The Institute for Global Health and Development
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Item Integrating healthcare financing for refugees into national health systems: findings from a rapid review of the literature(Elsevier, 2025-10-16) Bertone, Maria Paola; Palmer, Natasha; Witter, SophieAs the number of refugees increases and displacement becomes protracted, providing equitable healthcare in sustainable ways is increasingly challenging. The Global Compact for Refugees calls for greater inclusion of refugees in national health systems. However, evidence is limited on the most suitable approaches to achieve integration, including from a health financing perspective. This study reviewed normative and empirical literatures on health financing for refugees, reflecting on existing arrangements, and their level of integration with national health systems. A total of 52 documents were reviewed following a purposeful search of grey and published literature. Data were analysed according to core health financing sub-functions as defined by the WHO, specifically reflecting on pathways and approaches to integration for each. The analysis found that challenges remains in relation to funding for refugee healthcare, and areas of focus concern fair burden-sharing and engagement of development funders. Fund pooling proves to be a potential entry point for integration to reduce fragmentation in health financing through use of existing mechanisms (budgets or social health insurance schemes), despite challenges highlighted in the empirical literature. Fewer documents look at purchasing and benefit packages, and they highlight the importance of tailoring those to the specific needs of refugees. In relation to equity and efficiency, integration is often assumed to lead to improvements, but evidence is limited and issues related to the underlying weaknesses of the national health system might hamper the benefits of integration. Overall, the review findings support the development of hypotheses as to how best support health financing integration processes, and highlight areas for further research.Item Exploring refugees' experience of accessing dental health services in host countries: a scoping review(Frontiers Media S.A., 2024-03-12) Asfari, Elaf; Rodriguez, Andrea; Dakessian, Arek; Yuan, SiyangIntroduction: Refugees often face worse oral health outcomes, such as periodontal diseases and dental caries in host countries due to barriers including language and cultural differences, institutional discrimination, and restricted use of dental health services. This scoping review aims to map and summarise the available studies on refugees’ experience of accessing dental health services in the host countries, to identify the main characteristics of the dental health services that refugees access and to explore the barriers and enablers to navigate the dental health service system in their host countries. Methods: The Joanna Briggs Institute (JBI) framework was adopted. PubMed, Scopus, Assia, CINAHL and Social Services Abstract were searched. A search strategy was developed using Medical Subject Headings (MeSH) terms and a combination of search operators and syntax used in MEDLINE were adopted for the remaining databases. Data were synthesised using thematic analysis. Results: Fourteen articles were included. Most studies used qualitative methods and Australia seemed to be the country with the highest number of publications surrounding this topic. The included studies showed that refugees frequently encountered substantial obstacles when attempting to access dental services in host countries. Numerous barriers such as language barriers, cultural differences, and lack of health insurance or financial support hindered refugees' ability to access these services. Additionally, many refugees possessed limited knowledge of the dental care system in their new country. As a result of untreated dental problems, refugees suffered from pain and other health complications. Discussion: This scoping review explored the challenges refugees have experienced in accessing dental health services in host countries, which included the key barriers such as affordability, accessibility, accommodation, availability, awareness, and acceptability. The scarcity of relevant research highlighted the need for a more comprehensive understanding of refugees’ experiences accessing dental health services in host countries. Limited data were identified regarding evidence focusing on the characteristics of dental services accessed by refugees in host countries.Item Participation by conflict-affected and forcibly displaced communities in humanitarian healthcare responses: A systematic review(Elsevier, 2020-12-09) Rass, Ella; Lokot, Michelle; Brown, Felicity L; Fuhr, Daniela C; Asmar, Michèle Kosremelli; Smith, James; McKee, Martin; Bou-Orm, Ibrahim; Yeretzian, Joumana Stephan; Roberts, BayardBackground Community participation in health responses in humanitarian crises is increasingly promoted by