“The needs have clearly evolved as time has gone on.”: A qualitative study to explore stakeholders’ perspectives on the health needs of Syrian refugees in Greece following the 2016 European Union-Turkey agreement
Tóm tắt
By 2017, more than 500,000 Syrian refugees had passed through Greece seeking safety and asylum. Understanding how their health needs evolved over the refugee crisis in Greece and in relation to changing migration policy, and exploring the challenges involved in delivering their healthcare is timely as non-governmental organizations (NGOs) transition health service provision to the Greek health authorities. We conducted a qualitative study to explore stakeholders’ perspectives on delivering health services to Syrian refugees over the course of the humanitarian response in Greece from 2015 to 2017. Twenty-five in-depth interviews were conducted face-to-face or by Skype with healthcare providers, NGO staff, and organizational and government representatives involved in coordinating and managing healthcare for the Syrian refugee population in Greece. Following informed consent, interviews were audio-recorded or detailed summaries were manually recorded. Data were coded inductively to identify emerging themes. Following the implementation of the European Union-Turkey agreement in 2016, healthcare providers in refugee camps reported a shift from acute physical health issues to mental health disorders, and heightened risks of gender-based violence among Syrian refugees. Key challenges to service delivery included a narrow model of healthcare provision and insufficient referral mechanisms for social support and mental health services. Language and gender differences between refugees and healthcare providers, and a lack of privacy and space in clinics impeded the quality of care. Stakeholders observed deterioration in refugees’ mental health in relation to longer periods spent in the camps. Many also emphasized that services for gender-based violence and mental health should be prioritized. This study provides stakeholders’ perspectives on changes in refugee health needs over the course of the humanitarian response in Greece. With protracted encampment resulting from migration policy, addressing mental health disorders and gender-based violence should be prioritized, including psychosocial training for healthcare providers and strengthening referral mechanisms for specialized care. The findings also emphasize the importance of providing human-centered care and gender concordant services by incorporating female healthcare providers and interpreters into medical teams. Strategic communication and coordination is needed between NGOs and Greek health authorities to facilitate the transition of health service delivery to the Greek healthcare system and to improve access and quality of care for refugees.
Tài liệu tham khảo
United Nations Development Programme, United Nations High Commissioner for Refugees. 3RP. Regional Refugee and Resilience Plan 2016-2017 in Response to the Syria Crisis. 2015. http://www.3rpsyriacrisis.org/wp-content/uploads/2015/12/3RP-Regional-Overview-2016-2017.pdf. Accessed 13 Jul 2017.
United Nations Development Programme, United Nations High Commissioner for Refugees. 3RP Regional Strategic Overview 2017–18 in Response to the Syria Crisis. 2017. http://www.3rpsyriacrisis.org/wp-content/uploads/2016/12/3RP-Regional-Strategic-Overview-2017-18.pdf. Accessed 2 Nov 2017
United Nations High Commissioner for Refugees. Syria regional refugee response: Inter-agency Information Sharing Portal. 2016. http://data.unhcr.org/syrianrefugees/regional.php. Accessed 2 Nov 2017
United Nations High Commissioner for Refugees. Refugees/migrants emergency response - Mediterranean - regional overview. 2017. http://data.unhcr.org/mediterranean/regional.php. Accessed 31 Oct 2016.
United Nations High Commissioner for Refugees. Greece data snapshot (26 Dec.). 2015. https://data2.unhcr.org/en/documents/download/46627. Accessed 15 Jan 2018.
Regulation (EU) No 604/2013 of the European Parliament and of the council of 26 June 2013. Official journal of the European Union. http://eur-lex.europa.eu/legal-content/EN/LSU/?uri=CELEX:32013R0604. Accessed 11 Jan 2018.
European Council. EU-Turkey statement, 18 march 2016. 2016. http://www.consilium.europa.eu/en/press/press-releases/2016/03/18/eu-turkey-statement/. Accessed 2 Nov 2017.
Rygiel K, Baban F, Ilcan S. The Syrian refugee crisis: the EU-Turkey ‘deal and temporary protection. Glob Soc Policy. 2016;16:315–20. https://doi.org/10.1177/1468018116666153.
European Commission. EU-Turkey statement: questions and answers. Brussels; 2016. http://europa.eu/rapid/press-release_MEMO-16-963_en.htm. Accessed 2 Nov 2017.
United Nations High Commissioner for Refugees. Regional Refugee and Migrant Response Plan for Europe January to December 2017. 2016. http://www.unhcr.org/partners/donors/589497d07/2017-regional-refugee-migrant-response-plan-europe-january-december-2017.html. Accessed 4 Nov 2017.
United Nations High Commissioner for Refugees. Greece. Factsheet 1 January - 31 May 2016. 2016. https://data2.unhcr.org/en/documents/download/49602. Accessed 31 Oct 2016.
National Health Operations Center (EKEPY). Health Working Group Meeting, 21/06/2017. 2017. https://data2.unhcr.org/en/documents/download/58793. Accessed 2 Oct 2017.
