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7311MED Social Determinants Of Health

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7311MED Social Determinants Of Health

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7311MED Social Determinants Of Health

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Course Code: 7311MED
University: Griffith University is not sponsored or endorsed by this college or university

Country: Australia


How To Impact Of Poverty And Refugee Status On The Women Has Been Immense?


The Syrian war led to the fleeing of its citizens from a state ridden with conflict. Leaving behind their jobs, social ties and assets and travelling to safer regions as refugee has affected their physical and mental health. Living in a war zone compromises the sense of well being of the citizens and humanitarian crisis faced by Syrians is colossal in magnitude. Devoid of a source of income they are impoverished and forced to rely on humanitarian aid. Social determinants of health are conditions that are prevalent at the time of an individual’s birth, during growth and the quality of a person’s life, employment and conditions during old age (WHO, 2017). The problems of each age -group among the refugees are different. While the children find it difficult to adjust to a life away from home, their developmental years are marred by the uncertainties, the young find it difficult to cope because they have to look for work and earn for their families. Those with disabilities due to war have to struggle hard in their new surroundings.  The elderly often face severe distress due to the trauma of living in a war zone and getting displaced from their homeland. The long and arduous armed conflict had already taken a toll on health. Jordan, Turkey, Lebanon are examples of countries where the refugees are living in temporary camps (UNHCR, 2014-2015). Refugees are often unwelcome in the host countries because their growing numbers strain the economy and the refugees begin to compete with the host country’s citizens for education, employment, medical needs and food. So, their needs are likely to remain unmet and they continue to face hostility in a new environment. The UNHCR supports a program that supports a sustainable healthcare program for the Syrian refugees to meet their requirements in an equitable fashion. Alleviation of poverty through legal employment of the refugee population can help them access healthcare and the resources of the host country will be under lesser strain. In a study on Syrian refugees, the most common ailments that the refugees suffered from included, acute infectious diseases, neurological problems and chronic gastrointestinal problems. Musculoskeletal problems were also common (Pfortmueller, Schwetlick, Mueller, Lehmann, & Exadaktylos, 2016). Odd jobs take the place of regular employment among the refugees; lower wages make them impoverished. Poverty pushes them further into a life full of illness and unmet medical needs (Blanchet, Fouad, & Pherali, 2016).  
The direct fallout of lack of livelihood is poverty and the indirect impact on health results in mental and physical illness. Unmet needs of sanitation, clean drinking water, lack of nutrition and clean housing takes a toll on the health of refugee populations. The hazardous journey from their conflict ridden home country is fraught with health risks. Injuries and disabilities as a consequence of ongoing war where civilians are often caught in the crossfire between the warring factions generate additional medical needs. One study has reported a high prevalence of tuberculosis among Syrian refugees (Cookson, et al., 2015).
The impact of poverty and refugee status on the women has been immense. Early marriages, pregnancy, pregnancy loss, lack of use of contraception, prevalence of sexually transmitted diseases, symptoms of mental illness, language barrier, Vitamin B12 deficiency were commonly reported problems in a study on Syrian women refugees living in Turkey (Simsek, Yentur Doni, Gül Hilali, & Yildirimkaya, 2017). Many women in the reproductive age group have been reported to suffer from vaginitis (Yentür Doni N1, et al., 2016). A study on refugee women in Lebanon were found to receive lower than standard antenatal and their sheltering arrangements were also found to be subpar (Benage, Greenough, Vinck, Omeira, & Pham, 2015). The displacement has had  severe impact on the ability of the refugees from Syria to access to healthcare. Often they are left at the mercy of the host country and aid provisions that are struggling to meet the demand.
Children among the Syrian refugees have been impacted in several ways. Loss of family members, separation from siblings and lack of parental income has compromised their nutritional needs. Residents from the Zataari camp in Jordan have been found to suffer from anemia (Bilukha, et al., 2014). Only a few of them attend school and some have injuries due to the armed conflict.
