R Habib Health of Palestinian refugees in Lebanon
Post on 12-Sep-2021
1 Views
Preview:
Transcript
Health of Palestinian Refugees in Camps and Gatherings in LebanonCamps and Gatherings in Lebanon
As part of a Larger study:As part of a Larger study:
UNRWA‐AUB Socio‐Economic Survey of Palestinian Refugees in Lebanonof Palestinian Refugees in Lebanon
Ri R H bib PhD MPH MOHSRima R. Habib, PhD, MPH, MOHSAssociate ProfessorFaculty of Health SciencesAmerican University of BeirutAmerican University of Beirutrima.habib@aub.edu.lb
1
Multidisciplinary teamMultidisciplinary teamA team of investigators at AUB including:
Economists : Dr. Jad Chaaban
Dr. Nisrine SaltiDr. Nisrine Salti
Public Health : Dr. Rima Habib
Nutrition experts : Dr. Hala Ghattas
Dr. Nadine Sahyoun
Social scientists : Dr. Sari Hanafi2
Purpose of the SurveyPurpose of the Survey
Profile the socio‐economic conditions and evaluate incidence of poverty among Palestine Refugees
Devise poverty reduction strategy andDevise poverty reduction strategy and optimize poverty targeting programs
Develop policy recommendations based on data gathered
3Rima R. Habib, 23 June 2011
IndicatorsIndicators
FoodHealth
H i Food Security
Housing
ASSETS
EconomicEd i
ASSETS
Education
Social INCOMEEXPENDITURE
4
ExclusionRima R. Habib, 23 June 2011
Study designStudy design
Nationally representative household surveyNationally representative household survey
Face‐to‐face interviews
l d l 20 0Late July and early August 2010
60 UNRWA social workers, trained and supervised by a working team at the American University of Beirut
Households in camps as well as in gatherings were interviewed, in a total of 32 localities,
5Rima R. Habib, 23 June 2011
Sampling2626 HH
C l bTyre
(552)
North
(601)
Central Lebanon Area
(593)
Bekaa
(262)
Saida
(618)
428 camps 355 camps 231 camps 113 camps 363 camps
Rashidieh, Beddawi, Nahr Debayeh, Mar Wavel Mia mia, ,Shemali, Buss
Beddawi, NahrElbared
y ,elias, Shatila, Burh Brajneh
Elhelweh
124 gatherings 246 gatherings 362 gatherings 149 gatherings 255 gatherings
Chabriha, jal El Nahr, Qasmeyeh, shemali
Zahriyeh, El‐Mina, Jabal Bedawi,
Haret Hriek, Mrayjeh, Burj Brajneh village,
Bar elias, jalala, taalbaya
Taameer, villat, old town, dalla, hay
6
surr, Masaken, Machouk
Jabal Bedawi, Bedawi village0 Jnah, Sabra and shatila,
Ard Jalloul, Tareeqjdeedeh, Aramoun, Nameh, Haret Nameh
taalbaya, saadnayel
zuhour, dakerman, haj hafez, hay njasa, al barrad, wadi zeinah
Results of the Survey
7Rima R. Habib, 23 June 2011
Population demographicsPopulation demographicsOf the 425,000 refugees registered with UNRWA since 1948,
l 260 000 280 000 l id i L bonly 260,000‐280,000 currently reside in Lebanon– A Quarter live in Tyre, Saida and Beirut areas
– One fifth live in the NorthOne fifth live in the North
– 4% Live in the Bekaa.
The Palestine refugee population is young, with an average age of 30 years, and half the population younger than 25 years
53% of refugees are women53% of refugees are women
The average household size is 4.5 members (compared to 4.2 for Lebanese households)
8Rima R. Habib, 23 June 2011
Livelihoods and educationLivelihoods and education
Many Palestinian workers are discouraged fromMany Palestinian workers are discouraged from working: – 56% of refugees are jobless56% of refugees are jobless
– only 37% of the working age population is employed
Two thirds of Palestinians above the age of 15 doTwo thirds of Palestinians above the age of 15 do not have Brevet– compared to a Lebanese rate of 50%compared to a Lebanese rate of 50%
Only 50% of youths in Secondary school age (16‐18 years old) are enrolled in education18 years old) are enrolled in education
9Rima R. Habib, 23 June 2011
Health
10Rima R. Habib, 23 June 2011
Health indicatorsHealth indicators
Chronic illnesses and functional DisabilitiesChronic illnesses and functional DisabilitiesPersist for remainder of people’s lifecycleOngoing costs for treatmentg gConcentrated among most vulnerable populations (conflict, poverty, unsafe environments)
Acute illnessesUnpleasant short term consequencesSubstantial medical bills
Psychological problems
11Rima R. Habib, 23 June 2011
AGE < 20 yrs
20 – 55 yrs
> 55 yrs
Total Palestinian
Total Lebanese*
Prevalence of chronic illness % % % % %
Yes 10.07 32.94 83.32 31.1 17.4
No 89 79 67 06 16 68 68 8 82 6No 89.79 67.06 16.68 68.8 82.6
Prevalence of functional disability
Yes 2.2 4.64 9.63 4.4 2.0
No 97.8 95.36 90.37 95.6 98.0
Prevalence of acute illness in the pas 6 months
Yes 23.16 22.14 36.69 24.5 ‐
No 76.84 77.86 63.23 75.4 ‐
Prevalence of psychologicalPrevalence of psychological problems in the past 12 months
Yes 8.10 26.57 35.91 20.65 ‐
N 91 05 73 10 63 56 78 78No 91.05 73.10 63.56 78.78 ‐