humanitarian actors to support adoption of measures that are relevant and effective to local needs. Our aim was to understand the role of community participation in humanitarian health responses for conflict-affected populations (including forcibly displaced populations) in low- and middle-income countries and the barriers and facilitators to community participation in healthcare responses. Methods Using a systematic review methodology, following the PRISMA protocol, we searched four bibliographic databases for publications reporting peer-reviewed primary research. Studies were selected if they reported how conflict-affected populations were involved in healthcare responses in low- and middle-income settings, and associated changes in healthcare responses or health outcomes. We applied descriptive thematic synthesis and assessed study quality using study design-specific appraisal tools. Results Of 18,247 records identified through the database searching, 18 studies met our inclusion criteria. Various types of community participation were observed, with participation mostly involved in implementing interventions rather than framing problems or designing solutions. Most studies on community participation focused on changes in health services (access, utilisation, quality), community acceptability and awareness, and ownership and sustainability. Key barriers and facilitators to community participation included political will at national and local level, ongoing armed conflict, financial and economic factors, socio-cultural dynamics of communities, design of humanitarian responses, health system factors, and health knowledge and beliefs. Included studies were of mixed quality and the overall strength of evidence was weak. More generally there was limited critical engagement with concepts of participation. Conclusion This review highlights the need for more research on more meaningful community participation in healthcare responses in conflict-affected communities, particularly in framing problems and creating solutions. More robust research is also required linking community participation with longer-term individual and health system outcomes, and that critically engages in constructs of community participation.Item Social determinants and mental health needs of Palestine refugees and UNRWA responses in Gaza during the COVID-19 pandemic: a qualitative assessment(BioMed Central, 2022-12-08) Jamal, Zeina; ElKhatib, Zoheir; AlBaik, Shatha; Horino, Masako; Waleed, Mohammed; Fawaz, Farah; Loffreda, Giulia; Seita, Akihiro; Witter, Sophie; Diaconu, KarinBackground: Due to pre-existing difficulties, refugees are especially susceptible to the negative effects of the pandemic; nonetheless, the pandemic’s effect on this group is still unclear. The purpose of this study was to determine the effects of the COVID-19 pandemic on the mental health of Palestine refugees in Gaza by identifying the role of social determinants. During the pandemic, the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) enacted a number of policies and measures. The purpose of this research was to assess their efficacy and acceptability. Methods: This qualitative study took place between August and November 2020. Twenty-nine key-informant interviews were conducted remotely with UNRWA Headquarters, field and clinical staff in Gaza and with community members, aged ≥18 years and residing in Rafah and Jabalia camps. We sought informed consent verbally or via email. Data was coded based on the framework for social determinants of mental health. Results: Interview results indicated that the relationship might be unidirectional, with COVID-19 causing the degradation of living conditions and vice versa, with living conditions exacerbating the COVID-19 situation by facilitating virus transmission. In other instances, the association between mental health determinants and COVID-19 might be bidirectional. In terms of experiencing violence and anxieties, women, children, and daily-paid employees were significantly more disadvantaged than other groups in the community. UNRWA modified its service delivery techniques in order to continue providing essential services. In general, UNRWA’s strategies throughout the pandemic were deemed beneficial, but insufficient to meet the needs of Gazans. Conclusion: The pandemic highlights the need to go beyond disease treatment and prevention to address social determinants to improve refugees’ health and reduce their susceptibility to future shocks. UNRWA has rapidly implemented telemedicine and mental telehealth services, making it imperative to assess the efficacy of these novel approaches to provide care at a distance. A long-term option may be to employ a hybrid strategy, which combines online and in-person therapy.Item The determinants of the quality of clinical management among diabetic and hypertensive patients in a context of fragility: A cross-sectional survey from Lebanon(Frontiers Media S.A., 