The elderly often have health issues and have not received treatment and medication for a host of chronic conditions with diabetes, hypertension and the lack of preventative medical care severely compromises their health. The mental stress of having lived in a war zone, travel to the host country and a new set of challenges as refugees further aggravates their problems (Bazzi & Chemali, 2016). Host countries, such as, Jordan struggle to receive aid to be able to meet the medical needs of the children among the Syrian children. The World Health Organisation (WHO), The United Nations Refugee Agency (UNHCR) and the United Nations Children’s Fund (UNICEF) had called for cessation of war because the humanitarian aid they were providing would run out in a matter of weeks and funding could not keep pace peace with the rising demands of the refugees from Syria (Syrians flee violence and disrupted health services to Jordan, 2013).
Chronic social stress among displaced people can cause physiological changes. Poverty can make people likely to suffer from pro-inflammatory responses and increased IL-6 and C-reactive protein production. Lower income, lack of employment, lack of proper schooling for children can cause hypertension and increased cholesterol levels. Low socioeconomic status has now been found to be associated with the manner in which genes controlling immune system are expressed. Lack of education, erratic work schedules and intimate partner violence have been associated with premature telomere shortening that is a marker for cellular aging. Chronic stress due to social disruption can affect physiological parameters and may affect current and future health status of an individual. The impact of social factors on a person’s health depends on whether the gene with deleterious effects is expressed or remains suppressed. Resilient persons may be able to withstand social stressors, such as, poverty due to lack of employment while some people may be more vulnerable to the adverse conditions and develop mental or physical illness (Braveman & Gottlieb, 2014).
Many of the Syrian refugees prior to the conflict had comfortable lives, regular employment, access to land, their children attended schools and colleges and most importantly they had access to a healthcare system. They led normal social lives. All this was snatched away the moment they became displaced from their country and their homes. Not being used to an impoverished life has made the stresses of poverty, unemployment and lack of educational opportunities for the young and regular homes and a disrupted social life has made them more susceptible to disease and disability.
The public health challenge of providing refugees with mental health care is not small. The exposure to trauma and torture makes it difficult for the refugees to cope. 39% of family members, who were respondents during  study were found to be suffering from distress and were disturbed. 33.5 % of the Syrian residents in a tent city in Turkey suffered from post traumatic stress disorder (Alpak, et al., 2015). Anxiety and depression are commonly seen among refugees trying to adapt to life in a new setting. Economic problems, difficulties with acculturation, impediments in the children’s education are stressors that cause mental illness.
The goal of equitable healthcare for Syrian refugees in Lebanon, Jordan and Turkey is difficult but the efforts of NGOs working in coordination with UNHCR are trying to meet demand. The lack of access to government funded primary healthcare and vaccination programs has to be replaced with alternate arrangements. For the poverty stricken, the UNHGR has a cash assistance program. The problem of poverty can be solved if the Syrian refugees find employment, which is again dependent on the provision of work permits. If more people are employed they can pay for treatment of health problems and afford better quality housing. Better nutrition will be ensured if the refugees are able to buy food. Education of children will be possible once the parents have money to send them to school. All these facilities are available in refugee camps but those who live outside camps find it difficult to buy medicines, food and to fund the education for children. It is likely that many of the refugees may never return to their homeland, so improving their economic status is the only available option. (Bicer, 2017).
The resources in the host countries have to be distributed equitably among the host population and the refugees. The UNHCR supports immunization of Syrian children and screening of new refugees upon arrival in the host country. Information about the availability of health resources needs to be dispensed to the refugees in their language and with the use of easy-to-understand picture tools because many of the refugees may not be educated. Rational use of diagnostics may help in reducing costs. Clinical diagnoses for diseases is the more economical way forward. Training of primary healthcare workers in cooperation with the ministry of health in the prevention, diagnosis and treatment of non-communicable diseases will help to reduce the risk of complications and the need for expensive secondary and tertiary treatment. Cutting costs is important due to the because of the dwindling funds and the inability of host countries to distribute their resources among their own citizens and the refugees. UNHCR clinics will partner with NGOs and clinics in developing and sharing health information systems (HIS) (UNHCR, 2014-2015). In 2013, a $150 million aid was received by Jordan through the world bank to mitigate the crisis of resources in healthcare for the Syrian refugees (/world-banks-response-to-the-syrian-conflict-september-2016, 2016).
