Syria’s health professionals have been displaced to neighbouring countries including Jordan and Lebanon since the devastating civil war began in 2011. Our mixed-methods research focused on Lebanon, exploring the emerging phenomenon of qualified Syrians carrying out informal healthcare work to meet local needs. We found a diverse workforce practising in the informal sector, predominantly in primary care settings and as volunteers. But interviewees reported living in fear of exposure and experience wage discrimination in comparison with locals. We recommend that the Lebanese government consider limited registration for Syrian healthcare workers — enabling them to deliver services formally to Syrian refugees — and that donors radically expand the scale and scope of their support for education and training initiatives in the region to prevent the generational gap in the Syrian health workforce from growing.
Syria’s health system has been crippled by a conflict in which the targeting of health professionals has contributed to an exodus of qualified healthcare professionals. Those now residing in neighbouring countries face practical, legal and political barriers to working as doctors; registration is possible for a minority but is costly and bureaucratic. Flagship initiatives such as the Jordan Compact offer valuable employment opportunities for Syrian refugees, but focus on low-skilled sectors. While the humanitarian response has continually emphasised economic livelihoods and education for displaced Syrians, it has overlooked necessary links between these domains and health and healthcare, and in particular, the need to invest consistently along the continuum from health worker training through continuous professional development to workforce replenishment.
This briefing summarises findings from an in-depth exploration of the position of qualified Syrian healthcare workers (HCWs), now working either formally or informally, displaced to Lebanon (see Box 1), and offers a series of policy and research recommendations for different stakeholder groups involved in the humanitarian response.
Syrian refugees: distribution and needs
Over the last six years, Lebanon has experienced an unprecedented refugee migration from neighbouring Syria, with 1 million refugees registered as of January 2018. While UN agencies conventionally view this as an urban refugee phenomenon, displaced Syrians are in fact living across urban and peri-urban areas and often some distance from the major centres (such as Beirut, Tripoli and Saida). Many live in informal makeshift dwellings. Three northern governorates now host almost 60% of the entire refugee population in Lebanon; many reside in areas where a majority of the host population were already living below the poverty line. Health needs among Syrian refugee populations are significant: among those in Lebanon, chronic conditions such as cardiovascular disease, hypertension and type II diabetes have been predominant since 2012. These conditions often require long-term management by healthcare professionals with regular clinic visits and medication.
The resulting strain on Lebanese public services is reportedly severe; even without the added pressure, many of these areas have struggled historically to attract qualified health professionals to meet local community demand. Syrian refugees often find it very difficult to afford the care they need in Lebanon’s highly privatised healthcare system and may need to travel long distances to access specialist services. As a result, the primary public healthcare system has become key in responding to refugee health needs, supported by the Lebanese Ministry of Public Health as well as NGO partners and UN agencies. But there remains a large healthcare gap for Syrian refugees, including those without documentation and those who need affordable healthcare. This is where the informal market comes into play.