12Rima R. Habib, 23 June 2011
Chronic Illness ‐ TypeChronic Illness TypeType of chronic illness %
Hypertension 32.32Hypertension 32.32
Back Pain 9.26
Asthma 8.50
Diabetes 8.31
Rheumatism 5.63
Heart Problems 3.61
Epilepsy 2.62
Other* 29 63Other 29.63
*Other chronic illness include cholesterol, chest pains, heart arrest, stroke, anemia, prostate, cancer, osteoporosis, kidney problems, Thalessemia, autism, down’s syndrome, schizophrenia, mental madness
13Rima R. Habib, 23 June 2011
Functional Disability ‐ TypeFunctional Disability TypeType of Functional Disability %
Disability of extremities – excluding paralysis and amputations 30 22Disability of extremities excluding paralysis and amputations 30.22
Paralysis 14.73
Blindness 8.91
Deafness 8.25
Amputation of extremities 8.78
Inability to speak 2.84
Other 26.04
About 1 in 4 extreme poor households have a disability case, whereas only 1 in 7 non‐extremepoor households do
14Rima R. Habib, 23 June 2011
Acute Illness ‐ TypeAcute Illness TypeType of Acute illness %
Cold/flu 19.41Cold/flu 19.41
Respiratory 17.24
Gastrointestinal 18.59
Musculoskeletal 9.26
Urinary/Reproductive 5.98
Other 29.53
Most common types of illnesses reported were /
yp pcold/flu and other respiratory problems
No difference between extreme poor households and
15
No difference between extreme poor households and non‐extreme poor households
Rima R. Habib, 23 June 2011
Health indicators by AreaHealth indicators by Area
16Rima R. Habib, 23 June 2011
North Central Lebanon Area
Saida Tyre Bekaa
% within region
% across Lebanon
% within region
% across Lebanon
% within region
% across Lebanon
% within region
% across Lebanon
% within region
% across Lebanon
Chronicillness
24.4 15.6 35.5 25.1 32.4 27.9 31.3 27.7 30.8 3.8illness
Disability 3.2 14.5 5.5 27.2 5.0 30.3 3.8 24.3 4.3 3.7Acute illness
19.4 15.9 32.5 29.1 23.2 25.3 20.2 22.5 46.0 7.2
Psychol‐ogicalproblems
19.3 18.5 34.6 36.6 13.9 17.6 16.3 21.7 31.0 5.7
Chronic illnesses and psychological problems were most frequently reported in the Central Area
Acute illnesses were most frequently reported in Bekaa
Camps and gatherings in the North reported the lowest rates of illness compared to the other regionsrates of illness compared to the other regions
17Rima R. Habib, 23 June 2011
Cost and Expenditure on Health
IndicatorIndicator
Costs incurred in the past 6 months from:– Hospital visits– Acute illness Continues doctor visits and medications for– Continues doctor visits and medications for chronic illness
– Continues doctor visits and medications for functional disabilities
18Rima R. Habib, 23 June 2011
Household payment (in USD) for illness Mean (in USD)
Hospital visit in past 6 months 614
Non‐chronic illness in past 6 months 164
Regular doctor visits or medication for chronic illness 137Regular doctor visits or medication for chronic illness 137
Regular doctor visits or medication for disability 252
Source of financial contributions to Health sourcesSource of financial contributions to Health sources varied from friends, family and organizationsOrganizations (main source being UNRWA) were the primary benefactors assisting those in need
Helped in hospital payments 75% of the timeH l d ith t ill t f 61% fHelped with acute illness payments of 61% of casesHelped with doctor and medical payments of 71% of chronic casesof chronic cases
19Rima R. Habib, 23 June 2011
Health Expenditure/MonthMean (USD)
Share of Health Expenditure from Total Expenditure (%)( ) p ( )
Prevalence of Chronic Illness
Yes 139.4 14.7
N 88 5 6 2No 88.5 6.2
Prevalence of disability
Yes 168.4 15.2
No 125.1 10.9
Prevalence of acute illness
Yes 141 4 12.4Yes 141.4 12.4
No 116.6 10.4
Prevalence of psychological problems
Yes 162.5 13.6
No 106.8 10.1
Households with an illness spend a higher proportion ofHouseholds with an illness spend a higher proportion of total expenditure on health than those without illness
20Rima R. Habib, 23 June 2011
Health ExpenditureHealth Expenditure
On average Palestinian refugees spend anOn average, Palestinian refugees spend an average of 12% of their total expenditure on health ($132)health ($132)
– Lowest in the North: 6%
– Highest in Tyre: 14%
Lebanese population spend an average of 14%of their total expenditure on health ($343) p ($ )(Ammar, 2003)
21Rima R. Habib, 23 June 2011
Health Services available to Palestinian Refugees
Indicator:Indicator:
Where was the health care service received in h f ill i h 6the event of an acute illness in the past 6 months
22Rima R. Habib, 23 June 2011
Health services for Palestinian fRefugees
