Health system responsiveness to the mental health needs of Syrian refugees: mixed-methods rapid appraisals in eight host countries in Europe and the Middle East

Background: Syrian refugees have a high burden of mental health symptoms and face challenges in accessing mental health and psychosocial support (MHPSS). This study assesses health system responsiveness (HSR) to the MHPSS needs of Syrian refugees, comparing countries in Europe and the Middle East to inform recommendations for strengthening MHPSS systems. Methods: A mixed-methods rapid appraisal methodology guided by an adapted WHO Health System Framework was used to assess HSR in eight countries (Egypt, Germany, Jordan, Lebanon, Netherlands, Sweden, Switzerland, and Türkiye). Quantitative and qualitative analysis of primary and secondary data was used. Data collection and analysis were performed iteratively by multiple researchers. Country reports were used for comparative analysis and synthesis. Results: We found numerous constraints in HSR: i) Too few appropriate mental health providers and services; ii) Travel-related barriers impeding access to services, widening rural-urban inequalities in the distribution of mental health workers; iii) Cultural, language, and knowledge-related barriers to timely care likely caused by insufficient numbers of culturally sensitive providers, costs of professional interpreters, somatic presentations of distress by Syrian refugees, limited mental health awareness, and stigma associated to mental illness; iv) High out-of-pocket costs for psychological treatment and transportation to services reducing affordability, particularly in middle-income countries; v) Long waiting times for specialist mental health services; vi) Information gaps on the mental health needs of refugees and responsiveness of MHPSS systems in all countries. Six recommendations are provided. Conclusions: All eight host countries struggle to provide responsive MHPSS to Syrian refugees. Strengthening the mental health workforce (in terms of quantity, quality, diversity, and distribution) is urgently needed to enable Syrian refugees to receive culturally appropriate and timely care and improve mental health outcomes. Increased financial investment in mental health and improved health information systems are crucial

Intense Hairdressing

Color photography.https://hsrc.himmelfarb.gwu.edu/artshow_gallery_2012/1048/thumbnail.jp

Chicken and Man

Color photography.https://hsrc.himmelfarb.gwu.edu/artshow_gallery_2012/1045/thumbnail.jp

Field of Gold

Color photography.https://hsrc.himmelfarb.gwu.edu/artshow_gallery_2012/1046/thumbnail.jp

Unsung Hero Rickshaw Puller

Black and white photography.https://hsrc.himmelfarb.gwu.edu/artshow_gallery_2012/1050/thumbnail.jp

Industrial Revolution

Color photography.https://hsrc.himmelfarb.gwu.edu/artshow_gallery_2012/1047/thumbnail.jp

Twin Boats Early Morning

Color photography.https://hsrc.himmelfarb.gwu.edu/artshow_gallery_2012/1049/thumbnail.jp

In a life full of risks, COVID-19 makes little difference. Responses to COVID-19 among mobile migrants in gold mining areas in Suriname and French Guiana

International audienceWorldwide, the socioeconomic impacts of COVID-19 disproportionally affect vulnerable groups in society. This paper assesses responses to, and impacts of, the pandemic among mobile migrant populations who work in Artisanal and Small-scale Gold Mining (ASGM) in Suriname and French Guiana. These populations are characterized by poverty, informal or illegal status, and limited access to health care and information. Field research in Suriname (November 2020–January 2021) and French Guiana (January, May, June 2021) included qualitative interviews, informal conversations and observations, and a quantitative survey with 361 men and women in ASGM communities.Contrary to reports from the ASGM sector elsewhere, interviewed inhabitants of ASGM areas in Suriname and French Guiana showed little concern about COVID-19. Respondents reported feeling safer in the forest where they work than in the urban areas or in their home country. Trust in home remedies and over-the-counter pharmaceuticals further reduced anxiety about the pandemic. Three-quarters of survey respondents reported that the COVID-19 pandemic had not affected their work or income at all.The researchers conclude that in these remote Amazon communities, responses to COVID-19 mirror attitudes and behavior vis-à-vis malaria and other health risks: self-medicate, ignore, and pray. Living on the margins of society mitigates the socioeconomic impacts of COVID-19, as containment measures are not applied to these socially invisible populations. Whereas the urban poor are severely hit by the pandemic, this hidden population benefits from high gold prices, an outdoors lifestyle, and traditional resourcefulness in dealing with a life full of risks