Conflict and Health
Volume 13, Issue 1, 2019

Informal healthcare provision in Lebanon: An adaptive mechanism among displaced Syrian health professionals in a protracted crisis (Article) (Open Access)

Honein-Abouhaidar G. , Noubani A. , El Arnaout N. , Ismail S. , Nimer H. , Menassa M. , Coutts A.P. , Rayes D. , Jomaa L. , Saleh S. , Fouad F.M.*
  • a Global Health Institute, American University of Beirut, Beirut, Lebanon, Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
  • b Global Health Institute, American University of Beirut, Beirut, Lebanon
  • c Global Health Institute, American University of Beirut, Beirut, Lebanon
  • d Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
  • e Global Health Institute, American University of Beirut, Beirut, Lebanon
  • f Global Health Institute, American University of Beirut, Beirut, Lebanon
  • g Department of Sociology and Magdalene College, University of Cambridge, Cambridge, United Kingdom
  • h Syria Public Health Network, London, United Kingdom
  • i Global Health Institute, American University of Beirut, Beirut, Lebanon, Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
  • j Global Health Institute, American University of Beirut, Beirut, Lebanon, Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
  • k Global Health Institute, American University of Beirut, Beirut, Lebanon, Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon

Abstract

Background: Syrian healthcare workers (HCWs) are among those who fled the Syrian conflict only to face further social and economic challenges in host countries. In Lebanon, this population group cannot formally practice, yet many are believed to be operating informally. These activities remain poorly documented and misunderstood by the academic, policy and humanitarian communities. This study aims to understand mechanisms of informal provision of services, the facilitators and barriers for such practices and to present policy recommendations for building on this adaptive mechanism. Method: A qualitative descriptive study based on an in-depth interview approach with a sample of Syrian informal healthcare workers (IHCWs) residing in Lebanon was adopted. Known sponsor networks followed by snowball sampling approaches were used to recruit participants. Data collection occurred between September and December 2017. All interviews were audio-recorded, transcribed and translated into English. An inductive thematic analysis was used. Results: Twenty-two participants were recruited. Motivational factors that led HCWs to practice informally were personal (e.g. source of income/livelihood), societal (cultural competency), and need to fulfill a gap in the formal health service sector. Being connected to a network of IHCWs facilitated initiation of the informal practice until eventually becoming part of a community of informal practice. The central challenge was the informal nature of their practice and its negative consequences. Most IHCWs were afraid of arrest by the government upon identification. Most interviewees indicated being discriminated against by host communities in the form of differential wages and tense interpersonal relationships. Almost all recommended a change in policy allowing them to practice formally under a temporary registration until their return to Syria. Conclusion: Our study confirmed the presence of IHCWs operating in Lebanon. Despite its informal nature, participants perceived that this practice was filling a gap in the formal health system and was helping to alleviate the burden of IHCWs and refugee health needs. In line with interviewees' views, we recommend that policy decision makers within humanitarian agencies and the Government of Lebanon explore the possibilities for allowing temporary registration of displaced Syrian IHCW to benefit local host communities and refugee populations. © 2019 The Author(s).

Author Keywords

Informal provision Host communities Healthcare workers Refugees Health system Lebanon Syria

Index Keywords

male government female thematic analysis refugee clinical article cultural competence Article human relation Syrian Arab Republic interview genetic transcription health care personnel human adult human tissue human experiment Lebanon

Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85072019080&doi=10.1186%2fs13031-019-0224-y&partnerID=40&md5=d953453230bcdc622817dcd169b44af7

DOI: 10.1186/s13031-019-0224-y
ISSN: 17521505
Original Language: English