Issue 15: Economic Precarity among Syrian Refugee Families Living in Lebanon: Policy Recommendations to Restore Hope in the Context of Displacement

The conflict in Syria has been described as the largest humanitarian crisis to date. Ongoing for over eight years, the conflict has resulted in over five million refugees and 6.6 million people internally displaced within the borders of Syria. Most refugees from Syria have been displaced to neighbouring countries such as Jordan, Turkey, Iraq, and Lebanon. Lebanon is host to over one million Syrian refugees. Prior to the Syrian crisis, Lebanon was struggling economically, which has since exacerbated anti-refugee sentiment and government policies that aim to discourage Syrians from seeking refuge in Lebanon. Within Lebanon, Syrian families are challenged with high rates of poverty, restrictive governmental policies and regulations, a lack of affordable housing and health care, food insecurity, and family violence. These challenges have a destabilizing effect on Syrian families, impacting the mental health of parents as well as their ability to meet their families’ basic needs. This policy brief draws on research conducted with Syrian families in Lebanon to highlight policy points to address the impacts of economic precarity on the health and well-being of Syrian families. The lessons drawn from this research can be applied both within areas of displacement and in post-resettlement settings where issues of economic precarity can often persist

Addressing the Psychosocial Needs of Pregnant Women Affected by War: Program Approaches and Program Gaps

Today’s female refugee and internally displaced population faces the increasing risk of adverse birth outcomes associated with stress related to conflict, flight, and displacement. Programs addressing the specific psychosocial needs of pregnant women in situations of war are scarce, and there is little consensus regarding best practices. Initiatives have recently emerged, including psychosocial groups, safe motherhood training, and social support systems, all which aim to alleviate the psychosocial stress experienced by this cohort. However, there remain existing program gaps, such as the absence of specific quality research, the use of a deficits-based vernacular concentrated on vulnerabilities, no focus on postpartum care, and little development of gender-based violence prevention initiatives addressing pregnancies resulting from rape. It is clear that more needs to be done to provide and support comprehensive quality psychosocial services for this population.De nos jours les femmes réfugiées et les populations déplacées à l’intérieur des frontières font face à un risque croissant d’accouchements à problèmes résultant du stress lié aux conflits, à la fuite, et au déplacement. Les programmes pour satisfaire les besoins psychosociaux spécifiques de femmes enceintes dans les situations de guerre sont rares, et il y a peu de consensus en matière de meilleures pratiques. Des initiatives sont apparues récemment, y compris l’émergence de groupes psychosociaux, de la formation pour une maternité sans risque, et des systèmes de support sociaux, qui visent tous à alléger le stress psychosocial éprouvé par toutes celles concernées. Cependant ces programmes comportent encore des lacunes, telles que l’absence de recherche spécifique de bonne qualité, l’utilisation d’un vernaculaire fondé sur les déficiences et se concentrant sur les vulnérabilités, le manque de considération pour les soins suivant l’accouchement, et peu de développement dans les initiatives concernant la prévention de la violence liée au sexe et traitant des grossesses résultant du viol. Il est clair que davantage doit être fait pour fournir et soutenir des services psychosociaux complets et de qualité pour cette population

Issue 15: Economic Precarity among Syrian Refugee Families Living in Lebanon: Policy Recommendations to Restore Hope in the Context of Displacement

The conflict in Syria has been described as the largest humanitarian crisis to date. Ongoing for over eight years, the conflict has resulted in over five million refugees and 6.6 million people internally displaced within the borders of Syria. Most refugees from Syria have been displaced to neighbouring countries such as Jordan, Turkey, Iraq, and Lebanon. Lebanon is host to over one million Syrian refugees. Prior to the Syrian crisis, Lebanon was struggling economically, which has since exacerbated anti-refugee sentiment and government policies that aim to discourage Syrians from seeking refuge in Lebanon. Within Lebanon, Syrian families are challenged with high rates of poverty, restrictive governmental policies and regulations, a lack of affordable housing and health care, food insecurity, and family violence. These challenges have a destabilizing effect on Syrian families, impacting the mental health of parents as well as their ability to meet their families’ basic needs. This policy brief draws on research conducted with Syrian families in Lebanon to highlight policy points to address the impacts of economic precarity on the health and well-being of Syrian families. The lessons drawn from this research can be applied both within areas of displacement and in post-resettlement settings where issues of economic precarity can often persist

Most importantly, I hope God keeps illness away from us : The context and challenges surrounding access to health care for Syrian refugees in Lebanon

The influx of 1.5 million Syrians into Lebanon has created an increased demand for health services, which is largely unmet, due to cost, a highly fragmented and privatised system, and crises around legal documentation and refugee status. The aim of this study was to use a constant comparison analysis of qualitative data to explore how Syrian refugees living in Lebanon describe their experiences accessing healthcare (N = 351 individuals within 46 families). Pervasive fear, lack of confidence in the medical system, and high costs all hinder access to healthcare for Syrians in Lebanon. Findings demonstrate the need for attention to the costs and accessibility of care, and for stronger coordination of care within a centrally led comprehensive emergency plan. While we attend to understanding and alleviating the barriers surrounding refugee healthcare, we must also address the underlying cause of health crisis: the brutal realities caused by armed conflict

