This study investigates the relationship between legal residency status and the health of Syrian refugees in Lebanon, which hosts the world’s highest per capita refugee population, with over 1.5 million Syrian refugees, including approximately 815,000 registered with UNHCR. The Lebanese government mandates that Syrian nationals enter legally and renew their residency permits annually, a process that entails significant costs and paperwork.
This analysis utilizes data from two multi-wave longitudinal phone surveys conducted in 2022. The first survey, “Changing Vulnerabilities and COVID Adherence” (CVC study), included Syrian refugees aged 50 and older from various regions of Lebanon who received assistance from the Norwegian Refugee Council between 2017 and 2020. The second survey, “Community Action for Equity in Pandemic Preparedness and Control” (CAEP study), included all adult Syrian refugees aged 18 and older residing in Sin-El-Fil, a suburb of Beirut. The exposure variable was the self-reported possession of a legal residency permit in Lebanon, while the health outcomes measured were mental health status, COVID-19 vaccine uptake, and access to needed healthcare services. Separate logistic regression models were used to examine the association between lacking a legal residency permit and each health outcome, adjusting for age, length of stay in Lebanon, education, employment, wealth index, and receipt of assistance.
Main empirical results:
- Nearly all Syrian refugees reported not holding a legal residency permit. In the first sample of 3,357 participants, 85 percent lacked a legal residency permit, while in the second sample of 730 participants, 79 percent lacked one. Lower socioeconomic status and unemployment were more common among those without legal residency, and men were more likely than women to possess legal residency documentation.
- The lack of a legal residency permit was associated with poorer mental health, likely due to increased sense of insecurity, fear of arrest, detention, deportation, and protection risks, as well as the inability to gain formal employment, leading to financial instability and higher risks of exploitation in the informal sector.
- COVID-19 vaccine uptake was lower among those lacking a legal residency permit, despite vaccines being available free of charge to all residents of Lebanon. Fear of detention or deportation and mistrust of the Lebanese government likely contributed to lower uptake rates among Syrian refugees.
- Lacking a legal residency permit decreased the odds of accessing primary healthcare. This trend was observed in both studies, although it was not statistically significant in the CVC study, possibly due to limited study power. Movement restrictions and fear of repercussions at healthcare facilities, which require identification, may prevent refugees from seeking necessary care.
The results indicate that most Syrian refugees in Lebanon lack legal residency permits, adversely affecting their mental health, access to primary healthcare, and receipt of COVID-19 vaccinations during the pandemic. These findings underscore the urgent need for initiatives to facilitate access to legal documentation for refugees and to ensure equitable access to vaccination campaigns, as well as health and mental health services, for this vulnerable population.