2022-07-25) Saleh, Shadi; Muhieddine, Dina; Hamadeh, Randa; Dimassi, Hani; Diaconu, Karin; Arakelyan, Stella; Ager, Alastair; Alameddine, MohamadIntroduction: The management of NCDs is a growing challenge in low- and middle-income settings with the increasing prevalence and the associated demands that such conditions make on health systems. Fragile settings both exacerbate the risk of NCDs and undermine systems capacity. Lebanon is a setting where strategies to address rising NCDs burden have faced particularly acute contextual challenges. Methods: We conducted a cross-sectional survey with patients accessing non-communicable disease across 11 primary care centers within the Greater Beirut and Beqaa areas. Response were received from 1,700 patients. We generated a Clinical Management Index Score as a measure of quality of care, and scores related to a range of socio-demographic characteristics and other context specific variables. Results: Significantly higher clinical management index scores (better quality of care) were associated with patients living in the semi-urban/rural context of Beqaa (compared to Greater Beirut), having health insurance coverage, aged above 60, having high levels of educational attainment, and making partial or full payment for their treatment. Relatively lower index scores (poorer quality of care) were associated with Syrian nationality (compared to Lebanese) and with patients suffering from diabetes or hypertension (compared to comorbid patients). Conclusion: The study identified a wide margin for improving quality of NCDs care in fragile contexts with particular gaps identified in referral to ophthalmology, accessing all prescribed medication and receiving counseling for smoking cessation. Additionally, findings indicate a number of predictors of comparatively poor quality of care that warrant attention, notably with regard to Syrian nationality/legal status, lack of health coverage, seeking free health provision and lower educational attachment. Although these are all relevant risk factors, the findings call on donor agencies, NGOs and provider institutions to design targeted programs and activities that especially ensure equitable delivery of services to diabetic and hypertensive patients with compounded vulnerability as a result of a number of these factors.Item Refugees, political bounding and the pandemic: Material effects and experiences of categorisations amongst refugees in Scotland(Routledge, 2022-04-25) Burns, Nicola; Mulvey, Gareth; Piacentini, Teresa; Vidal, Nicole L.Scholars are increasingly interested in and concerned with both the way various migrant populations are categorised, and the lived impacts of that categorisation. In this article, we examine how categorisation was experienced by people at various stages of the refugee journey during the biggest public health crisis for generations. We argue, using original interview data, that the way refugees are categorised, or politically bound, has material impacts on the way they experience their lives, and that this was evident in extremis during the Covid-19 lockdown in Scotland. As populations attempted to traverse public health messaging, this is shown to interact with longstanding state proclivities to control, marginalise and stratify. Consequently, how people experienced and managed the request to ‘stay home and save lives’ varied markedly by where they were in their refugee journey and how they arrived in the UK.Item Towards a typology of social protection for migrants and refugees in Latin America during the COVID-19 pandemic(Springer, 2021-11-16) Vera Espinoza, Marcia; Prieto Rosas, Victoria; Zapata, Gisela P.; Gandini, Luciana; Fernández de la Reguera, Alethia; Herrera, Gioconda; López Villami, Stéphanie; Zamora Gómez, Cristina María; Blouin, Cécile; Montiel, Camila; Cabezas Gálvez, Gabriela; Palla, IreneThe COVID-19 health crisis has put to the test Latin America’s already precarious social protection systems. This paper comparatively examines what type of social protection has been provided, by whom, and to what extent migrant and refugee populations have been included in these programmes in seven countries of the region during the COVID-19 pandemic, between March and December 2020. We develop a typology of models of social protection highlighting the assemblages of actors, different modes of protection and the emerging migrants’ subjectification in Brazil, Chile, Colombia, Ecuador, Mexico, Peru, and Uruguay in relation to Non-Contributory Social Transfer (NCST) programmes and other actions undertaken by state and non-state actors. The analysis is based on 85 semi-structured interviews with representatives of national and local governments, International Organisations, Civil Society Organisations, and migrant-led organisations across 16 cities, and a systematic review of regulatory frameworks in the country-case studies. The proposed typology shows broad heterogeneity and complexity regarding different degrees of inclusion of migrant and refugee populations, particularly in pre-existing and new NCST