Refugee Access to Surgical Care in Lebanon: A Post Hoc Analysis of the SCAR Study

Hechi, Majed W. El; Khalifeh, Jawad M.; Ramly, Elie P.; Elahad, Joana Abed; Bonde, Alexander; Velmahos, George C.; Hoballah, Jamal J.; Kaafarani, Haytham M.A.

doi:10.1016/j.jss.2019.03.007

Cited by 5 publications

(4 citation statements)

References 12 publications

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“…9 Lebanon has served as host to an estimated 1 million Syrian refugees through the United Nations High Commissioner for Refugees (UNHCR). 22 Cross-sectional analysis of 129 Lebanese hospitals contracted with the UNHCR highlighted the need for further coverage, particularly in hospitals in the North-East of Lebanon that border with Syria. 22 A retrospective medical chart review of 103 Syrian refugee children presenting at a Cleft and Craniofacial Centre in Lebanon between 2013 and 2019 confirmed the presence of malnourishment and stunting of growth in a significantly high number of patients with cleft lip and/or cleft palate.…”

Section: Discussionmentioning

confidence: 99%

“…22 Cross-sectional analysis of 129 Lebanese hospitals contracted with the UNHCR highlighted the need for further coverage, particularly in hospitals in the North-East of Lebanon that border with Syria. 22 A retrospective medical chart review of 103 Syrian refugee children presenting at a Cleft and Craniofacial Centre in Lebanon between 2013 and 2019 confirmed the presence of malnourishment and stunting of growth in a significantly high number of patients with cleft lip and/or cleft palate. 23 This highlights the need for members of the multidisciplinary team in addition to surgeons, including dieticians, speech and language therapists as well as cleft nurses.…”

Section: Discussionmentioning

confidence: 99%

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Simulation Training Approach for Cleft Lip and Palate Repair in Low-Income Countries

Borg

Solomon

Alfarrouh³

et al. 2022

The Cleft Palate Craniofacial Journal

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Background During periods of civil strife, the need for trauma care and lack of sufficient cleft surgeons causes an increase in children left untreated with cleft lip and palate deformities. During the Syrian war, some cleft care was provided through visiting charities, with surgeries performed both in Syria and neighboring countries. There is a need to increase the number of adequately trained cleft surgeons available in such regions so that care can be achieved beyond mission trips. Methodology Cleft lip and palate repair workshops were delivered to 50 doctors in Syria. Pre-workshop, trainees received supplementary learning material. During the workshop, attendees received didactic teaching followed by 2 simulation sessions. Pre- and post-workshop, attendees completed questionnaires regarding their confidence and ability to perform cleft lip and palate repair. Results Pre-workshop, 96% of workshop attendees had never independently performed cleft lip repair while 100% of attendees had not previously performed cleft palate repair. The mean pre-workshop confidence score was 2.452. Post-workshop, the mean confidence score was 3.503. Confidence rating scores significantly improved ( P < .001). Conclusion The workshop delivered in Syria, together with this cleft lip and palate simulator provides an effective training tool that may support surgical training globally, particularly those in low-income countries. Further support is needed by charity organizations to ensure the continued delivery of such training.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Simulation Training Approach for Cleft Lip and Palate Repair in Low-Income Countries

Borg

Solomon

Alfarrouh³

et al. 2022

The Cleft Palate Craniofacial Journal

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“…It should be noted that not all Lebanese hospitals are contracted by the UNHCR and only those contracted are reimbursed for the care they provide to refugees [ 26 ]. Healthcare facilities in Lebanon have experienced an escalation in the costs of service provision and are now incapable of covering the needs for all the refugee population despite UNHCR subsidies [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

The Burden of Surgical Disease and Access to Care in a Vulnerable Syrian Refugee Population in Lebanon

et al. 2021

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Background The Syrian conflict has produced one of the largest refugee crises in modern times. Lebanon has taken in more Syrian refugees per capita than any other nation. We aimed to study the burden of surgical disease and access to surgical care among Syrian refugees in Lebanon. Methods This study was designed as a convenient cross-sectional cluster-based population survey of all refugee camps throughout the Bekaa region of Lebanon. We used a modified version of the Surgeons OverSeas Assessment of Surgical Need to identify surgical conditions and barriers to care access. The head of household of each informal tented settlement provided demographic information after which two household members were randomly chosen and administered the survey. Results A total of 1,500 individuals from 750 households representing 21 camps were surveyed. Respondents had a mean age of 36.6 (15.0) years, 54.6% were female, and 59% were illiterate. Nearly 25% of respondents reported at least one surgical condition within the past year, most commonly involving the face, head, and neck region (32%) and extremities (22%). Less than 20% of patients with a surgical condition reported seeing any healthcare provider, > 75% due to financial hardship. Conclusions The prevalence of surgical disease among Syrian refugees is very high with a fourth of refugees suffering from one or more surgical conditions over the past year. The surgical needs of this vulnerable population are largely unmet as financial reasons prevent patients from seeking care. Local and humanitarian efforts need to include increased access to surgical care.

