Structural and political determinants of health among Syrian refugee young adults in the Bekaa, Lebanon: a prospective cohort study of the impact of security raids on perceived discrimination and well-being

Abstract

Objectives In this work, which forms part of a larger study of a longitudinal intervention focused on empowering Community Mental Health Workers in a humanitarian context, we examine changes in and correlates of well-being of refugees as a result of discriminatory practices by the State, with comparisons motivated by a mechanistic model of well-being.Design This cohort study examines well-being at a single follow-up time as predicted by baseline characteristics in response to a changing social conditions including security raids on our participants; the parent interventional randomised trial focuses on a population of youth in a refugee context, but the present work precedes the main intervention period.Setting Refugee populations are among the most vulnerable globally, and the total refugee population is growing dramatically. As of 2022, more than 12 million Syrians have been forcibly displaced with 6.5 million of them classified as refugees. In Lebanon specifically, tension between refugees and the host government has recently risen most evident through security raids, threatening the well-being of already displaced persons.Participants The study recruited Syrian refugee young adults (18–24 years) who have completed at least high school; additional inclusion criteria included: living in the catchment areas within the Bekaa at the time of screening, having been involved in non-governmental organisations (NGOs) or service to their community and having expressed motivation to serve their community. Applicants who fit the inclusion criteria were further screened by a psychiatrist to ensure that they were not experiencing acute distress at the time of recruitment (February 2023–March 2023). Recruitment occurred through posters on social media platforms of Multi-Aid Programmes. Ninety-two young adults were randomly assigned to one of the three randomised controlled trial arms.Interventions None at the time of the study.Primary and secondary outcome measures Primary outcomes were measures of well-being at baseline and follow-up.Results We find that the ability of NGOs to work with refugee populations may be threatened in important ways by government security raids, with possibly the most vulnerable subjects participating at baseline being less likely to respond during the raids. Moreover, we discuss the paradoxical short-term effects of the isolation induced by the raids, where daily experience of stigmatising events actually decreased during this period.Conclusions These results highlight the challenging environment in which refugees in Lebanon live in, and raise important questions about long-term solutions to the crisis.Trial registration number NCT05265611; LBCTR2023015206.