programmes. These actions are furthering notions of migrant protection that are contingent and crisis-driven, imposing temporal limitations that often selectively exclude migrants based on legal status. It also brings to the fore the path-dependent nature of policies and practices of exclusion/inclusion in the region, which impact on migrants’ effective access to social and economic rights, while shaping the broader dynamics of migration governance in the region.Item Theorizing refugeedom: Becoming young political subjects in Beirut(Springer, 2020-05-05) Riga, Liliana; Langer, Johannes; Dakessian, ArekRefugees can be formed as “subjects” as they navigate forced displacement in countries that are not their own. In particular, everyday life as the politicized Other, and as humanitarianism’s depoliticized beneficiary, can constitute them as political subjects. Understanding these produced subjects and subjectivities leads us to conceive of forced displacement – or “refugeedom” – as a human condition or experience of political (sub)alterity, within which inhere distinctive subjectivations and subjectivities. Drawing on fieldwork in Beirut, Lebanon, we use young Syrian and Iraqi refugees’ experiences with everyday racism, violent bullying and racialized discrimination as heuristic lenses with which to see displacement’s political subjects and subjectivities. We argue that the young refugees emerge as both political and moral subjects through core and defining struggles within – and against – these politicizing constraints. We interpret their struggles as ambivalently and dynamically situated within humanitarianism’s and racism’s subjections and subjectivities. Yet we also found that occasionally the young refugees could eclipse these produced subjectivities to claim repoliticized subjecthoods distinct from those of humanitarianism and outside displacement’s normal politics. We interpret these in Rancièrian terms as “political subjectivation.” Abstracting our findings, we offer a simple theoretical architecture of refugeedom’s subjectivations, subjects, and subjectivities as comprising humanitarianism’s rights-bearing or juridical subject; the vulnerable and resilient, innocent and suffering subject; and the Othered or racialized subject, formed through the exclusions of displacement’s politicized spaces. But we also conceive refugeedom as a space of values, and so the ground on which moral meaning and significance attach to agency and subjectivity.Item Short‐ and longer‐term impacts of Child Friendly Space Interventions in Rwamwanja Refugee Settlement, Uganda(Wiley, 2019-05-20) Metzler, Janna; Diaconu, Karin; Hermosilla, Sabrina; Kaijuka, Robert; Ebulu, George; Savage, Kevin; Ager, AlastairBackground The establishment of Child Friendly Spaces (CFSs) has become a widespread intervention targeting protection and support for displaced children in humanitarian contexts. There is a lack of evidence of impact of these interventions with respect to both short‐term outcomes and longer‐term developmental trajectories.Item The role of a trauma-sensitive football group in the recovery of survivors of torture(International Rehabilitation Council for Torture Victims, 2019-05-22) Horn, Rebecca; Ewart-Biggs, Robin; Hudson, Freddie; Berilgen, Selcuk; Ironside, Jack; Prodromou, AnthonyIntroduction: Whilst there is some preliminary evidence for the benefits of sports-related interventions for survivors of torture, there remains a need to understand better how sport and exercise can contribute to the rehabilitation of torture survivors. Specifically, this paper aims to: 1) explore the ways in which a football group contributed to the wellbeing of participants; and 2) suggest characteristics of the football group which could potentially contribute to its effectiveness. Method: We undertook an exploratory mixed methods study with participants and trainers of a joint programme delivered by Arsenal Football Club (London) and Freedom from Torture. We conducted individual and group discussions plus participatory ranking activities which led to the development of an initial programme model. This model was subsequently further developed through a variety of data collection methods . Results: Six potential outcomes of involvement in the football group were identified, some of which were inter-related: relationships; sense of belonging; hope for the future; emotion management; enjoyment; and improved physical health. In addition, the process highlighted factors contributing to the effectiveness of the football group: sense of safety; therapeutic aims; similar participants; partnership approach; staff characteristics; other opportunities; consistency. Conclusions: Our exploratory study suggests potential benefits from the programme that would require validation through a case-control study plus follow-up of participants. Nevertheless, we offer a model of understanding and some recommendations that can be a starting point for similar programmes and academic research in the area.