Palestinians receive health services from a wide variety of care providersUNRWA provides primary health care services (secondary and limited tertiary services) to refugees by way of 29 health centers located in areas with high densities of Palestinian refugees– Walk‐in general consultations– Maternal and child health care services– Treatment of chronic diseases– Provision of medications– Specialists, dental, and laboratory services available in some
centers • UNRWA clinics were the most frequently visited for cases of
acute illnesses (32%)
23Rima R. Habib, 23 June 2011
H i Q liHousing Quality
24Rima R. Habib, 23 June 2011
Housing QualityHousing Quality
Well established evidence on the negative impact of g ppoor housing conditions on health
Bonnefoy et al. 2003
WHO 2004
Habib et al. 2009
Harpham 2009
25Rima R. Habib, 23 June 2011
Results on Housing ConditionsResults on Housing Conditions
40% of households have water leaking through roof or40% of households have water leaking through roof or walls
8% of households live in shelters where the roof and/or walls are made from corrugated iron, wood or asbestos
9% of households have no water heater or fridge
8% of the studied population live in overcrowded conditions (more than three people live in one room)
– Surface area of camps has not increased with the population, leading to cramped shantytowns,
i t l diti d tpoor environmental conditions and exposure to health hazards
26Rima R. Habib, 23 June 2011
Linking Housing and Health IndicatorsLinking Housing and Health Indicators
Households with more than 3 people per room reported p p p phigher rates of acute illness and functional disability
Households that used kerosene fuel for cooking reported higher rates of disability, acute illness, and psychological problems
Households living in homes built of stone experienced theHouseholds living in homes built of stone experienced the lowest prevalence of illness
Households with dampness and leaks reported a higher prevalence of chronic and acute illnesses
Poor housing is concentrated in the South, particularly R hidi h d Ai l H l h d th iRashidiyeh and Ain el Helweh camps and gatherings throughout Tyre region
27Rima R. Habib, 23 June 2011
In summaryIn summaryA third of the Palestine refugee population was estimated to have chronic illnesshave chronic illness
4% of the Palestine refugee population was estimated to have a functional disability; Hypertension is particularly y; yp p yprevalent
A Quarter of refugee households had an acute illness in the past six months, often leading to additional expenses and periods out of work
A third of acute illness cases had the flu or common cold or otherA third of acute illness cases had the flu or common cold or other respiratory tract illnesses
21% of the Palestinian population experienced depression, i dianxiety or distress
28Rima R. Habib, 23 June 2011
In summaryIn summary
The Central Lebanon Area reported the highest incidence of chronic and psychological problems
The Bekaa area reported very high incidence of acute illillnesses
29Rima R. Habib, 23 June 2011
In summaryIn summaryHouseholds with poorer housing quality were more likely to report health problems
95% of the population are without insurance p pand most in precarious employment– They are unlikely to receive sick leaves and as such a y ycase of acute illness may push a household into poverty
Costly secondary and tertiary health care
UNRWA is the most frequently used health careUNRWA is the most frequently used health care provider
30Rima R. Habib, 23 June 2011
Policy RecommendationsPolicy Recommendations
Provision of mental health servicesProvision of mental health services
Primary health care ‐ Awareness campaignsF th ti f t itt bl i t– For the prevention of transmittable respiratory diseases and diarrheal illnesses
T ti h lthTertiary health care
Introduce initiatives for improving housing quality
31Rima R. Habib, 23 June 2011
THANK YOU
32Rima R. Habib, 23 June 2011
ReferencesReferences
B f X R t l 2003 H i d h lth i E li i lt fBonnefoy, X.R. et al., 2003. Housing and health in Europe: preliminary results of a pan‐European study. American Journal of Public Health, 93(9), 1559‐1563.
Habib, R. et al., 2009. Housing quality and ill health in a disadvantaged urban i P bli H l h 123(2) 174 181community. Public Health, 123(2), 174‐181
Harpham, T., 2009. Urban health in developing countries: what do we know and where do we go? Health & Place, 15(1), 107‐116.
Ugland, O., 2003. Difficult Past, Uncertain Future Fafo‐report 409, FAFO. Available at: http://www.fafo.no/pub/rapp/409/index.htm [Accessed October 30, 2010]
WHO, 2004. Housing and Health Health and environment briefing pamplhet serie, Copenhagen: WHO Regional Office for Europe.: WHO
33Rima R. Habib, 23 June 2011
top related