Most importantly, I hope God keeps illness away from us : The context and challenges surrounding access to health care for Syrian refugees in Lebanon

The influx of 1.5 million Syrians into Lebanon has created an increased demand for health services, which is largely unmet, due to cost, a highly fragmented and privatised system, and crises around legal documentation and refugee status. The aim of this study was to use a constant comparison analysis of qualitative data to explore how Syrian refugees living in Lebanon describe their experiences accessing healthcare (N = 351 individuals within 46 families). Pervasive fear, lack of confidence in the medical system, and high costs all hinder access to healthcare for Syrians in Lebanon. Findings demonstrate the need for attention to the costs and accessibility of care, and for stronger coordination of care within a centrally led comprehensive emergency plan. While we attend to understanding and alleviating the barriers surrounding refugee healthcare, we must also address the underlying cause of health crisis: the brutal realities caused by armed conflict

"So the World Will Know Our Story": Ethical Reflections on Research with Families Displaced by War

In this article we examine the ethical implications of a qualitative research study exploring the everyday mobilities of Syrian families displaced in Lebanon. The multiple methods of data collection - collaborative family interviews, children's drawing and mapmaking, GIS-tracked neighborhood walks, and activity logging - encouraged children and family voices. At the same time, these methods provide an opportunity to explore family networks, relationships, and environments that are impacting their lives in the context of war and displacement. These methods, like all research with vulnerable populations, also raise several ethical questions. Using a process of ethical reflexivity, we discuss six ethical points related to both procedural and micro-ethics. In addition to shedding light on the importance of uncovering the everyday experiences of refugees using creative methods, we suggest broader ethical implications regarding how we respectfully work with vulnerable populations while still upholding research integrity.In diesem Beitrag befassen wir uns mit den ethischen Implikationen einer qualitativen Studie zu Mobilität im Alltag von syrischen Familien, die angesichts des Krieges in Syrien in den Libanon geflohen sind. Die Daten wurden mit verschiedenen Methoden erhoben - mit kollaborativen Familieninterviews, Zeichnungen und Karten von Kindern, GIS-unterstützten Spaziergängen sowie einem Logbuch für Aktivitäten - wodurch insbesondere die Teilnahme von Kindern und Familien ermöglicht wurde. Diese Methoden erlaubten es, familiäre Netzwerke und Beziehungen zu untersuchen und auch die Umwelten zu erfassen, die auf das Leben der Familien nach Krieg und Flucht einwirken. Unser Vorgehen, wie im Grunde jede Erforschung von vulnerablen Gruppen, war von ethischen Fragen begleitet. Auf Basis eines ethischen Reflexionsprozesses diskutieren wir in diesem Beitrag sechs Punkte, die sowohl mit Fragen der prozeduralen Ethik als auch mit Fragen der Mikro-Ethik verbunden sind. Dabei unterstreichen wir die Bedeutung von kreativen Forschungsmethoden, die es erlauben, alltägliche Erfahrungen von geflüchteten Familien zu erfassen. Darüber hinaus besprechen wir weiter gefasste ethische Implikationen, insbesondere wie sich eine respektvolle Arbeit mit vulnerablen Bevölkerungsgruppen mit einer Gewährleistung der Integrität als Forschende verbinden lässt

Research as intervention? Exploring the health and well-being of children and youth facing global adversity through participatory visual methods

Global health research typically relies on the translation of knowledge (from health professionals to the community) and the dissemination of knowledge (from research results to the wider public). However, Greenhalgh and Wieringa [2011. Is it time to drop the ‘knowledge translation’ metaphor? A critical literature review. Journal of the Royal Society of Medicine, 104(12), 501–509. doi:10.1258/jrsm.2011.110285] suggest ‘that while “translation” is a widely used metaphor in medicine, it constrains how we conceptualize and study the link between knowledge and practice’ (p. 501). Often the knowledge garnered from such research projects comes from health professionals rather than reflecting the lived experiences of people and communities. Likewise, there has been a gap in ‘translating’ and ‘disseminating’ the results of participatory action research projects to policymakers and medical practitioners. This paper will look at how using participatory visual methodologies in global health research with children and youth facing global adversity incorporates the multiple functions of their lived realities so that research becomes a means of intervention. Drawing from a literature review of participatory visual methods as media, content and processes of global health research, this paper raises practical, theoretical, and ethical questions that arise from research as intervention. The paper concludes by exploring what lessons emerge when participatory visual methodologies are integrated into global health research with children and youth facing global adversity

‘Stepping back’ as researchers: How are we addressing ethics in arts-based approaches to working with war-affected children in school and community settings.

There is a need for an ethically responsible means of conducting arts-based research with children affected by global adversity, including children affected by war. The multiple effects of war on children remains a global issue. While there are many approaches to working with waraffected children, participatory arts-based methods such as photovoice, drama, and drawing are being increasingly relied upon. However, what are the ethical issues and how are researchers and practitioners taking up these issues in school, community, and “on the street” settings? By reviewing the literature on ethical issues that may arise when working with children through arts-based methods, this article identifies four critical ethical issues that represent specific challenges in relation to children affected by war: (1) informed consent; (2) truth, interpretation, and representation; (3) dangerous emotional terrain; and (4) aesthetics. The article highlights current gaps in the research and poses several unanswered questions in arts-based research with war-affected children