Health Service Access and Utilization among Syrian Refugees and Affected Host Communities in Lebanon

Emily Lyles, Baptiste Hanquart, Lara Chlela Michael Woodman, LHAS Study Team, Fouad M Fouad Abla Sibai, Shannon Doocy

Journal of Refugee Studies, Volume 31, Issue 1 (2018), Pages 104–130


This paper examines adult health needs, care-seeking behaviors and barriers to health care among Syrian refugees and affected host communities in Lebanon. The analysis is based on a 2015 survey of 1,376 Syrian refugee households and 686 host community households. The authors find that refugees have worse access to health care and medication compared to the host community; the primary barrier to care in both groups was cost. Specifically:

  • A substantial proportion of households, both refugee (89 percent) and host community (94 percent), reported that medical care was needed for an adult household member in the month preceding the survey. Infectious diseases were the main reason for needing medical care followed by chronic conditions, obstetric/gynecological needs and injuries. Just over half of Syrian refugee households had one or more members with a chronic health condition.
  • For households that needed health care for an adult member, 85 percent of host community households and 69 percent of refugee households received care. Cost was the most commonly reported reason for not seeking care.
  • Approximately half of refugees who sought care did so in primary care facilities, followed by private clinics, pharmacies and hospitals, while most host households sought care in private clinics, followed by a much smaller proportion seeking care at primary care facilities, pharmacies and hospitals.
  • Among refugees prescribed medication, 89 per cent were able to obtain all of the prescribed medications (compared to 97 percent for hosts). For refugees unable to obtain medications, the primary reason was that the household could not afford the medication, with a smaller proportion citing that the medication was out of stock at the facility.
  • Average host community household out-of-pocket costs were significantly higher than refugee households for consultation and medication. While lower in absolute terms among refugees, when considering the exceptionally poor financial circumstances of most refugee households, even modest out-of-pocket payments are likely to present a significant financial burden to many households, which in some cases left health care out of reach.
  • Hospitalization of a household member in Lebanon for reasons other than childbirth in the year preceding the survey was significantly lower among refugee households (20 percent) compared to host community households (43 percent). No significant differences were observed between those using private versus public hospitals in either population group.

The authors suggest that strengthening primary health services and educating communities about rational care seeking and home treatment of mild illness may decrease heath costs and reduce the burden on the Lebanese health system. Moreover, health system reform towards universal health care for refugees and vulnerable Lebanese that is supported by the international community could help to ensure integration and provide less costly and more sustainable health services access for refugees.