Physical trauma and injury: A multi-center study comparing local residents and refugees in Lebanon

Abstract

Background Refugees are susceptible to various types of injury mechanisms associated with their dire living conditions and settlements. This study aims to compare and characterize the emergency department admissions due to physical trauma and injuries among local residents and refugees in greater Beirut. Methods This epidemiological study analyzes injury incidence and characteristics of patients presenting to Emergency Departments of 5 sentinel hospitals between 2017 and 2019. Using the WHO Injury Surveillance Guidelines and Pan-Asia Trauma Outcomes Study form, an injury data surveillance form was designed and used in hospital settings to collect data on injuries. Chi-square test analysis was performed to compare differences in injury characteristics between local residents and refugees. Regression models were constructed to assess the effect of being a refugee on the characteristics of injuries and outcomes of interest. Results A total of 4847 injuries (3933 local residents and 914 refugees) were reported. 87.4% of the total injuries among refugees were sustained by the younger age groups 0-45 years compared to 68.8% among local residents. The most prevalent injury mechanism was fall (39.4%) for locals and road traffic injury (31.5%) for refugees. The most injured body part was extremities for both populations (78.2% and 80.1%). Injuries mostly occurred at home or its vicinity (garden or inside the camp) for both populations (29.3% and 23.1%). Refugees sustained a higher proportion of injuries at work (6%) compared to locals (1.3%). On multivariate analysis, refugee status was associated with higher odds of having an injury due to a stab/gunshot (odds ratio (OR) = 3.392, 95% confidence interval (CI) = 2.605-4.416), having a concussion injury (OR = 1.718, 95% CI = 1.151-2.565), and being injured at work (OR = 4.147, 95% CI = 2.74-6.278). Refugee status was associated with increased odds of leaving the hospital with injury-related disability (OR = 2.271, 95% CI = 1.891-2.728)] Conclusions Injury remains a major public health problem among resident and refugee communities in Beirut, Lebanon. Refugees face several injury-related vulnerabilities, which adversely affect their treatment outcomes and long-term disabilities. The high prevalence of occupational and violence-related injuries among refugees necessitates the introduction of targeted occupational safety and financial security interventions, aiming at reducing injuries while enhancing social justice among residents.

Work-Related Injuries among Insured Construction Workers Presenting to a Swiss Adult Emergency Department: A Retrospective Study (2016–2020)

“…This study identified 397 patients who sustained occupational injuries while working for a construction income and were covered by Suva insurance, the Swiss Accident Insurance Fund. Consistent with previous studies, our research shows a predominance of male patients [ 37 , 38 ], and is in accordance with statistics showing that persons suffering from these types of injuries are males in 98% of the cases [ 37 ]. This is not surprising, considering that males, due to the nature of the job, are more frequently employed in high-risk sectors (e.g., construction industries and manufacturing) compared to females [ 39 ].…”

“…Considering the severity of the injuries, our data show that the proportion of severe injuries is relatively low and comparable to that previously reported [ 38 ]. Indeed, only 9.8% of the patients had to be transferred by ambulance, whereas 79.3% were walk-in patients.…”

Exploring Inequalities between Migrant and Non-Migrant Populations in the Utilization of Emergency Departments: A Systematic Review

“…Al-Hajj et al [59] examined injured patients presenting to the ED and found that almost 90% of Lebanese patients sought care at private hospitals, as compared to only 52% of refugees (p-value < 0.001). According to the authors, a reason for this difference is that refugees are frequently unable to pay for medical care, therefore they are obliged to go to public hospitals or other facilities sponsored by local nongovernmental organizations (NGOs) or the United Nations High Commissioner for Refugees (UNHCR).…”

Political economy of health in fragile and conflict-affected regions in the Middle East and North Africa region

“…The current series further highlights that malnutrition, lack of quality education, poor physical and mental health, and extreme poverty have long- term consequences on children refugees, pushing them into labour market at an early age and young girls into early marriage. Moreover, Al-Haj et al, highlights that refugees are more susceptible to various types of injuries, including traumatic brain injury (TBI), due to the harsh living and working conditions that they endure [ 5 ]. Al Haj et al, found that the leading cause of these injuries among refugees in Lebanon were falls (44%) and violence (10%) [ 5 ].…”

“…Moreover, Al-Haj et al, highlights that refugees are more susceptible to various types of injuries, including traumatic brain injury (TBI), due to the harsh living and working conditions that they endure [ 5 ]. Al Haj et al, found that the leading cause of these injuries among refugees in Lebanon were falls (44%) and violence (10%) [ 5 ]. The series also highlights the inequitable distribution of the COVID-19 vaccine in Lebanon.…”