Healthcare utilization among urbanized syrian refugees in Jordan: exploring access, needs, barriers and adaptation strategies

Abstract

Since the Syria crisis started, about one quarter of its population have fled to the neighbouring countries, mainly Turkey, Lebanon, and Jordan. Jordan has hosted more than 12% of the refugees from Syria and numbers are increasing. This increase in migration and refugee either due to long-lasting conflicts or ongoing economic crises has made the refugee movement a concern at global level and prompted hosting countries, as well as humanitarian organisations to respond to this alarming crisis. The study explores the access to and utilization of healthcare services among urbanized Syrian refugees in Jordan. Using the mixed method design, this phenomenon was studied among two refugees’ communities urbanized in central governorates. The study settings were selected conveniently, the participant sample for the quantitative part were randomly chosen while sampling was purposive for the qualitative part. A cross-sectional survey among 383 refugees aged 18 – 75 years old was conducted between November 2019 and January 2020. Participants answers were entered directly using on tablet using KOBO tool. Concurrently, in-depth semi-structured interviews were conducted among a subset of twenty participants. Data were analyzed with descriptive and thematic analysis, while quantitative data were analyzed with descriptive statistical analysis, qualitative data were transcribed and analysed using Braun and Clarke thematic analysis approach. Both dataset analyses identified a set of fragmented needs in relation to health needs and help seeking, such as emergency care, psychological-mental support needs, rehabilitation, disability, elderly care, childcare, women's care, and chronic disease care. The analysis of seeking behaviour found that primary awareness, beliefs, access policy, financial capacities and practice are the main drivers for health-seeking behaviours. The standard barriers quantified through quantitative assessment were cost, awareness, quality of services and discrimination. The qualitative assessment detected the same access barriers in addition to access policy, service availability, waiting time and distance. The standard adaptation strategies quantified by quantitative assessment were a theme in qualitative findings. These include seeking free services, delaying seeking care, reducing, or stopping the use of medication, using alternative medicine, borrowing money or use saving, and moving onward. However, the qualitative assessment also detected adaptation strategies included self-medication, collection donation, illegal labour, and prioritising between health and other livelihood needs. Four themes found under the impact of adaptation strategies include psychological and mental health consequences, compromise of other livelihood needs, deterioration of health status and legal consequences. The perceived needs, seeking behaviours, and experienced barriers with healthcare interacts with each other. Another contextual set-up, inform Syrian refugees’ healthcare utilization behaviours, drive adaptation strategies and result in a negative impact on refugee health status, but also may extend to another means of livelihood. The study’s findings may be relevant to the global responses to the refugee crisis. The hosting countries can use it to develop a balanced response regarding health interventions and policies to avoid negative consequences on refugees and host communities. Additionally, the third countries that received the secondary movement of refugees may use these findings to enhance support to host countries for better accommodation for refugees' needs and avoid unnecessary subsequent movements that pose additional global health and other risks.