United Nations High Commissioner for Refugees. Greece Fact Sheet / 1–30 September 2017. 2017. https://data2.unhcr.org/en/documents/download/60346. Accessed 10 Nov 2017.
Doocy S, Lyles E, Hanquart B, Woodman M. Prevalence, care-seeking, and health service utilization for non-communicable diseases among Syrian refugees and host communities in Lebanon. Confl Health. 2016;10:21.
Strong J, Varady C, Chahda N, Doocy S, Burnham G. Health status and health needs of older refugees from Syria in Lebanon. Confl Health. 2015;9:12.
Reese Masterson A, Usta J, Gupta J, Ettinger AS. Assessment of reproductive health and violence against women among displaced Syrians in Lebanon. BMC Womens Health. 2014;14:25. https://doi.org/10.1186/1472-6874-14-25.
Harvey C, Garwood R, El-Masri R. Changing gender roles among refugees in Lebanon. 2013; SEPTEMBER. https://www.oxfam.org/sites/www.oxfam.org/files/rr-shifting-sands-lebanon-syria-refugees-gender-030913-summ-en.pdf. Accessed 2 Nov 2017.
Arsenijević J, Schillberg E, Ponthieu A, Malvisi L, Ahmed WAE, Argenziano S, et al. A crisis of protection and safe passage: violence experienced by migrants/refugees travelling along the western Balkan corridor to northern Europe. Confl Health. 2017;11:6. https://doi.org/10.1186/s13031-017-0107-z.
Jefee-Bahloul H, Barkil-Oteo A, Pless-Mulloli T, Fouad FM. Mental health in the Syrian crisis: beyond immediate relief. Lancet. 2015;386:1531. https://doi.org/10.1016/S0140-6736(15)00482-1.
United Nations High Commissioner for Refugees. Initial assessment report: protection risks for women and girls in the European refugee and migrant crisis. 2015. http://www.unhcr.org/protection/operations/569f8f419/initial-assessment-report-protection-risks-women-girls-european-refugee.html. Accessed 13 Jul 2017.
Priebe S, Giacco D, El-Nagib R. Public health aspects of mental health among migrants and refugees: a review of the evidence on mental health Care for Refugees, asylum seekers and irregular migrants in the WHO European region. Helath Evidence Network Synthesis Report. 2016;27(ISBN-13):978–92. -890-5165-1
Daynes L. The health impacts of the refugee crisis: a medical charity perspective. Clin Med (Northfield Il). 2016;16:437–40.
Pavli A, Maltezou H. Health problems of newly arrived migrants and refugees in Europe. Journal of Travel Medicine. 2017;24:4. https://doi.org/10.1093/jtm/tax016.
Pope C, Ziebland S, Mays N. Qualitative research in health care. Analysing qualitative data. BMJ. 2000;320:114–6. https://doi.org/10.1136/BMJ.320.7227.114.
Kousoulis AA, Ioakeim-Ioannidou M, Economopoulos KP. Access to health for refugees in Greece: lessons in inequalities. Int J Equity Health. 2016;15:122. https://doi.org/10.1186/s12939-016-0409-6.
Hermans MPJ, Kooistra J, Cannegieter SC, Rosendaal FR, Mook-Kanamori DO, Nemeth B. Healthcare and disease burden among refugees in long-stay refugee camps at lesbos. Greece Eur J Epidemiol. 2017;32:851–4. https://doi.org/10.1007/s10654-017-0269-4.
Shortall CK, Glazik R, Sornum A, Pritchard C. On the ferries: the unmet health care needs of transiting refugees in Greece. Int Health. 2017;9:272–80. https://doi.org/10.1093/inthealth/ihx032.
Grove N, Zwi AB. Our health and theirs: forced migration, othering, and public health. Social Science & Medecine. 2006;62:1931–42. https://doi.org/10.1016/J.SOCSCIMED.2005.08.061.
Hassan G, Ventevogel P, Jefee-Bahloul H, Barkil-Oteo A, Kirmayer LJ. Mental health and psychosocial wellbeing of Syrians affected by armed conflict. Epidemiol Psychiatr Sci. 2016;25:129–41. https://doi.org/10.1017/S2045796016000044.
Hunter-Adams H-A, Hunter-Adams J. A qualitative study of language barriers between south African health care providers and cross-border migrants. BMC Health Serv Res. 2017;17:1–9.
Ekmekci PE. Syrian refugees, health and migration legislation in Turkey. J Immigr Minor Health. 2016:1–8. https://doi.org/10.1007/s10903-016-0405-3.
Rowley EA, Burnham GM, Drabe RM. Protracted refugee situations: parallel health systems and planning for the integration of services. J Refug Stud. 2006;19:158–86. https://doi.org/10.1093/jrs/fej019.
Kentikelenis AE, Shriwise A. International organizations and migrant health in Europe. Public Health Rev. 2016;37:19. https://doi.org/10.1186/s40985-016-0033-4.