Inclusion of Older Syrian Refugees in the Humanitarian Response in Lebanon

Abstract

This dissertation explores the health and wellbeing of older people affected by humanitarian crises, with a special focus on Syrian refugees in Lebanon and their inclusion in the humanitarian response. The study aims to explore the breadth of the literature on the health and wellbeing of older populations affected by humanitarian crises. It also aims to fill existing gaps in the literature on the unmet needs, coping strategies across the shelter, health, nutrition and food security, and water, sanitation, and hygiene sectors, and indicators of humanitarian inclusion of older Syrian refugees in Lebanon. Furthermore, it also aims to explore the perceptions and multi-dimensional determinants of their self-rated health and mental health, with a special focus on humanitarian cash assistance and its indirect effect via improving food security and affordability of healthcare. In order to achieve these objectives, the dissertation work included a scoping review of published peer-reviewed literature, and a mixed methods study with older Syrian refugees (aged 50 or older) in Lebanon. The quantitative component includes a cross-sectional survey with 461 refugees while the qualitative component included 14 key informant interviews. The scoping review showed that limited literature exists on the health and well-being of older populations affected by humanitarian crises, with most studies focusing on mental health and on non-displaced populations. The research predominantly employs cross-sectional designs and lacks evidence on the effectiveness of humanitarian health interventions and on healthcare utilization. Significant research gaps exist across multiple dimensions, including under-researched themes (e.g., NCDs, communicable diseases), contexts (e.g., armed conflicts), sub-populations (e.g., gender, mainly older men, displaced populations, older persons with disability), and study designs (longitudinal and quasi-experimental). The mixed methods study found a myriad of unmet needs across the sectors of interest, namely high rents, inappropriate shelters, high cost of medication and healthcare, inappropriate latrines and lack of access to clean and affordable water, and food insecurity. Indicators of inclusion showed poor inclusion of OSRs in the humanitarian response. SRH was mainly construed as physical health, with 4 in 10 reporting poor SRH. Risk factors included health-related variables such as number chronic diseases, bodily pain, caregiving need, and poor mental health. In addition, poor SRH was correlated with worse household hunger. On the other hand, MH was also reported to be poor by most OSRs, and the main determinants included the number of diagnosed chronic diseases, and poverty-related indicators such as the presence of household debt, consuming less than 2 meals per day, and reporting inability to afford healthcare when needed. Furthermore, exposure to severe traumatic incidents and poor neighborhood safety were correlated with poorer mental health. Cash assistance was not found to affect either outcomes directly or indirectly. However, cash assistance was found to improve household hunger. The findings point to the inadequacy and inappropriateness of cash assistance to older members of households and the need for more tailored and contextualized aid. This dissertation hence provides evidence for the gaps in the literature, and fills some of them by revealing unmet needs through a comprehensive multi-sectoral assessment. It also reveals, in detail, the coping strategies employed, and the risk factors of poor physical and mental health. Findings point to the central role of social determinants, such as poverty and lack of access to monetary resources in contexts of forced displacement and under exclusionary regulations. The dissertation also presents the first attempt to explore the effect of cash assistance on the health and wellbeing of older members of supported households. It shows, consistently with existing literature, that older populations affected by humanitarian crises are indeed overlooked by humanitarian actors, a fact that becomes grimmer when nested within a context of overlapping socioeconomic and political crises with targeted exclusionary regulations against refugees. These findings call for immediate action at the level of policy, programming, and research to ensure older populations are no longer ‘left behind’ in such complex situations.