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“…For example, a recent systematic review estimated the average prevalence rate of posttraumatic stress disorder (PTSD) among Syrian refugees to be 43.0%, while rates of depression and anxiety were 40.9% and 26.6%, respectively (Peconga & Høgh Thøgersen, 2019). In general, financial, environmental, and social postmigration stressors (Alfadhli & Drury, 2018; Ay et al, 2016; Dator et al, 2018; El Hechi et al, 2019) are precursors for poor mental health.…”

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confidence: 99%

Cultural assimilation of adult Syrian refugees in Lebanon: Effect modification by religiosity and sex on the relation between cultural adversities and common mental health disorders.

Abou-Abbass,

El Sheikh,

Bizri

et al. 2024

Psychological Trauma: Theory, Research, Practice, and Policy

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Objective: In this study, we aimed to explore the prevalence and determinants of common mental health disorders (CMHDs, posttraumatic stress disorder [PTSD], depression, and anxiety) in Syrian refugees in Lebanon. Specifically, we examined how the associations between cultural adversities (discrimination, unemployment, and separation from family) and CMHDs are modified by levels of religiosity and sex. Method: Between March and June 2017, a cross-sectional study was conducted targeting adult Arab Syrian refugees residing in Beirut and Southern Lebanon. Eligibility criteria comprised being a United Nations High Commissioner for Refugees-registered Syrian refugee residing in Lebanon, 18 years and older, and having no history of mental disorder or physical disability. A total of 191 refugees agreed to participate and complete a battery of six questionnaires. Exposures were measured using a sociodemographic questionnaire, the Postmigration Living Difficulties Checklist, the Harvard Trauma Questionnaire, and the Belief into Action Scale, while outcomes were measured using the Posttraumatic Stress Disorder Checklist for DSM-5 and the Depression and Anxiety Scale-21 Items. Results: Half (50.3%) of our sample had high PTSD risk, 73.8% had high depression risk, and 73.8% had high anxiety risk. Stratified analysis revealed religiosity and sex to be effect modifiers of the associations between cultural adversities and CMHDs. Specifically, cultural adversities were only significantly associated with CMHDs in the low religiosity stratum and males. Only unemployment was a significant risk factor for PTSD in both males (OR = 4.53, 95% CI [1.44, 14.27]) and females (OR = 2.77, 95% CI [1.14, 6.74]). Conclusions: Religiosity and sex are effect modifiers of the associations between cultural adversities and CMHDs. Religious and spiritual interventions in mental health care should be adopted in refugee settings. Moreover, there is an urgent need for capacity-building initiatives addressing social determinants of mental health among Syrian refugees in Lebanon.Walaa G. El Sheikh https://orcid.org/0000-0002-4890-0222 Firas Kobeissy https://orcid.org/0000-0002-5008-6944 The authors would like to thank Blue Mission Organization for facilitating the recruitment process. The authors have no conflicts of interest to declare.Hussein Abou-Abbass and Walaa G. El Sheikh contributed equally to this study. Hussein Abou-Abbass served as lead for data curation and methodology and served in a supporting role for writing-review and editing. Walaa G. El Sheikh served as lead for formal analysis, software, writing-original draft, and writing-review and editing. Maya Bizri and Hani Tamim served in a supporting role for formal analysis and writing-review and editing. Samar Al-Hajj, Farah Allouch, Rawan Chehade, Mayssa Ghannam, Youssef Fares, and Zeina Nasser served in a supporting role for writing-review and editing. Lina Karout contributed equally to data curation and served in a supporting role for writing-review and editing. Hayat Harati served in a su...

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Refugee Access to Surgical Care in Lebanon: A Post Hoc Analysis of the SCAR Study

Cited by 5 publications

References 12 publications

Simulation Training Approach for Cleft Lip and Palate Repair in Low-Income Countries

Simulation Training Approach for Cleft Lip and Palate Repair in Low-Income Countries

The Burden of Surgical Disease and Access to Care in a Vulnerable Syrian Refugee Population in Lebanon

Cultural assimilation of adult Syrian refugees in Lebanon: Effect modification by religiosity and sex on the relation between cultural adversities and common mental health disorders.

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