ABSTRACT
INTRODUCTION:
The Lebanese
government estimates the number of Syrian
refugees to be 1.5 million, representing 25% of the
population.
Refugee healthcare services have been integrated into the existing Lebanese
health system. This study aims to describe the integration of Syrian
refugee health services into the Lebanese
national health system from 2011 to 2022, amid an ongoing economic crisis since 2019 and the COVID-19 pandemic.
METHODS:
This
paper employs a mixed-
methods approach drawing upon different
data sources including 1-
document review (
policies, legislation,
laws, etc.); 2- semi-structured interviews with policymakers, stakeholders, and
health workers; 3-
focus group discussions with
patients from both host and
refugee populations; and 4-
health systems and care seeking
indicators.
RESULTS:
Although the demand for
primary health care increased due to the Syrian
refugee crisis, the
provision of
primary health care services was maintained. The infusion of international funding over
time allowed
primary health care centers to expand their
resources to accommodate increased demand. The oversupply of
physicians in
Lebanon allowed the system to maintain a relatively high density of
physicians even after the massive influx of
refugees. The highly privatized, fragmented and expensive healthcare system has impeded Syrian
refugees' access to
secondary and
tertiary healthcare services. The economic crisis further exacerbated limits on access for both the host and
refugee populations and caused tension between the two
populations. Our findings showed that the
funds are not channeled through the
government, fragmentation across multiple financing sources and reliance on international funding. Common medications and
vaccines were available in the public system for both
refugee and host
communities and were reported to be affordable. The economic crisis hindered both
communities'
access to medications due to shortages and dramatic
price increases.
CONCLUSION:
Integrating
refugees in
national health systems is essential to achieve
sustainable development goals, in particular
universal health coverage. Although it can strengthen the capacity of
national health systems, the integration of
refugees in low-
resource settings can be challenging due to existing
health system arrangements (e.g., heavily privatized care, curative-oriented, high out-of-pocket, fragmentation across multiple financing sources, and system
vulnerability to economic shocks).