This is a guest blog by Amelia Reese Masterson, currently a Research Fellow at the Center for Research on Population & Health at the American University of Beirut, and co-author on an article published today in BMC Women’s Health.
As a researcher interviewing displaced Syrian women in Lebanon during the summer of 2012, I heard many stories of war, escape, and above all the shock of life as a refugee. “In Syria it is a fast death; here it is a slow death,” one Syrian woman lamented, comparing the two extremes of hardship she and her family had endured.
The conflict in Syria responsible for this refugee crisis began in March 2011 amidst a harsh government crackdown on protestors and civilians, which has since escalated into a bloody civil war that drags on today. Syrian refugees in Lebanon face daily hazards, not only due to war-related violence, but also threats to health and lack of access to basic health services, including reproductive healthcare.
My colleagues and I conducted a needs assessment, alongside the United Nations Population Fund (UNFPA), to document basic needs and daily struggles, reproductive health issues, and experiences of violence that displaced Syrian women face. I arrived in Lebanon in June 2012 amidst reports of an increasing flow of displaced Syrians and the possibility of violence threatening Lebanon’s own fragile balance.
Since then, the number of Syrian refugees has increased from about 10,000 to almost one million, a staggering addition to a Lebanese population of around four million. Lebanon is now hosting more refugees as a percentage of its population than any other country in the world. As a former aid worker in Syria during the Iraqi refugee crisis, I remain in close contact with Syrian friends who update me on the situation inside Syria. Upon coming to Lebanon, it was sad to realize that Syrians – so recently hosting hundreds of thousands of Iraqi refugees – are now refugees themselves in even greater numbers.
I worked alongside Dr. Jinan Usta, a family health doctor at the American University in Beirut Medical Center, to prepare questionnaires and establish contact with the six primary health clinics and three community centers where our research would take place. As we started interviews in the mountainous border region of northern Lebanon, I noticed that although some Syrian women who elected to participate were nervous at first, many came to us eager to communicate their struggles and identify modes of support. Some even told us that it was a relief to talk with other women about their problems.
During the interview, women spoke of difficult pregnancies and lack of money for OB/GYN services. They spoke of heightened tensions in the home with crowded conditions, lack of activities for children, and cases of intimate partner violence. They also spoke of abuse and violence at the hands of armed men in Syria.
Syrian women reported inadequate access to reproductive health services in Lebanon, particularly antenatal care, delivery services, and care for survivors of sexual violence. The price of delivery services in Lebanon’s highly privatized healthcare system, at around 200 USD, is prohibitive for most Syrians. Though the UN offers registered Syrian refugees support for delivery, many were either unaware of this assistance or unable to make the trip to a supported hospital.
Beyond the direct effects of conflict on health and access to services, we found that women who experienced high stress levels – living in a combat zone or as a refugee – experienced the worst health outcomes. Stress linked experiences of conflict-related violence to reported overall health status, and correlated with certain gynecologic health conditions.
It was not until I collated the survey responses and quotes from focus group discussions at the end of the summer that the enormity of the situation sunk in. These 452 lines of data represented 452 individual women – most with families, children – all struggling to make the most of a life in limbo while wondering if they would ever be able to return to their homes in nearby rural Syria or urban centers such as Homs and Damascus.
The Syrian women I spoke with are facing their displacement with remarkable resilience, at times caring for children and relatives without the support of a husband or a steady income. Some have even gone to work for the first time to support their families. Among the many issues they voiced, the need for reproductive health care and mental health support stood out.
The results of our study, published today in BMC Women’s Health, add to mounting evidence of violence against women in this population, and point to the need for greater attention to the variety of health problems that women confront as a consequence of war and displacement.