating the financial strain on families (Hachem et al, 2022).…”

By the numbers and in their own words: A mixed methods study of unmet needs and humanitarian inclusion of older Syrian refugees in Lebanon

“…While multiple studies have been conducted with older Syrian refugees (OSRs) in Lebanon [ 14 , 23 – 26 ], and other neighboring countries [ 27 – 30 ], an extensive needs assessment with a focus on their reports and perceptions of inclusion is missing. This study guided by a human-rights lens is looking at a population with a myriad of intersecting vulnerabilities to emphasize its right to access humanitarian assistance.…”