LAUSR

The United Nations High Commissioner for Refugees (UNHCR) estimates that there are 66 million people displaced worldwide, including 22.5 million refugees, more than half of whom are under the age of 18 years. There are also 10 million stateless people who have been denied a nationality and access to basic rights such as education and health care. Armed conflicts in the Middle East, particularly Afghanistan, Iraq, and Syria, have forced people to flee in vast numbers to neighboring countries, and this has added substantial strains to existing resources. Countries such as Turkey, Pakistan, and Lebanon host the largest numbers of refugees, with Lebanon hosting the highest proportion of refugees per capita (>1 million Syrian refugees living in a country with a population of 4 million before the start of the Syrian conflict). For the better part of the 20th century, refugee crises happened in low-income and less-developed countries, and infectious diseases and acute malnutrition were the most common conditions addressed by health care providers; these conditions could be treated with relatively straightforward interventions such as antibiotics, vaccination, and nutritional supplementation if barriers to timely care were removed. The recent conflicts in Syria and Iraq have created long-lasting crises that affect low-income and middle-income countries alike. In this context, the needs of refugees with noncommunicable diseases can unfortunately be overlooked because of the complexities of coordinating multidisciplinary care, the expenses associated with specialized care, and the lack of resources for managing acute complications of therapy. In 2016, the Vulnerability Assessment for Syrian Refugees in Lebanon was commissioned by the United Nations Children’s Fund, the UNHCR, and the United Nations World Food Programme to better assess the state of Syrian refugees living in Lebanon and to examine the impact that the refugee crisis has had on the infrastructure of Lebanon. Between May 23 and June 4, 2016, the survey team visited 4596 Syrian refugee households randomly selected from 26 districts across Lebanon. The population was stratified by district to allow districtand governorate-level analysis. The report found that almost two-thirds of all households (63%) had at least 1 member with specific needs defined according to the following categories: 1) physical or mental disability, 2) chronic illness, 3) temporary illness or injury, 4) serious medical condition, and 5) need for support in basic daily activities. The UNHCR reported that 55% of displaced persons were under the age of 18 years, and approximately 7% of households had children with disabilities (physical, sensory, or mental/intellectual). Nearly half of the interviewed households required primary health care services in the past 6 months, and approximately one-quarter of the surveyed households (26%) required secondary health care services. However, 23% of those households did not obtain the required specialized care or hospitalization. The main obstacles to access were fees (71%), which were followed by transportation costs (13%) and rejection by a health care provider (13%). Not surprisingly, the overwhelming majority of refugee households (90%) had borrowed money in the previous 3 months, and there was a steady increase in the amount of debt accrued over time.