Strengthening the sense of self efficacy in cases of mental illness can help build  person’s resilience and improve the process of post trauma recovery (Almoshmosh, 2016). Neuropsychiatric disorders are often not part of a refugee health program. Greater emphasis on stroke prevention can reduce costs. High costs incurred in the treatment of multiple sclerosis, epilepsy and schizophrenia can be covered through targeted donations (McKenzie, Spiegel, Khalifa, & Mateen, 2015). Prevention and self management of health issues is key to making healthcare provision for Syrian refugees.
In conclusion, it is clear that poverty among Syrian refugees compounds their problems in receiving healthcare. They are a population at a higher risk of falling ill due to circumstances of war, travel and relocation to reluctant host countries. The social determinants of health in a population stressed with poor habitation, lost livelihoods and earning low wages compounds the problems of health due to poverty. Low levels of education and poverty go hand in hand. The risks of ill health across all age groups are higher and the responsibility to mitigate the healthcare crisis has fallen on the host nations and the global community. The WHO, UNHCR, the World Bank and international NGOs are playing an important role in healthcare provision for the Syrian refugees
/world-banks-response-to-the-syrian-conflict-september-2016. (2016, September). Retrieved from
Almoshmosh, N. (2016). The role of war trauma survivors in managing their own mental conditions, Syria civil war as an example. Avicenna Journal of Medicine, 6(2): 54–59.
Alpak, G., Unal, A., Bulbul, F., Sagaltici, E., Bez, Y., Altindag, A., . . . Savas, H. (2015). Post-traumatic stress disorder among Syrian refugees in Turkey: a cross-sectional study. International Journal of Psychiatry in Clinical Practice, 19(1):45-50.
Bazzi, L., & Chemali, Z. (2016). A Conceptual Framework of Displaced Elderly Syrian Refugees inLebanon: Challenges and Opportunities . Global Journal of Health Science, 8(11).
Benage, M., Greenough, P., Vinck, P., Omeira, N., & Pham, P. (2015). An assessment of antenatal care among Syrian refugees in Lebanon. Conflict and Health, 9:8. doi: 10.1186/s13031-015-0035-8. .
Bicer, N. (2017). The Views of Syrian Refugees Migrating to Turkey on the Turkish. Journal of Education and Training Studies, 5?(3):97-109.
Bilukha, O., Jayasekaran, D., Burton, A., Faender, G., King’ori, J., Amiri, M., . . . (CDC)., C. f. (2014). Nutritional status of women and child refugees from Syria-Jordan, April-May 2014. Morbidity and Mortality Weekly Report, 63(29):638-9.
Blanchet, K., Fouad, F., & Pherali, T. (2016). Syrian refugees in Lebanon: the search for universal health coverage. Conflict and Health, 10: 12. doi: 10.1186/s13031-016-0079-4.
Braveman, P., & Gottlieb, L. (2014). The Social Determinants of Health: It’s Time to Consider the Causes of the Causes. Public Health Reports, 129(Suppl 2): 19–31.
Cookson, S., Abaza, H., Clarke, K., Burton, A., Sabrah, N., Rumman, K., . . . Naoum, M. (2015). Impact of and response to increased tuberculosis prevalence among Syrian refugees compared with Jordanian tuberculosis prevalence: case study of a tuberculosis public health strategy”. Conflict and Health, 9:18. doi: 10.1186/s13031-015-0044-7.
McKenzie, E., Spiegel, P., Khalifa, A., & Mateen, F. (2015). Neuropsychiatric disorders among Syrian and Iraqi refugees in Jordan: a retrospective cohort study 2012-2013. Conflict and Health, 9: 10.doi: 10.1186/s13031-015-0038-5.
Pfortmueller, C., Schwetlick, M., Mueller, T., Lehmann, B., & Exadaktylos, A. (2016). Adult Asylum Seekers from the Middle East Including Syria in Central Europe: What Are Their Health Care Problems? PLOS ONE , 11(2): e0148196.
Simsek, Z., Yentur Doni, N., Gül Hilali, N., & Yildirimkaya, G. (2017). A Community-Based Survey on Syrian Refugee Women’s Health and Its Predictors in ?anliurfa, Turkey. Women Health, doi: 10.1080/03630242.2017.
Syrians flee violence and disrupted health services to Jordan. (2013). Bulletin of the World Health Organisation, 91(6): 394–395.
UNHCR. (2014-2015). Regional Public Health and Nutrition Strategy for Syrian Refugees Egypt, Iraq, Jordan, Lebanon and Turkey.
WHO. (2017). sdh_definition/en/. Retrieved from
Yentür Doni N1, A. M., ?im?ek, Z., Gürses, G., Hilali, N., Y?ld?z Zeyrek, F., Özek, B., & Y?ld?r?mkaya, G. (2016). Investigation of the prevalence of Trichomonas vaginalis among female Syrian refugees with the complaints of vaginitis aged between 15-49 years]. Mikrobiyology Bulteni, 50(4):590-597.

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